Download ACCS Oakes practice Exam Questions and answers with 100% correct solutions | A+ Grade and more Exams Nursing in PDF only on Docsity!
ACCS Oakes practice Exam Questions and
answers with 100% correct solutions | A+ Grade
A difficult intubation is anticipated with an obese pt. The decision is made to intubate by video laryngoscopy. Which of the following is LEAST likely to be needed: A) Cook's Exchanger B) Rigid Stylet C) Cuffed Endotracheal Tube D) Video-enabled Laryngoscope ✔✔A) cook's exchanger Video laryngoscopy involves use of a normal ET Tube with the addition of a rigid stylet, as well as a video-enabled laryngoscope and other normal intubation equipment. A Cook's Tube Exchanger is not necessary - this is used to exchange tubes already in place. A 5'6" female has been transferred from Intermediate Care to Intensive Care in respiratory distress. She is intubated with a silver-coated #7.0 Endotracheal tube. CXR immediately following intubation shows Right Upper Lobe infiltrate with bibasilar atelectasis. The ET Tube is noted to be approximately 4 cm above the carina. The Respiratory Therapist would BEST recommend: A) Initiation of broad-spectrum antibiotics for probably pneumonia B)Withdraw Endotracheal tube at least 3 cm C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-pressure/high-volume cuffed tube
D) Immediate V/Q Scan ✔✔Correct answer is A This pt has gone into respiratory failure, requiring intubation. The X-ray is consistent with a possible pneumonia diagnosis. The best option therefore is to start antibiotics. Withdrawing ET Tube is not indicated as 4 cm is likely adequate. Pulling back 3 cm could result in inadvertent extubation and would cause harm to patient Use of tube exchanger is unnecessary. A silver-coated endotracheal tube is intended to help prevent VAP Immediate V/Q scan is not indicated - it is a poor use of resources for what is needed right away. You are part of Physician Rounding this morning, and consulting on a patient who is currently on APRV. They were originally admitted with a pneumonia which developed into ARDS with a P/F ratio as low as
- The patient was transitioned to APRV from PC due to an elevated Plateau Pressure required to maintain VT around 4 cc/kg IBW. The patient is arousable and taking breaths on their own. The physician has asked you what should be done to address the patient's latest ABG. Ph 7. PaCo2 49 PaO2 88 torr HCO3 19 Mode- APRV Phigh- 24
Ph 7. PaCO2 62 mmHg PaO2 54 mmHg HCO3 18 mEq/L Mode - pressure control Set PIP- 24 cm H2O VTE- 380 ml measured Rate- 24/min PEEP- 8 cm H2O FiO2- 100 This data is MOST consistent with the following diagnosis: A) ARDS B) Tension Pneumothorax C) Pulmonary Hypertension D) Exacerbation of COPD ✔✔Correct answer A The data is overall representative of ARDS. The CXR shows bilateral infiltrates (and relative white-out). P/F ratio is easily calculable on FIO2 100%: 54. A P/F < 200 is consistent with ARDS. The process was acute onset (sudden). All of the following have been shown to reduce VAP, EXCEPT: A) subglottic suctioning B) aggressive endotracheal suctioning C) Use of specialty airways, such as a silver-coated endotracheal tube
D) Aggressively weaning patients to minimize time on the ventilator ✔✔Correct answer B Aggressive endotracheal suctioning does NOT prevent VAP (though subglottic suctioning may). Which of the following pharmacologic agents is MOST indicated in an intubated patient who was admitted to Trauma ICU with multiple gunshot wounds to the abdomen and upper thigh. A) propofol B) ativan C) norepinephrine D) vecuronium ✔✔This patient is likely in pain following their injuries. Initially, pain and sedation are most indicated. Now it is important to pick out the correct medication from those given to you: vecuronium is a paralytic (not indicated) ativan is an anti-anxiety medication (not indicated) norepinephrine is a pressor (not indicated) propofol is a sedative (correct answer) You are asked to consult on a patient in the ED who is being admitted to the Medical ICU. ABG is below. CXR shows flattened diaphragms with hyperlucency in the apices. ABG shows: Ph 7. PaCO2 66 PaO2 56 HCO3 30 What do you recommend as the BEST choice? A) Intubate patient and place on a Pressure-Control mode of Ventilation
You have been asked to make a recommendation regarding specialty airways that help prevent colonization of organisms on it which might lead to VAP. What would you recommend? A) Microcuff Tube B) Silver-coated Endotracheal Tube C) Use of ET Tube with closed suctioning only D) Mercury-coated Endotracheal Tube ✔✔Correct answer B Silver-coated endotracheal tubes are designed to help prevent Ventilator Associated Pneumonias. Mercury-Coated Endotracheal Tubes don't exist (would be harmcul). Use of ET tube with Closed Suctioning might help prevent VAP but not Colonization on the Tube. Microcuffs are again intended on preventing VAP by preventing microaspiration, but does not act by reducing colonization. A 58 y/o is in the cardiac critical care unit. You are called urgently to his room as he has gone into flash pulmonary edema. You note the following data: RR: 30 breaths/minute HR: 132 bpm, gallop noted (S3) BP: 84/ GCS: 9T Disposition: Obtunded Skin: mottled, clammy Jugular Veins: distended ABG
