ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER-
BOARD CERTIFIED (AGACNP-BC) QUESTIONS WITH 100%
CORRECT ANSWERS AND DETAILED RATIONALES
1. A 72-year-old patient with septic shock on norepinephrine has a
MAP of 52 mmHg despite maximum infusion. Which intervention is
most appropriate?
A. Increase norepinephrine to 30 mcg/min
B. Initiate vasopressin at 0.03 units/min
C. Administer a 2 L crystalloid bolus
D. Start dobutamine infusion
Correct Answer: B. Initiate vasopressin at 0.03 units/min
RATIONALE: According to Surviving Sepsis Campaign guidelines,
vasopressin is recommended as a second-line vasopressor in septic
shock refractory to norepinephrine to increase MAP and reduce
catecholamine requirements. Fixed-dose vasopressin at 0.03 units/min
is standard.
2. A patient with a mechanical mitral valve has an INR of 1.8. What is
the priority intervention?
A. Transition to aspirin 325 mg daily
B. Initiate heparin bridging and increase warfarin dose
,C. Stop warfarin and administer Vitamin K
D. Check INR again in 24 hours
Correct Answer: B. Initiate heparin bridging and increase warfarin
dose
RATIONALE: Patients with mechanical mitral valves are at high risk for
thromboembolism and require therapeutic anticoagulation. When INR
is subtherapeutic, heparin bridging is necessary until INR reaches
therapeutic range (2.5-3.5 for mechanical mitral valve).
3. A 68-year-old 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
Correct Answer: B. Decrease the tidal volume
RATIONALE: Plateau pressures >30 cm H2O indicate decreased lung
compliance or alveolar overdistention and increase risk of ventilator-
induced lung injury. Reducing tidal volume to 6 mL/kg predicted body
weight is the primary strategy to prevent lung injury.
4. Which laboratory marker is most sensitive for early acute kidney
injury in a critically ill patient?
A. Serum creatinine
B. Blood urea nitrogen
,C. Serum cystatin C
D. Urine output
Correct Answer: C. Serum cystatin C
RATIONALE: Cystatin C is a more sensitive marker than serum creatinine
for detecting early changes in glomerular filtration rate because it is not
influenced by muscle mass, age, or nutritional status, allowing earlier
detection of AKI.
5. An elderly patient presents with confusion, fever, and a positive
urinalysis. Which finding most suggests 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
Correct Answer: C. Acute fluctuation in level of consciousness
RATIONALE: Delirium is characterized by acute onset and fluctuating
course with disturbances in attention and consciousness, whereas
dementia is typically progressive, chronic, and gradual in onset.
6. A 75-year-old 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
Correct Answer: 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. It is a hallmark finding in systolic heart failure.
7. 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
Correct Answer: B. Selective alpha-2 adrenergic agonist
RATIONALE: Dexmedetomidine provides sedation and analgesia by
acting as a selective alpha-2 adrenergic agonist in the locus coeruleus,
resulting in decreased sympathetic outflow and sedation without
significant respiratory depression.
8. A patient has been on a ventilator for 14 days and 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 only
BOARD CERTIFIED (AGACNP-BC) QUESTIONS WITH 100%
CORRECT ANSWERS AND DETAILED RATIONALES
1. A 72-year-old patient with septic shock on norepinephrine has a
MAP of 52 mmHg despite maximum infusion. Which intervention is
most appropriate?
A. Increase norepinephrine to 30 mcg/min
B. Initiate vasopressin at 0.03 units/min
C. Administer a 2 L crystalloid bolus
D. Start dobutamine infusion
Correct Answer: B. Initiate vasopressin at 0.03 units/min
RATIONALE: According to Surviving Sepsis Campaign guidelines,
vasopressin is recommended as a second-line vasopressor in septic
shock refractory to norepinephrine to increase MAP and reduce
catecholamine requirements. Fixed-dose vasopressin at 0.03 units/min
is standard.
2. A patient with a mechanical mitral valve has an INR of 1.8. What is
the priority intervention?
A. Transition to aspirin 325 mg daily
B. Initiate heparin bridging and increase warfarin dose
,C. Stop warfarin and administer Vitamin K
D. Check INR again in 24 hours
Correct Answer: B. Initiate heparin bridging and increase warfarin
dose
RATIONALE: Patients with mechanical mitral valves are at high risk for
thromboembolism and require therapeutic anticoagulation. When INR
is subtherapeutic, heparin bridging is necessary until INR reaches
therapeutic range (2.5-3.5 for mechanical mitral valve).
3. A 68-year-old 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
Correct Answer: B. Decrease the tidal volume
RATIONALE: Plateau pressures >30 cm H2O indicate decreased lung
compliance or alveolar overdistention and increase risk of ventilator-
induced lung injury. Reducing tidal volume to 6 mL/kg predicted body
weight is the primary strategy to prevent lung injury.
4. Which laboratory marker is most sensitive for early acute kidney
injury in a critically ill patient?
A. Serum creatinine
B. Blood urea nitrogen
,C. Serum cystatin C
D. Urine output
Correct Answer: C. Serum cystatin C
RATIONALE: Cystatin C is a more sensitive marker than serum creatinine
for detecting early changes in glomerular filtration rate because it is not
influenced by muscle mass, age, or nutritional status, allowing earlier
detection of AKI.
5. An elderly patient presents with confusion, fever, and a positive
urinalysis. Which finding most suggests 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
Correct Answer: C. Acute fluctuation in level of consciousness
RATIONALE: Delirium is characterized by acute onset and fluctuating
course with disturbances in attention and consciousness, whereas
dementia is typically progressive, chronic, and gradual in onset.
6. A 75-year-old 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
Correct Answer: 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. It is a hallmark finding in systolic heart failure.
7. 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
Correct Answer: B. Selective alpha-2 adrenergic agonist
RATIONALE: Dexmedetomidine provides sedation and analgesia by
acting as a selective alpha-2 adrenergic agonist in the locus coeruleus,
resulting in decreased sympathetic outflow and sedation without
significant respiratory depression.
8. A patient has been on a ventilator for 14 days and 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 only
