ACUTE CARE NURSE PRACTITIONER CERTIFICATION
Second Edition EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Assessment and Management
2. Pulmonary Critical Care and Ventilator Management
3. Renal Failure and Electrolyte Disturbance Management
4. Neurological Critical Care and Stroke Protocols
5. Infectious Disease, Sepsis, and Immunologic Emergencies
6. Gastrointestinal and Hepatic Critical Care
7. Hematology and Hemostasis in the Critically Ill
8. Endocrine Emergencies and Metabolic Support
9. Ethical, Legal, and Advanced Practice Professional Standards
10. Multi-Organ System Failure and Trauma Resuscitation
1. A 64-year-old patient with a history of heart failure is admitted with acute dyspnea, S3 gallop,
and bilateral crackles. BNP is 1,200 pg/mL. The patient is currently on Lisinopril and
Furosemide. Which intervention is the highest priority for stabilizing cardiac output?
A. Initiate a beta-blocker to reduce myocardial oxygen demand.
B. Administer intravenous loop diuretics and assess hemodynamic profile.
C. Order a cardiac catheterization to rule out acute MI.
, D. Increase the dose of the ACE inhibitor to promote vasodilation.
CORRECT ANSWER : B
Rationale: Acute decompensated heart failure with volume overload requires immediate diuresis
to reduce preload. Beta-blockers are generally avoided in the acute phase of decompensated
heart failure, and ACE inhibitors should not be titrated aggressively until the patient is
hemodynamically stable.
2. A patient on mechanical ventilation is in the Assist-Control (AC) mode. The arterial blood gas
(ABG) reveals pH 7.52, PaCO2 28 mmHg, PaO2 95 mmHg. What is the most appropriate
ventilator adjustment?
A. Increase the respiratory rate.
B. Decrease the respiratory rate or tidal volume.
C. Increase the fraction of inspired oxygen (FiO2).
D. Add dead space to the circuit.
CORRECT ANSWER : B
Rationale: The ABG indicates respiratory alkalosis due to alveolar hyperventilation. Reducing
the rate or tidal volume will decrease minute ventilation and allow the PaCO2 to rise toward the
normal range, correcting the pH.
3. A patient in the ICU develops sudden onset of confusion, hypotension (88/50 mmHg), and fever
(102.2°F). Lactate is 4.5 mmol/L. According to the Surviving Sepsis Campaign, what is the
initial action?
A. Initiate vasopressors.
B. Administer 30 mL/kg of isotonic crystalloid fluid resuscitation.
C. Start broad-spectrum antibiotics within 4 hours.
D. Draw blood cultures after administering antibiotics.
CORRECT ANSWER : B
Rationale: Early goal-directed therapy for septic shock emphasizes rapid fluid resuscitation (30
mL/kg) within the first hour to restore tissue perfusion. Antibiotics should be administered as
soon as possible, but fluids remain the foundation of early hemodynamic stabilization.
,4. A 55-year-old patient with cirrhosis presents with hematemesis. Initial management should
include:
A. Administration of oral propranolol to reduce portal pressure.
B. Placement of a large-bore IV and initiation of octreotide infusion.
C. Immediate esophagogastroduodenoscopy (EGD) before resuscitation.
D. Transfusion of packed red blood cells to a target hemoglobin of 12 g/dL.
CORRECT ANSWER : B
Rationale: Management of variceal hemorrhage requires immediate resuscitation and
pharmacological stabilization with octreotide, which reduces splanchnic blood flow. EGD is
vital but follows initial resuscitation, and restrictive transfusion thresholds (Hgb 7-8 g/dL) are
used to avoid exacerbating portal hypertension.
5. A patient is being evaluated for potential brain death. Which of the following findings is a
prerequisite before performing the apnea test?
A. Absence of all cranial nerve reflexes.
B. Core body temperature > 36°C and systolic BP ≥ 100 mmHg.
C. A positive doll's eyes reflex.
D. Presence of spontaneous respiratory movements.
CORRECT ANSWER : B
Rationale: Normothermia and hemodynamic stability are essential prerequisites to ensure that
the patient is not in a reversible coma or profound shock. Cranial nerve absence is a result of
brain death, and spontaneous breathing movements would contradict the diagnosis.
