ACNS-BC Adult Health Clinical Nurse Specialist
exam, Actual Questions with Verified Answers |
New 2025/2026 Update | 100% Correct.
1. A 68-year-old patient with heart failure has a BNP of 950
pg/mL. Which interpretation is most accurate?
A. Normal finding
B. Mild heart failure
C. Worsening heart failure
D. Dehydration
Answer: C
Rationale: BNP levels above 900 pg/mL typically indicate
worsening heart failure. Normal BNP is usually less than 100
pg/mL.
2. Which assessment finding is most concerning in a patient
receiving digoxin?
A. Heart rate of 88 bpm
B. Visual disturbances with yellow halos
C. Blood pressure of 118/76 mm Hg
,D. Mild fatigue
Answer: B
Rationale: Visual disturbances such as yellow halos are signs of
digoxin toxicity. This requires immediate intervention.
3. A patient with COPD has an oxygen saturation of 88%. What
is the appropriate initial action?
A. Administer high-flow oxygen
B. Position patient supine
C. Administer low-flow oxygen
D. Encourage coughing
Answer: C
Rationale: In COPD, low-flow oxygen (1-2 L/min) is used to avoid
suppressing the hypoxic drive while improving saturation.
4. Which lab value indicates acute kidney injury in a patient
with decreased urine output?
A. BUN 18 mg/dL
B. Creatinine 2.8 mg/dL
C. Potassium 4.0 mEq/L
,D. Hemoglobin 13 g/dL
Answer: B
Rationale: Creatinine above 1.3 mg/dL suggests impaired kidney
function. A rise to 2.8 indicates significant injury.
5. A patient on heparin has a PTT of 95 seconds. What is the
priority action?
A. Increase heparin dose
B. Hold heparin and notify provider
C. Continue current infusion
D. Administer vitamin K
Answer: B
Rationale: Therapeutic PTT is typically 1.5 to 2.5 times normal
(about 60-80 seconds). A PTT of 95 is elevated and increases
bleeding risk.
6. Which finding suggests increased intracranial pressure?
A. Pupils equal and reactive
B. Blood pressure 110/70 mm Hg
C. Decreased level of consciousness
, D. Heart rate 90 bpm
Answer: C
Rationale: A decreasing level of consciousness is an early and
sensitive indicator of increased intracranial pressure.
7. A patient with diabetes has a blood glucose of 45 mg/dL and
is unconscious. What should the nurse do first?
A. Give oral glucose gel
B. Administer IV dextrose
C. Start an insulin drip
D. Check HbA1c
Answer: B
Rationale: For an unconscious patient with hypoglycemia, IV
dextrose is given because oral intake is unsafe.
8. Which intervention is most important for preventing
ventilator-associated pneumonia?
A. Suctioning every hour
B. Elevating the head of the bed 30 to 45 degrees
C. Changing the ventilator circuit daily
exam, Actual Questions with Verified Answers |
New 2025/2026 Update | 100% Correct.
1. A 68-year-old patient with heart failure has a BNP of 950
pg/mL. Which interpretation is most accurate?
A. Normal finding
B. Mild heart failure
C. Worsening heart failure
D. Dehydration
Answer: C
Rationale: BNP levels above 900 pg/mL typically indicate
worsening heart failure. Normal BNP is usually less than 100
pg/mL.
2. Which assessment finding is most concerning in a patient
receiving digoxin?
A. Heart rate of 88 bpm
B. Visual disturbances with yellow halos
C. Blood pressure of 118/76 mm Hg
,D. Mild fatigue
Answer: B
Rationale: Visual disturbances such as yellow halos are signs of
digoxin toxicity. This requires immediate intervention.
3. A patient with COPD has an oxygen saturation of 88%. What
is the appropriate initial action?
A. Administer high-flow oxygen
B. Position patient supine
C. Administer low-flow oxygen
D. Encourage coughing
Answer: C
Rationale: In COPD, low-flow oxygen (1-2 L/min) is used to avoid
suppressing the hypoxic drive while improving saturation.
4. Which lab value indicates acute kidney injury in a patient
with decreased urine output?
A. BUN 18 mg/dL
B. Creatinine 2.8 mg/dL
C. Potassium 4.0 mEq/L
,D. Hemoglobin 13 g/dL
Answer: B
Rationale: Creatinine above 1.3 mg/dL suggests impaired kidney
function. A rise to 2.8 indicates significant injury.
5. A patient on heparin has a PTT of 95 seconds. What is the
priority action?
A. Increase heparin dose
B. Hold heparin and notify provider
C. Continue current infusion
D. Administer vitamin K
Answer: B
Rationale: Therapeutic PTT is typically 1.5 to 2.5 times normal
(about 60-80 seconds). A PTT of 95 is elevated and increases
bleeding risk.
6. Which finding suggests increased intracranial pressure?
A. Pupils equal and reactive
B. Blood pressure 110/70 mm Hg
C. Decreased level of consciousness
, D. Heart rate 90 bpm
Answer: C
Rationale: A decreasing level of consciousness is an early and
sensitive indicator of increased intracranial pressure.
7. A patient with diabetes has a blood glucose of 45 mg/dL and
is unconscious. What should the nurse do first?
A. Give oral glucose gel
B. Administer IV dextrose
C. Start an insulin drip
D. Check HbA1c
Answer: B
Rationale: For an unconscious patient with hypoglycemia, IV
dextrose is given because oral intake is unsafe.
8. Which intervention is most important for preventing
ventilator-associated pneumonia?
A. Suctioning every hour
B. Elevating the head of the bed 30 to 45 degrees
C. Changing the ventilator circuit daily
