ACCS ADULT CRITICAL CARE TEST
2026 | COMPREHENSIVE EXAM
PREP WITH PRACTICE PDF
The Centers for Disease Control (CDC) provides a report to area hospitals regarding the spread of an
influenza pandemic through the region. It is estimated the pandemic will reach the area in a few weeks.
The adult critical care supervisor is asked to create a protocol for the anticipated pandemic. Which of
the following should be in the protocol?
A. Obtain a memorandum of understanding with hospitals located within 200 miles.
B. Develop a protocol regarding mask CPAP therapy.
C. Instruct staff on rescue ventilation.
D. Purchase or rent additional mechanical ventilators. - ANSWER-The correct answer is : C
Explanation : Compared to the options of renting or purchasing additional equipment, developing a
protocol, and obtaining an agreement with another facility, the action to instruct staff on rescue
ventilation is a more practical preparation. Given the fact that the issue will probably involve all local
facilities, it is likely that there will be a shortage of patient beds and equipment
A 42-year-old male is admitted to the neurologic intensive care unit (NICU) following traumatic brain
injury sustained from a motor vehicle accident. The family is making preparation for organ donation and
expresses an interest in cessation of life support. Prior to an apnea test, the following ventilator graphics
are observed. The adult critical care specialist should recommend:
(Picture)
A. initiating organ donor protocol after assessing cardiac function.
B. beginning an SBT.
C. sedating the patient with propofol (Diprivan).
D. evaluating the ventilator's auto-triggering settings. - ANSWER-The correct answer is : D
Explanation : The ventilator graphic shows no patient-triggered breaths. As the family is considering the
cessation of life support, it would be valuable to note if the patient would attempt breathing on his own.
Since the graph shows no patient-trigged breaths, the sensitivity should be examined. If sensitivity is not
,sensitive enough, then it may not be possible to detect patient attempts to breathe. Sensitivity should
be increased to further assess any patient ventilation attempts.
A patient is admitted to the ICU after a laparoscopic cholecystectomy. Thirty minutes later, the patient is
extubated and placed on a non-rebreather mask. Initial breath sounds are diminished with bilateral
crackles. The following is observed:
RR 32/min HR 128/minSpO2 86%
In response to these data, the physician attempts to reintubate but fails on several attempts. The adult
critical care specialist should recommend which of the following NEXT?
A. Apply a laryngeal mask airway (LMA).
B. Insert a double lumen endotracheal tube.
C. Perform fiberoptic bronchoscopy.
D. Surgically implant a tracheostomy. - ANSWER-The correct answer is : A
Explanation : The use of an LMA is a suitable, short-term alternative when ET tube establishment is
complicated or not possible. While it will not facilitate manual ventilation, it will promote a patent
airway and allow for adequate self-ventilation. An LMA is never appropriate if the condition is long-
term.
A 48-year-old, 163-cm (5-ft, 4-in), 117-kg (258-lb) female is in the PACU following surgical repair of an
aortic aneurysm. The patient responds to light verbal stimuli, but remains somnolent and exhibits
snoring. While the patient is sleeping, the adult critical care specialist performs an arterial puncture for
blood gas analysis. The ABG results are as follows:
pH 7.30 PaCO2 54 torrPaO2 76 torrHCO3- 29 mEq/LBE 0 mEq/L
Which of the following is the MOST likely contributor to the current condition of the patient?
A. Cor Pulmonale
,B. COPD
C. OSA
D. Narcolepsy - ANSWER-The correct answer is : C
Explanation : The presence of snoring, hypoxemia, and lack of ventilation, in conjunction with the
patient's obesity, suggests a condition known as obstructive sleep apnea (OSA).
A patient who has a hemoglobin level of 6 gm/dL refuses the administration of blood products due to
religious beliefs. Which of the following would be most effective at acutely increasing arterial oxygen
content in this patient?
A. dobutamine HCL (Dobutrex)
B. CPAP by mask at 100%
C. platelets transfusion
D. vasopressor administration - ANSWER-The correct answer is : B
Explanation : 100% oxygen is the first step at providing a maximal increase in artery oxygenation.
Additionally, CPAP may be used to further improve oxygenation. CPAP works by expanding the surface
are of the alveoli, thereby increasing gas exchange between the alveoli and the artery.
During the implementation of general anesthesia, in preparation for a surgical procedure to repair a
closed tibial fracture, a 28-year-old male patient vomits and aspirates gastric contents. Post-operatively,
a chest radiograph reveals bilateral infiltrates. SpO2 is 92% while receiving 50% oxygen by facemask. The
adult critical care specialist should recommend which of the following?
