ATI AGACNP Adult-Gerontology Acute Care
Nurse Practitioner Test Bank 2026/2027 –
Verified Q&As with Detailed Rationales
(Test Bank Bundle - 86 Questions)
---
**QUESTION 1:**
A 68-year-old patient with a history of heart failure and COPD is admitted with acute respiratory
distress. Arterial blood gas reveals a pH of 7.28, PaCO2 of 65 mm Hg, and PaO2 of 55 mm Hg. Which
intervention is most appropriate initially?
A) Administer 100% oxygen via a non-rebreather mask
B) Initiate bi-level positive airway pressure (BiPAP) ventilation
C) Prepare for emergent intubation and mechanical ventilation
D) Administer intravenous sodium bicarbonate
> 🎯 **CORRECT ANSWER:** B) Initiate bi-level positive airway pressure (BiPAP) ventilation
> 💡 **DETAILED RATIONALE:** The ABG shows acute respiratory acidosis (pH < 7.35, PaCO2 > 45) with
hypoxemia. BiPAP is non-invasive positive pressure ventilation that can effectively manage hypercapnic
respiratory failure by improving alveolar ventilation, especially in patients with COPD, without the need
for intubation. A non-rebreather mask (A) provides oxygen but does not assist ventilation or reduce
CO2; intubation (C) is the next step if BiPAP fails, but BiPAP is the appropriate initial trial in a patient
who is awake and cooperative; sodium bicarbonate (D) is not indicated for respiratory acidosis as it can
worsen hypercapnia.
---
**QUESTION 2:**
A 72-year-old patient presents with sudden onset of severe headache, nausea, vomiting, and
photophobia. Lumbar puncture reveals xanthochromia. What is the most likely diagnosis?
A) Migraine with aura
B) Subarachnoid hemorrhage
,C) Meningitis
D) Temporal arteritis
> 🎯 **CORRECT ANSWER:** B) Subarachnoid hemorrhage
> 💡 **DETAILED RATIONALE:** Xanthochromia (yellow-tinged CSF) indicates the presence of bilirubin
from lysis of red blood cells, which is a classic finding of subarachnoid hemorrhage (SAH) after 6-12
hours. Meningitis (C) typically shows elevated WBCs and protein, not xanthochromia; migraine (A) does
not produce xanthochromia; temporal arteritis (D) is associated with jaw claudication and elevated ESR,
not xanthochromia.
---
**QUESTION 3:**
A 74-year-old patient with chronic kidney disease (stage 3) is prescribed enoxaparin for prevention of
venous thromboembolism. Which dose adjustment is most appropriate?
A) No dose adjustment is needed
B) Reduce the dose by 50%
C) Use a prophylactic dose with creatinine clearance < 30 mL/min
D) Avoid enoxaparin and use unfractionated heparin
> 🎯 **CORRECT ANSWER:** D) Avoid enoxaparin and use unfractionated heparin
> 💡 **DETAILED RATIONALE:** In patients with CKD stage 3 (or CrCl < 30 mL/min), enoxaparin
accumulates due to reduced renal clearance, increasing the risk of bleeding; unfractionated heparin is
preferred as it can be monitored with aPTT and has a shorter half-life. Dose reduction (B) is not
sufficient; prophylactic doses may still accumulate; no dose adjustment (A) is unsafe.
---
**QUESTION 4:**
A 65-year-old male presents with acute urinary retention and suprapubic pain. A Foley catheter is placed
and 1,200 mL of urine is drained. What should the AGACNP monitor for immediately?
A) Hyperkalemia
B) Hypovolemic shock
C) Post-obstructive diuresis
D) Hyponatremia
> 🎯 **CORRECT ANSWER:** C) Post-obstructive diuresis
,> 💡 **DETAILED RATIONALE:** After relief of chronic urinary retention, the patient is at risk for post-
obstructive diuresis, a large volume of urine output due to osmotic diuresis and impaired concentrating
ability, which can lead to dehydration and electrolyte imbalance. Hyperkalemia (A) is not a classic risk;
shock (B) is less likely; hyponatremia (D) is not the primary concern.
