AACN CERTIFICATION EXAM TEST
BANK 2026 -EXCLUSIVE STUDY
GUIDE| GUARANTEED PASS|
GRADED A+
QUESTION 1
While caring for a patient with an IABP at 3:1, the nurse notes decreasing urine output
as well as increasing BUN and CR levels. Which action is most appropriate?
A. Increase timing to 2:1
B. Apply pressure at the insertion site
C. Plan for removal of the IABP
D. Anticipate the need for an emergency fasciotomy
Correct Answer: C. Plan for removal of the IABP
Rationale: Decreasing urine output with increasing BUN and CR levels with an IABP
in place indicates obstruction of the renal arteries. The nurse should plan for removal.
Increasing timing to 2:1 would not address the obstruction. Absent pulses distal to the
insertion site would indicate occlusion, but this scenario describes renal indicators.
Blood in the IABP tubing would indicate rupture, which is not described here.
QUESTION 2
An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation.
In addition to resuscitative measures, the nurse should:
A. Change the trigger to internal or pressure support
B. Increase timing back to 1:1 to increase coronary artery perfusion pressure
C. Put the pump on standby until the return of spontaneous circulation
D. Assess the IABP timing to chest compressions at 1:2
Correct Answer: A. Change the trigger to internal or pressure support
,Rationale: The IABP will not be able to time correctly when a patient is in V-Fib. By
placing the system to trigger on internal or pressure support, it will generate off the
pressure created during compressions. Attempting to time the IABP back to 1:1 will be
counterproductive, as it will not be able to trigger correctly. There is significant risk of
clot forming on the IABP when placed on standby for an indeterminate amount of time.
The primary goal during resuscitative measures is to attempt to circulate blood volume
as effectively as possible; assessing the timing of the IABP is unnecessary.
QUESTION 3
The nurse is reviewing the home medications list for a patient admitted with severe
chest pain. Serial EKGs and blood testing are negative, so an exercise stress test is
scheduled. Which of the following medications may result in a false-positive finding
on the stress test?
A. Digitalis (Digoxin)
B. Potassium chloride (K-Dur)
C. Sotalol (Betapace)
D. Diltiazem (Cardizem)
Correct Answer: A. Digitalis (Digoxin)
Rationale: Digitalis can cause false-positive EKG changes during a stress test. There is
an association between the development of ST segment depression during stress testing.
The mechanism of this EKG change is not clear. Further, digitalis should be withheld
on the day of the test because of its negative chronotropic effects. Beta-blockers and
calcium channel blockers blunt the heart rate response to exercise and may prevent
achievement of maximum predicted heart rate; they should be withheld on the day of
the test, but they do not cause false-positive findings.
QUESTION 4
A patient is admitted with elevated troponin levels and ST segment elevation in leads II,
,III, and aVF. Administration of which of the following should the nurse anticipate
initially?
A. Enoxaparin (Lovenox)
B. Streptokinase (Strepase)
C. Alteplase (Activase)
D. Reteplase (Retavase)
Correct Answer: D. Reteplase (Retavase)
Rationale: Reteplase is indicated for AMI when fibrinolytics are indicated. Enoxaparin
is an alternative to heparin in patients with unstable angina, NSTEMI or DVT.
Streptokinase is indicated for acute arterial thrombosis or embolism, or occluded AV
cannulas. Alteplase is indicated for acute ischemic stroke or acute massive pulmonary
embolism.
QUESTION 5
Which of the following is a characteristic of diastolic heart failure?
A. Inability of the heart muscle to relax
B. Dilation of the ventricular chambers
C. Increased filling of the left ventricle
D. Decreased ability of the ventricle to contract
Correct Answer: A. Inability of the heart muscle to relax
Rationale: With diastolic heart failure the left ventricle is unable to relax, leading to
signs and symptoms of heart failure, but the patient maintains a preserved EF as the
muscle retains its ability to contract. Dilation of the ventricular chambers is a
characteristic of systolic heart failure. Diastolic heart failure is an abnormality with
heart filling; the heart muscle does not relax normally, and the heart may fill too slowly
or asynchronously. Decreased ability of the ventricle to contract is a symptom of
overextension of the heart muscle in patients with cardiomyopathy.
, QUESTION 6
Following a STEMI, the nurse auscultates a late systolic murmur at the apex. The nurse
should suspect the finding is related to the new onset of a:
A. Right bundle branch block
B. Left bundle branch block
C. Papillary muscle rupture
D. Calcific plaque rupture
Correct Answer: C. Papillary muscle rupture
Rationale: A papillary muscle chord rupture results from ischemia to the tissue
supplying the mitral valve. A systolic murmur is heard due to mitral regurgitation. A
RBBB would cause an electrical delay in conduction for a wide split S2. A LBBB
would cause an electrical delay in ventricular conduction for a paradoxical split S2.
Plaque rupture would cause an occlusion of the coronary artery that would not directly
cause a new systolic murmur.
QUESTION 7
The nurse is reviewing the plan of care for a patient with systolic heart failure who has
enalapril (Vasotec), furosemide (Lasix), metoprolol (Lopressor), and carvedilol (Coreg)
ordered. Which of the following will provide the most accurate assessment of the
regimen?
A. Daily weights
B. Strict I&O
C. BMP every morning
D. Serial CXRs
Correct Answer: A. Daily weights
Rationale: Assessing daily weights is a noninvasive and easy method to assess
compliance with the effectiveness of a medical regimen in patients with heart failure.