pH 7. PaCO2 24 mmHg PaO2 60 mmHg HCO3 24 mEq/L BE 0 Urinary Output 10 mL/hour This presentation supports a classification of: A) Cardiogenic Shock B) Hypovolemic Shock (non-hemorrhagic) C) Distributive (septic) Shock D) Obstructive Shock ✔✔Correct answer A This presentation is consistent with cardiogenic shock, including decreased pulse pressure, hypotension, decreased UO, JVD, initial respiratory alkalosis, flash pulmonary edema, mottling, etc. Full discussion of shock is beyond the scope of this explanation - we recommend reviewing relevant content for a detailed explanation Which of the following is LEAST likely to reduce incidence of VAP? A) Frequent oral care and hygiene using Chlorhexidine B) Administration of an H2 receptor inhibitor C) Daily sedation vacation and assessment of readiness to extubate
lopressor is a pressor (not indicated) propofol is a sedative (contraindicated) A new RN has asked you what you recommend to help sedate a patient who is fighting the ventilator. The graphics show double-stacking with breaths, and the patient appears uncomfortable. He is currently on V-CMV, and his SpO2 has been steadily drifting down. Which of the following drugs is MOST appropriate? A) Lopressor B) Albuterol C) Precedex D) Ativan ✔✔Correct answer C Precedex is a sedative which is usually easy to metabolize. The other medications are not sedatives: Ativan is an anti-anxiety, Lopressor is a pressor, and Albuterol is a bronchodilator You are transporting a patient with a PA Line. What value must you watch continuously during the trip? A) PAP B) PCWP C) CVP D) LVEDP ✔✔Correct answer A It is very important to ensure that the PA Catheter does not float into an incorrect (and dangerous!) position, such as in the right ventricle or a capillary (wedge). The only way to do this is to monitor the Pulmonary Artery Pressure (PAP). The other values will not provide this information. A 28-year-old female has suffered an MI with anoxic brain injury. Current data: HR 76/min RR 16/min
Temp 35.5° C ABG pH 7. PaCO2 37 torr PaO2 186 torr HCO3 20 mEq/L The team has decided upon proceeding with diagnosis of brain death. The best way to do this is: A) EEG B) Perform Apnea Test C) Perform Brain Perfusion Study D) Determination by Cardiac Death ✔✔Correct answer C The first temptation for many on this question is to go with the Apnea Test. That is, after all, what most of us do clinically. With all these types of question, carefully considers the Indications and Contraindications for each test: Apnea Test: Contraindication includes pts who are not normothermic. This pt is hypothermic so does not meet the criteria. EEG: This test is not considered definitive. Cardiac Determination: Is an option when patients have a drive to breathe so will obviously fail the Apnea Test. This is not the best choice. Brain Perfusion: This test is a definitive test of brain death. You are called emergently to a patient's room who has become increasingly lethargic following repeated administration of morphine due to pain throughout the last few hours. Current SpO2 is 92% on NC 4LPM. Respirations are shallow, at about 8 breaths/minute. The BEST course of action is:
B) Increase rate to 16 C) Recommend increase in Enteral Feed D) Decrease set rate to 10 ✔✔Correct answer A The patient's Respiratory Quotient is too high (normal high is 1.2), meaning they are being overnourished which produces too much CO2. Decreasing the feed will result in a decreased RQ. The Respiratory Therapist has been asked to make a recommendation on ordering ventilators for a potential disaster response. Which factor should be considered LEAST? A) Ability to provide active humidification B) Battery Life C) Presence of internal gas blender D) Portability ✔✔Correct answer A This question tests your ability to consider disaster planning. We know that Respiratory Therapists face these kinds of issues in real life. Your best option is to consider each option and whether there are better options in a time of crisis: Portability is of foremost interest in choosing a ventilator. You want a ventilator that can easily go with a patient, whether that is in the crowded hospital, or in the event of an evacuation Internal Blender is of concern. A lack of an internal blender means running a patient on 100% FIO2 with O2 tanks, or also carrying an Air Tank which can become further burdensome. Battery Life, for obvious reason, is an important consideration as well. Finally, that leaves us with active humidification. The temptation is to consider humidity as important as we are bypassing the upper airway. The chance that you'll have a battery to power the humidifier is unlikely, and HME's have been shown to provide adequate humidity, especially in the short-term. In adults, the following placement of an indwelling artery catheter (A-Line) is LEAST preferred A) Brachial B) Radial
C) Dorsalis Pedis D) Femoral ✔✔Correct answer A Brachial is the least preferred artery as it is an "end artery" and increases the potential of causing hand ischemia. A patient has had an OG tube placed and enteral feeding is scheduled to begin. Which of the following is TRUE? A) Confirm placement by x-ray of chest and abdomen B) The area must be dopplered for proper placement of tube C) Auscultate over lung fields and abdomen to ensure proper placement. D) Start feeding and then monitor for tube-feed colored secretions when suctioning ✔✔Correct answer A The appropriate way to ensure proper placement is via x-ray. Auscultation will suggest proper placement but cannot confirm it. Doppler will not give you this data. Note that checking for tube-feed colored secretions is contraindicated and will cause the patient harm. Which of the following will NOT affect the accuracy of a pulse oximeter? A) Lack of room lighting B) Excessive motion of sensor C) Propofol administration D) Presence of carb oxyhemoglobin ✔✔Correct answer A Lack of room lighting is the correct answer - too much lighting may affect accuracy, but too little light will not.
