AACN ACNPC-AG Certification Review Exam – Adult-
Gerontology Acute Care NP Questions and Correct Answers With
Rationales Graded A+| 2026 Updated
1. A 68-year-old male with a history of COPD is admitted with acute exacerbation.
He is tachypneic, using accessory muscles, and has an oxygen saturation of 88%
on 2 L nasal cannula. Which is the most appropriate initial management?
A. Initiate noninvasive positive pressure ventilation (NIPPV)
B. Increase supplemental oxygen to 6 L/min via nasal cannula
C. Immediate intubation and mechanical ventilation
D. Administer intravenous corticosteroids only
Answer: A
Rationale: Acute exacerbation of COPD with hypoxemia and increased work of
breathing warrants NIPPV to reduce work of breathing and avoid intubation.
Simply increasing oxygen may worsen hypercapnia. Intubation is reserved for
those failing NIPPV. Corticosteroids alone are insufficient in acute respiratory
distress.
2. A patient presents with sepsis secondary to pneumonia. Initial labs show lactate
4.2 mmol/L and BP 88/52 mmHg. According to current sepsis guidelines, what is
the first-line intervention?
A. Start broad-spectrum IV antibiotics and fluid resuscitation
B. Obtain cultures only, hold fluids until source control
C. Immediate vasopressors without fluids
D. Begin corticosteroids immediately
Answer: A
Rationale: Early broad-spectrum antibiotics and aggressive fluid resuscitation
are the cornerstone of sepsis management. Vasopressors are added if hypotension
persists after fluids. Delaying antibiotics increases mortality.
,3. A 72-year-old female with atrial fibrillation is admitted with rapid ventricular
response and acute decompensated heart failure. She is hypotensive and dyspneic.
Which agent is contraindicated?
A. IV diltiazem
B. IV digoxin
C. IV amiodarone
D. IV furosemide
Answer: A
Rationale: Calcium channel blockers such as diltiazem are contraindicated in
hypotensive patients with acute decompensated heart failure due to negative
inotropic effects. Digoxin may help control rate, amiodarone is safe for rate/rhythm
control, and furosemide treats volume overload.
4. A patient develops acute hypoxemia after initiation of enteral feeding via NG
tube. CXR shows right lower lobe infiltrate. The most likely cause is:
A. Pulmonary embolism
B. Aspiration pneumonia
C. Heart failure exacerbation
D. Pneumothorax
Answer: B
Rationale: Acute hypoxemia following enteral feeding with localized infiltrate is
consistent with aspiration pneumonia. Risk factors include altered mental status
or impaired swallowing.
5. A 65-year-old male presents with acute chest pain and ST-elevation in leads II,
III, aVF. Which coronary artery is most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Posterior descending artery
Answer: B
,Rationale: Inferior STEMI (leads II, III, aVF) is usually due to right coronary
artery (RCA) occlusion. LAD occlusion causes anterior STEMI (V1–V4), and
circumflex occlusion often causes lateral wall changes.
6. A 70-year-old male with chronic kidney disease stage 4 develops hyperkalemia
(K+ 6.8 mmol/L) with peaked T waves on ECG. Immediate management should
include:
A. IV calcium gluconate
B. Oral potassium binder only
C. IV furosemide
D. Observation and repeat labs
Answer: A
Rationale: IV calcium gluconate stabilizes the cardiac membrane in
hyperkalemia. This is emergent management. Other interventions (insulin/glucose,
beta-agonist, dialysis) follow for potassium reduction.
7. Which of the following is the preferred first-line empiric antibiotic for a
suspected hospital-acquired pneumonia in a mechanically ventilated patient?
A. Vancomycin alone
B. Piperacillin-tazobactam plus vancomycin
C. Azithromycin alone
D. Ceftriaxone alone
Answer: B
Rationale: Combination therapy covering Pseudomonas and MRSA is
recommended empirically for ventilator-associated or hospital-acquired pneumonia
in high-risk patients. Narrowing is done after cultures.
