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

Endotracheal tube displacement and secretion accumulation are the most common reversible causes of oxygenation decline during prone positioning and should be assessed first.

Question 2

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

Accepted Answer

Transpulmonary pressure at end-expiration

Answer

End-expiratory transpulmonary pressure (airway pressure minus esophageal pressure) guides PEEP titration to maintain alveolar patency without overdistension.

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

Air bubbles in an ABG sample equilibrate with atmospheric O2 (~150 mmHg), falsely elevating pO2; the bright red color and very high pO2 on room air indicate air contamination.

Question 4

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

Accepted Answer

Mean airway pressure (mPaw)

Answer

Mean airway pressure determines alveolar recruitment and oxygenation in HFOV, while amplitude controls CO2 elimination.

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

Decreased pump flow at constant RPM with visible cannula vibration (chatter) indicates inadequate venous return due to hypovolemia or cannula malposition.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Technological and Procedural Proficiency 3