Practice Test Geeks(ACCS) Adult Critical Care Specialty Practice Test
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Technological and Procedural Proficiency Flashcards

7 cards from real ACCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Technological and Procedural Proficiency flashcards as text

  1. A patient with severe ARDS has a PaO2/FiO2 ratio of 68 mmHg despite optimized conventional ventilation. According to Berlin criteria, this qualifies as:

    Answer: Severe ARDS

    Severe ARDS is defined by PaO2/FiO2 ≤100 mmHg on PEEP ≥5 cmH2O; a ratio of 68 mmHg falls well within this category.

  2. When performing a spontaneous breathing trial (SBT), which finding is the STRONGEST indication to abort and return to full ventilatory support?

    Answer: Paradoxical abdominal movement

    Paradoxical abdominal movement indicates respiratory muscle fatigue and impending failure; it is a strong sign to terminate the SBT immediately.

  3. For a patient on VV-ECMO with persistent hypercapnia despite adequate pump flows, the MOST appropriate adjustment is:

    Answer: Increase sweep gas (fresh gas) flow rate

    CO2 removal in ECMO is primarily controlled by sweep gas flow rate; increasing sweep gas flow increases CO2 clearance across the oxygenator membrane.

  4. During ultrasound-guided thoracentesis, the needle should be inserted:

    Answer: Above the superior rib margin to avoid neurovascular bundle

    The neurovascular bundle runs beneath each rib, so the needle should be advanced just above the superior border of the lower rib to avoid vessel and nerve injury.

  5. A patient's CRRT circuit shows a pre-filter pressure of -250 mmHg (suction side). This most likely indicates:

    Answer: Catheter malposition or kinking reducing inflow

    Excessively negative pre-filter (access) pressure indicates inadequate blood inflow, commonly from catheter malposition, kinking, or hypovolemia.

  6. Which bedside maneuver is used to assess fluid responsiveness WITHOUT giving a fluid bolus in a spontaneously breathing patient?

    Answer: Passive leg raise (PLR) with continuous cardiac output monitoring

    Passive leg raise mobilizes approximately 300 mL of venous blood from the legs, acting as a reversible auto-fluid challenge; a ≥10% increase in cardiac output predicts fluid responsiveness.

  7. In a patient with suspected right-sided infective endocarditis and a pulmonary artery catheter in situ, which waveform abnormality on the right ventricular tracing would suggest tricuspid regurgitation?

    Answer: Large V-waves on the RA waveform

    Tricuspid regurgitation causes large V-waves on the right atrial (RA) waveform due to retrograde systolic flow back into the atrium during ventricular contraction.