AGACNP Practice Set (130
Questions) — Comprehensive,
Exam-Style
1) Shock identification
A 72-year-old with pneumonia is hypotensive (MAP 58), febrile, warm extremities, bounding
pulses, and lactate 4.2 mmol/L. Which shock type is most likely?
A. Cardiogenic
B. Hypovolemic
C. Distributive (septic)
D. Obstructive
Answer: C
Rationale: Warm, vasodilated skin early in sepsis + high lactate and infection suggests
distributive shock. Cardiogenic tends to be cool/clammy with pulmonary edema; hypovolemic
has cool extremities and narrow pulse pressure; obstructive has specific clues (tamponade, PE,
tension PTX).
2) First-line vasopressor in septic shock
After 30 mL/kg crystalloid, patient remains hypotensive. Best next medication?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin as sole agent
Answer: B
Rationale: Norepinephrine is first-line vasopressor for septic shock to restore MAP ≥65.
Vasopressin is commonly added as adjunct; phenylephrine is generally not first-line in sepsis.
3) STEMI immediate management
,A patient has chest pain and ECG shows inferior STEMI. BP 82/50, clear lungs, JVP elevated. Best
immediate action?
A. IV nitroglycerin infusion
B. Furosemide IV
C. 250–500 mL IV fluid bolus and assess RV infarct
D. Morphine IV then observe
Answer: C
Rationale: Inferior STEMI + hypotension + elevated JVP with clear lungs suggests right
ventricular infarct → preload dependent. Give cautious fluids; avoid nitrates (can worsen
hypotension).
4) Atrial fibrillation with RVR and instability
AFib with HR 160, BP 78/40, altered mental status. Best next step?
A. Diltiazem bolus
B. Amiodarone infusion
C. Synchronized cardioversion
D. Digoxin
Answer: C
Rationale: Hemodynamic instability = immediate synchronized cardioversion.
5) DKA priority
In DKA: glucose 540, anion gap 24, K+ 3.1. Next best step?
A. Start insulin infusion immediately
B. Give potassium first, then insulin
C. Give bicarbonate first
D. Restrict fluids until potassium corrected
Answer: B
Rationale: K+ <3.3 → replace potassium before insulin (insulin will shift K intracellularly and can
precipitate arrhythmias).
6) COPD exacerbation—oxygen target
,A COPD patient with acute exacerbation arrives with SpO₂ 79% on room air. Target saturation?
A. 80–85%
B. 88–92%
C. 94–98%
D. 100%
Answer: B
Rationale: COPD exacerbations: titrate oxygen to 88–92% to reduce risk of worsening
hypercapnia while treating hypoxemia.
7) ARDS ventilation strategy
Best ventilator approach for ARDS?
A. High tidal volumes to reduce atelectasis
B. Low tidal volume (≈6 mL/kg predicted body weight) + adequate PEEP
C. Zero PEEP to prevent barotrauma
D. Routine hyperventilation to normalize PaCO₂
Answer: B
Rationale: Lung-protective ventilation: low tidal volume and appropriate PEEP reduces
ventilator-induced lung injury.
8) PE risk stratification clue
A post-op patient has sudden dyspnea, pleuritic chest pain, tachycardia, and new RV strain on
echo. First-line diagnostic test if stable?
A. V/Q scan always
B. CTA chest
C. Chest X-ray only
D. Bronchoscopy
Answer: B
Rationale: CT pulmonary angiography is the preferred test if hemodynamically stable and no
major contraindication to contrast.
9) Tension pneumothorax
, Ventilated patient suddenly becomes hypotensive with high peak pressures, unilateral absent
breath sounds, tracheal deviation. Best immediate action?
A. Portable chest X-ray
B. Needle decompression
C. IV antibiotics
D. Bronchodilator nebulizers
Answer: B
Rationale: Classic tension pneumothorax → treat immediately with needle decompression
(don’t wait for imaging).
10) Upper GI bleed management
Massive hematemesis, hypotension, tachycardia. What is the priority?
A. Immediate endoscopy before resuscitation
B. Stabilize airway/breathing/circulation and transfuse as needed
C. Start oral PPI
D. Avoid IV access until labs return
Answer: B
Rationale: ABCs first; large-bore IVs, fluids/blood, airway protection if needed, then endoscopy.
11) Acute pancreatitis diagnosis
Which lab is most supportive for acute pancreatitis?
A. AST elevated only
B. Serum lipase elevated (typically >3× ULN)
C. Alkaline phosphatase low
D. ESR elevated
Answer: B
Rationale: Lipase is more specific than amylase and supports diagnosis when elevated
significantly with compatible symptoms.
12) AKI—postrenal clue
Patient with AKI has bilateral hydronephrosis on ultrasound. Most likely cause?
