ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER-BOARD CERTIFIED (AGACNP-BC)
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALE | LATEST VERSION PDF
Section One: Questions 1–100
A 68-year-old patient with septic shock is receiving norepinephrine. The mean arterial pressure
(MAP) remains 55 mmHg. What is the most appropriate next step?
A. Increase the norepinephrine infusion rate
B. Initiate vasopressin infusion
C. Administer a bolus of 500 mL crystalloid
D. Add phenylephrine to the regimen
🟢 B. Initiate vasopressin infusion
🔴 RATIONALE: According to Surviving Sepsis Campaign guidelines, vasopressin is
recommended as a second-line agent to increase MAP or decrease catecholamine requirements in
patients with septic shock refractory to norepinephrine.
Which legal doctrine allows a nurse practitioner to be held responsible for the actions of a medical
assistant under their supervision?
A. Res ipsa loquitur
B. Respondeat superior
C. Stare decisis
D. Capitation
🟢 B. Respondeat superior
🔴 RATIONALE: Respondeat superior, or "let the master answer," holds the employer or
supervisor responsible for the negligent acts of employees committed within the scope of their
employment.
An elderly patient presents with confusion, fever, and a positive urinalysis for nitrites and
leukocytes. Which finding is most suggestive of delirium rather than dementia?
,A. Gradual onset of symptoms
B. Stable attention span
C. Acute fluctuation in level of consciousness
D. History of memory loss
🟢 C. Acute fluctuation in level of consciousness
🔴 RATIONALE: Delirium is characterized by an acute onset and fluctuating course with
disturbances in attention and consciousness, whereas dementia is typically progressive and
chronic.
A patient in the ICU on mechanical ventilation has a plateau pressure of 38 cm H2O. What is the
immediate priority?
A. Increase the respiratory rate
B. Decrease the tidal volume
C. Check for patient-ventilator asynchrony
D. Increase the PEEP
🟢 B. Decrease the tidal volume
🔴 RATIONALE: Plateau pressures >30 cm H2O indicate decreased lung compliance or
overdistention. Reducing tidal volume is the primary strategy to prevent ventilator-induced lung
injury.
What is the most sensitive laboratory marker for early acute kidney injury (AKI) in a critically ill
patient?
A. Serum creatinine
B. Blood urea nitrogen
C. Serum cystatin C
D. Urine output
🟢 C. Serum cystatin C
,🔴 RATIONALE: Cystatin C is a more sensitive marker than serum creatinine for detecting early
changes in glomerular filtration rate (GFR) because it is not influenced by muscle mass or
nutritional status.
A patient with a mechanical mitral valve presents with subtherapeutic INR. What is the priority
intervention?
A. Transition to aspirin
B. Re-initiate heparin bridging and adjust warfarin dose
C. Stop warfarin immediately
D. Administer Vitamin K
🟢 B. Re-initiate heparin bridging and adjust warfarin dose
🔴 RATIONALE: Patients with mechanical mitral valves are at high risk for thromboembolism;
therapeutic anticoagulation must be maintained, and bridging with heparin is necessary when INR
is subtherapeutic.
Which ethical principle is violated if a nurse practitioner forces a patient to undergo a procedure
against their will despite the patient being cognitively intact?
A. Justice
B. Beneficence
C. Autonomy
D. Non-maleficence
🟢 C. Autonomy
🔴 RATIONALE: Autonomy is the right of a patient to make their own healthcare decisions. Forcing
a procedure violates this right.
A 75-year-old patient with heart failure has an S3 heart sound. What does this indicate?
A. Mitral stenosis
B. Left ventricular systolic dysfunction
, C. Aortic valve calcification
D. Pericardial friction rub
🟢 B. Left ventricular systolic dysfunction
🔴 RATIONALE: An S3 heart sound occurs during early diastole and is associated with rapid
ventricular filling into a non-compliant or volume-overloaded ventricle, common in systolic heart
failure.
What is the primary mechanism of action of dexmedetomidine?
A. GABA receptor agonist
B. Selective alpha-2 adrenergic agonist
C. NMDA receptor antagonist
D. Dopamine receptor antagonist
🟢 B. Selective alpha-2 adrenergic agonist
🔴 RATIONALE: Dexmedetomidine provides sedation and analgesia by acting as a selective
alpha-2 adrenergic agonist, resulting in decreased sympathetic outflow.
A patient on a ventilator for 14 days requires long-term airway management. What is the
recommended next step?
A. Continue endotracheal intubation
B. Perform a tracheostomy
C. Extubate to high-flow nasal cannula
D. Frequent suctioning
🟢 B. Perform a tracheostomy
🔴 RATIONALE: A tracheostomy is typically considered for patients expected to require
mechanical ventilation for an extended period, as it improves patient comfort and facilitates
weaning.