A. Perform a mini BAL.
B. Administer an antiemetic medication.
C. Perform plasmapheresis.
D. Maintain current therapy, continue close observation. - ANSWER-The correct answer is : D
Explanation : When it is suspected that a patient has aspirated a small amount of gastric contents, there
is no clearly defined preventive and reversing procedure. The patient should simply be monitored
closely for the onset of pneumonia or aspiration pneumonitis. A mini BAL (bronchial-alveolar lavage)
would be too significant of an intervention. The other options are not relevant to the problem.
, A 62-year old patient, who has unstable recurrent ventricular tachycardia, is admitted to the cardiac
intensive care unit (CICU). A recent supine chest radiograph reveals bibasilar haziness. The physician
would like to rule out pleural effusion. Which of the following would be most appropriate?
A. ultrasound of the chest
B. MRI
C. PA chest radiograph
D. V/Q scan - ANSWER-The correct answer is : A
Explanation : Of the options given, an ultrasound of the chest is the most practical method of ruling out
a pleural effusion. A lateral decubitus radiograph would also be helpful, but is not offered in this
question.
Following admission to the emergency department (ED) after sustaining a spinal cord injury from a
motor vehicle accident, a 38-year-old female is lethargic. The patient is somnolent but awakens with
light stimulation and appears oriented to time, person, and place. Numbness in the arms and legs is
reported. The following clinical and laboratory data is observed:
VC 10 mL/kg VT 5 mL/kgHR 98/minRR 30/min pH 7.33PaCO2 48 torrPaO2 108 torrHCO3- 24 mEq/LBE 0
mEq/L
The adult critical care specialist should recommend which of the following FIRST?
A. NPPV
B. IV aminophylline bolus
C. oral intubation
D. IV bolus of naloxone HCL (Narcan) - ANSWER-The correct answer is : C
Explanation : All evidence, including lethargy, somnolence, and presence of a spinal cord injury, suggests
that the patient's ability to protect their own airway is unpredictable. An artificial airway will help
protect the airway and guard against aspiration.
A patient is brought to the emergency room by paramedics after being found unconscious in a parked
car. An empty bottle of opioids was found near the patient. The patient is obtunded. SpO2 is 95% on 3
2026 | COMPREHENSIVE EXAM
PREP WITH PRACTICE PDF
The Centers for Disease Control (CDC) provides a report to area hospitals regarding the spread of an
influenza pandemic through the region. It is estimated the pandemic will reach the area in a few weeks.
The adult critical care supervisor is asked to create a protocol for the anticipated pandemic. Which of
the following should be in the protocol?
A. Obtain a memorandum of understanding with hospitals located within 200 miles.
B. Develop a protocol regarding mask CPAP therapy.
C. Instruct staff on rescue ventilation.
D. Purchase or rent additional mechanical ventilators. - ANSWER-The correct answer is : C
Explanation : Compared to the options of renting or purchasing additional equipment, developing a
protocol, and obtaining an agreement with another facility, the action to instruct staff on rescue
ventilation is a more practical preparation. Given the fact that the issue will probably involve all local
facilities, it is likely that there will be a shortage of patient beds and equipment
A 42-year-old male is admitted to the neurologic intensive care unit (NICU) following traumatic brain
injury sustained from a motor vehicle accident. The family is making preparation for organ donation and
expresses an interest in cessation of life support. Prior to an apnea test, the following ventilator graphics
are observed. The adult critical care specialist should recommend:
(Picture)
A. initiating organ donor protocol after assessing cardiac function.
B. beginning an SBT.
C. sedating the patient with propofol (Diprivan).
D. evaluating the ventilator's auto-triggering settings. - ANSWER-The correct answer is : D
Explanation : The ventilator graphic shows no patient-triggered breaths. As the family is considering the
cessation of life support, it would be valuable to note if the patient would attempt breathing on his own.
Since the graph shows no patient-trigged breaths, the sensitivity should be examined. If sensitivity is not
,sensitive enough, then it may not be possible to detect patient attempts to breathe. Sensitivity should
be increased to further assess any patient ventilation attempts.
A patient is admitted to the ICU after a laparoscopic cholecystectomy. Thirty minutes later, the patient is
extubated and placed on a non-rebreather mask. Initial breath sounds are diminished with bilateral
crackles. The following is observed:
RR 32/min HR 128/minSpO2 86%
In response to these data, the physician attempts to reintubate but fails on several attempts. The adult
critical care specialist should recommend which of the following NEXT?
