AACN ACNPC-AG Certification PSI Proctored Exam Complete 175
Questions Adult -Gerontology Acute Care Nurse Practitioner
Certification AACN ACNPC-AG Exam Review with Answers and
Rationales | 100% Pass Guaranteed | Graded A+ |
AACN ACNPC-AG Certification Practice Exam – Batch 1a
(Adult-Gerontology Acute Care Nurse Practitioner)
1. A 74-year-old male with severe COPD is admitted with acute
hypoxemic respiratory failure. ABGs: pH 7.30, PaCO₂ 65 mmHg, PaO₂
52 mmHg. Which initial intervention is most appropriate?
A. Initiate high-flow nasal cannula at 60 L/min
B. Begin noninvasive positive pressure ventilation (NPPV)
C. Administer 100% oxygen via non-rebreather mask
D. Proceed directly to endotracheal intubation
Rationale: In acute-on-chronic respiratory failure due to COPD, NPPV
is preferred to avoid intubation and reduce mortality. High oxygen
concentrations without ventilation support can worsen hypercapnia.
Intubation is reserved for failure of NPPV.
Test-taking strategy: Watch for COPD cases with hypercapnia —
NPPV is often the first-line unless contraindicated.
2. In acute decompensated heart failure with pulmonary edema, the
nurse practitioner’s first priority is:
,A. Initiate IV beta-blocker therapy
B. Administer IV loop diuretics
C. Restrict fluids to <1 L/day
D. Arrange for urgent echocardiography
Rationale: IV loop diuretics rapidly reduce preload and relieve
pulmonary congestion. Beta-blockers should not be initiated in acute
decompensation.
Test-taking strategy: In “flash” pulmonary edema, think oxygen +
diuresis first.
3. A 68-year-old woman with atrial fibrillation is starting amiodarone.
Which baseline test is most important?
A. Fasting lipid profile
B. Thyroid function tests
C. Serum magnesium level
D. Liver ultrasound
Rationale: Amiodarone affects thyroid function (hypo- or
hyperthyroidism). Baseline thyroid, liver, and pulmonary function
testing is recommended.
Test-taking strategy: Always recall amiodarone → “Lung, Liver,
Thyroid” monitoring.
4. Which lab abnormality is most consistent with tumor lysis
syndrome?
A. Hypophosphatemia, hypercalcemia, hypouricemia
B. Hypokalemia, hypophosphatemia, hypercalcemia
C. Hyperkalemia, hyperphosphatemia, hyperuricemia
D. Hypernatremia, hypocalcemia, hypophosphatemia
,Rationale: Tumor lysis releases potassium, phosphate, and uric acid,
often causing secondary hypocalcemia.
Test-taking strategy: Remember “KPU” — potassium, phosphate, uric
acid ↑.
5. A patient with septic shock has MAP 58 mmHg after 30 mL/kg
crystalloid bolus. Which is the best next step?
A. Start dopamine infusion
B. Begin norepinephrine infusion
C. Give another fluid bolus of 2 L
D. Administer IV hydrocortisone immediately
Rationale: After adequate fluid resuscitation, norepinephrine is the
first-line vasopressor in septic shock to maintain MAP ≥65 mmHg.
Test-taking strategy: In septic shock, fluids first → norepinephrine if
MAP <65.
6. A 70-year-old with ischemic stroke arrives 1 hour after symptom
onset. CT head is negative for hemorrhage. What is the next best
step?
A. Start aspirin 325 mg
B. Initiate IV alteplase (tPA) per protocol
C. Begin heparin infusion
D. Arrange for carotid Doppler study
Rationale: IV alteplase within 3–4.5 hours improves outcomes in
ischemic stroke if no contraindications. Aspirin is given after tPA or if
outside the window.
Test-taking strategy: Stroke timing is everything — if in window and
no bleed, go tPA.
, 7. Which finding is most specific for cardiogenic shock?
A. Narrow pulse pressure
B. Warm, flushed extremities
C. Elevated pulmonary capillary wedge pressure (PCWP)
D. Low systemic vascular resistance
Rationale: Cardiogenic shock shows high filling pressures (PCWP >18
mmHg) with low cardiac output. Low SVR is more common in
distributive shock.
Test-taking strategy: PCWP high = pump failure, PCWP low =
distributive or hypovolemic.
8. Which antibiotic requires serum level monitoring due to
nephrotoxicity risk?
A. Piperacillin-tazobactam
B. Cefepime
C. Vancomycin
D. Azithromycin
Rationale: Vancomycin requires trough monitoring to ensure efficacy
and minimize nephrotoxicity and ototoxicity.
Test-taking strategy: High-yield: Aminoglycosides + Vancomycin =
“check the troughs.”
9. A patient with cirrhosis presents with confusion, asterixis, and
ammonia level 88 μmol/L. Which intervention is first-line?