---
**QUESTION 5:**
A patient with advanced COPD is receiving oxygen at 2 L/min via nasal cannula. The AGACNP notes that
the patient's oxygen saturation is 92% and the patient is somnolent. Which action is most appropriate?
A) Increase the oxygen flow to 4 L/min
B) Check an arterial blood gas (ABG) to assess CO2 levels
C) Apply a non-rebreather mask
D) Encourage the patient to use pursed-lip breathing
> 🎯 **CORRECT ANSWER:** B) Check an arterial blood gas (ABG) to assess CO2 levels
> 💡 **DETAILED RATIONALE:** Somnolence in a COPD patient on oxygen suggests possible CO2
retention (hypercapnia) and impending respiratory failure; an ABG is needed to assess CO2 levels.
Increasing oxygen (A) or using a non-rebreather (C) can worsen hypercapnia by suppressing the hypoxic
drive; pursed-lip breathing (D) is beneficial but does not address the acute change in mental status.
---
**QUESTION 6:**
A 60-year-old patient with a history of atrial fibrillation is admitted with a new diagnosis of ischemic
stroke. The patient is on warfarin with an INR of 2.8. Which treatment is indicated?
A) Administer intravenous alteplase (tPA) immediately
B) Hold warfarin and administer vitamin K
C) Administer fresh frozen plasma
D) Continue warfarin and monitor
> 🎯 **CORRECT ANSWER:** B) Hold warfarin and administer vitamin K
> 💡 **DETAILED RATIONALE:** In a patient on warfarin with an INR > 1.7, IV alteplase (tPA) is
contraindicated due to the risk of intracranial hemorrhage; warfarin should be held, and vitamin K
should be administered to reverse the anticoagulation. FFP may be given if there is active bleeding, but
vitamin K is the standard reversal for elevated INR.
, ---
**QUESTION 7:**
A 78-year-old patient is diagnosed with sepsis and acute kidney injury. Which hemodynamic parameter
is the most appropriate initial fluid resuscitation target?
A) Central venous pressure (CVP) of 8-12 mm Hg
B) Mean arterial pressure (MAP) of 65 mm Hg
C) Urine output of 0.5 mL/kg/hr
D) Cardiac index of 2.5 L/min/m²
> 🎯 **CORRECT ANSWER:** B) Mean arterial pressure (MAP) of 65 mm Hg
> 💡 **DETAILED RATIONALE:** In sepsis, the initial resuscitation goal is to achieve a MAP ≥ 65 mm Hg
to ensure adequate organ perfusion; this is a core recommendation of the Surviving Sepsis Campaign.
CVP (A) and urine output (C) are important but are not the primary initial targets; cardiac index (D) is a
more advanced goal.
---
**QUESTION 8:**
A patient in the ICU develops acute respiratory distress syndrome (ARDS). Which ventilator strategy is
recommended to reduce mortality?
A) High tidal volume (10-12 mL/kg) ventilation
B) Low tidal volume (6-8 mL/kg) ventilation with plateau pressure < 30 cm H2O
C) High positive end-expiratory pressure (PEEP) of 20 cm H2O
D) Prone positioning only
> 🎯 **CORRECT ANSWER:** B) Low tidal volume (6-8 mL/kg) ventilation with plateau pressure < 30 cm
H2O
> 💡 **DETAILED RATIONALE:** Low tidal volume ventilation (6-8 mL/kg) with a plateau pressure < 30
cm H2O is the standard of care in ARDS to prevent ventilator-induced lung injury (volutrauma). High
tidal volume (A) worsens lung injury; high PEEP (C) may be beneficial but not as a standalone; prone
positioning (D) is used in severe cases but not as the sole strategy.
