ANCC AGACNP Frances Guide | 2026/2027
500+ PRACTICE QUESTIONS FOR ACUTE CARE NP BOARD SUCCESS
(1) An 85-year-old male presents with sudden onset of severe chest pain radiating to the back. A CT scan
reveals a Stanford Type A aortic dissection. What is the immediate priority management?
A. Emergent surgical consultation and blood pressure control with esmolol.
B. Administration of high-dose thrombolytics.
C. Immediate discharge with follow-up in 1 week.
D. Initiation of anticoagulation with heparin.
CORRECT ANSWER: A
Board Review Rationale: Stanford Type A dissections involve the ascending aorta and are surgical emergencies.
Management involves heart rate and BP control (to reduce shearing forces) and immediate surgical repair.
(2) A patient in the ICU has a Swan-Ganz catheter. The hemodynamic profile shows: PCWP 22 mmHg, CVP
12 mmHg, and Cardiac Index 1.8 L/min/m². Which type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstructive
CORRECT ANSWER: B
Board Review Rationale: Cardiogenic shock is characterized by high filling pressures (PCWP > 18, CVP > 10) and
a low cardiac index (< 2.2).
(3) A mechanically ventilated patient has an ABG showing: pH 7.28, PaCO2 55, HCO3 26, PaO2 65 on FiO2
60%. Which ventilator adjustment is most appropriate?
A. Decrease the PEEP.
B. Increase the tidal volume or respiratory rate.
C. Decrease the FiO2.
D. Administer sodium bicarbonate.
CORRECT ANSWER: B
Board Review Rationale: The patient has respiratory acidosis (high CO2, low pH). Increasing minute ventilation
(RR x TV) helps blow off excess CO2.
,(4) Which medication is the gold standard for the rapid treatment of hyperkalemia-induced EKG changes
(e.g., peaked T-waves)?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Furosemide
D. Insulin and D50
CORRECT ANSWER: B
Board Review Rationale: Calcium gluconate stabilizes the myocardial membrane to prevent arrhythmias but
does not lower potassium levels. Insulin/D50 and Kayexalate are used subsequently to lower levels.
(5) A patient with Diabetic Ketoacidosis (DKA) is being treated with an insulin drip. At what blood glucose
level should the NP add dextrose (D5) to the IV fluids?
A. 300 mg/dL
B. 250 mg/dL
C. 150 mg/dL
D. 100 mg/dL
CORRECT ANSWER: B
Board Review Rationale: In DKA, dextrose is added when glucose reaches 250 mg/dL to prevent hypoglycemia
and allow for the continuation of insulin to resolve ketosis.
(6) Which ethical principle involves the NP's duty to 'do no harm' to the patient?
A. Autonomy
B. Beneficence
C. Non-maleficence
D. Fidelity
CORRECT ANSWER: C
Board Review Rationale: Non-maleficence is the fundamental duty to avoid causing harm. Beneficence is the
duty to do good.
,(7) An ICU patient develops a fever and new infiltrates on CXR after being intubated for 72 hours. What is
the most appropriate initial empiric antibiotic regimen for suspected VAP?
A. Amoxicillin only.
B. Vancomycin plus Cefepime or Piperacillin-Tazobactam.
C. Oral Ciprofloxacin.
D. Fluconazole.
CORRECT ANSWER: B
Board Review Rationale: Ventilator-Associated Pneumonia (VAP) treatment requires empiric coverage for MRSA
and Pseudomonas aeruginosa.
(8) A patient with cirrhosis presents with hematemesis and hypotension. What is the most likely cause
and the priority medication?
A. Peptic ulcer; PPI.
B. Esophageal varices; Octreotide.
C. Diverticulitis; Metronidazole.
D. GERD; Antacids.
CORRECT ANSWER: B
Board Review Rationale: Esophageal varices are common in cirrhosis. Octreotide reduces portal pressure to
control bleeding.
