NRNP 6566 Advanced Care of Adults in Acute Settings I
Final Comprehensive Examination 2026/2027: Verified
Practice Questions & Detailed Rationales | Walden
University | AGACNP, Acute Care NP, Critical Care,
Respiratory, Cardiovascular, Neurological, GI, Renal, and
Endocrine Emergencies
INTRODUCTION
The questions are organized across four core domains: Domain 1 – Acute
Respiratory and Pulmonary Disorders (40 questions); Domain 2 – Cardiovascular
Emergencies and Hemodynamics (40 questions); Domain 3 – Neurological Critical
Care and Trauma (40 questions); and Domain 4 – Gastrointestinal, Renal, and
Endocrine Acute Care (37 questions). Each question is accompanied by the correct
answer and a detailed rationale grounded in foundational acute and critical care
nursing methodology, including principles drawn from university-level advanced
nursing curricula and established textbooks such as Urden's Critical Care Nursing
and Burns' AACN Essentials of Critical Care Nursing. The content emphasizes
rapid recognition, differential diagnosis, and evidence-based acute interventions
for life-threatening conditions.
ACTUAL QUESTIONS
Domain 1: Acute Respiratory and Pulmonary Disorders
Question 1. A client with acute respiratory distress syndrome (ARDS) is
receiving mechanical ventilation. Which ventilator strategy is most consistent
with lung-protective ventilation?
A. Low tidal volume (approximately 6 mL/kg predicted body weight) with plateau
pressure limited to ≤30 cm H2O
B. High tidal volumes of 12-15 mL/kg to normalize PaCO2
C. Zero positive end-expiratory pressure (PEEP)
D. Permissive hyperoxia with FiO2 1.0 continuously
Correct Answer: A
Rationale: Lung-protective ventilation using low tidal volumes and limited plateau
,pressures reduces ventilator-induced lung injury and has been shown to improve
survival in ARDS.
Question 2. Which arterial blood gas finding is most consistent with acute
hypercapnic respiratory failure?
A. PaO2 >100 mm Hg on room air
B. Normal PaCO2 with elevated bicarbonate
C. PaCO2 >50 mm Hg with pH <7.35
D. PaO2 90 mm Hg with pH 7.45
Correct Answer: C
Rationale: Hypercapnic (ventilatory) failure is defined by elevated PaCO2 and
resulting respiratory acidosis. Hypoxemic failure is defined by low PaO2.
Question 3. A client with severe community-acquired pneumonia develops
progressive hypoxemia. The PaO2/FiO2 ratio is 140. This value is consistent
with:
A. Moderate ARDS (PaO2/FiO2 100-200)
B. Mild ARDS only
C. Severe ARDS exclusively
D. Normal gas exchange
Correct Answer: A
Rationale: The Berlin definition classifies ARDS severity by PaO2/FiO2 ratio:
mild 200-300, moderate 100-200, severe <100, all with PEEP ≥5 cm H2O.
Question 4. A client is admitted with a suspected pulmonary embolism. Which
diagnostic test is considered the gold standard for confirmation?
A. D-dimer
B. Chest X-ray
C. CT pulmonary angiography (CTPA)
D. Ventilation-perfusion (V/Q) scan
Correct Answer: C
Rationale: CT pulmonary angiography is the gold standard for diagnosing
pulmonary embolism, providing direct visualization of the thrombus in the
pulmonary arteries.
Question 5. A client with an acute exacerbation of asthma is unresponsive to
initial beta-agonist therapy. Which medication should the AGACNP consider
next?
A. Oral montelukast
,B. Intravenous magnesium sulfate
C. Inhaled salmeterol
D. Oral prednisone
Correct Answer: B
Rationale: IV magnesium sulfate is used for severe asthma exacerbations that do
not respond to standard bronchodilator and corticosteroid therapy. It acts as a
smooth muscle relaxant.
Question 6. A client presents with sudden onset of dyspnea, pleuritic chest
pain, and a history of recent surgery. Which finding on assessment is most
concerning for a tension pneumothorax?
A. Tracheal deviation toward the affected side
B. Tracheal deviation away from the affected side and hypotension
C. Hyperresonance to percussion on the affected side
D. Decreased breath sounds bilaterally
Correct Answer: B
Rationale: Tension pneumothorax causes mediastinal shift away from the affected
side, leading to tracheal deviation away from the affected side, hypotension, and
severe respiratory distress. Immediate needle decompression is required.
