ACCS Technological and Procedural Proficiency 3

Question 1

A patient undergoing prone positioning for severe ARDS develops worsening oxygenation after 2 hours. The MOST appropriate initial action is:

Accepted Answer

Assess endotracheal tube position and secretion clearance

Answer

Immediately return to supine position

Answer

Increase FiO2 to 1.0

Answer

Increase PEEP by 5 cmH2O

Question 2

Which parameter from an esophageal pressure catheter most directly guides PEEP titration in ARDS?

Accepted Answer

Transpulmonary pressure at end-expiration

Answer

Esophageal pressure at end-expiration

Answer

Esophageal pressure swing during tidal breath

Answer

Peak esophageal pressure

Question 3

During an arterial blood gas draw from a radial arterial line, the specimen appears bright red and the pO2 is 450 mmHg on room air. What error has most likely occurred?

Accepted Answer

Air bubble contamination

Answer

Venous contamination

Answer

Clot in the sample

Answer

Metabolic alkalosis artifact

Question 4

In high-frequency oscillatory ventilation (HFOV), oxygenation is primarily controlled by adjusting:

Accepted Answer

Mean airway pressure (mPaw)

Answer

Frequency (Hz)

Answer

Amplitude (ΔP)

Answer

Inspiratory time percentage

Question 5

A critically ill patient requires extracorporeal membrane oxygenation (ECMO). The circuit shows a sudden drop in pump flow with normal RPM. The MOST likely cause is:

Accepted Answer

Hypovolemia causing inlet cannula collapse (chatter)

Answer

Oxygenator thrombosis

Answer

Circuit air embolism

Answer

Pump head failure

Question 6

Which complication is MOST specific to femoral vein central venous catheter placement compared to subclavian placement?

Accepted Answer

Higher infection and thrombosis rates

Answer

Air embolism

Answer

Arterial puncture

Answer

Pneumothorax

Question 7

During point-of-care ultrasound assessment for pneumothorax, which finding CONFIRMS the absence of pneumothorax at the examined site?

Accepted Answer

Lung sliding sign

Answer

Presence of A-lines

Answer

Absence of B-lines

Answer

Hyperechoic pleural line