6. A patient with acute kidney injury (AKI) presents with a serum potassium of 6.8 mEq/L and
peaked T-waves on ECG. What is the priority intervention?
A. Administer sodium polystyrene sulfonate.
B. Administer intravenous calcium gluconate.
C. Begin hemodialysis immediately.
D. Administer insulin and dextrose.
, CORRECT ANSWER : B
Rationale: Intravenous calcium gluconate stabilizes the cardiac membrane to prevent fatal
arrhythmias in the setting of severe hyperkalemia. While insulin and dextrose shift potassium
into cells, they do not provide immediate protection against cardiac conduction abnormalities.
7. A patient in the ICU requires sedation for a painful procedure. The patient has a history of
hypotension. Which sedative-hypnotic agent is most likely to maintain hemodynamic stability?
A. Propofol.
B. Etomidate.
C. Midazolam.
D. Thiopental.
CORRECT ANSWER : B
Rationale: Etomidate is noted for its favorable profile regarding cardiovascular stability,
causing minimal change in blood pressure or heart rate. Propofol and benzodiazepines like
midazolam are frequent causes of hypotension in critically ill patients.
8. Which diagnostic marker is most sensitive for determining the severity of acute pancreatitis?
A. Serum amylase levels.
B. BUN and Hematocrit elevation (hemoconcentration).
C. WBC count.
D. Serum lipase levels.
CORRECT ANSWER : B
Rationale: Amylase and lipase are used for initial diagnosis but do not correlate with disease
severity. Hemoconcentration, reflected by rising BUN and Hct, is a validated marker for early
organ dysfunction and fluid sequestration in pancreatitis.
9. A patient is receiving a continuous infusion of heparin for a pulmonary embolism. The aPTT is
120 seconds. What is the most appropriate management?
A. Continue the current rate.
B. Stop the infusion and recheck the aPTT in 1 hour.
Second Edition EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Assessment and Management
2. Pulmonary Critical Care and Ventilator Management
3. Renal Failure and Electrolyte Disturbance Management
4. Neurological Critical Care and Stroke Protocols
5. Infectious Disease, Sepsis, and Immunologic Emergencies
6. Gastrointestinal and Hepatic Critical Care
7. Hematology and Hemostasis in the Critically Ill
8. Endocrine Emergencies and Metabolic Support
9. Ethical, Legal, and Advanced Practice Professional Standards
10. Multi-Organ System Failure and Trauma Resuscitation
1. A 64-year-old patient with a history of heart failure is admitted with acute dyspnea, S3 gallop,
and bilateral crackles. BNP is 1,200 pg/mL. The patient is currently on Lisinopril and
Furosemide. Which intervention is the highest priority for stabilizing cardiac output?
A. Initiate a beta-blocker to reduce myocardial oxygen demand.
B. Administer intravenous loop diuretics and assess hemodynamic profile.
C. Order a cardiac catheterization to rule out acute MI.
, D. Increase the dose of the ACE inhibitor to promote vasodilation.
CORRECT ANSWER : B
Rationale: Acute decompensated heart failure with volume overload requires immediate diuresis
to reduce preload. Beta-blockers are generally avoided in the acute phase of decompensated
heart failure, and ACE inhibitors should not be titrated aggressively until the patient is
hemodynamically stable.
2. A patient on mechanical ventilation is in the Assist-Control (AC) mode. The arterial blood gas
(ABG) reveals pH 7.52, PaCO2 28 mmHg, PaO2 95 mmHg. What is the most appropriate
ventilator adjustment?
A. Increase the respiratory rate.
B. Decrease the respiratory rate or tidal volume.
C. Increase the fraction of inspired oxygen (FiO2).
D. Add dead space to the circuit.
CORRECT ANSWER : B
Rationale: The ABG indicates respiratory alkalosis due to alveolar hyperventilation. Reducing
the rate or tidal volume will decrease minute ventilation and allow the PaCO2 to rise toward the
normal range, correcting the pH.