(9) A patient with a traumatic brain injury has an ICP of 25 mmHg. Which intervention is appropriate to
decrease ICP?
A. Keep the head of the bed flat.
B. Administer IV Mannitol.
C. Increase the PaCO2 through hypoventilation.
D. Limit environmental stimulation.
CORRECT ANSWER: B
Board Review Rationale: Mannitol is an osmotic diuretic that pulls fluid from brain tissue to reduce intracranial
pressure. HOB should be elevated 30-45 degrees.
, (10) Which sedative used in the ICU is known for causing hypotension but allowing for rapid 'wake-up' for
neurological exams?
A. Lorazepam (Ativan)
B. Propofol (Diprivan)
C. Midazolam (Versed)
D. Phenobarbital
CORRECT ANSWER: B
Board Review Rationale: Propofol has a very short half-life and rapid onset/offset, making it ideal for daily
sedation vacations, though it commonly causes vasodilation/hypotension.
(11) An 85-year-old male presents with sudden onset of severe chest pain radiating to the back. A CT scan
reveals a Stanford Type A aortic dissection. What is the immediate priority management?
A. Emergent surgical consultation and blood pressure control with esmolol.
B. Administration of high-dose thrombolytics.
C. Immediate discharge with follow-up in 1 week.
D. Initiation of anticoagulation with heparin.
CORRECT ANSWER: A
Board Review Rationale: Stanford Type A dissections involve the ascending aorta and are surgical emergencies.
Management involves heart rate and BP control (to reduce shearing forces) and immediate surgical repair.
(12) A patient in the ICU has a Swan-Ganz catheter. The hemodynamic profile shows: PCWP 22 mmHg, CVP
12 mmHg, and Cardiac Index 1.8 L/min/m². Which type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstructive
CORRECT ANSWER: B
Board Review Rationale: Cardiogenic shock is characterized by high filling pressures (PCWP > 18, CVP > 10) and
a low cardiac index (< 2.2).
500+ PRACTICE QUESTIONS FOR ACUTE CARE NP BOARD SUCCESS
(1) An 85-year-old male presents with sudden onset of severe chest pain radiating to the back. A CT scan
reveals a Stanford Type A aortic dissection. What is the immediate priority management?
A. Emergent surgical consultation and blood pressure control with esmolol.
B. Administration of high-dose thrombolytics.
C. Immediate discharge with follow-up in 1 week.
D. Initiation of anticoagulation with heparin.
CORRECT ANSWER: A
Board Review Rationale: Stanford Type A dissections involve the ascending aorta and are surgical emergencies.
Management involves heart rate and BP control (to reduce shearing forces) and immediate surgical repair.
(2) A patient in the ICU has a Swan-Ganz catheter. The hemodynamic profile shows: PCWP 22 mmHg, CVP
12 mmHg, and Cardiac Index 1.8 L/min/m². Which type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstructive
CORRECT ANSWER: B
Board Review Rationale: Cardiogenic shock is characterized by high filling pressures (PCWP > 18, CVP > 10) and
a low cardiac index (< 2.2).
(3) A mechanically ventilated patient has an ABG showing: pH 7.28, PaCO2 55, HCO3 26, PaO2 65 on FiO2
60%. Which ventilator adjustment is most appropriate?
A. Decrease the PEEP.
B. Increase the tidal volume or respiratory rate.
C. Decrease the FiO2.
D. Administer sodium bicarbonate.
CORRECT ANSWER: B
Board Review Rationale: The patient has respiratory acidosis (high CO2, low pH). Increasing minute ventilation
(RR x TV) helps blow off excess CO2.
,(4) Which medication is the gold standard for the rapid treatment of hyperkalemia-induced EKG changes
(e.g., peaked T-waves)?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Furosemide
D. Insulin and D50
CORRECT ANSWER: B
Board Review Rationale: Calcium gluconate stabilizes the myocardial membrane to prevent arrhythmias but
does not lower potassium levels. Insulin/D50 and Kayexalate are used subsequently to lower levels.
