10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The RRT-ACCS exam has 170 questions and runs 4 hours.
These 10 free RRT-ACCS questions are organized by exam domain, so you can see how each part of the Adult Critical Care Specialty blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: RESPIRATORY CRITICAL CARE
Question 1
A patient intubated for status asthmaticus becomes hypotensive after the set respiratory rate is increased from 12 to 24/min to lower a PaCO2 of 66 mm Hg. Blood pressure is 62/38 mm Hg. The patient is passive, expiratory flow continues when each new breath begins, and an end-expiratory hold measures total PEEP of 18 cm H2O despite a set PEEP of 5 cm H2O. A suction catheter passes freely, and ultrasound shows bilateral lung sliding. Which maneuver most directly reverses the mechanism causing the hypotension?
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Correct answer: B - Briefly disconnect the circuit to allow trapped gas to escape.
Question 2
Eighteen hours after a major aspiration event, an adult with ARDS has a PaO2/FiO2 ratio of 110 despite optimized PEEP of 14 cm H2O and FiO2 of 0.70. Tidal volume is 6 mL/kg predicted body weight, plateau pressure is 28 cm H2O, and ventilator synchrony is satisfactory. Hemodynamics are stable, and there is no positioning contraindication. Which addition has the strongest evidence for improving survival at this stage?
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Correct answer: A - Begin prone positioning for sessions lasting at least 16 hours.
Question 3
The high-pressure alarm sounds during volume-controlled ventilation. At unchanged tidal volume and inspiratory flow, peak pressure has risen from 28 to 48 cm H2O, but a valid inspiratory hold still gives a plateau pressure of 22 cm H2O. Suction catheter passage is easy and yields scant secretions. Manual ventilation through the existing heat-and-moisture exchanger remains difficult; connecting the same resuscitation bag directly to the endotracheal tube restores easy ventilation. Before reconnecting the ventilator, what should be done?
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Correct answer: B - Replace the heat-and-moisture exchanger.
Question 4
A 68-year-old with a COPD exacerbation starts bilevel noninvasive ventilation with pH 7.24, PaCO2 78 mm Hg, and a respiratory rate of 34/min. After 90 minutes, pH is 7.30, PaCO2 is 67 mm Hg, and respiratory rate is 24/min. The patient is alert, clears secretions, and reports less breathlessness. SpO2 is 90% on FiO2 0.28. How should support proceed over the next hour?
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Correct answer: D - Continue bilevel support with current oxygen titration and repeat clinical and blood-gas assessment.
Question 5
A 165-cm woman weighing 110 kg is receiving volume-controlled ventilation for ARDS. Tidal volume is 500 mL, plateau pressure is 34 cm H2O, and total PEEP is 10 cm H2O. She is passive during the measurements and has a pH of 7.36. The therapist plans an initial reduction to 6 mL/kg predicted body weight, followed by another plateau-pressure measurement. Which setting is appropriate?
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Correct answer: A - Reduce tidal volume to approximately 340 mL.
Question 6
An adult with severe pulmonary hypertension and right-ventricular dysfunction is receiving inhaled nitric oxide. During a transport-cylinder change, nitric oxide delivery is unintentionally interrupted, although ventilation and oxygen delivery continue unchanged. Within minutes, pulmonary artery pressure rises sharply, systemic blood pressure falls, and SpO2 decreases from 95% to 84%. Airway pressures and delivered tidal volumes are unchanged. What best explains the abrupt deterioration?
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Correct answer: B - Rebound pulmonary vasoconstriction after interruption of nitric oxide
Domain 2: GENERAL CRITICAL CARE
Question 7
Ninety minutes into a red-cell transfusion, a 76-year-old with chronic kidney disease and heart failure develops acute dyspnea. Blood pressure rises from 126/70 to 178/96 mm Hg, neck veins become distended, and chest radiography shows new bilateral pulmonary opacities with small pleural effusions. Fluid balance is positive by 3 L. There is no fever, rash, back pain, or hemoglobinuria. The transfusion has been stopped and oxygen started. Which complication best accounts for this pattern?
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Correct answer: D - Transfusion-associated circulatory overload
Question 8
A patient being treated for diabetic ketoacidosis has had metabolic acidosis for several hours and now develops shallower breathing and somnolence. Arterial results are pH 7.10, PaCO2 40 mm Hg, and HCO3 12 mmol/L. Using Winter's formula, which expected PaCO2 range and interpretation best fit these findings?
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Correct answer: C - 24-28 mm Hg; the measured PaCO2 indicates an additional respiratory acidosis.
Question 9
After antibiotics and initial crystalloid resuscitation for septic shock, a 58-year-old remains warm and hypotensive with a MAP of 54 mm Hg. Passive leg raising increases continuously measured cardiac output by only 2%. Lung ultrasound now shows diffuse B-lines, while echocardiography shows preserved biventricular systolic function. During the resuscitation discussion, which recommendation is best supported by these findings?
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Correct answer: A - Start norepinephrine and titrate toward a MAP of 65 mm Hg.
Question 10
During four hours of observation, an adult with myasthenia gravis and pneumonia has a fall in vital capacity from 28 to 13 mL/kg. Negative inspiratory force is now -18 cm H2O. Speech has become nasal, saliva pools in the mouth, and the cough is weak. SpO2 remains 96% on 2 L/min oxygen and PaCO2 is 43 mm Hg. How should this change alter the airway plan?
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Correct answer: C - Arrange controlled intubation now.
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