AG-ACNP Board Exam with Complete
Solutions
what is the creatinine clearance formula? Correct Ans-140 - age in years x body weight in kg
(times 0.58 for women)
what is a normal creatinine clearance in males and females? Correct Ans-males: 97-137
females: 88-128
what is the most common illness for adults over 65 years of age? Correct Ans-UTI
what does CVP measure? what is normal? Correct Ans-measure of the pressure exerted by
fluid in the right atrium; indicative of right-sided heart failure; normal is 0-6
what does the pulmonary artery pressure? what is normal? Correct Ans--measure of the
systolic and diastolic pressures in the pulmonary artery
-(15-25)/(5-15)
what does the pulmonary capillary wedge pressure measure? what is another name for it? what is
normal? Correct Ans--measure of the pressure in the left ventricle at end-diastole (maximal
stretch); indicative of left sided heart function and reflects the tendency to develop pulmonary
edema
-pulmonary artery occlusion pressure (PAOP)
,- 6-12 mmHg
what does the cardiac output measure? what is normal? Correct Ans--amount of fluid in liters
per minute that the heart pumps into systemic circulation; HR X SV
- normal is 4-8 L/min
what does the cardiac index measure? what is the normal? Correct Ans--cardiac output/body
surface area; more accurate measure than CO because it takes BSA into account
-normal is 2.5-4 L/min
what does the systemic vascular resistance measure? what is the formula? what is normal?
Correct Ans--the resistance provided by the systemic circulation against which the left
ventricle must pump blood
-(MAP-mean CVP X 80)/CO
-800-1200 dynes/sec/cm-5
what does mixed venous O2 saturation measure? what is normal? what do low values mean?
what do high values mean? Correct Ans--continuous display of mixed venous oxygen
,saturation by the pulmonary artery catheter; assesses the effectiveness of peripheral oxygen
delivery
-normal is 60-80%
-values <60% means the patient needs more O2
-values >80% implies the patient is getting O2 but not using it
what causes hypovolemic shock? what do the hemodynamic values look like? what is the
management? Correct Ans--loss of greater than 20% of circulating blood volume caused by
bleeding, burns, DKA/HHNK, dehydration, OR, etc
-all values decreased except SVR is high as a compensatory technique for decreased CO
-fluid resuscitation is the mainstay of treatment
what causes cardiogenic shock? what do the hemodynamic values look like? what is the
management? Correct Ans--loss of effective contractile function results in impaired CO,
impaired O2 delivery, and reduced tissue perfusion caused by acute MI (most common cause),
dysrhythmia, tamponade, hypoxemia, pulmonary edema
-decreased CO/CI, increased SVR (compensate for low CO), increased CVP and PCWP (blood
pooling in heart since it cannot be pumped out), and decreased SVO2 (decreased CO means less
O2 in periphery)
, -careful IV fluids, vasopressor support
what is distributive shock? what causes it? Correct Ans--three forms of shock characterized
by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss
of capillary integrity which can be caused by septic, anaphylactic, and neurogenic
what causes septic shock? what do the hemodynamic values look like? what is the management?
Correct Ans--infective organisms that invade the bloodstream and alter vascular tone; blood
pools in the microcirculation
-increased CO/CI (only type of shock that does this), decreased CVP, decreased PCWP,
decreased SVR, decreased SVO2
-fluid resuscitation, initiate abx within one hour of diagnosis, vasopressor agents
what causes anaphylactic shock? what do the hemodynamic values look like? what is the
management? Correct Ans--IgE mediated reaction that occurs shortly after exposure to an
allergen creating vasodilation
-decreased all hemodynamics
-maintain airway, crystalloids for volume, diphenhydramine IV or IM, epinephrine SQ for
respiratory distress/stridor/wheezing, IV glucocorticoids
Solutions
what is the creatinine clearance formula? Correct Ans-140 - age in years x body weight in kg
(times 0.58 for women)
what is a normal creatinine clearance in males and females? Correct Ans-males: 97-137
females: 88-128
what is the most common illness for adults over 65 years of age? Correct Ans-UTI
what does CVP measure? what is normal? Correct Ans-measure of the pressure exerted by
fluid in the right atrium; indicative of right-sided heart failure; normal is 0-6
what does the pulmonary artery pressure? what is normal? Correct Ans--measure of the
systolic and diastolic pressures in the pulmonary artery
-(15-25)/(5-15)
what does the pulmonary capillary wedge pressure measure? what is another name for it? what is
normal? Correct Ans--measure of the pressure in the left ventricle at end-diastole (maximal
stretch); indicative of left sided heart function and reflects the tendency to develop pulmonary
edema
-pulmonary artery occlusion pressure (PAOP)
,- 6-12 mmHg
what does the cardiac output measure? what is normal? Correct Ans--amount of fluid in liters
per minute that the heart pumps into systemic circulation; HR X SV
- normal is 4-8 L/min
what does the cardiac index measure? what is the normal? Correct Ans--cardiac output/body
surface area; more accurate measure than CO because it takes BSA into account
-normal is 2.5-4 L/min
what does the systemic vascular resistance measure? what is the formula? what is normal?
Correct Ans--the resistance provided by the systemic circulation against which the left
ventricle must pump blood
-(MAP-mean CVP X 80)/CO
-800-1200 dynes/sec/cm-5
what does mixed venous O2 saturation measure? what is normal? what do low values mean?
what do high values mean? Correct Ans--continuous display of mixed venous oxygen
,saturation by the pulmonary artery catheter; assesses the effectiveness of peripheral oxygen
delivery
-normal is 60-80%
-values <60% means the patient needs more O2
-values >80% implies the patient is getting O2 but not using it
what causes hypovolemic shock? what do the hemodynamic values look like? what is the
management? Correct Ans--loss of greater than 20% of circulating blood volume caused by
bleeding, burns, DKA/HHNK, dehydration, OR, etc
-all values decreased except SVR is high as a compensatory technique for decreased CO
-fluid resuscitation is the mainstay of treatment
what causes cardiogenic shock? what do the hemodynamic values look like? what is the
management? Correct Ans--loss of effective contractile function results in impaired CO,
impaired O2 delivery, and reduced tissue perfusion caused by acute MI (most common cause),
dysrhythmia, tamponade, hypoxemia, pulmonary edema
-decreased CO/CI, increased SVR (compensate for low CO), increased CVP and PCWP (blood
pooling in heart since it cannot be pumped out), and decreased SVO2 (decreased CO means less
O2 in periphery)
, -careful IV fluids, vasopressor support
what is distributive shock? what causes it? Correct Ans--three forms of shock characterized
by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss
of capillary integrity which can be caused by septic, anaphylactic, and neurogenic
what causes septic shock? what do the hemodynamic values look like? what is the management?
Correct Ans--infective organisms that invade the bloodstream and alter vascular tone; blood
pools in the microcirculation
-increased CO/CI (only type of shock that does this), decreased CVP, decreased PCWP,
decreased SVR, decreased SVO2
-fluid resuscitation, initiate abx within one hour of diagnosis, vasopressor agents
what causes anaphylactic shock? what do the hemodynamic values look like? what is the
management? Correct Ans--IgE mediated reaction that occurs shortly after exposure to an
allergen creating vasodilation
-decreased all hemodynamics
-maintain airway, crystalloids for volume, diphenhydramine IV or IM, epinephrine SQ for
respiratory distress/stridor/wheezing, IV glucocorticoids
