BARKLEY ACUTE CARE NURSE PRACTITIONER
(ACNP) CERTIFICATION REVIEW 100 Comprehensive
Board-Style Questions with Verified Answers & Rationales
SECTION 1: SHOCK STATES & HEMODYNAMICS (Questions 1-15)
Question 1
A 74-year-old male with a history of CHF presents with an audible S3 gallop and
increased jugular venous distention. This finding most likely indicates:
A) Decreased cardiac output
B) Fluid volume overload
C) Pericardial effusion
D) Valvular stenosis
Answer: B) Fluid volume overload
Rationale: The S3 heart sound is a classic sign of fluid volume overload in heart failure
patients, caused by blood rushing into a distended ventricle during early diastole. This
finding, combined with JVD, indicates elevated filling pressures and volume overload .
Question 2
Which vasopressor is considered first-line for a patient in septic shock who remains
hypotensive despite adequate fluid resuscitation?
A) Dopamine
B) Norepinephrine
,C) Phenylephrine
D) Vasopressin
Answer: B) Norepinephrine
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock to
achieve a target MAP of ≥65 mmHg due to its potent alpha-1 vasoconstrictive effects
with less chronotropic effect than dopamine .
Question 3
A patient with hypovolemic shock would most likely demonstrate which set of
hemodynamic values?
A) CO low, CVP high, SVR high, SvO2 low
B) CO low, CVP low, SVR high, SvO2 low
C) CO low, CVP low, SVR low, SvO2 low
D) CO high, CVP low, SVR low, SvO2 high
Answer: B) CO low, CVP low, SVR high, SvO2 low
Rationale: Hypovolemic shock results from a loss of 20% of circulating blood volume.
Key lab findings include low cardiac output (CO), low central venous pressure (CVP),
high systemic vascular resistance (SVR) due to compensatory vasoconstriction, and low
mixed venous oxygen saturation (SvO2) .
Question 4
A patient with cardiogenic shock would most likely demonstrate which of the following
hemodynamic profiles?
,A) CO low, CVP high, PCWP high, SVR high, SvO2 low
B) CO low, CVP low, PCWP low, SVR high, SvO2 low
C) CO high, CVP low, PCWP low, SVR low, SvO2 high
D) CO low, CVP normal, PCWP normal, SVR low, SvO2 low
Answer: A) CO low, CVP high, PCWP high, SVR high, SvO2 low
Rationale: Cardiogenic shock is characterized by low cardiac output, elevated filling
pressures (CVP and PCWP), compensatory high SVR, and low SvO2 indicating impaired
oxygen delivery .
Question 5
Which of the following is the most common cause of cardiogenic shock?
A) Pericardial tamponade
B) Myocardial infarction
C) Massive pulmonary embolism
D) Tension pneumothorax
Answer: B) Myocardial infarction
Rationale: Myocardial infarction is the most common cause of cardiogenic shock,
resulting from loss of effective contractile function leading to impaired cardiac output
and reduced tissue perfusion .
Question 6
A patient presents with distributive shock characterized by low SVR. Which of the
following is NOT a type of distributive shock?
, A) Septic shock
B) Anaphylactic shock
C) Neurogenic shock
D) Obstructive shock
Answer: D) Obstructive shock
Rationale: Distributive shock has three forms: septic, anaphylactic, and neurogenic. All
are characterized by vasodilation, decreased intravascular volume, reduced peripheral
vascular resistance, and loss of capillary integrity. Obstructive shock is a distinct category
caused by mechanical obstruction to cardiac filling .
Question 7
Which of the following hemodynamic profiles is characteristic of obstructive shock?
A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
B) CO low, CVP high, PCWP high, SVR high, SvO2 low
C) CO low, CVP low, PCWP low, SVR high, SvO2 low
D) CO high, CVP low, PCWP low, SVR low, SvO2 high
Answer: A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
Rationale: Obstructive shock results from impaired ventricular filling due to mechanical
obstruction (e.g., massive PE, tension pneumothorax, cardiac tamponade).
Hemodynamics show low CO, elevated CVP, normal or low PCWP, high SVR, and high
SvO2 due to impaired oxygen extraction .
