ACNPC-AG Adult-Gerontology Acute Care Nurse Practitioner Certification — Questions and Answers

Question 1: Which parameter is MOST predictive of successful extubation?

PaO₂/FiO₂ >200
Minute ventilation <10 L/min
Rapid shallow breathing index (RSBI) <105 (Correct answer)
Negative inspiratory force (NIF) < −30 cmH₂O

Correct answer: Rapid shallow breathing index (RSBI) <105

RSBI (f/Vt) <105 breaths/min/L is the best validated predictor of successful extubation from mechanical ventilation.

Question 2: Status epilepticus (SE) is defined as continuous seizure activity lasting longer than how many minutes?

30 minutes
2 minutes
5 minutes (Correct answer)
10 minutes

Correct answer: 5 minutes

Status epilepticus is defined as seizure activity lasting ≥5 minutes or two seizures without return to baseline, requiring immediate treatment.

Question 3: A patient has a pulmonary artery catheter showing: CI 1.8 L/min/m², PCWP 8 mmHg, SVR 1800 dynes/sec/cm⁵. This pattern is most consistent with:

Cardiogenic shock
Obstructive shock from tension pneumothorax
Hypovolemic shock (Correct answer)
Distributive (septic) shock

Correct answer: Hypovolemic shock

Hypovolemic shock presents with low cardiac index, low PCWP (low filling pressures), and elevated SVR as compensatory vasoconstriction occurs.

Question 4: A patient presents with confusion, hyponatremia (Na 118 mEq/L), and is found to have SIADH. What is the safest initial treatment?

Fluid restriction to 500-1000 mL/day (Correct answer)
Immediate hemodialysis
IV normal saline at 200 mL/hr
Rapid IV bolus of 3% hypertonic saline

Correct answer: Fluid restriction to 500-1000 mL/day

Fluid restriction is the first-line treatment for SIADH; sodium correction should not exceed 8-10 mEq/L per 24 hours to prevent osmotic demyelination.

Question 5: Which rhythm is a contraindication to synchronized cardioversion?

Atrial flutter
Ventricular fibrillation (Correct answer)
Ventricular tachycardia with pulse
Atrial fibrillation

Correct answer: Ventricular fibrillation

Ventricular fibrillation has no organized QRS complex to synchronize to, requiring unsynchronized defibrillation instead.

Question 6: A patient on mechanical ventilation develops sudden hypoxia, decreased breath sounds on the left, and tracheal deviation to the right. The ACNP's immediate action should be:

Administer IV epinephrine
Increase FiO2 to 100%
Perform needle decompression at the second intercostal space, midclavicular line (Correct answer)
Obtain a STAT chest X-ray

Correct answer: Perform needle decompression at the second intercostal space, midclavicular line

Tension pneumothorax requires immediate needle decompression; delaying for imaging is life-threatening.

Question 7: With the exception of one, every one of the following statements describes what the nurse practitioner (NP) should do when giving a patient with a hemoglobin level of 4.3 blood.

The NP should administer oxygen to support the patient’s breathing
Monitor the patient for any fever symptoms
Monitor for any hypoxia symptoms
The NP should complete the transfusion as fast as possible to avoid the patient feeling discomfort (Correct answer)

Correct answer: The NP should complete the transfusion as fast as possible to avoid the patient feeling discomfort

A patient with a critically low hemoglobin level of 4.3 requires careful blood transfusion. While administering oxygen and monitoring for hypoxia and fever are crucial, completing the transfusion 'as fast as possible' is incorrect and dangerous. Rapid transfusion can lead to fluid overload, cardiac complications, and severe transfusion reactions, making a slow, controlled rate essential for patient safety and comfort.

Question 8: Which intervention is indicated for a patient in third-degree (complete) AV block with a ventricular rate of 28 bpm and hypotension?

Start amiodarone infusion
Give adenosine 6 mg IV
Immediate synchronized cardioversion
Administer atropine 0.5 mg IV and prepare for transvenous pacing (Correct answer)

Correct answer: Administer atropine 0.5 mg IV and prepare for transvenous pacing

Atropine is the first-line pharmacologic treatment for symptomatic bradycardia while arranging emergency transvenous pacing.

