NR-569 ADULT-GERONTOLOGY ACUTE CARE I QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Foundations of Diagnostic Reasoning and Clinical Decision-
Making
Comprehensive Patient Assessment, History Taking, and
Documentation
Respiratory System Differential Diagnosis
Cardiovascular System Differential Diagnosis
Gastrointestinal and Abdominal Differential Diagnosis
Neurological and Musculoskeletal Differential Diagnosis
Genitourinary and Renal Differential Diagnosis
Infectious Diseases, Systemic Conditions, and Fever Evaluation
Integrated Clinical Scenarios and Diagnostic Decision-Making
Professional Role, Ethics, and Scope of Practice in Acute Care
Introduction
The NR-569 Adult-Gerontology Acute Care I examination assesses
the advanced knowledge and clinical reasoning skills required for
formulating differential diagnoses in acute care settings. This
examination evaluates competency in hypothesis-driven diagnostic
reasoning, comprehensive patient assessment, pattern recognition,
and evidence-based clinical decision-making. The test employs
multiple-choice and scenario-based questions that simulate high-
acuity clinical encounters involving critically ill adults and older
adults. Emphasis is placed on processing patient information in a
logical, progressive manner, identifying red flags, prioritizing life-
threatening conditions, and developing comprehensive differential
,diagnoses. Candidates must demonstrate the ability to synthesize
complex clinical data, recognize diagnostic errors, and implement
safe, effective, and ethically sound diagnostic strategies consistent
with the AGACNP scope of practice.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with COPD exacerbation has ABG: pH 7.28,
PaCO2 68 mmHg, PaO2 55 mmHg. Which acid-base disorder is
present?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with hypoxemia
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with hypoxemia
🟢 Correct answer: B
🔴 RATIONALE: Low pH, elevated PaCO2, and low PaO2 indicate
acute respiratory acidosis with hypoxemia, consistent with CO2
retention in COPD exacerbation.
2. A 72-year-old female is post-op day 1 after hip fracture repair.
She develops confusion and a petechial rash on the chest.
Which complication is most likely?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Delirium from anesthesia
D. Sepsis from surgical site infection
,🟢 Correct answer: B
🔴 RATIONALE: Fat embolism syndrome classically presents after
long bone fractures with confusion, petechiae, and respiratory
distress.
3. A 55-year-old male has an inferior wall STEMI with ST
elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Right coronary artery
B. Left anterior descending artery
C. Left circumflex artery
D. Left main coronary artery
🟢 Correct answer: A
🔴 RATIONALE: Inferior wall MI is most commonly caused by
occlusion of the right coronary artery in 80% of cases.
4. A 60-year-old female with DKA has glucose 520 mg/dL, pH
7.15, bicarbonate 12 mEq/L. What is the initial priority?
A. IV insulin bolus
B. IV sodium bicarbonate
C. Potassium replacement before insulin
D. IV 0.9% normal saline resuscitation
🟢 Correct answer: D
, 🔴 RATIONALE: Initial management of DKA is aggressive IV fluid
resuscitation with 0.9% normal saline to restore intravascular
volume before insulin.
5. A 70-year-old male in septic shock remains hypotensive with
MAP 58 mmHg after 30 mL/kg crystalloid. What is the next best
step?
A. Additional 30 mL/kg fluid bolus
B. Initiate norepinephrine
C. Start broad-spectrum antibiotics
D. Obtain echocardiogram
🟢 Correct answer: B
🔴 RATIONALE: When hypotension persists after adequate fluid
resuscitation, norepinephrine is first-line to maintain MAP ≥65
mmHg.
6. A 48-year-old male with acute pancreatitis has CRP >150
mg/L at 48 hours. What does this indicate?
