NR-570 ADULT-GERONTOLOGY ACUTE CARE II EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Cardiovascular Emergencies and Hemodynamic Monitoring
Respiratory Distress and Mechanical Ventilation
Sepsis, Shock States, and Infection Management
Fluid, Electrolyte, and Acid-Base Imbalances
Acute Renal Failure and Genitourinary Emergencies
Neurologic and Endocrine Emergencies
Gastrointestinal and Hepatic Emergencies
Professional Practice, Ethics, and Evidence-Based Decision-
Making
Introduction
This comprehensive assessment evaluates the knowledge and
clinical judgment required of the adult-gerontology acute care
nurse practitioner. It covers cardiovascular emergencies, respiratory
failure, sepsis and shock states, fluid and electrolyte imbalances,
acute renal failure, neurologic and endocrine emergencies, and
evidence-based management protocols. Questions are multiple-
choice and scenario-based, emphasizing real-world clinical
decision-making, hemodynamic interpretation, ventilator
management, and prioritization of care. The examination is
designed to reflect AACN Acute Care Nurse Practitioner Core
Competencies and to strengthen readiness for safe, effective acute
care practice.
SECTION ONE: QUESTIONS 1-120
,1. A 62-year-old male with a history of hypertension and
hyperlipidemia presents to the emergency department with
substernal chest pressure radiating to the left arm, diaphoresis,
and nausea. An ECG shows ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. 🟢 Right coronary artery (RCA)
D. Left main coronary artery
🔴 RATIONALE: Leads II, III, and aVF reflect the inferior wall of the
left ventricle, which is supplied by the right coronary artery in
most right-dominant circulations. Inferior STEMI is most
commonly due to RCA occlusion.
2. The AGACNP is managing a patient in cardiogenic shock after
an anterior STEMI. A pulmonary artery catheter reveals a
cardiac index of 1.6 L/min/m², pulmonary capillary wedge
pressure (PCWP) of 24 mmHg, and systemic vascular resistance
(SVR) of 1,800 dynes/sec/cm⁻⁵. Which intervention is the
priority?
A. Administer a 500 mL bolus of normal saline
B. 🟢 Initiate dobutamine infusion
C. Initiate nitroprusside infusion
D. Administer furosemide IV push
🔴 RATIONALE: The cardiac index is low and the PCWP is high,
indicating pump failure with elevated filling pressures.
Dobutamine, a beta-1 agonist, increases cardiac contractility and
cardiac output without significantly increasing afterload. It is the
inotrope of choice for cardiogenic shock with elevated filling
pressures.
,3. A 68-year-old male presents to the ED with crushing chest pain
for 45 minutes. BP is 90/60 mmHg, HR 110 bpm, RR 24. ECG
shows ST-elevation in leads II, III, and aVF. The patient is
diagnosed with an Inferior Wall STEMI. Which of the following
medications is strictly contraindicated in this specific
hemodynamic profile?
A. Aspirin 325 mg chewed
B. Heparin infusion
C. 🟢 Nitroglycerin sublingual
D. Clopidogrel 600 mg loading dose
🔴 RATIONALE: In Inferior Wall STEMI, right ventricular infarction
is a common complication. These patients are preload dependent.
Administration of nitroglycerin, a potent venodilator, can cause
severe hypotension and cardiovascular collapse in RV infarction
patients who are already hypotensive.
4. A 72-year-old female with a history of CHF (EF 30%) presents
with progressive dyspnea, orthopnea, and weight gain of 8 lbs
in 3 days. Vitals: BP 160/90, HR 102, RR 28, SpO2 88% on room
air. Physical exam reveals bilateral crackles and S3 heart sound.
Which pathophysiologic mechanism primarily drives her
presentation?
A. Decreased afterload leading to high output failure
B. 🟢 Increased preload and pulmonary congestion due to
volume overload
C. Vasodilation of the pulmonary vasculature
D. Acute loss of atrial kick due to sinus tachycardia
🔴 RATIONALE: The patient is presenting with acute
decompensated heart failure characterized by volume overload
(weight gain, crackles, orthopnea). The primary driver is increased
, preload overwhelming the weakened left ventricle, leading to
pulmonary congestion.
5. A patient is on mechanical ventilation for ARDS. ABG results
are: pH 7.28, PaCO2 58 mmHg, PaO2 65 mmHg (on FiO2 60%).
The current ventilator settings are AC/VC mode, Tidal Volume
450 mL (8 mL/kg IBW), Rate 14. According to the ARDSNet
protocol, what is the most appropriate initial adjustment?
A. Increase Tidal Volume to 600 mL to improve ventilation
B. 🟢 Increase Respiratory Rate to 18 breaths/min
C. Increase FiO2 to 100%
D. Initiate a Paralytic infusion
🔴 RATIONALE: The patient has acute respiratory acidosis (low
pH, high PaCO2) indicating hypoventilation. According to
ARDSNet, the first step to correct hypercapnia while keeping
plateau pressure less than 30 cm H2O is to increase the
respiratory rate.
6. A 68-year-old patient in the ICU has a pulmonary artery
catheter in place. The nurse reports a cardiac output of 2.8
L/min, cardiac index of 1.6 L/min/m², and systemic vascular
resistance of 1,800 dynes/sec/cm⁻⁵. These findings are most
consistent with which type of shock?