Question 7. A client is receiving mechanical ventilation. Which finding
indicates the need for immediate suctioning?
A. Peak inspiratory pressure (PIP) is stable.
B. The client has audible coarse crackles and a rising PIP.
C. The client's SpO2 is 98%.
D. The client is resting comfortably.
Correct Answer: B
Rationale: Audible coarse crackles, a rising PIP, and visible secretions indicate
the need for suctioning to maintain airway patency.
Question 8. A client with COPD is experiencing an acute exacerbation. Which
oxygen delivery method is safest to maintain SpO2 between 88-92%?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 2-4 L/min
C. Simple face mask at 8 L/min
D. High-flow nasal cannula at 20 L/min
Correct Answer: B
, Rationale: COPD clients are at risk for oxygen-induced hypercapnia. Low-flow
oxygen via Venturi mask (2-4 L/min) is safest to maintain SpO2 between 88-92%.
Question 9. A client develops a large pleural effusion. Which finding is
expected during percussion?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
Correct Answer: C
Rationale: Fluid in the pleural space dampens sound transmission, leading to
dullness on percussion over the effusion.
Question 10. A client is diagnosed with a pulmonary embolism and is started
on a heparin infusion. Which laboratory value should the AGACNP monitor
to evaluate therapeutic effectiveness?
A. PT/INR
B. aPTT
C. Bleeding time
D. Platelet count
Correct Answer: B
Rationale: Unfractionated heparin therapy is monitored using the activated partial
thromboplastin time (aPTT), with a target range typically 1.5-2.5 times the control
value.
Question 11. A client with ARDS is being considered for prone positioning.
What is the primary goal of this intervention?
A. To improve oxygenation by recruiting collapsed alveoli in the dorsal lung
regions
B. To reduce the risk of ventilator-associated pneumonia
C. To facilitate easier suctioning
D. To decrease intra-abdominal pressure
Correct Answer: A
Rationale: Prone positioning improves oxygenation in ARDS by redistributing
blood flow and recruiting collapsed alveoli in the dorsal lung regions, reducing
shunt.
Question 12. A client is admitted with acute respiratory failure. Which finding
indicates the client is experiencing hypoxemic respiratory failure?
Final Comprehensive Examination 2026/2027: Verified
Practice Questions & Detailed Rationales | Walden
University | AGACNP, Acute Care NP, Critical Care,
Respiratory, Cardiovascular, Neurological, GI, Renal, and
Endocrine Emergencies
INTRODUCTION
The questions are organized across four core domains: Domain 1 – Acute
Respiratory and Pulmonary Disorders (40 questions); Domain 2 – Cardiovascular
Emergencies and Hemodynamics (40 questions); Domain 3 – Neurological Critical
Care and Trauma (40 questions); and Domain 4 – Gastrointestinal, Renal, and
Endocrine Acute Care (37 questions). Each question is accompanied by the correct
answer and a detailed rationale grounded in foundational acute and critical care
nursing methodology, including principles drawn from university-level advanced
nursing curricula and established textbooks such as Urden's Critical Care Nursing
and Burns' AACN Essentials of Critical Care Nursing. The content emphasizes
rapid recognition, differential diagnosis, and evidence-based acute interventions
for life-threatening conditions.
ACTUAL QUESTIONS
Domain 1: Acute Respiratory and Pulmonary Disorders
Question 1. A client with acute respiratory distress syndrome (ARDS) is
receiving mechanical ventilation. Which ventilator strategy is most consistent
with lung-protective ventilation?
A. Low tidal volume (approximately 6 mL/kg predicted body weight) with plateau
pressure limited to ≤30 cm H2O
B. High tidal volumes of 12-15 mL/kg to normalize PaCO2
C. Zero positive end-expiratory pressure (PEEP)
D. Permissive hyperoxia with FiO2 1.0 continuously
Correct Answer: A
Rationale: Lung-protective ventilation using low tidal volumes and limited plateau
,pressures reduces ventilator-induced lung injury and has been shown to improve
survival in ARDS.
Question 2. Which arterial blood gas finding is most consistent with acute
hypercapnic respiratory failure?
A. PaO2 >100 mm Hg on room air
B. Normal PaCO2 with elevated bicarbonate
C. PaCO2 >50 mm Hg with pH <7.35
D. PaO2 90 mm Hg with pH 7.45
Correct Answer: C
Rationale: Hypercapnic (ventilatory) failure is defined by elevated PaCO2 and
resulting respiratory acidosis. Hypoxemic failure is defined by low PaO2.