A. Severe acute pancreatitis
B. Mild acute pancreatitis
C. Pancreatic pseudocyst
D. Chronic pancreatitis
🟢 Correct answer: A
🔴 RATIONALE: CRP >150 mg/L at 48 hours is a marker of severe
acute pancreatitis and increased risk of necrosis and organ failure.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Foundations of Diagnostic Reasoning and Clinical Decision-
Making
Comprehensive Patient Assessment, History Taking, and
Documentation
Respiratory System Differential Diagnosis
Cardiovascular System Differential Diagnosis
Gastrointestinal and Abdominal Differential Diagnosis
Neurological and Musculoskeletal Differential Diagnosis
Genitourinary and Renal Differential Diagnosis
Infectious Diseases, Systemic Conditions, and Fever Evaluation
Integrated Clinical Scenarios and Diagnostic Decision-Making
Professional Role, Ethics, and Scope of Practice in Acute Care
Introduction
The NR-569 Adult-Gerontology Acute Care I examination assesses
the advanced knowledge and clinical reasoning skills required for
formulating differential diagnoses in acute care settings. This
examination evaluates competency in hypothesis-driven diagnostic
reasoning, comprehensive patient assessment, pattern recognition,
and evidence-based clinical decision-making. The test employs
multiple-choice and scenario-based questions that simulate high-
acuity clinical encounters involving critically ill adults and older
adults. Emphasis is placed on processing patient information in a
logical, progressive manner, identifying red flags, prioritizing life-
threatening conditions, and developing comprehensive differential
,diagnoses. Candidates must demonstrate the ability to synthesize
complex clinical data, recognize diagnostic errors, and implement
safe, effective, and ethically sound diagnostic strategies consistent
with the AGACNP scope of practice.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old male with COPD exacerbation has ABG: pH 7.28,
PaCO2 68 mmHg, PaO2 55 mmHg. Which acid-base disorder is
present?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with hypoxemia
C. Respiratory alkalosis with metabolic compensation
D. Metabolic alkalosis with hypoxemia
🟢 Correct answer: B
🔴 RATIONALE: Low pH, elevated PaCO2, and low PaO2 indicate
acute respiratory acidosis with hypoxemia, consistent with CO2
retention in COPD exacerbation.
2. A 72-year-old female is post-op day 1 after hip fracture repair.
She develops confusion and a petechial rash on the chest.
Which complication is most likely?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Delirium from anesthesia
D. Sepsis from surgical site infection
,🟢 Correct answer: B
🔴 RATIONALE: Fat embolism syndrome classically presents after
long bone fractures with confusion, petechiae, and respiratory
distress.
3. A 55-year-old male has an inferior wall STEMI with ST
elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Right coronary artery
B. Left anterior descending artery
C. Left circumflex artery
D. Left main coronary artery
🟢 Correct answer: A
🔴 RATIONALE: Inferior wall MI is most commonly caused by
occlusion of the right coronary artery in 80% of cases.
4. A 60-year-old female with DKA has glucose 520 mg/dL, pH
7.15, bicarbonate 12 mEq/L. What is the initial priority?
A. IV insulin bolus
B. IV sodium bicarbonate
C. Potassium replacement before insulin
D. IV 0.9% normal saline resuscitation
🟢 Correct answer: D
, 🔴 RATIONALE: Initial management of DKA is aggressive IV fluid
resuscitation with 0.9% normal saline to restore intravascular
volume before insulin.
5. A 70-year-old male in septic shock remains hypotensive with
MAP 58 mmHg after 30 mL/kg crystalloid. What is the next best
step?
A. Additional 30 mL/kg fluid bolus
B. Initiate norepinephrine
C. Start broad-spectrum antibiotics
D. Obtain echocardiogram
🟢 Correct answer: B
🔴 RATIONALE: When hypotension persists after adequate fluid
resuscitation, norepinephrine is first-line to maintain MAP ≥65
mmHg.
6. A 48-year-old male with acute pancreatitis has CRP >150
mg/L at 48 hours. What does this indicate?
A. Severe acute pancreatitis
B. Mild acute pancreatitis
C. Pancreatic pseudocyst
D. Chronic pancreatitis
🟢 Correct answer: A
🔴 RATIONALE: CRP >150 mg/L at 48 hours is a marker of severe
acute pancreatitis and increased risk of necrosis and organ failure.
