AACN ACNPC-AG
Certification PSI
Proctored Exam
1. A 68-year-old male presents with sudden onset shortness of breath and pleuritic
chest pain. Oxygen saturation is 88% on room air. Which is the most likely initial
diagnostic test?
A) ECG
B) Chest X-ray
C) D-dimer
D) Pulmonary CT angiography
Answer: D) Pulmonary CT angiography
Rationale: Sudden dyspnea and pleuritic pain in older adults raises concern for
pulmonary embolism. CT pulmonary angiography is the gold standard for diagnosis
in hemodynamically stable patients.
2. Which lab value most accurately reflects long-term glycemic control in a patient
with type 2 diabetes?
A) Fasting glucose
B) Random glucose
C) Hemoglobin A1c
D) Serum fructosamine
Answer: C) Hemoglobin A1c
,Rationale: Hemoglobin A1c reflects average blood glucose over 2–3 months and is
preferred for long-term management assessment.
3. A patient presents with new-onset confusion, fever, and nuchal rigidity. What is
the next best step?
A) Start broad-spectrum antibiotics
B) Perform lumbar puncture
C) Obtain head CT
D) Start antiviral therapy
Answer: C) Obtain head CT
Rationale: CT is recommended before lumbar puncture if there are signs of increased
intracranial pressure or neurologic deficits to prevent herniation.
Domain 2: Pharmacology and Therapeutics
4. A patient with acute decompensated heart failure presents with pulmonary
edema. Which medication is first-line for rapid symptom relief?
A) Furosemide
B) Metoprolol
C) Lisinopril
D) Spironolactone
Answer: A) Furosemide
Rationale: Loop diuretics provide rapid diuresis and symptom relief in acute
pulmonary edema.
5. Which antibiotic is first-line for methicillin-resistant Staphylococcus aureus (MRSA)
bacteremia in adults?
A) Vancomycin
B) Ceftriaxone
C) Amoxicillin
,D) Piperacillin-tazobactam
Answer: A) Vancomycin
Rationale: Vancomycin is recommended for initial empiric treatment of MRSA
bacteremia in adults.
6. A patient with chronic kidney disease stage 4 requires pain control. Which
medication is safest for long-term use?
A) Morphine
B) Hydromorphone
C) Ibuprofen
D) Oxycodone
Answer: B) Hydromorphone
Rationale: Morphine accumulates in renal failure; hydromorphone is safer as it has
fewer active metabolites excreted renally.
Domain 3: Clinical Management
7. A patient with COPD exacerbation presents with increased sputum, dyspnea, and
wheezing. Which management is most appropriate?
A) Initiate inhaled corticosteroids only
B) Prescribe systemic corticosteroids and bronchodilators
C) Start long-term oxygen therapy only
D) Recommend immediate intubation
Answer: B) Prescribe systemic corticosteroids and bronchodilators
Rationale: Exacerbations are treated with short courses of systemic corticosteroids
and inhaled bronchodilators to reduce inflammation and improve airflow.
8. Which parameter is most indicative of septic shock?
A) Systolic BP <100 mmHg with tachycardia
, B) MAP <65 mmHg after fluid resuscitation
C) Fever >38°C
D) WBC >12,000
Answer: B) MAP <65 mmHg after fluid resuscitation
Rationale: Persistent hypotension despite adequate fluid resuscitation defines septic
shock per the Sepsis-3 criteria.
9. For a patient with newly diagnosed atrial fibrillation, which therapy is
recommended for stroke prevention in a patient with CHA₂DS₂-VASc score of 3?
A) Aspirin
B) Warfarin or DOAC
C) No anticoagulation needed
D) Clopidogrel
Answer: B) Warfarin or DOAC
Rationale: Patients with CHA₂DS₂-VASc ≥2 should receive anticoagulation to reduce
stroke risk.
Domain 4: Advanced Practice Skills & Professional Issues
10. Which is the most appropriate action if a colleague is practicing outside their
scope of practice?
A) Ignore it
B) Report to the facility risk manager or supervisor
C) Confront them aggressively
D) Post about it on social media
Answer: B) Report to the facility risk manager or supervisor
Rationale: Patient safety is paramount. Professional channels should be used to
address scope-of-practice violations.