3. A patient in the ICU develops sudden onset of confusion, hypotension (88/50 mmHg), and fever
(102.2°F). Lactate is 4.5 mmol/L. According to the Surviving Sepsis Campaign, what is the
initial action?
A. Initiate vasopressors.
B. Administer 30 mL/kg of isotonic crystalloid fluid resuscitation.
C. Start broad-spectrum antibiotics within 4 hours.
D. Draw blood cultures after administering antibiotics.
CORRECT ANSWER : B
Rationale: Early goal-directed therapy for septic shock emphasizes rapid fluid resuscitation (30
mL/kg) within the first hour to restore tissue perfusion. Antibiotics should be administered as
soon as possible, but fluids remain the foundation of early hemodynamic stabilization.
,4. A 55-year-old patient with cirrhosis presents with hematemesis. Initial management should
include:
A. Administration of oral propranolol to reduce portal pressure.
B. Placement of a large-bore IV and initiation of octreotide infusion.
C. Immediate esophagogastroduodenoscopy (EGD) before resuscitation.
D. Transfusion of packed red blood cells to a target hemoglobin of 12 g/dL.
CORRECT ANSWER : B
Rationale: Management of variceal hemorrhage requires immediate resuscitation and
pharmacological stabilization with octreotide, which reduces splanchnic blood flow. EGD is
vital but follows initial resuscitation, and restrictive transfusion thresholds (Hgb 7-8 g/dL) are
used to avoid exacerbating portal hypertension.
5. A patient is being evaluated for potential brain death. Which of the following findings is a
prerequisite before performing the apnea test?
A. Absence of all cranial nerve reflexes.
B. Core body temperature > 36°C and systolic BP ≥ 100 mmHg.
C. A positive doll's eyes reflex.
D. Presence of spontaneous respiratory movements.
CORRECT ANSWER : B
Rationale: Normothermia and hemodynamic stability are essential prerequisites to ensure that
the patient is not in a reversible coma or profound shock. Cranial nerve absence is a result of
brain death, and spontaneous breathing movements would contradict the diagnosis.
6. A patient with acute kidney injury (AKI) presents with a serum potassium of 6.8 mEq/L and
peaked T-waves on ECG. What is the priority intervention?
A. Administer sodium polystyrene sulfonate.
B. Administer intravenous calcium gluconate.
C. Begin hemodialysis immediately.
D. Administer insulin and dextrose.
, CORRECT ANSWER : B
Rationale: Intravenous calcium gluconate stabilizes the cardiac membrane to prevent fatal
arrhythmias in the setting of severe hyperkalemia. While insulin and dextrose shift potassium
into cells, they do not provide immediate protection against cardiac conduction abnormalities.
7. A patient in the ICU requires sedation for a painful procedure. The patient has a history of
hypotension. Which sedative-hypnotic agent is most likely to maintain hemodynamic stability?
A. Propofol.
B. Etomidate.
C. Midazolam.
D. Thiopental.
CORRECT ANSWER : B
Rationale: Etomidate is noted for its favorable profile regarding cardiovascular stability,
causing minimal change in blood pressure or heart rate. Propofol and benzodiazepines like
midazolam are frequent causes of hypotension in critically ill patients.
8. Which diagnostic marker is most sensitive for determining the severity of acute pancreatitis?
A. Serum amylase levels.
B. BUN and Hematocrit elevation (hemoconcentration).
C. WBC count.
D. Serum lipase levels.
CORRECT ANSWER : B
Rationale: Amylase and lipase are used for initial diagnosis but do not correlate with disease
severity. Hemoconcentration, reflected by rising BUN and Hct, is a validated marker for early
organ dysfunction and fluid sequestration in pancreatitis.
9. A patient is receiving a continuous infusion of heparin for a pulmonary embolism. The aPTT is
120 seconds. What is the most appropriate management?
A. Continue the current rate.
B. Stop the infusion and recheck the aPTT in 1 hour.
