ACUTE CARE AGACNP TEST 1 – ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER –
COMPREHENSIVE EXAM REVIEW AND PRACTICE QUESTIONS WITH ANSWERS A+ VERIFIED LATEST VERSION
(2026-2027)
1. 1. A 25-year-old male patient is admitted to the intensive care unit after a
motor vehicle collision resulting in an isolated severe traumatic brain injury
causing elevated intracranial pressure. He is on a ventilator and minimally re-
sponsive. On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. To address this problem, the
nurse practitioner would:
1. Order a fluid restriction.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of the head.: Answer:2. Order
serum sodium, urine-specific gravity.
Rationale: This scenario suggests a diagnosis of diabetes insipidus, for which serum sodium and urine specific gravity
will aid in the diagnosis.
2. 2. A 25-year-old male patient is admitted to the intensive care unit after a
motor vehicle collision resulting in an isolated severe traumatic brain injury
causing elevated intracranial pressure. He is on a ventilator and minimally re-
sponsive. On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. His serum sodium increased
from 146 to 155 in the last 6 hours and urine specific gravity (SG) is 1.001. To
address this problem, the nurse practitioner would:
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
2. Increase maintenance fluids from 75 to 150 mL/hr and repeat sodium and
SG in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water via nasogastric tube.: 1.
Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
Rationale: This patient has central diabetes insipidus from pituitary compression. Treatment involves urgent admin-
istration of desmopressin and fluids to attenuate the hypernatremia.
3. 3. A 68-year-old 70-kg male patient with a history of tobacco abuse was
admitted with dyspnea. A chest x-ray revealed a pulmonary mass, flattened
bilateral diaphragm, and no pulmonary edema. He is alert and breathing
comfortably after being started on 4 L of oxygen via nasal cannula. His initial
, ACUTE CARE AGACNP TEST 1 – ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER –
COMPREHENSIVE EXAM REVIEW AND PRACTICE QUESTIONS WITH ANSWERS A+ VERIFIED LATEST VERSION
(2026-2027)
sodium is 128 mEq/L. Based on the nurse practitioner's knowledge of the
probable diagnosis, how would the nurse practitioner correct his sodium?
1. Start 3% saline at 75 mL/hr.
2. Start 0.9% saline at 1000 mL/hr.
3. Institute a fluid restriction.
4. Order 40 mg furosemide and repeat sodium in 8 hours.: 3. Institute a fluid restriction.
Rationale: The syndrome of inappropriate antidiuretic hormone is commonly caused by pulmonary disease and
malignancy. First-line treatment is a fluid restriction in the absence of symptoms such as seizure, mental status change,
and falls.
4. 4. A 55-year-old female patient with a history of type 2 diabetes and divertic-
ulitis is admitted to the intensive care unit following laparotomy for colectomy.
She remains intubated and requires norepinephrine at 0.06 mcg/kg/min to
maintain a mean arterial pressure greater than 65 mmHg despite adequate
intraoperative fluid resuscitation. Her blood glucose is 220 mg/dL. The nurse
practitioner's initial glucose management strategy will entail starting:
1. Insulin(R) infusion with target glucose less than 120 mg/dL.
2. Insulin(R) subcutaneous (SQ) sliding scale with target glucose 140 to 180
mg/dL.
3. Insulin(R) SQ sliding scale with target glucose less than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.: 4. Insulin(R) infusion with
target glucose 140 to 180 mg/dL.
Rationale: Preferred insulin route in the intensive care unit setting is intravenous infusion with a target of 140 to
180 mg/dL to avoid hypoglycemic complications. Vasoconstriction and edema of subcutaneous tissue can alter
absorption.
5. 5. A 55-year-old female patient with a history of type 2 diabetes and diver-
ticulitis was admitted to the intensive care unit after laparotomy for colecto-
my. She was briefly intubated and on vasopressors. She is now weaned off
norepinephrine and transferred to a med/surg floor. She is tolerating oral
nutrition with a carbohydrate-controlled diet and is still on insulin infusion
at 0.5 units/hr with a 24-hour glucose range of 150 to 180 mg/dL. Her home
regimen involves metformin 1000 mg twice a day (BID) by mouth and a
carbohydrate-controlled diet. Hemoglobin A1c is 7.8%. The most appropriate
, ACUTE CARE AGACNP TEST 1 – ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER –
COMPREHENSIVE EXAM REVIEW AND PRACTICE QUESTIONS WITH ANSWERS A+ VERIFIED LATEST VERSION
(2026-2027)
next step in the management of this patient's diabetes is:
1. Restart home metformin and monitor blood glucose Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcutaneous sliding scale.: 1. Restart
home metformin and monitor blood glucose Q achs.