Certification PSI
Proctored Exam
1. A 68-year-old male presents with sudden onset shortness of breath and pleuritic
chest pain. Oxygen saturation is 88% on room air. Which is the most likely initial
diagnostic test?
A) ECG
B) Chest X-ray
C) D-dimer
D) Pulmonary CT angiography
Answer: D) Pulmonary CT angiography
Rationale: Sudden dyspnea and pleuritic pain in older adults raises concern for
pulmonary embolism. CT pulmonary angiography is the gold standard for diagnosis
in hemodynamically stable patients.
2. Which lab value most accurately reflects long-term glycemic control in a patient
with type 2 diabetes?
A) Fasting glucose
B) Random glucose
C) Hemoglobin A1c
D) Serum fructosamine
Answer: C) Hemoglobin A1c
,Rationale: Hemoglobin A1c reflects average blood glucose over 2–3 months and is
preferred for long-term management assessment.
3. A patient presents with new-onset confusion, fever, and nuchal rigidity. What is
the next best step?
A) Start broad-spectrum antibiotics
B) Perform lumbar puncture
C) Obtain head CT
D) Start antiviral therapy
Answer: C) Obtain head CT
Rationale: CT is recommended before lumbar puncture if there are signs of increased
intracranial pressure or neurologic deficits to prevent herniation.
Domain 2: Pharmacology and Therapeutics
4. A patient with acute decompensated heart failure presents with pulmonary
edema. Which medication is first-line for rapid symptom relief?
A) Furosemide
B) Metoprolol
C) Lisinopril
D) Spironolactone
Answer: A) Furosemide
Rationale: Loop diuretics provide rapid diuresis and symptom relief in acute
pulmonary edema.
5. Which antibiotic is first-line for methicillin-resistant Staphylococcus aureus (MRSA)
bacteremia in adults?
A) Vancomycin
B) Ceftriaxone
C) Amoxicillin
,D) Piperacillin-tazobactam
Answer: A) Vancomycin
Rationale: Vancomycin is recommended for initial empiric treatment of MRSA
bacteremia in adults.
6. A patient with chronic kidney disease stage 4 requires pain control. Which
medication is safest for long-term use?
A) Morphine
B) Hydromorphone
C) Ibuprofen
D) Oxycodone
Answer: B) Hydromorphone
Rationale: Morphine accumulates in renal failure; hydromorphone is safer as it has
fewer active metabolites excreted renally.
Domain 3: Clinical Management
7. A patient with COPD exacerbation presents with increased sputum, dyspnea, and
wheezing. Which management is most appropriate?
A) Initiate inhaled corticosteroids only
B) Prescribe systemic corticosteroids and bronchodilators
C) Start long-term oxygen therapy only
D) Recommend immediate intubation
Answer: B) Prescribe systemic corticosteroids and bronchodilators
Rationale: Exacerbations are treated with short courses of systemic corticosteroids
and inhaled bronchodilators to reduce inflammation and improve airflow.
8. Which parameter is most indicative of septic shock?
A) Systolic BP <100 mmHg with tachycardia
, B) MAP <65 mmHg after fluid resuscitation
C) Fever >38°C
D) WBC >12,000
Answer: B) MAP <65 mmHg after fluid resuscitation
Rationale: Persistent hypotension despite adequate fluid resuscitation defines septic
shock per the Sepsis-3 criteria.
9. For a patient with newly diagnosed atrial fibrillation, which therapy is
recommended for stroke prevention in a patient with CHA₂DS₂-VASc score of 3?
A) Aspirin
B) Warfarin or DOAC
C) No anticoagulation needed
D) Clopidogrel
Answer: B) Warfarin or DOAC
Rationale: Patients with CHA₂DS₂-VASc ≥2 should receive anticoagulation to reduce
stroke risk.
Domain 4: Advanced Practice Skills & Professional Issues
10. Which is the most appropriate action if a colleague is practicing outside their
scope of practice?
A) Ignore it
B) Report to the facility risk manager or supervisor
C) Confront them aggressively
D) Post about it on social media
Answer: B) Report to the facility risk manager or supervisor
Rationale: Patient safety is paramount. Professional channels should be used to
address scope-of-practice violations.