A. Acute tubular necrosis
Questions) — Comprehensive,
Exam-Style
1) Shock identification
A 72-year-old with pneumonia is hypotensive (MAP 58), febrile, warm extremities, bounding
pulses, and lactate 4.2 mmol/L. Which shock type is most likely?
A. Cardiogenic
B. Hypovolemic
C. Distributive (septic)
D. Obstructive
Answer: C
Rationale: Warm, vasodilated skin early in sepsis + high lactate and infection suggests
distributive shock. Cardiogenic tends to be cool/clammy with pulmonary edema; hypovolemic
has cool extremities and narrow pulse pressure; obstructive has specific clues (tamponade, PE,
tension PTX).
2) First-line vasopressor in septic shock
After 30 mL/kg crystalloid, patient remains hypotensive. Best next medication?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin as sole agent
Answer: B
Rationale: Norepinephrine is first-line vasopressor for septic shock to restore MAP ≥65.
Vasopressin is commonly added as adjunct; phenylephrine is generally not first-line in sepsis.
3) STEMI immediate management
,A patient has chest pain and ECG shows inferior STEMI. BP 82/50, clear lungs, JVP elevated. Best
immediate action?
A. IV nitroglycerin infusion
B. Furosemide IV
C. 250–500 mL IV fluid bolus and assess RV infarct
D. Morphine IV then observe
Answer: C
Rationale: Inferior STEMI + hypotension + elevated JVP with clear lungs suggests right
ventricular infarct → preload dependent. Give cautious fluids; avoid nitrates (can worsen
hypotension).
4) Atrial fibrillation with RVR and instability
AFib with HR 160, BP 78/40, altered mental status. Best next step?
A. Diltiazem bolus
B. Amiodarone infusion
C. Synchronized cardioversion
D. Digoxin
Answer: C
Rationale: Hemodynamic instability = immediate synchronized cardioversion.
5) DKA priority
In DKA: glucose 540, anion gap 24, K+ 3.1. Next best step?
A. Start insulin infusion immediately
B. Give potassium first, then insulin
C. Give bicarbonate first
D. Restrict fluids until potassium corrected
Answer: B
Rationale: K+ <3.3 → replace potassium before insulin (insulin will shift K intracellularly and can
precipitate arrhythmias).
6) COPD exacerbation—oxygen target
,A COPD patient with acute exacerbation arrives with SpO₂ 79% on room air. Target saturation?
A. 80–85%
B. 88–92%
C. 94–98%
D. 100%
Answer: B
Rationale: COPD exacerbations: titrate oxygen to 88–92% to reduce risk of worsening
hypercapnia while treating hypoxemia.
7) ARDS ventilation strategy
Best ventilator approach for ARDS?
A. High tidal volumes to reduce atelectasis
B. Low tidal volume (≈6 mL/kg predicted body weight) + adequate PEEP
C. Zero PEEP to prevent barotrauma
D. Routine hyperventilation to normalize PaCO₂
Answer: B
Rationale: Lung-protective ventilation: low tidal volume and appropriate PEEP reduces
ventilator-induced lung injury.
8) PE risk stratification clue
A post-op patient has sudden dyspnea, pleuritic chest pain, tachycardia, and new RV strain on
echo. First-line diagnostic test if stable?
A. V/Q scan always
B. CTA chest
C. Chest X-ray only
D. Bronchoscopy
Answer: B
Rationale: CT pulmonary angiography is the preferred test if hemodynamically stable and no
major contraindication to contrast.
9) Tension pneumothorax
, Ventilated patient suddenly becomes hypotensive with high peak pressures, unilateral absent
breath sounds, tracheal deviation. Best immediate action?
A. Portable chest X-ray
B. Needle decompression
C. IV antibiotics
D. Bronchodilator nebulizers
Answer: B
Rationale: Classic tension pneumothorax → treat immediately with needle decompression
(don’t wait for imaging).
10) Upper GI bleed management
Massive hematemesis, hypotension, tachycardia. What is the priority?
A. Immediate endoscopy before resuscitation
B. Stabilize airway/breathing/circulation and transfuse as needed
C. Start oral PPI
D. Avoid IV access until labs return
Answer: B
Rationale: ABCs first; large-bore IVs, fluids/blood, airway protection if needed, then endoscopy.
11) Acute pancreatitis diagnosis
Which lab is most supportive for acute pancreatitis?
A. AST elevated only
B. Serum lipase elevated (typically >3× ULN)
C. Alkaline phosphatase low
D. ESR elevated
Answer: B
Rationale: Lipase is more specific than amylase and supports diagnosis when elevated
significantly with compatible symptoms.
12) AKI—postrenal clue
Patient with AKI has bilateral hydronephrosis on ultrasound. Most likely cause?
A. Acute tubular necrosis