Rationale: This patient had adequate glucose control and can be safely transitioned back to her home regimen in the
absence of other contraindications.
6. 6. An 85-year-old female patient is admitted to a med/surg floor with a
urinary tract infection and confusion. She is tolerating a regular diet and
has no history of diabetes. The glucose on her initial chemistry panel is 230
mg/dL and hemoglobin A1c is 10%. The most appropriate management of
this patient's glucose is:
1. Start insulin infusion and follow glucose once every hour.
2. Initiate a subcutaneous basal, prandial, correction regimen.
3. Start metformin 1500 mg twice a day.
4. Instruct patient to follow up with her primary care provider 2 weeks after
discharge.: 2. Initiate a subcutaneous basal, prandial, correction regimen.
Rationale: Hospitalized patients with new hyperglycemia should be managed with basal, prandial, correction.
7. 7. An 85-year-old female patient is admitted to a med/surg floor with urinary
tract infection and confusion. She is tolerating a regular diet and has no
history of diabetes. The glucose on her initial chemistry panel is 230 mg/dL
and hemoglobin A1c is 10%. Her glucose was 140 mg/dL with glargine and
lispro. When planning the discharge for this patient, you learn that she plans
to return home but is confused during insulin teaching. What is the best way
to manage this patient's hyperglycemia at home?
1. Transition to an oral agent and confirm follow-up with primary care is
available.
2. Discharge with prescriptions for glargine, lispro, and syringes.
3. Discharge with prescriptions for glargine and lispro pens.
4. Refer the patient to her home county's adult protective services.: 1. Transition
to an oral agent and confirm follow-up with primary care is available
COMPREHENSIVE EXAM REVIEW AND PRACTICE QUESTIONS WITH ANSWERS A+ VERIFIED LATEST VERSION
(2026-2027)
1. 1. A 25-year-old male patient is admitted to the intensive care unit after a
motor vehicle collision resulting in an isolated severe traumatic brain injury
causing elevated intracranial pressure. He is on a ventilator and minimally re-
sponsive. On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. To address this problem, the
nurse practitioner would:
1. Order a fluid restriction.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of the head.: Answer:2. Order
serum sodium, urine-specific gravity.
Rationale: This scenario suggests a diagnosis of diabetes insipidus, for which serum sodium and urine specific gravity
will aid in the diagnosis.
2. 2. A 25-year-old male patient is admitted to the intensive care unit after a
motor vehicle collision resulting in an isolated severe traumatic brain injury
causing elevated intracranial pressure. He is on a ventilator and minimally re-
sponsive. On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. His serum sodium increased
from 146 to 155 in the last 6 hours and urine specific gravity (SG) is 1.001. To
address this problem, the nurse practitioner would:
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
2. Increase maintenance fluids from 75 to 150 mL/hr and repeat sodium and
SG in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water via nasogastric tube.: 1.
Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
Rationale: This patient has central diabetes insipidus from pituitary compression. Treatment involves urgent admin-
istration of desmopressin and fluids to attenuate the hypernatremia.
3. 3. A 68-year-old 70-kg male patient with a history of tobacco abuse was
admitted with dyspnea. A chest x-ray revealed a pulmonary mass, flattened
bilateral diaphragm, and no pulmonary edema. He is alert and breathing
comfortably after being started on 4 L of oxygen via nasal cannula. His initial
, ACUTE CARE AGACNP TEST 1 – ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER –
COMPREHENSIVE EXAM REVIEW AND PRACTICE QUESTIONS WITH ANSWERS A+ VERIFIED LATEST VERSION
(2026-2027)
sodium is 128 mEq/L. Based on the nurse practitioner's knowledge of the
probable diagnosis, how would the nurse practitioner correct his sodium?