(ACNP) CERTIFICATION REVIEW 100 Comprehensive
Board-Style Questions with Verified Answers & Rationales
SECTION 1: SHOCK STATES & HEMODYNAMICS (Questions 1-15)
Question 1
A 74-year-old male with a history of CHF presents with an audible S3 gallop and
increased jugular venous distention. This finding most likely indicates:
A) Decreased cardiac output
B) Fluid volume overload
C) Pericardial effusion
D) Valvular stenosis
Answer: B) Fluid volume overload
Rationale: The S3 heart sound is a classic sign of fluid volume overload in heart failure
patients, caused by blood rushing into a distended ventricle during early diastole. This
finding, combined with JVD, indicates elevated filling pressures and volume overload .
Question 2
Which vasopressor is considered first-line for a patient in septic shock who remains
hypotensive despite adequate fluid resuscitation?
A) Dopamine
B) Norepinephrine
,C) Phenylephrine
D) Vasopressin
Answer: B) Norepinephrine
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock to
achieve a target MAP of ≥65 mmHg due to its potent alpha-1 vasoconstrictive effects
with less chronotropic effect than dopamine .
Question 3
A patient with hypovolemic shock would most likely demonstrate which set of
hemodynamic values?
A) CO low, CVP high, SVR high, SvO2 low
B) CO low, CVP low, SVR high, SvO2 low
C) CO low, CVP low, SVR low, SvO2 low
D) CO high, CVP low, SVR low, SvO2 high
Answer: B) CO low, CVP low, SVR high, SvO2 low
Rationale: Hypovolemic shock results from a loss of 20% of circulating blood volume.
Key lab findings include low cardiac output (CO), low central venous pressure (CVP),
high systemic vascular resistance (SVR) due to compensatory vasoconstriction, and low
mixed venous oxygen saturation (SvO2) .
Question 4
A patient with cardiogenic shock would most likely demonstrate which of the following
hemodynamic profiles?
,A) CO low, CVP high, PCWP high, SVR high, SvO2 low
B) CO low, CVP low, PCWP low, SVR high, SvO2 low
C) CO high, CVP low, PCWP low, SVR low, SvO2 high
D) CO low, CVP normal, PCWP normal, SVR low, SvO2 low
Answer: A) CO low, CVP high, PCWP high, SVR high, SvO2 low
Rationale: Cardiogenic shock is characterized by low cardiac output, elevated filling
pressures (CVP and PCWP), compensatory high SVR, and low SvO2 indicating impaired
oxygen delivery .
Question 5
Which of the following is the most common cause of cardiogenic shock?
A) Pericardial tamponade
B) Myocardial infarction
C) Massive pulmonary embolism
D) Tension pneumothorax
Answer: B) Myocardial infarction
Rationale: Myocardial infarction is the most common cause of cardiogenic shock,
resulting from loss of effective contractile function leading to impaired cardiac output
and reduced tissue perfusion .
Question 6
A patient presents with distributive shock characterized by low SVR. Which of the
following is NOT a type of distributive shock?
, A) Septic shock
B) Anaphylactic shock
C) Neurogenic shock
D) Obstructive shock
Answer: D) Obstructive shock
Rationale: Distributive shock has three forms: septic, anaphylactic, and neurogenic. All
are characterized by vasodilation, decreased intravascular volume, reduced peripheral
vascular resistance, and loss of capillary integrity. Obstructive shock is a distinct category
caused by mechanical obstruction to cardiac filling .
Question 7
Which of the following hemodynamic profiles is characteristic of obstructive shock?
A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
B) CO low, CVP high, PCWP high, SVR high, SvO2 low
C) CO low, CVP low, PCWP low, SVR high, SvO2 low
D) CO high, CVP low, PCWP low, SVR low, SvO2 high
Answer: A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
Rationale: Obstructive shock results from impaired ventricular filling due to mechanical
obstruction (e.g., massive PE, tension pneumothorax, cardiac tamponade).
Hemodynamics show low CO, elevated CVP, normal or low PCWP, high SVR, and high
SvO2 due to impaired oxygen extraction .
