ACCS Technological and Procedural Proficiency 4

Question 1

A mechanically ventilated patient develops sudden hemodynamic collapse with absent breath sounds on the left and tracheal deviation to the right. The FIRST intervention should be:

Accepted Answer

Immediate needle decompression of the left chest

Answer

Tension pneumothorax is a clinical emergency requiring immediate needle decompression; delaying for imaging in an unstable patient is contraindicated.

Question 2

The driving pressure (ΔP) in mechanical ventilation is calculated as:

Accepted Answer

Plateau pressure − PEEP

Answer

Driving pressure equals plateau pressure minus PEEP, representing the tidal stress applied to the respiratory system and correlating with ARDS mortality.

Question 3

During insertion of a chest tube for hemothorax, initial drainage exceeds 1,500 mL. The MOST appropriate next step is:

Accepted Answer

Immediate surgical consultation for thoracotomy

Answer

Initial drainage >1,500 mL from a hemothorax meets criteria for massive hemothorax and mandates immediate surgical consultation for operative intervention.

Question 4

In a patient receiving vasopressors via peripheral IV due to lack of central access, which site is PREFERRED to minimize tissue necrosis risk?

Accepted Answer

Forearm (proximal to antecubital)

Answer

Proximal forearm veins are preferred for peripheral vasopressor administration because they allow earlier detection of extravasation and have better flow rates than distal sites.

Question 5

What is the primary purpose of performing an occlusion (wedge) pressure measurement with a pulmonary artery catheter?

Accepted Answer

Estimate left ventricular end-diastolic pressure

Answer

Pulmonary artery occlusion pressure (PAOP) reflects left atrial pressure and, by extension, left ventricular end-diastolic pressure, guiding volume status assessment.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Technological and Procedural Proficiency 4