1. Start 3% saline at 75 mL/hr.
2. Start 0.9% saline at 1000 mL/hr.
3. Institute a fluid restriction.
4. Order 40 mg furosemide and repeat sodium in 8 hours.: 3. Institute a fluid restriction.
Rationale: The syndrome of inappropriate antidiuretic hormone is commonly caused by pulmonary disease and
malignancy. First-line treatment is a fluid restriction in the absence of symptoms such as seizure, mental status change,
and falls.
4. 4. A 55-year-old female patient with a history of type 2 diabetes and divertic-
ulitis is admitted to the intensive care unit following laparotomy for colectomy.
She remains intubated and requires norepinephrine at 0.06 mcg/kg/min to
maintain a mean arterial pressure greater than 65 mmHg despite adequate
intraoperative fluid resuscitation. Her blood glucose is 220 mg/dL. The nurse
practitioner's initial glucose management strategy will entail starting:
1. Insulin(R) infusion with target glucose less than 120 mg/dL.
2. Insulin(R) subcutaneous (SQ) sliding scale with target glucose 140 to 180
mg/dL.
3. Insulin(R) SQ sliding scale with target glucose less than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.: 4. Insulin(R) infusion with
target glucose 140 to 180 mg/dL.
Rationale: Preferred insulin route in the intensive care unit setting is intravenous infusion with a target of 140 to
180 mg/dL to avoid hypoglycemic complications. Vasoconstriction and edema of subcutaneous tissue can alter
absorption.
5. 5. A 55-year-old female patient with a history of type 2 diabetes and diver-
ticulitis was admitted to the intensive care unit after laparotomy for colecto-
my. She was briefly intubated and on vasopressors. She is now weaned off
norepinephrine and transferred to a med/surg floor. She is tolerating oral
nutrition with a carbohydrate-controlled diet and is still on insulin infusion
at 0.5 units/hr with a 24-hour glucose range of 150 to 180 mg/dL. Her home
regimen involves metformin 1000 mg twice a day (BID) by mouth and a
carbohydrate-controlled diet. Hemoglobin A1c is 7.8%. The most appropriate
, ACUTE CARE AGACNP TEST 1 – ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER –
COMPREHENSIVE EXAM REVIEW AND PRACTICE QUESTIONS WITH ANSWERS A+ VERIFIED LATEST VERSION
(2026-2027)
next step in the management of this patient's diabetes is:
1. Restart home metformin and monitor blood glucose Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcutaneous sliding scale.: 1. Restart
home metformin and monitor blood glucose Q achs.
Rationale: This patient had adequate glucose control and can be safely transitioned back to her home regimen in the
absence of other contraindications.
6. 6. An 85-year-old female patient is admitted to a med/surg floor with a
urinary tract infection and confusion. She is tolerating a regular diet and
has no history of diabetes. The glucose on her initial chemistry panel is 230
mg/dL and hemoglobin A1c is 10%. The most appropriate management of
this patient's glucose is:
1. Start insulin infusion and follow glucose once every hour.
2. Initiate a subcutaneous basal, prandial, correction regimen.
3. Start metformin 1500 mg twice a day.
4. Instruct patient to follow up with her primary care provider 2 weeks after
discharge.: 2. Initiate a subcutaneous basal, prandial, correction regimen.
Rationale: Hospitalized patients with new hyperglycemia should be managed with basal, prandial, correction.
7. 7. An 85-year-old female patient is admitted to a med/surg floor with urinary
tract infection and confusion. She is tolerating a regular diet and has no
history of diabetes. The glucose on her initial chemistry panel is 230 mg/dL
and hemoglobin A1c is 10%. Her glucose was 140 mg/dL with glargine and
lispro. When planning the discharge for this patient, you learn that she plans
to return home but is confused during insulin teaching. What is the best way
to manage this patient's hyperglycemia at home?
1. Transition to an oral agent and confirm follow-up with primary care is
available.
2. Discharge with prescriptions for glargine, lispro, and syringes.
3. Discharge with prescriptions for glargine and lispro pens.
4. Refer the patient to her home county's adult protective services.: 1. Transition
to an oral agent and confirm follow-up with primary care is available