Question 3. A client with severe community-acquired pneumonia develops
progressive hypoxemia. The PaO2/FiO2 ratio is 140. This value is consistent
with:
A. Moderate ARDS (PaO2/FiO2 100-200)
B. Mild ARDS only
C. Severe ARDS exclusively
D. Normal gas exchange
Correct Answer: A
Rationale: The Berlin definition classifies ARDS severity by PaO2/FiO2 ratio:
mild 200-300, moderate 100-200, severe <100, all with PEEP ≥5 cm H2O.
Question 4. A client is admitted with a suspected pulmonary embolism. Which
diagnostic test is considered the gold standard for confirmation?
A. D-dimer
B. Chest X-ray
C. CT pulmonary angiography (CTPA)
D. Ventilation-perfusion (V/Q) scan
Correct Answer: C
Rationale: CT pulmonary angiography is the gold standard for diagnosing
pulmonary embolism, providing direct visualization of the thrombus in the
pulmonary arteries.
Question 5. A client with an acute exacerbation of asthma is unresponsive to
initial beta-agonist therapy. Which medication should the AGACNP consider
next?
A. Oral montelukast
,B. Intravenous magnesium sulfate
C. Inhaled salmeterol
D. Oral prednisone
Correct Answer: B
Rationale: IV magnesium sulfate is used for severe asthma exacerbations that do
not respond to standard bronchodilator and corticosteroid therapy. It acts as a
smooth muscle relaxant.
Question 6. A client presents with sudden onset of dyspnea, pleuritic chest
pain, and a history of recent surgery. Which finding on assessment is most
concerning for a tension pneumothorax?
A. Tracheal deviation toward the affected side
B. Tracheal deviation away from the affected side and hypotension
C. Hyperresonance to percussion on the affected side
D. Decreased breath sounds bilaterally
Correct Answer: B
Rationale: Tension pneumothorax causes mediastinal shift away from the affected
side, leading to tracheal deviation away from the affected side, hypotension, and
severe respiratory distress. Immediate needle decompression is required.
Question 7. A client is receiving mechanical ventilation. Which finding
indicates the need for immediate suctioning?
A. Peak inspiratory pressure (PIP) is stable.
B. The client has audible coarse crackles and a rising PIP.
C. The client's SpO2 is 98%.
D. The client is resting comfortably.
Correct Answer: B
Rationale: Audible coarse crackles, a rising PIP, and visible secretions indicate
the need for suctioning to maintain airway patency.
Question 8. A client with COPD is experiencing an acute exacerbation. Which
oxygen delivery method is safest to maintain SpO2 between 88-92%?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 2-4 L/min
C. Simple face mask at 8 L/min
D. High-flow nasal cannula at 20 L/min
Correct Answer: B
, Rationale: COPD clients are at risk for oxygen-induced hypercapnia. Low-flow
oxygen via Venturi mask (2-4 L/min) is safest to maintain SpO2 between 88-92%.
Question 9. A client develops a large pleural effusion. Which finding is
expected during percussion?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
Correct Answer: C
Rationale: Fluid in the pleural space dampens sound transmission, leading to
dullness on percussion over the effusion.
Question 10. A client is diagnosed with a pulmonary embolism and is started
on a heparin infusion. Which laboratory value should the AGACNP monitor
to evaluate therapeutic effectiveness?
A. PT/INR
B. aPTT
C. Bleeding time
D. Platelet count
Correct Answer: B
Rationale: Unfractionated heparin therapy is monitored using the activated partial
thromboplastin time (aPTT), with a target range typically 1.5-2.5 times the control
value.
Question 11. A client with ARDS is being considered for prone positioning.
What is the primary goal of this intervention?
A. To improve oxygenation by recruiting collapsed alveoli in the dorsal lung
regions
B. To reduce the risk of ventilator-associated pneumonia
C. To facilitate easier suctioning
D. To decrease intra-abdominal pressure
Correct Answer: A
Rationale: Prone positioning improves oxygenation in ARDS by redistributing
blood flow and recruiting collapsed alveoli in the dorsal lung regions, reducing
shunt.
Question 12. A client is admitted with acute respiratory failure. Which finding
indicates the client is experiencing hypoxemic respiratory failure?