A sample of pleural fluid shows a ratio of pleural to serum protein of 0.7. This would indicate: A) Sampling Error B) Transudate C) Exudate D) Normal Sample ✔✔Correct answer C A ratio of > 0.5 indicates an exudate. < 0.5 would indicate a transudate. With a ratio of 0.7, this would be an exudate. A patient is on iNO 20 PPM through a ventilator. A recent co-oximeter value indicates a patient's last methemoglobin level to be 9%. What should you recommend? A) Maintain iNO at 20 PPM B) Reduce iNO immediately to 10 PPM C) Increase iNO to 30 PPM D) Administer Methylene Blue ✔✔Correct answer D Normal methemoblobin value is usually less than 1%, so this patient has a clinically significant value. It should be treated with Methylene Blue (restores iron to hemoglobin). If possible, iNO should only be adjusted per clinical need related to pulmonary hyptertension. You have received transport of a patient with ARDS. She is 49 y/o, 5' 5", and weighs 130 lbs. She is on Diprivan, Nimbex, and Norepinephrine. Her current ventilator settings are: Volume Control Mode Set VT: 550 cc Set Rate: 16 bpm PEEP: 5 cmH2O FIO2: 0. TI: 0.75 second
What Ventilator Settings will you start her on? A) Volume Control Mode Set VT: 550 cc Set Rate: 16 bpm PEEP: 5 cmH2O FIO2: 0. TI: 0.75 second B) Pressure Support Mode PS: 20 cmH2O PEEP: 8 cmH2O FIO2: 0. C) Pressure-Control Mode Set Insp Pressure for VT 425-450 cc RR 18 bpm PEEP 8 cmH2O FIO2 1. TI 1.1 sec D) Pressure-Control Mode Set Insp Pressure for VT 350-400 cc RR 24 bpm PEEP 10 cmH2O FIO2 0.
ABG
pH 7. PaCO2 24 mmHg PaO2 60 mmHg HCO3 12 mEq/L BE - 5 Anion Gap 20 mEq/L Lactic Acid: 7 mM This presentation supports a classification of: A) Hypovolemic Shock B) Septic Shock C) Anaphylactic Shock D) Cardiogenic Shock ✔✔Correct answer A This presentation is consistent with Hypovolemic Shock - the patient has likely had massive blood loss (the exact shock would be "Hypovolemic Hemorrhagic Shock"). This is evidenced by the patient's agitation, flat jugular veins, decreased pulse pressure, tachypnea and tachycardia, etc. Full discussion of shock is beyond the scope of this explanation - we recommend reviewing relevant content for a detailed explanation You are called to the ICU where you do a routine assessment on a patient you extubated about 2 hours ago. She was originally intubated for a CAP, complicated by being immunodeficient due to a drug used to treat her rheumatoid arthritis.
She is on 2L NC, HR 86, Mean BP 82, SpO2 97%. She is currently resting. You perform exam and note her GCS to be 13, auscultation slightly diminished in her left base, and slightly anxious. What do you recommend? A) Increase Oxygen flow to 4L NC and re-assess in 20 minutes. B) Reintubation as pt is failing extubation C) Administration of Lopressor D) Review of Deep Breathing exercises or Incentive Spirometer ✔✔Correct answer D This patient is currently in no distress, and her oxygenation seems adequate. Increasing the O2 flow would be inappropriate at this time, as would reintubation (she is stable). Lopressor is a medication that would be used to treat hypotension, which is unnecessary with a Mean BP of around 80 (70-110 is seen as normal). Decreased breath sounds in a base of a lung can indicate atelectasis. Deep Breathing or IS would be indicated in this case, and is the best option here. You are working in the ICU with a patient who has been slowly deteriorating secondary to urosepsis. The team has decided that intubation is imminent. You ask the patient to open her mouth as wide as she can, and you observe the hard palate, soft palate, and just the base of the vallecula. This is consistent with a Mallampati of: A) 1 B) 2