A. Hypovolemic shock
B. 🟢 Cardiogenic shock
C. Distributive shock
D. Obstructive shock
🔴 RATIONALE: Cardiogenic shock is characterized by a low
cardiac output/index (CI less than 2.2 L/min/m²) with elevated
systemic vascular resistance (SVR greater than 1,200
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Cardiovascular Emergencies and Hemodynamic Monitoring
Respiratory Distress and Mechanical Ventilation
Sepsis, Shock States, and Infection Management
Fluid, Electrolyte, and Acid-Base Imbalances
Acute Renal Failure and Genitourinary Emergencies
Neurologic and Endocrine Emergencies
Gastrointestinal and Hepatic Emergencies
Professional Practice, Ethics, and Evidence-Based Decision-
Making
Introduction
This comprehensive assessment evaluates the knowledge and
clinical judgment required of the adult-gerontology acute care
nurse practitioner. It covers cardiovascular emergencies, respiratory
failure, sepsis and shock states, fluid and electrolyte imbalances,
acute renal failure, neurologic and endocrine emergencies, and
evidence-based management protocols. Questions are multiple-
choice and scenario-based, emphasizing real-world clinical
decision-making, hemodynamic interpretation, ventilator
management, and prioritization of care. The examination is
designed to reflect AACN Acute Care Nurse Practitioner Core
Competencies and to strengthen readiness for safe, effective acute
care practice.
SECTION ONE: QUESTIONS 1-120
,1. A 62-year-old male with a history of hypertension and
hyperlipidemia presents to the emergency department with
substernal chest pressure radiating to the left arm, diaphoresis,
and nausea. An ECG shows ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. 🟢 Right coronary artery (RCA)
D. Left main coronary artery
🔴 RATIONALE: Leads II, III, and aVF reflect the inferior wall of the
left ventricle, which is supplied by the right coronary artery in
most right-dominant circulations. Inferior STEMI is most
commonly due to RCA occlusion.
2. The AGACNP is managing a patient in cardiogenic shock after
an anterior STEMI. A pulmonary artery catheter reveals a
cardiac index of 1.6 L/min/m², pulmonary capillary wedge
pressure (PCWP) of 24 mmHg, and systemic vascular resistance
(SVR) of 1,800 dynes/sec/cm⁻⁵. Which intervention is the
priority?
A. Administer a 500 mL bolus of normal saline
B. 🟢 Initiate dobutamine infusion
C. Initiate nitroprusside infusion
D. Administer furosemide IV push
🔴 RATIONALE: The cardiac index is low and the PCWP is high,
indicating pump failure with elevated filling pressures.
Dobutamine, a beta-1 agonist, increases cardiac contractility and
cardiac output without significantly increasing afterload. It is the
inotrope of choice for cardiogenic shock with elevated filling
pressures.
,3. A 68-year-old male presents to the ED with crushing chest pain
for 45 minutes. BP is 90/60 mmHg, HR 110 bpm, RR 24. ECG
shows ST-elevation in leads II, III, and aVF. The patient is
diagnosed with an Inferior Wall STEMI. Which of the following
medications is strictly contraindicated in this specific
hemodynamic profile?
A. Aspirin 325 mg chewed
B. Heparin infusion
C. 🟢 Nitroglycerin sublingual
D. Clopidogrel 600 mg loading dose
🔴 RATIONALE: In Inferior Wall STEMI, right ventricular infarction
is a common complication. These patients are preload dependent.
Administration of nitroglycerin, a potent venodilator, can cause
severe hypotension and cardiovascular collapse in RV infarction
patients who are already hypotensive.
4. A 72-year-old female with a history of CHF (EF 30%) presents
with progressive dyspnea, orthopnea, and weight gain of 8 lbs
in 3 days. Vitals: BP 160/90, HR 102, RR 28, SpO2 88% on room
air. Physical exam reveals bilateral crackles and S3 heart sound.
Which pathophysiologic mechanism primarily drives her
presentation?
A. Decreased afterload leading to high output failure
B. 🟢 Increased preload and pulmonary congestion due to
volume overload
C. Vasodilation of the pulmonary vasculature
D. Acute loss of atrial kick due to sinus tachycardia
🔴 RATIONALE: The patient is presenting with acute
decompensated heart failure characterized by volume overload
(weight gain, crackles, orthopnea). The primary driver is increased
, preload overwhelming the weakened left ventricle, leading to
pulmonary congestion.
5. A patient is on mechanical ventilation for ARDS. ABG results
are: pH 7.28, PaCO2 58 mmHg, PaO2 65 mmHg (on FiO2 60%).
The current ventilator settings are AC/VC mode, Tidal Volume
450 mL (8 mL/kg IBW), Rate 14. According to the ARDSNet
protocol, what is the most appropriate initial adjustment?
A. Increase Tidal Volume to 600 mL to improve ventilation
B. 🟢 Increase Respiratory Rate to 18 breaths/min
C. Increase FiO2 to 100%
D. Initiate a Paralytic infusion
🔴 RATIONALE: The patient has acute respiratory acidosis (low
pH, high PaCO2) indicating hypoventilation. According to
ARDSNet, the first step to correct hypercapnia while keeping
plateau pressure less than 30 cm H2O is to increase the
respiratory rate.
6. A 68-year-old patient in the ICU has a pulmonary artery
catheter in place. The nurse reports a cardiac output of 2.8
L/min, cardiac index of 1.6 L/min/m², and systemic vascular
resistance of 1,800 dynes/sec/cm⁻⁵. These findings are most
consistent with which type of shock?
A. Hypovolemic shock
B. 🟢 Cardiogenic shock
C. Distributive shock
D. Obstructive shock
🔴 RATIONALE: Cardiogenic shock is characterized by a low
cardiac output/index (CI less than 2.2 L/min/m²) with elevated
systemic vascular resistance (SVR greater than 1,200