A. Apply a laryngeal mask airway (LMA).
B. Insert a double lumen endotracheal tube.
C. Perform fiberoptic bronchoscopy.
D. Surgically implant a tracheostomy. - ANSWER-The correct answer is : A
Explanation : The use of an LMA is a suitable, short-term alternative when ET tube establishment is
complicated or not possible. While it will not facilitate manual ventilation, it will promote a patent
airway and allow for adequate self-ventilation. An LMA is never appropriate if the condition is long-
term.
A 48-year-old, 163-cm (5-ft, 4-in), 117-kg (258-lb) female is in the PACU following surgical repair of an
aortic aneurysm. The patient responds to light verbal stimuli, but remains somnolent and exhibits
snoring. While the patient is sleeping, the adult critical care specialist performs an arterial puncture for
blood gas analysis. The ABG results are as follows:
pH 7.30 PaCO2 54 torrPaO2 76 torrHCO3- 29 mEq/LBE 0 mEq/L
Which of the following is the MOST likely contributor to the current condition of the patient?
A. Cor Pulmonale
,B. COPD
C. OSA
D. Narcolepsy - ANSWER-The correct answer is : C
Explanation : The presence of snoring, hypoxemia, and lack of ventilation, in conjunction with the
patient's obesity, suggests a condition known as obstructive sleep apnea (OSA).
A patient who has a hemoglobin level of 6 gm/dL refuses the administration of blood products due to
religious beliefs. Which of the following would be most effective at acutely increasing arterial oxygen
content in this patient?
A. dobutamine HCL (Dobutrex)
B. CPAP by mask at 100%
C. platelets transfusion
D. vasopressor administration - ANSWER-The correct answer is : B
Explanation : 100% oxygen is the first step at providing a maximal increase in artery oxygenation.
Additionally, CPAP may be used to further improve oxygenation. CPAP works by expanding the surface
are of the alveoli, thereby increasing gas exchange between the alveoli and the artery.
During the implementation of general anesthesia, in preparation for a surgical procedure to repair a
closed tibial fracture, a 28-year-old male patient vomits and aspirates gastric contents. Post-operatively,
a chest radiograph reveals bilateral infiltrates. SpO2 is 92% while receiving 50% oxygen by facemask. The
adult critical care specialist should recommend which of the following?
A. Perform a mini BAL.
B. Administer an antiemetic medication.
C. Perform plasmapheresis.
D. Maintain current therapy, continue close observation. - ANSWER-The correct answer is : D
Explanation : When it is suspected that a patient has aspirated a small amount of gastric contents, there
is no clearly defined preventive and reversing procedure. The patient should simply be monitored
closely for the onset of pneumonia or aspiration pneumonitis. A mini BAL (bronchial-alveolar lavage)
would be too significant of an intervention. The other options are not relevant to the problem.
, A 62-year old patient, who has unstable recurrent ventricular tachycardia, is admitted to the cardiac
intensive care unit (CICU). A recent supine chest radiograph reveals bibasilar haziness. The physician
would like to rule out pleural effusion. Which of the following would be most appropriate?
A. ultrasound of the chest
B. MRI
C. PA chest radiograph
D. V/Q scan - ANSWER-The correct answer is : A
Explanation : Of the options given, an ultrasound of the chest is the most practical method of ruling out
a pleural effusion. A lateral decubitus radiograph would also be helpful, but is not offered in this
question.
Following admission to the emergency department (ED) after sustaining a spinal cord injury from a
motor vehicle accident, a 38-year-old female is lethargic. The patient is somnolent but awakens with
light stimulation and appears oriented to time, person, and place. Numbness in the arms and legs is
reported. The following clinical and laboratory data is observed:
VC 10 mL/kg VT 5 mL/kgHR 98/minRR 30/min pH 7.33PaCO2 48 torrPaO2 108 torrHCO3- 24 mEq/LBE 0
mEq/L
The adult critical care specialist should recommend which of the following FIRST?
A. NPPV
B. IV aminophylline bolus
C. oral intubation
D. IV bolus of naloxone HCL (Narcan) - ANSWER-The correct answer is : C
Explanation : All evidence, including lethargy, somnolence, and presence of a spinal cord injury, suggests
that the patient's ability to protect their own airway is unpredictable. An artificial airway will help
protect the airway and guard against aspiration.
A patient is brought to the emergency room by paramedics after being found unconscious in a parked
car. An empty bottle of opioids was found near the patient. The patient is obtunded. SpO2 is 95% on 3
