AGACNP-BC BOARD CERTIFICATION
Practice Exam 2 Questions and Answers with
Rationales Latest Versions
Question 1
A 74-year-old patient with a history of heart failure with reduced ejection fraction
presents with worsening dyspnea, orthopnea, and bilateral crackles. BP is 168/94
mmHg, oxygen saturation is 86%, and chest radiograph demonstrates pulmonary
edema. Which intervention is most appropriate initially?
A. Large-volume IV crystalloid administration
B. IV loop diuretic and appropriate ventilatory support
C. Immediate administration of IV potassium
D. Fluid restriction without pharmacologic therapy
Answer: B. IV loop diuretic and appropriate ventilatory support
Rationale: The presentation is consistent with acute decompensated heart failure
with pulmonary edema. Treatment commonly includes IV loop diuretics to reduce
congestion and supplemental oxygen or noninvasive ventilation when indicated.
Because the patient is hypertensive, vasodilator therapy may also be considered if
appropriate. Large-volume fluid administration would worsen pulmonary
congestion.
Question 2
A 69-year-old patient with atrial fibrillation presents with a ventricular rate of
155/min, BP 78/44 mmHg, chest discomfort, and altered mental status. What is the
priority intervention?
A. Oral metoprolol
B. Synchronized cardioversion
C. Oral anticoagulation
D. Vagal maneuvers
Answer: B. Synchronized cardioversion
,Rationale: The patient has unstable tachyarrhythmia manifested by hypotension,
altered mental status, and ischemic symptoms. Immediate synchronized
cardioversion is indicated. Rate-control medications should not delay treatment of
an unstable rhythm.
Question 3
A 71-year-old patient with COPD presents with worsening dyspnea. ABG shows:
• pH: 7.25
• PaCO₂: 72 mmHg
• HCO₃⁻: 31 mEq/L
• PaO₂: 54 mmHg
Which interpretation is most accurate?
A. Acute respiratory alkalosis
B. Chronic compensated respiratory acidosis
C. Acute-on-chronic respiratory acidosis
D. Metabolic alkalosis without respiratory involvement
Answer: C. Acute-on-chronic respiratory acidosis
Rationale: The elevated bicarbonate indicates chronic renal compensation for CO₂
retention, while the low pH indicates an acute worsening of respiratory acidosis.
This pattern is typical of acute-on-chronic hypercapnic respiratory failure.
Question 4
A 67-year-old patient with COPD exacerbation is awake, cooperative, and has
respiratory acidosis despite supplemental oxygen. Which intervention should be
considered?
A. Noninvasive positive-pressure ventilation
B. Immediate discharge
C. Routine administration of sedatives
D. Fluid restriction
,Answer: A. Noninvasive positive-pressure ventilation
Rationale: NIV is particularly useful in COPD exacerbations complicated by acute
or acute-on-chronic hypercapnic respiratory acidosis when the patient can protect
the airway and cooperate with therapy. It decreases work of breathing and
improves ventilation.
Question 5
A 78-year-old patient develops sudden aphasia and right-sided weakness. Last
known well was 90 minutes ago. CT shows no intracranial hemorrhage. Which
additional assessment is essential before considering IV thrombolytic therapy?
A. Blood glucose and contraindications to thrombolysis
B. Serum cholesterol only
C. Bone density
D. Urine culture
Answer: A. Blood glucose and contraindications to thrombolysis
Rationale: Acute stroke evaluation includes rapid assessment of glucose because
hypoglycemia can mimic stroke. Eligibility for thrombolytic therapy also requires
assessment of time of onset, bleeding risk, anticoagulant use, blood pressure,
imaging, and other contraindications.
Question 6
A 75-year-old patient with ischemic stroke develops worsening headache,
vomiting, and decreased level of consciousness several hours after reperfusion
therapy. What complication should be suspected?
A. Hemorrhagic transformation
B. Chronic dementia
C. Stable hypertension
D. Peripheral neuropathy
Answer: A. Hemorrhagic transformation
, Rationale: Acute neurologic deterioration after reperfusion therapy should prompt
urgent evaluation for intracranial hemorrhage, including hemorrhagic
transformation of the infarct. Emergent neuroimaging is indicated.
Question 7
A 72-year-old patient presents with fever, productive cough, hypotension,
tachycardia, and lactate elevation. Which intervention is most important in
suspected septic shock?
A. Delay antibiotics until all cultures are finalized
B. Prompt antimicrobial therapy and hemodynamic resuscitation
C. Administer routine corticosteroids to every patient
D. Restrict all fluids
Answer: B. Prompt antimicrobial therapy and hemodynamic resuscitation
Rationale: Septic shock requires rapid recognition and treatment. Appropriate
cultures should be obtained promptly when feasible without causing significant
delay in antimicrobial administration. Hemodynamic support and source control
are also essential.
Question 8
A patient with septic shock remains hypotensive after appropriate initial fluid
resuscitation. Which medication is generally considered a first-line vasopressor?
A. Norepinephrine
B. Furosemide
C. Nitroglycerin
D. Verapamil
Answer: A. Norepinephrine
Rationale: Norepinephrine is generally the first-line vasopressor for septic shock
requiring vasopressor support. It primarily increases vascular tone and helps
restore adequate mean arterial pressure.