Question 9: A nephrotoxic substance most likely contributed to a patient's acute tubular necrosis. What would the NP's first course of action be?

Make sure that no further exposure to the nephrotoxic agent is happening (Correct answer)
Stop the patient's medications for diabetes
Monitor the kidney function on a daily basis
None of the above

Correct answer: Make sure that no further exposure to the nephrotoxic agent is happening

Acute tubular necrosis (ATN) caused by a nephrotoxic substance requires immediate removal of the offending agent to prevent further kidney damage. While monitoring kidney function is important, stopping the exposure directly addresses the root cause and is the most critical first step. This intervention aims to halt the progression of injury and allow for potential renal recovery.

Question 10: A patient develops sudden dyspnea and hypotension after central line placement. Trachea is deviated. What is the IMMEDIATE intervention?

Endotracheal intubation
Chest X-ray
CT scan of chest
Needle decompression of the affected side (Correct answer)

Correct answer: Needle decompression of the affected side

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression at the 2nd intercostal space, midclavicular line — do not wait for imaging.

Question 11: A patient with severe pancreatitis has a Ranson's criteria score of 5 on admission. What does this predict?

Need for immediate surgical intervention
High mortality risk requiring ICU-level care (Correct answer)
Mild pancreatitis requiring outpatient management
Likelihood of gallstone etiology

Correct answer: High mortality risk requiring ICU-level care

A Ranson's score ≥3 indicates severe pancreatitis; a score of 5 is associated with approximately 40% mortality risk and necessitates ICU-level monitoring.

Question 12: Which electrolyte abnormality is a common COMPLICATION of massive blood transfusion?

Hypernatremia
Hyperkalemia from stored RBCs combined with metabolic alkalosis from citrate (Correct answer)
Hypomagnesemia
Hypocalcemia

Correct answer: Hyperkalemia from stored RBCs combined with metabolic alkalosis from citrate

Massive transfusion causes hypocalcemia (citrate chelates calcium) and initially hyperkalemia from stored RBCs, though citrate metabolism later produces alkalosis.

Question 13: Intra-aortic balloon pump (IABP) counterpulsation improves hemodynamics through which mechanism?

Inflates in diastole to augment coronary perfusion and deflates in systole to reduce afterload (Correct answer)
Acts as a left ventricular assist device replacing cardiac output
Inflates in systole to increase coronary perfusion
Increases heart rate to improve cardiac output

Correct answer: Inflates in diastole to augment coronary perfusion and deflates in systole to reduce afterload

IABP inflates during diastole (augmenting coronary perfusion) and deflates just before systole (reducing afterload and myocardial oxygen demand).

Question 14: Which drugs are most likely to be prescribed to a patient who is having a hypertensive crisis?

IV Nitroprusside (Nitropress) (Correct answer)
IV Torsemide
None of the above
IV Nitroglycerin (Correct answer)

Correct answer: IV Nitroprusside (Nitropress)

Both IV Nitroprusside (Nitropress) and IV Nitroglycerin are potent vasodilators commonly used in the acute management of hypertensive crises. Nitroprusside is a very rapid-acting agent often used for severe cases, while Nitroglycerin is also effective, particularly when there's associated myocardial ischemia or heart failure. Torsemide is a loop diuretic, which is not a primary agent for immediate reduction of blood pressure in a crisis.

Question 15: An ACNP is titrating vasopressors for a patient with refractory septic shock. Which adjunctive agent has been shown to reduce vasopressor requirements?

Hydrocortisone 200 mg/day (Correct answer)
Fludrocortisone alone
Methylprednisolone 1 g IV daily
Dexamethasone 10 mg IV

Correct answer: Hydrocortisone 200 mg/day

Hydrocortisone 200 mg/day is recommended for vasopressor-refractory septic shock as it reduces vasopressor requirements.

Question 16: A patient receiving norepinephrine has an SVR of 1,800 dynes/s/cm⁻⁵ and MAP of 92 mmHg, but urine output is 15 mL/hr. What is the MOST appropriate next step?

