ACCS Oakes practice Exam Questions and Answers with complete solution

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/highvolume 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 patientUse 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 110. 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 7.16 PaCo2 49 PaO2 88 torr HCO3 19 Mode- APRV Phigh- 24 Plow- 0 Thigh- 5.0 sec Tlow- o.5 sec PS- 26 FiO2- 80% A) Increase Phigh to 28 cmH2O B) Decrease Phigh to 20 cmH2O C) Increase sedation D) Increase Thigh to 6.0 sec - Correct answer is A