---
**QUESTION 9:**
Nurse Practitioner Test Bank 2026/2027 –
Verified Q&As with Detailed Rationales
(Test Bank Bundle - 86 Questions)
---
**QUESTION 1:**
A 68-year-old patient with a history of heart failure and COPD is admitted with acute respiratory
distress. Arterial blood gas reveals a pH of 7.28, PaCO2 of 65 mm Hg, and PaO2 of 55 mm Hg. Which
intervention is most appropriate initially?
A) Administer 100% oxygen via a non-rebreather mask
B) Initiate bi-level positive airway pressure (BiPAP) ventilation
C) Prepare for emergent intubation and mechanical ventilation
D) Administer intravenous sodium bicarbonate
> 🎯 **CORRECT ANSWER:** B) Initiate bi-level positive airway pressure (BiPAP) ventilation
> 💡 **DETAILED RATIONALE:** The ABG shows acute respiratory acidosis (pH < 7.35, PaCO2 > 45) with
hypoxemia. BiPAP is non-invasive positive pressure ventilation that can effectively manage hypercapnic
respiratory failure by improving alveolar ventilation, especially in patients with COPD, without the need
for intubation. A non-rebreather mask (A) provides oxygen but does not assist ventilation or reduce
CO2; intubation (C) is the next step if BiPAP fails, but BiPAP is the appropriate initial trial in a patient
who is awake and cooperative; sodium bicarbonate (D) is not indicated for respiratory acidosis as it can
worsen hypercapnia.
---
**QUESTION 2:**
A 72-year-old patient presents with sudden onset of severe headache, nausea, vomiting, and
photophobia. Lumbar puncture reveals xanthochromia. What is the most likely diagnosis?
A) Migraine with aura
B) Subarachnoid hemorrhage
,C) Meningitis
D) Temporal arteritis
> 🎯 **CORRECT ANSWER:** B) Subarachnoid hemorrhage
> 💡 **DETAILED RATIONALE:** Xanthochromia (yellow-tinged CSF) indicates the presence of bilirubin
from lysis of red blood cells, which is a classic finding of subarachnoid hemorrhage (SAH) after 6-12
hours. Meningitis (C) typically shows elevated WBCs and protein, not xanthochromia; migraine (A) does
not produce xanthochromia; temporal arteritis (D) is associated with jaw claudication and elevated ESR,
not xanthochromia.
---
**QUESTION 3:**
A 74-year-old patient with chronic kidney disease (stage 3) is prescribed enoxaparin for prevention of
venous thromboembolism. Which dose adjustment is most appropriate?
A) No dose adjustment is needed
B) Reduce the dose by 50%
C) Use a prophylactic dose with creatinine clearance < 30 mL/min
D) Avoid enoxaparin and use unfractionated heparin
> 🎯 **CORRECT ANSWER:** D) Avoid enoxaparin and use unfractionated heparin
> 💡 **DETAILED RATIONALE:** In patients with CKD stage 3 (or CrCl < 30 mL/min), enoxaparin
accumulates due to reduced renal clearance, increasing the risk of bleeding; unfractionated heparin is
preferred as it can be monitored with aPTT and has a shorter half-life. Dose reduction (B) is not
sufficient; prophylactic doses may still accumulate; no dose adjustment (A) is unsafe.
---
**QUESTION 4:**
A 65-year-old male presents with acute urinary retention and suprapubic pain. A Foley catheter is placed
and 1,200 mL of urine is drained. What should the AGACNP monitor for immediately?
A) Hyperkalemia
B) Hypovolemic shock
C) Post-obstructive diuresis
D) Hyponatremia
> 🎯 **CORRECT ANSWER:** C) Post-obstructive diuresis
,> 💡 **DETAILED RATIONALE:** After relief of chronic urinary retention, the patient is at risk for post-
obstructive diuresis, a large volume of urine output due to osmotic diuresis and impaired concentrating
ability, which can lead to dehydration and electrolyte imbalance. Hyperkalemia (A) is not a classic risk;
shock (B) is less likely; hyponatremia (D) is not the primary concern.