Increase norepinephrine dose
Add vasopressin
Start dobutamine (Correct answer)
Give a fluid bolus

Correct answer: Start dobutamine

With adequate MAP and high SVR but low urine output suggesting poor perfusion, adding dobutamine addresses low cardiac output and improves organ perfusion.

Question 17: A patient's Glasgow Coma Scale is assessed as E2V3M4. What is the total GCS score?

11
7
13
9 (Correct answer)

Correct answer: 9

GCS = Eye (2) + Verbal (3) + Motor (4) = 9; scores ≤8 typically indicate the need for airway protection.

Question 18: Contrary to the health center's visitation protocol, four family members insist on staying the night with a patient. Please select the option that will be the best course of action for the NP from the list below.

Allow them to stay overnight considering they are insistent
Allow only one to two members to stay but carefully check the effect on the patient (Correct answer)
None of the above is appropriate
Say it is contrary to the policy and deny granting their request

Correct answer: Allow only one to two members to stay but carefully check the effect on the patient

The best course of action balances hospital policy with the patient's and family's emotional needs, prioritizing patient well-being. Allowing a limited number of family members to stay demonstrates empathy and flexibility, supporting the patient's comfort and family presence. However, it's crucial to monitor the impact on the patient's rest and care environment to ensure it doesn't negatively affect their recovery, making a compromise the most appropriate approach.

Question 19: An ACNP orders dexmedetomidine for a delirious, agitated ICU patient. Which side effect must be monitored closely?

Hyperglycemia
Bradycardia and hypotension (Correct answer)
Hypertension and tachycardia
Respiratory depression

Correct answer: Bradycardia and hypotension

Dexmedetomidine's alpha-2 agonism reduces sympathetic tone, causing bradycardia and hypotension as its primary adverse effects.

Question 20: A patient with hemorrhagic stroke on warfarin has an INR of 4.2. Which reversal strategy should be used FIRST?

4-factor prothrombin complex concentrate (PCC) (Correct answer)
Vitamin K 10 mg IV only
Fresh frozen plasma alone
Recombinant factor VIIa

Correct answer: 4-factor prothrombin complex concentrate (PCC)

4-factor PCC rapidly and completely reverses warfarin anticoagulation and is preferred over FFP for urgent reversal in hemorrhagic stroke.

Question 21: An ACNP manages a patient with new-onset rapid ventricular response atrial fibrillation and LVEF of 25%. Which rate control agent is preferred?

Metoprolol IV
Diltiazem IV
Digoxin IV (Correct answer)
Verapamil IV

Correct answer: Digoxin IV

Digoxin is preferred for rate control in AF with reduced EF (HFrEF) because beta-blockers and calcium channel blockers may further depress cardiac output.

Question 22: Which complication of mechanical ventilation is characterized by new infiltrates on CXR, fever, purulent secretions, and leukocytosis after 48 hours of ventilation?

ARDS
Ventilator-associated pneumonia (VAP) (Correct answer)
Pulmonary embolism
Atelectasis

Correct answer: Ventilator-associated pneumonia (VAP)

VAP is defined as pneumonia developing ≥48 hours after intubation, presenting with new infiltrates, fever, leukocytosis, and purulent secretions.

Question 23: Which empiric antibiotic regimen is most appropriate for a patient with community-acquired septic shock of unknown source?

Vancomycin plus cefazolin for narrow-spectrum gram-positive coverage
Azithromycin plus amoxicillin-clavulanate as oral equivalent if hemodynamically stable
Ciprofloxacin 400 mg IV q8h monotherapy for broad enteric gram-negative coverage
Vancomycin plus piperacillin-tazobactam or meropenem, with atypical coverage if pneumonia is suspected (Correct answer)

Correct answer: Vancomycin plus piperacillin-tazobactam or meropenem, with atypical coverage if pneumonia is suspected

Empiric therapy for septic shock requires broad-spectrum coverage including MRSA (vancomycin) and gram-negative organisms (pip-tazo or carbapenem) until cultures guide de-escalation.

