Adult Acute Care Nurse Practitioner ACNP-BC
Actual Questions with Verified Answers | New
2025/2026 Update | 100% Correct.
1. A patient presents with acute respiratory distress,
hypoxemia, and bilateral pulmonary infiltrates without evidence
of heart failure. What is the most likely diagnosis?
A. Cardiogenic pulmonary edema
B. Acute respiratory distress syndrome
C. Pulmonary embolism
D. Pneumonia
Answer: B
Rationale: Acute respiratory distress syndrome presents with
acute onset hypoxemia, bilateral infiltrates, and no evidence of
cardiogenic cause. It is caused by increased alveolar-capillary
permeability from inflammation or injury.
2. Which hemodynamic parameter is most consistent with
cardiogenic shock?
A. Low cardiac index and high pulmonary capillary wedge
pressure
,B. High cardiac index and low pulmonary capillary wedge
pressure
C. Low cardiac index and low pulmonary capillary wedge
pressure
D. High cardiac index and high pulmonary capillary wedge
pressure
Answer: A
Rationale: Cardiogenic shock is characterized by a cardiac index
below 2.2 L/min/m2 and a pulmonary capillary wedge pressure
above 18 mm Hg, indicating pump failure with fluid backup.
3. A patient with severe sepsis has a lactate level of 5 mmol/L.
What is the priority intervention?
A. Administer antibiotics within one hour
B. Begin fluid resuscitation with crystalloids
C. Obtain blood cultures
D. Start vasopressors
Answer: B
Rationale: In sepsis, initial management includes rapid
crystalloid resuscitation of 30 mL/kg for hypotension or lactate
,of 4 mmol/L or greater. Cultures should be drawn before
antibiotics, but fluids are the immediate priority.
4. Which finding indicates acute respiratory distress syndrome
severity based on the Berlin definition?
A. PaO2/FiO2 ratio of 250 with positive end-expiratory pressure
of 5 or greater
B. PaO2/FiO2 ratio of 350
C. PaO2/FiO2 ratio of 500
D. PaO2/FiO2 ratio of 450
Answer: A
Rationale: The Berlin definition classifies acute respiratory
distress syndrome as mild with a PaO2/FiO2 ratio of 200 to 300,
moderate with 100 to 200, and severe with less than 100, all
requiring positive end-expiratory pressure of 5 or greater.
5. A patient is intubated and mechanically ventilated. Which
measure best reduces the risk of ventilator-induced lung injury?
A. High tidal volumes
B. Low tidal volumes of 6 mL/kg predicted body weight
C. High plateau pressures
, D. Zero positive end-expiratory pressure
Answer: B
Rationale: Lung-protective ventilation with tidal volumes of 6
mL/kg predicted body weight and plateau pressures below 30
cm H2O reduces ventilator-induced lung injury and mortality.
6. Which medication is first-line for anaphylactic shock?
A. Diphenhydramine
B. Epinephrine
C. Methylprednisolone
D. Albuterol
Answer: B
Rationale: Intramuscular epinephrine is the first-line treatment
for anaphylaxis. It reverses bronchospasm, vasodilation, and
capillary leak. Antihistamines and steroids are adjuncts.
7. A patient has a blood glucose of 45 mg/dL and is
unresponsive. What is the priority intervention?
A. Oral glucose
B. Intravenous dextrose
Actual Questions with Verified Answers | New
2025/2026 Update | 100% Correct.
1. A patient presents with acute respiratory distress,
hypoxemia, and bilateral pulmonary infiltrates without evidence
of heart failure. What is the most likely diagnosis?
A. Cardiogenic pulmonary edema
B. Acute respiratory distress syndrome
C. Pulmonary embolism
D. Pneumonia
Answer: B
Rationale: Acute respiratory distress syndrome presents with
acute onset hypoxemia, bilateral infiltrates, and no evidence of
cardiogenic cause. It is caused by increased alveolar-capillary
permeability from inflammation or injury.
2. Which hemodynamic parameter is most consistent with
cardiogenic shock?
A. Low cardiac index and high pulmonary capillary wedge
pressure
,B. High cardiac index and low pulmonary capillary wedge
pressure
C. Low cardiac index and low pulmonary capillary wedge
pressure
D. High cardiac index and high pulmonary capillary wedge
pressure
Answer: A
Rationale: Cardiogenic shock is characterized by a cardiac index
below 2.2 L/min/m2 and a pulmonary capillary wedge pressure
above 18 mm Hg, indicating pump failure with fluid backup.
3. A patient with severe sepsis has a lactate level of 5 mmol/L.
What is the priority intervention?
A. Administer antibiotics within one hour
B. Begin fluid resuscitation with crystalloids
C. Obtain blood cultures
D. Start vasopressors
Answer: B
Rationale: In sepsis, initial management includes rapid
crystalloid resuscitation of 30 mL/kg for hypotension or lactate
,of 4 mmol/L or greater. Cultures should be drawn before
antibiotics, but fluids are the immediate priority.
4. Which finding indicates acute respiratory distress syndrome
severity based on the Berlin definition?
A. PaO2/FiO2 ratio of 250 with positive end-expiratory pressure
of 5 or greater
B. PaO2/FiO2 ratio of 350
C. PaO2/FiO2 ratio of 500
D. PaO2/FiO2 ratio of 450
Answer: A
Rationale: The Berlin definition classifies acute respiratory
distress syndrome as mild with a PaO2/FiO2 ratio of 200 to 300,
moderate with 100 to 200, and severe with less than 100, all
requiring positive end-expiratory pressure of 5 or greater.
5. A patient is intubated and mechanically ventilated. Which
measure best reduces the risk of ventilator-induced lung injury?
A. High tidal volumes
B. Low tidal volumes of 6 mL/kg predicted body weight
C. High plateau pressures
, D. Zero positive end-expiratory pressure
Answer: B
Rationale: Lung-protective ventilation with tidal volumes of 6
mL/kg predicted body weight and plateau pressures below 30
cm H2O reduces ventilator-induced lung injury and mortality.
6. Which medication is first-line for anaphylactic shock?
A. Diphenhydramine
B. Epinephrine
C. Methylprednisolone
D. Albuterol
Answer: B
Rationale: Intramuscular epinephrine is the first-line treatment
for anaphylaxis. It reverses bronchospasm, vasodilation, and
capillary leak. Antihistamines and steroids are adjuncts.
7. A patient has a blood glucose of 45 mg/dL and is
unresponsive. What is the priority intervention?
A. Oral glucose
B. Intravenous dextrose