QUESTIONS AND CORRECT ANSWERS WITH DETAILED RATIONALE | LATEST VERSION PDF
Section One: Questions 1–100
A 68-year-old patient with septic shock is receiving norepinephrine. The mean arterial pressure
(MAP) remains 55 mmHg. What is the most appropriate next step?
A. Increase the norepinephrine infusion rate
B. Initiate vasopressin infusion
C. Administer a bolus of 500 mL crystalloid
D. Add phenylephrine to the regimen
🟢 B. Initiate vasopressin infusion
🔴 RATIONALE: According to Surviving Sepsis Campaign guidelines, vasopressin is
recommended as a second-line agent to increase MAP or decrease catecholamine requirements in
patients with septic shock refractory to norepinephrine.
Which legal doctrine allows a nurse practitioner to be held responsible for the actions of a medical
assistant under their supervision?
A. Res ipsa loquitur
B. Respondeat superior
C. Stare decisis
D. Capitation
🟢 B. Respondeat superior
🔴 RATIONALE: Respondeat superior, or "let the master answer," holds the employer or
supervisor responsible for the negligent acts of employees committed within the scope of their
employment.
An elderly patient presents with confusion, fever, and a positive urinalysis for nitrites and
leukocytes. Which finding is most suggestive of delirium rather than dementia?
,A. Gradual onset of symptoms
B. Stable attention span
C. Acute fluctuation in level of consciousness
D. History of memory loss
🟢 C. Acute fluctuation in level of consciousness
🔴 RATIONALE: Delirium is characterized by an acute onset and fluctuating course with
disturbances in attention and consciousness, whereas dementia is typically progressive and
chronic.
A patient in the ICU on mechanical ventilation has a plateau pressure of 38 cm H2O. What is the
immediate priority?
A. Increase the respiratory rate
B. Decrease the tidal volume
C. Check for patient-ventilator asynchrony
D. Increase the PEEP
🟢 B. Decrease the tidal volume
🔴 RATIONALE: Plateau pressures >30 cm H2O indicate decreased lung compliance or
overdistention. Reducing tidal volume is the primary strategy to prevent ventilator-induced lung
injury.
What is the most sensitive laboratory marker for early acute kidney injury (AKI) in a critically ill
patient?
A. Serum creatinine
B. Blood urea nitrogen
C. Serum cystatin C
D. Urine output
🟢 C. Serum cystatin C
,🔴 RATIONALE: Cystatin C is a more sensitive marker than serum creatinine for detecting early
changes in glomerular filtration rate (GFR) because it is not influenced by muscle mass or
nutritional status.
A patient with a mechanical mitral valve presents with subtherapeutic INR. What is the priority
intervention?
A. Transition to aspirin
B. Re-initiate heparin bridging and adjust warfarin dose
C. Stop warfarin immediately
D. Administer Vitamin K
🟢 B. Re-initiate heparin bridging and adjust warfarin dose
🔴 RATIONALE: Patients with mechanical mitral valves are at high risk for thromboembolism;
therapeutic anticoagulation must be maintained, and bridging with heparin is necessary when INR
is subtherapeutic.
Which ethical principle is violated if a nurse practitioner forces a patient to undergo a procedure
against their will despite the patient being cognitively intact?
A. Justice
B. Beneficence
C. Autonomy
D. Non-maleficence
🟢 C. Autonomy
🔴 RATIONALE: Autonomy is the right of a patient to make their own healthcare decisions. Forcing
a procedure violates this right.
A 75-year-old patient with heart failure has an S3 heart sound. What does this indicate?
A. Mitral stenosis
B. Left ventricular systolic dysfunction
, C. Aortic valve calcification
D. Pericardial friction rub
🟢 B. Left ventricular systolic dysfunction
🔴 RATIONALE: An S3 heart sound occurs during early diastole and is associated with rapid
ventricular filling into a non-compliant or volume-overloaded ventricle, common in systolic heart
failure.
What is the primary mechanism of action of dexmedetomidine?
A. GABA receptor agonist
B. Selective alpha-2 adrenergic agonist
C. NMDA receptor antagonist
D. Dopamine receptor antagonist
🟢 B. Selective alpha-2 adrenergic agonist
🔴 RATIONALE: Dexmedetomidine provides sedation and analgesia by acting as a selective
alpha-2 adrenergic agonist, resulting in decreased sympathetic outflow.
A patient on a ventilator for 14 days requires long-term airway management. What is the
recommended next step?
A. Continue endotracheal intubation
B. Perform a tracheostomy
C. Extubate to high-flow nasal cannula
D. Frequent suctioning
🟢 B. Perform a tracheostomy
🔴 RATIONALE: A tracheostomy is typically considered for patients expected to require
mechanical ventilation for an extended period, as it improves patient comfort and facilitates
weaning.