---
**QUESTION 5:**
A patient with advanced COPD is receiving oxygen at 2 L/min via nasal cannula. The AGACNP notes that
the patient's oxygen saturation is 92% and the patient is somnolent. Which action is most appropriate?
A) Increase the oxygen flow to 4 L/min
B) Check an arterial blood gas (ABG) to assess CO2 levels
C) Apply a non-rebreather mask
D) Encourage the patient to use pursed-lip breathing
> 🎯 **CORRECT ANSWER:** B) Check an arterial blood gas (ABG) to assess CO2 levels
> 💡 **DETAILED RATIONALE:** Somnolence in a COPD patient on oxygen suggests possible CO2
retention (hypercapnia) and impending respiratory failure; an ABG is needed to assess CO2 levels.
Increasing oxygen (A) or using a non-rebreather (C) can worsen hypercapnia by suppressing the hypoxic
drive; pursed-lip breathing (D) is beneficial but does not address the acute change in mental status.
---
**QUESTION 6:**
A 60-year-old patient with a history of atrial fibrillation is admitted with a new diagnosis of ischemic
stroke. The patient is on warfarin with an INR of 2.8. Which treatment is indicated?
A) Administer intravenous alteplase (tPA) immediately
B) Hold warfarin and administer vitamin K
C) Administer fresh frozen plasma
D) Continue warfarin and monitor
> 🎯 **CORRECT ANSWER:** B) Hold warfarin and administer vitamin K
> 💡 **DETAILED RATIONALE:** In a patient on warfarin with an INR > 1.7, IV alteplase (tPA) is
contraindicated due to the risk of intracranial hemorrhage; warfarin should be held, and vitamin K
should be administered to reverse the anticoagulation. FFP may be given if there is active bleeding, but
vitamin K is the standard reversal for elevated INR.
, ---
**QUESTION 7:**
A 78-year-old patient is diagnosed with sepsis and acute kidney injury. Which hemodynamic parameter
is the most appropriate initial fluid resuscitation target?
A) Central venous pressure (CVP) of 8-12 mm Hg
B) Mean arterial pressure (MAP) of 65 mm Hg
C) Urine output of 0.5 mL/kg/hr
D) Cardiac index of 2.5 L/min/m²
> 🎯 **CORRECT ANSWER:** B) Mean arterial pressure (MAP) of 65 mm Hg
> 💡 **DETAILED RATIONALE:** In sepsis, the initial resuscitation goal is to achieve a MAP ≥ 65 mm Hg
to ensure adequate organ perfusion; this is a core recommendation of the Surviving Sepsis Campaign.
CVP (A) and urine output (C) are important but are not the primary initial targets; cardiac index (D) is a
more advanced goal.
---
**QUESTION 8:**
A patient in the ICU develops acute respiratory distress syndrome (ARDS). Which ventilator strategy is
recommended to reduce mortality?
A) High tidal volume (10-12 mL/kg) ventilation
B) Low tidal volume (6-8 mL/kg) ventilation with plateau pressure < 30 cm H2O
C) High positive end-expiratory pressure (PEEP) of 20 cm H2O
D) Prone positioning only
> 🎯 **CORRECT ANSWER:** B) Low tidal volume (6-8 mL/kg) ventilation with plateau pressure < 30 cm
H2O
> 💡 **DETAILED RATIONALE:** Low tidal volume ventilation (6-8 mL/kg) with a plateau pressure < 30
cm H2O is the standard of care in ARDS to prevent ventilator-induced lung injury (volutrauma). High
tidal volume (A) worsens lung injury; high PEEP (C) may be beneficial but not as a standalone; prone
positioning (D) is used in severe cases but not as the sole strategy.
---
**QUESTION 9:**