Practice Exam 2 Questions and Answers with
Rationales Latest Versions
Question 1
A 74-year-old patient with a history of heart failure with reduced ejection fraction
presents with worsening dyspnea, orthopnea, and bilateral crackles. BP is 168/94
mmHg, oxygen saturation is 86%, and chest radiograph demonstrates pulmonary
edema. Which intervention is most appropriate initially?
A. Large-volume IV crystalloid administration
B. IV loop diuretic and appropriate ventilatory support
C. Immediate administration of IV potassium
D. Fluid restriction without pharmacologic therapy
Answer: B. IV loop diuretic and appropriate ventilatory support
Rationale: The presentation is consistent with acute decompensated heart failure
with pulmonary edema. Treatment commonly includes IV loop diuretics to reduce
congestion and supplemental oxygen or noninvasive ventilation when indicated.
Because the patient is hypertensive, vasodilator therapy may also be considered if
appropriate. Large-volume fluid administration would worsen pulmonary
congestion.
Question 2
A 69-year-old patient with atrial fibrillation presents with a ventricular rate of
155/min, BP 78/44 mmHg, chest discomfort, and altered mental status. What is the
priority intervention?
A. Oral metoprolol
B. Synchronized cardioversion
C. Oral anticoagulation
D. Vagal maneuvers
Answer: B. Synchronized cardioversion
,Rationale: The patient has unstable tachyarrhythmia manifested by hypotension,
altered mental status, and ischemic symptoms. Immediate synchronized
cardioversion is indicated. Rate-control medications should not delay treatment of
an unstable rhythm.
Question 3
A 71-year-old patient with COPD presents with worsening dyspnea. ABG shows:
• pH: 7.25
• PaCO₂: 72 mmHg
• HCO₃⁻: 31 mEq/L
• PaO₂: 54 mmHg
Which interpretation is most accurate?
A. Acute respiratory alkalosis
B. Chronic compensated respiratory acidosis
C. Acute-on-chronic respiratory acidosis
D. Metabolic alkalosis without respiratory involvement
Answer: C. Acute-on-chronic respiratory acidosis
Rationale: The elevated bicarbonate indicates chronic renal compensation for CO₂
retention, while the low pH indicates an acute worsening of respiratory acidosis.
This pattern is typical of acute-on-chronic hypercapnic respiratory failure.
Question 4
A 67-year-old patient with COPD exacerbation is awake, cooperative, and has
respiratory acidosis despite supplemental oxygen. Which intervention should be
considered?
A. Noninvasive positive-pressure ventilation
B. Immediate discharge
C. Routine administration of sedatives
D. Fluid restriction
,Answer: A. Noninvasive positive-pressure ventilation
Rationale: NIV is particularly useful in COPD exacerbations complicated by acute
or acute-on-chronic hypercapnic respiratory acidosis when the patient can protect
the airway and cooperate with therapy. It decreases work of breathing and
improves ventilation.
Question 5
A 78-year-old patient develops sudden aphasia and right-sided weakness. Last
known well was 90 minutes ago. CT shows no intracranial hemorrhage. Which
additional assessment is essential before considering IV thrombolytic therapy?
A. Blood glucose and contraindications to thrombolysis
B. Serum cholesterol only
C. Bone density
D. Urine culture
Answer: A. Blood glucose and contraindications to thrombolysis
Rationale: Acute stroke evaluation includes rapid assessment of glucose because
hypoglycemia can mimic stroke. Eligibility for thrombolytic therapy also requires
assessment of time of onset, bleeding risk, anticoagulant use, blood pressure,
imaging, and other contraindications.
Question 6
A 75-year-old patient with ischemic stroke develops worsening headache,
vomiting, and decreased level of consciousness several hours after reperfusion
therapy. What complication should be suspected?
A. Hemorrhagic transformation
B. Chronic dementia
C. Stable hypertension
D. Peripheral neuropathy
Answer: A. Hemorrhagic transformation
, Rationale: Acute neurologic deterioration after reperfusion therapy should prompt
urgent evaluation for intracranial hemorrhage, including hemorrhagic
transformation of the infarct. Emergent neuroimaging is indicated.
Question 7
A 72-year-old patient presents with fever, productive cough, hypotension,
tachycardia, and lactate elevation. Which intervention is most important in
suspected septic shock?
A. Delay antibiotics until all cultures are finalized
B. Prompt antimicrobial therapy and hemodynamic resuscitation
C. Administer routine corticosteroids to every patient
D. Restrict all fluids
Answer: B. Prompt antimicrobial therapy and hemodynamic resuscitation
Rationale: Septic shock requires rapid recognition and treatment. Appropriate
cultures should be obtained promptly when feasible without causing significant
delay in antimicrobial administration. Hemodynamic support and source control
are also essential.
Question 8
A patient with septic shock remains hypotensive after appropriate initial fluid
resuscitation. Which medication is generally considered a first-line vasopressor?
A. Norepinephrine
B. Furosemide
C. Nitroglycerin
D. Verapamil
Answer: A. Norepinephrine
Rationale: Norepinephrine is generally the first-line vasopressor for septic shock
requiring vasopressor support. It primarily increases vascular tone and helps
restore adequate mean arterial pressure.