Question 24: The ACNP is managing a patient with acute respiratory distress syndrome (ARDS). The lung-protective ventilation strategy includes:

Tidal volume 10-12 mL/kg ideal body weight, PEEP 5 cmH2O
Tidal volume 6 mL/kg ideal body weight, plateau pressure <30 cmH2O (Correct answer)
FiO2 100% with minimal PEEP
High-frequency oscillatory ventilation for all patients

Correct answer: Tidal volume 6 mL/kg ideal body weight, plateau pressure <30 cmH2O

ARDSNet protocol specifies low tidal volume (6 mL/kg IBW) with plateau pressure kept below 30 cmH2O to prevent ventilator-induced lung injury.

Question 25: A patient is admitted with acute decompensated heart failure and a BNP of 1,800 pg/mL. Which intervention has the strongest evidence for improving dyspnea in the first 24 hours?

IV beta-blockers to reduce heart rate
Vasopressin receptor antagonist (tolvaptan)
Immediate BiPAP initiation
IV loop diuretics for decongestion (Correct answer)

Correct answer: IV loop diuretics for decongestion

IV loop diuretics (furosemide) remain the cornerstone of acute decompensated heart failure treatment, rapidly reducing preload and relieving pulmonary congestion.

Question 26: A patient with a subarachnoid hemorrhage (SAH) develops worsening neurological deficits on day 5. Which complication should the ACNP suspect?

Re-bleeding
Meningitis
Cerebral vasospasm (Correct answer)
Hydrocephalus

Correct answer: Cerebral vasospasm

Cerebral vasospasm typically occurs 4–14 days after SAH (peak days 7–10), causing delayed ischemic neurological deficits.

Question 27: A patient's ABG shows: pH 7.28, PaCO2 58, HCO3 26. What is the PRIMARY acid-base disturbance?

Metabolic acidosis
Respiratory alkalosis
Respiratory acidosis (Correct answer)
Mixed metabolic and respiratory acidosis

Correct answer: Respiratory acidosis

Elevated PaCO2 (>45) with low pH indicates respiratory acidosis; the near-normal HCO3 suggests this is acute with limited compensation.

Question 28: Recovery of renal function after AKI in the ICU is BEST predicted by which factor?

Underlying cause of AKI (reversibility) (Correct answer)
Patient age
Peak creatinine level
Duration of oliguria before RRT initiation

Correct answer: Underlying cause of AKI (reversibility)

The underlying etiology and its reversibility is the strongest predictor of renal recovery; pre-renal and ATN from reversible causes recover more reliably than CKD-related AKI.

Question 29: A patient with severe traumatic brain injury has a Glasgow Coma Scale of 7 and ICP of 28 mmHg. After elevating the head of bed to 30° and ensuring normocapnia, the next intervention is:

Immediate decompressive craniectomy
Administer 23.4% hypertonic saline or mannitol (Correct answer)
Administer dexamethasone 10 mg IV
Hyperventilate to PaCO2 of 25 mmHg

Correct answer: Administer 23.4% hypertonic saline or mannitol

Hyperosmolar therapy with hypertonic saline or mannitol is the next step to reduce ICP after basic positioning and ventilation optimization.

Question 30: Which of the following assertions regarding the endotracheal tube is true? (ETT).

The NP will deflate the cuff before removing the ETT
All of the above (Correct answer)
In removing the ETT, receiving help from another NP is in order.
The ETT is removed when the patient does not require an artificial airway anymore.

Correct answer: All of the above

All the statements regarding endotracheal tube (ETT) management are true. Removing an ETT is a critical procedure that often requires assistance to ensure patient safety (A). The cuff must be fully deflated before removal to prevent tracheal injury (B). The ETT is removed when the patient no longer requires mechanical ventilation or airway protection, indicating successful weaning (C). Therefore, all options are correct.

ACNPC-AG Adult-Gerontology Acute Care Nurse Practitioner Certification

The ACNPC-AG certifies adult-gerontology acute care nurse practitioners in advanced clinical judgment and professional practice across critical and complex care settings for adult and geriatric populations.

175

Questions

210 min

Time Limit

70%

To Pass

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