(5) A patient with Diabetic Ketoacidosis (DKA) is being treated with an insulin drip. At what blood glucose
level should the NP add dextrose (D5) to the IV fluids?
A. 300 mg/dL
B. 250 mg/dL
C. 150 mg/dL
D. 100 mg/dL
CORRECT ANSWER: B
Board Review Rationale: In DKA, dextrose is added when glucose reaches 250 mg/dL to prevent hypoglycemia
and allow for the continuation of insulin to resolve ketosis.
(6) Which ethical principle involves the NP's duty to 'do no harm' to the patient?
A. Autonomy
B. Beneficence
C. Non-maleficence
D. Fidelity
CORRECT ANSWER: C
Board Review Rationale: Non-maleficence is the fundamental duty to avoid causing harm. Beneficence is the
duty to do good.
,(7) An ICU patient develops a fever and new infiltrates on CXR after being intubated for 72 hours. What is
the most appropriate initial empiric antibiotic regimen for suspected VAP?
A. Amoxicillin only.
B. Vancomycin plus Cefepime or Piperacillin-Tazobactam.
C. Oral Ciprofloxacin.
D. Fluconazole.
CORRECT ANSWER: B
Board Review Rationale: Ventilator-Associated Pneumonia (VAP) treatment requires empiric coverage for MRSA
and Pseudomonas aeruginosa.
(8) A patient with cirrhosis presents with hematemesis and hypotension. What is the most likely cause
and the priority medication?
A. Peptic ulcer; PPI.
B. Esophageal varices; Octreotide.
C. Diverticulitis; Metronidazole.
D. GERD; Antacids.
CORRECT ANSWER: B
Board Review Rationale: Esophageal varices are common in cirrhosis. Octreotide reduces portal pressure to
control bleeding.
(9) A patient with a traumatic brain injury has an ICP of 25 mmHg. Which intervention is appropriate to
decrease ICP?
A. Keep the head of the bed flat.
B. Administer IV Mannitol.
C. Increase the PaCO2 through hypoventilation.
D. Limit environmental stimulation.
CORRECT ANSWER: B
Board Review Rationale: Mannitol is an osmotic diuretic that pulls fluid from brain tissue to reduce intracranial
pressure. HOB should be elevated 30-45 degrees.
, (10) Which sedative used in the ICU is known for causing hypotension but allowing for rapid 'wake-up' for
neurological exams?
A. Lorazepam (Ativan)
B. Propofol (Diprivan)
C. Midazolam (Versed)
D. Phenobarbital
CORRECT ANSWER: B
Board Review Rationale: Propofol has a very short half-life and rapid onset/offset, making it ideal for daily
sedation vacations, though it commonly causes vasodilation/hypotension.
(11) An 85-year-old male presents with sudden onset of severe chest pain radiating to the back. A CT scan
reveals a Stanford Type A aortic dissection. What is the immediate priority management?
A. Emergent surgical consultation and blood pressure control with esmolol.
B. Administration of high-dose thrombolytics.
C. Immediate discharge with follow-up in 1 week.
D. Initiation of anticoagulation with heparin.
CORRECT ANSWER: A
Board Review Rationale: Stanford Type A dissections involve the ascending aorta and are surgical emergencies.
Management involves heart rate and BP control (to reduce shearing forces) and immediate surgical repair.
(12) A patient in the ICU has a Swan-Ganz catheter. The hemodynamic profile shows: PCWP 22 mmHg, CVP
12 mmHg, and Cardiac Index 1.8 L/min/m². Which type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
C. Distributive
D. Obstructive
CORRECT ANSWER: B
Board Review Rationale: Cardiogenic shock is characterized by high filling pressures (PCWP > 18, CVP > 10) and
a low cardiac index (< 2.2).