A. Restrict protein intake
B. Administer lactulose
Questions Adult -Gerontology Acute Care Nurse Practitioner
Certification AACN ACNPC-AG Exam Review with Answers and
Rationales | 100% Pass Guaranteed | Graded A+ |
AACN ACNPC-AG Certification Practice Exam – Batch 1a
(Adult-Gerontology Acute Care Nurse Practitioner)
1. A 74-year-old male with severe COPD is admitted with acute
hypoxemic respiratory failure. ABGs: pH 7.30, PaCO₂ 65 mmHg, PaO₂
52 mmHg. Which initial intervention is most appropriate?
A. Initiate high-flow nasal cannula at 60 L/min
B. Begin noninvasive positive pressure ventilation (NPPV)
C. Administer 100% oxygen via non-rebreather mask
D. Proceed directly to endotracheal intubation
Rationale: In acute-on-chronic respiratory failure due to COPD, NPPV
is preferred to avoid intubation and reduce mortality. High oxygen
concentrations without ventilation support can worsen hypercapnia.
Intubation is reserved for failure of NPPV.
Test-taking strategy: Watch for COPD cases with hypercapnia —
NPPV is often the first-line unless contraindicated.
2. In acute decompensated heart failure with pulmonary edema, the
nurse practitioner’s first priority is:
,A. Initiate IV beta-blocker therapy
B. Administer IV loop diuretics
C. Restrict fluids to <1 L/day
D. Arrange for urgent echocardiography
Rationale: IV loop diuretics rapidly reduce preload and relieve
pulmonary congestion. Beta-blockers should not be initiated in acute
decompensation.
Test-taking strategy: In “flash” pulmonary edema, think oxygen +
diuresis first.
3. A 68-year-old woman with atrial fibrillation is starting amiodarone.
Which baseline test is most important?
A. Fasting lipid profile
B. Thyroid function tests
C. Serum magnesium level
D. Liver ultrasound
Rationale: Amiodarone affects thyroid function (hypo- or
hyperthyroidism). Baseline thyroid, liver, and pulmonary function
testing is recommended.
Test-taking strategy: Always recall amiodarone → “Lung, Liver,
Thyroid” monitoring.
4. Which lab abnormality is most consistent with tumor lysis
syndrome?
A. Hypophosphatemia, hypercalcemia, hypouricemia
B. Hypokalemia, hypophosphatemia, hypercalcemia
C. Hyperkalemia, hyperphosphatemia, hyperuricemia
D. Hypernatremia, hypocalcemia, hypophosphatemia
,Rationale: Tumor lysis releases potassium, phosphate, and uric acid,
often causing secondary hypocalcemia.
Test-taking strategy: Remember “KPU” — potassium, phosphate, uric
acid ↑.
5. A patient with septic shock has MAP 58 mmHg after 30 mL/kg
crystalloid bolus. Which is the best next step?
A. Start dopamine infusion
B. Begin norepinephrine infusion
C. Give another fluid bolus of 2 L
D. Administer IV hydrocortisone immediately
Rationale: After adequate fluid resuscitation, norepinephrine is the
first-line vasopressor in septic shock to maintain MAP ≥65 mmHg.
Test-taking strategy: In septic shock, fluids first → norepinephrine if
MAP <65.
6. A 70-year-old with ischemic stroke arrives 1 hour after symptom
onset. CT head is negative for hemorrhage. What is the next best
step?
A. Start aspirin 325 mg
B. Initiate IV alteplase (tPA) per protocol
C. Begin heparin infusion
D. Arrange for carotid Doppler study
Rationale: IV alteplase within 3–4.5 hours improves outcomes in
ischemic stroke if no contraindications. Aspirin is given after tPA or if
outside the window.
Test-taking strategy: Stroke timing is everything — if in window and
no bleed, go tPA.
, 7. Which finding is most specific for cardiogenic shock?
A. Narrow pulse pressure
B. Warm, flushed extremities
C. Elevated pulmonary capillary wedge pressure (PCWP)
D. Low systemic vascular resistance
Rationale: Cardiogenic shock shows high filling pressures (PCWP >18
mmHg) with low cardiac output. Low SVR is more common in
distributive shock.
Test-taking strategy: PCWP high = pump failure, PCWP low =
distributive or hypovolemic.
8. Which antibiotic requires serum level monitoring due to
nephrotoxicity risk?
A. Piperacillin-tazobactam
B. Cefepime
C. Vancomycin
D. Azithromycin
Rationale: Vancomycin requires trough monitoring to ensure efficacy
and minimize nephrotoxicity and ototoxicity.
Test-taking strategy: High-yield: Aminoglycosides + Vancomycin =
“check the troughs.”
9. A patient with cirrhosis presents with confusion, asterixis, and
ammonia level 88 μmol/L. Which intervention is first-line?
A. Restrict protein intake
B. Administer lactulose