Observing the patient's ability to maintain a consistent weight indicates compliance as
well as the effectiveness of the medical regimen. Strict I&O is only one component of a
plan of care but does not assess if a patient adheres to the medical regimen or if the
BANK 2026 -EXCLUSIVE STUDY
GUIDE| GUARANTEED PASS|
GRADED A+
QUESTION 1
While caring for a patient with an IABP at 3:1, the nurse notes decreasing urine output
as well as increasing BUN and CR levels. Which action is most appropriate?
A. Increase timing to 2:1
B. Apply pressure at the insertion site
C. Plan for removal of the IABP
D. Anticipate the need for an emergency fasciotomy
Correct Answer: C. Plan for removal of the IABP
Rationale: Decreasing urine output with increasing BUN and CR levels with an IABP
in place indicates obstruction of the renal arteries. The nurse should plan for removal.
Increasing timing to 2:1 would not address the obstruction. Absent pulses distal to the
insertion site would indicate occlusion, but this scenario describes renal indicators.
Blood in the IABP tubing would indicate rupture, which is not described here.
QUESTION 2
An IABP is currently at 3:1 when the patient suddenly goes into ventricular fibrillation.
In addition to resuscitative measures, the nurse should:
A. Change the trigger to internal or pressure support
B. Increase timing back to 1:1 to increase coronary artery perfusion pressure
C. Put the pump on standby until the return of spontaneous circulation
D. Assess the IABP timing to chest compressions at 1:2
Correct Answer: A. Change the trigger to internal or pressure support
,Rationale: The IABP will not be able to time correctly when a patient is in V-Fib. By
placing the system to trigger on internal or pressure support, it will generate off the
pressure created during compressions. Attempting to time the IABP back to 1:1 will be
counterproductive, as it will not be able to trigger correctly. There is significant risk of
clot forming on the IABP when placed on standby for an indeterminate amount of time.
The primary goal during resuscitative measures is to attempt to circulate blood volume
as effectively as possible; assessing the timing of the IABP is unnecessary.
QUESTION 3
The nurse is reviewing the home medications list for a patient admitted with severe
chest pain. Serial EKGs and blood testing are negative, so an exercise stress test is
scheduled. Which of the following medications may result in a false-positive finding
on the stress test?
A. Digitalis (Digoxin)
B. Potassium chloride (K-Dur)
C. Sotalol (Betapace)
D. Diltiazem (Cardizem)
Correct Answer: A. Digitalis (Digoxin)
Rationale: Digitalis can cause false-positive EKG changes during a stress test. There is
an association between the development of ST segment depression during stress testing.
The mechanism of this EKG change is not clear. Further, digitalis should be withheld
on the day of the test because of its negative chronotropic effects. Beta-blockers and
calcium channel blockers blunt the heart rate response to exercise and may prevent
achievement of maximum predicted heart rate; they should be withheld on the day of
the test, but they do not cause false-positive findings.
QUESTION 4
A patient is admitted with elevated troponin levels and ST segment elevation in leads II,
,III, and aVF. Administration of which of the following should the nurse anticipate
initially?
A. Enoxaparin (Lovenox)
B. Streptokinase (Strepase)
C. Alteplase (Activase)
D. Reteplase (Retavase)
Correct Answer: D. Reteplase (Retavase)
Rationale: Reteplase is indicated for AMI when fibrinolytics are indicated. Enoxaparin
is an alternative to heparin in patients with unstable angina, NSTEMI or DVT.
Streptokinase is indicated for acute arterial thrombosis or embolism, or occluded AV
cannulas. Alteplase is indicated for acute ischemic stroke or acute massive pulmonary
embolism.
QUESTION 5
Which of the following is a characteristic of diastolic heart failure?
A. Inability of the heart muscle to relax
B. Dilation of the ventricular chambers
C. Increased filling of the left ventricle
D. Decreased ability of the ventricle to contract
Correct Answer: A. Inability of the heart muscle to relax
Rationale: With diastolic heart failure the left ventricle is unable to relax, leading to
signs and symptoms of heart failure, but the patient maintains a preserved EF as the
muscle retains its ability to contract. Dilation of the ventricular chambers is a
characteristic of systolic heart failure. Diastolic heart failure is an abnormality with
heart filling; the heart muscle does not relax normally, and the heart may fill too slowly
or asynchronously. Decreased ability of the ventricle to contract is a symptom of
overextension of the heart muscle in patients with cardiomyopathy.
, QUESTION 6
Following a STEMI, the nurse auscultates a late systolic murmur at the apex. The nurse
should suspect the finding is related to the new onset of a:
A. Right bundle branch block
B. Left bundle branch block
C. Papillary muscle rupture
D. Calcific plaque rupture
Correct Answer: C. Papillary muscle rupture
Rationale: A papillary muscle chord rupture results from ischemia to the tissue
supplying the mitral valve. A systolic murmur is heard due to mitral regurgitation. A
RBBB would cause an electrical delay in conduction for a wide split S2. A LBBB
would cause an electrical delay in ventricular conduction for a paradoxical split S2.
Plaque rupture would cause an occlusion of the coronary artery that would not directly
cause a new systolic murmur.
QUESTION 7
The nurse is reviewing the plan of care for a patient with systolic heart failure who has
enalapril (Vasotec), furosemide (Lasix), metoprolol (Lopressor), and carvedilol (Coreg)
ordered. Which of the following will provide the most accurate assessment of the
regimen?
A. Daily weights
B. Strict I&O
C. BMP every morning
D. Serial CXRs
Correct Answer: A. Daily weights
Rationale: Assessing daily weights is a noninvasive and easy method to assess
compliance with the effectiveness of a medical regimen in patients with heart failure.
Observing the patient's ability to maintain a consistent weight indicates compliance as
well as the effectiveness of the medical regimen. Strict I&O is only one component of a
plan of care but does not assess if a patient adheres to the medical regimen or if the