, 8. A patient with septic shock is on norepinephrine infusion. MAP remains 58
mmHg despite fluids. Next best step:
A. Add vasopressin
B. Increase fluid bolus
C. Switch to dopamine
D. Start corticosteroids immediately
Answer: A
Rationale: Vasopressin is recommended as a second agent in septic shock
refractory to norepinephrine to maintain MAP ≥65 mmHg. Dopamine is less
preferred due to arrhythmia risk. Fluids may worsen overload, steroids are
adjunctive.
9. A 66-year-old male presents with acute confusion, fever, and a WBC of
22,000/mm³. CXR shows no infiltrates. Urinalysis reveals positive nitrites and
leukocyte esterase. Which is the most appropriate diagnosis?
A. Urinary tract infection with sepsis
B. Community-acquired pneumonia
C. Viral gastroenteritis
D. Meningitis
Answer: A
Rationale: Older adults may present with altered mental status and UTI without
localizing urinary symptoms. Positive nitrites and leukocyte esterase plus systemic
signs support UTI with systemic involvement.
10. In ARDS, lung-protective ventilation is defined as:
A. Tidal volume 10–12 mL/kg of ideal body weight
B. Tidal volume 6 mL/kg of ideal body weight
C. High-frequency oscillatory ventilation in all patients
D. Pressure-controlled ventilation only
Answer: B
Gerontology Acute Care NP Questions and Correct Answers With
Rationales Graded A+| 2026 Updated
1. A 68-year-old male with a history of COPD is admitted with acute exacerbation.
He is tachypneic, using accessory muscles, and has an oxygen saturation of 88%
on 2 L nasal cannula. Which is the most appropriate initial management?
A. Initiate noninvasive positive pressure ventilation (NIPPV)
B. Increase supplemental oxygen to 6 L/min via nasal cannula
C. Immediate intubation and mechanical ventilation
D. Administer intravenous corticosteroids only
Answer: A
Rationale: Acute exacerbation of COPD with hypoxemia and increased work of
breathing warrants NIPPV to reduce work of breathing and avoid intubation.
Simply increasing oxygen may worsen hypercapnia. Intubation is reserved for
those failing NIPPV. Corticosteroids alone are insufficient in acute respiratory
distress.
2. A patient presents with sepsis secondary to pneumonia. Initial labs show lactate
4.2 mmol/L and BP 88/52 mmHg. According to current sepsis guidelines, what is
the first-line intervention?
A. Start broad-spectrum IV antibiotics and fluid resuscitation
B. Obtain cultures only, hold fluids until source control
C. Immediate vasopressors without fluids
D. Begin corticosteroids immediately
Answer: A
Rationale: Early broad-spectrum antibiotics and aggressive fluid resuscitation
are the cornerstone of sepsis management. Vasopressors are added if hypotension
persists after fluids. Delaying antibiotics increases mortality.
,3. A 72-year-old female with atrial fibrillation is admitted with rapid ventricular
response and acute decompensated heart failure. She is hypotensive and dyspneic.
Which agent is contraindicated?
A. IV diltiazem
B. IV digoxin
C. IV amiodarone
D. IV furosemide
Answer: A
Rationale: Calcium channel blockers such as diltiazem are contraindicated in
hypotensive patients with acute decompensated heart failure due to negative
inotropic effects. Digoxin may help control rate, amiodarone is safe for rate/rhythm
control, and furosemide treats volume overload.
4. A patient develops acute hypoxemia after initiation of enteral feeding via NG
tube. CXR shows right lower lobe infiltrate. The most likely cause is:
A. Pulmonary embolism
B. Aspiration pneumonia
C. Heart failure exacerbation
D. Pneumothorax
Answer: B
Rationale: Acute hypoxemia following enteral feeding with localized infiltrate is
consistent with aspiration pneumonia. Risk factors include altered mental status
or impaired swallowing.
5. A 65-year-old male presents with acute chest pain and ST-elevation in leads II,
III, aVF. Which coronary artery is most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Posterior descending artery
Answer: B
,Rationale: Inferior STEMI (leads II, III, aVF) is usually due to right coronary
artery (RCA) occlusion. LAD occlusion causes anterior STEMI (V1–V4), and
circumflex occlusion often causes lateral wall changes.
6. A 70-year-old male with chronic kidney disease stage 4 develops hyperkalemia
(K+ 6.8 mmol/L) with peaked T waves on ECG. Immediate management should
include:
A. IV calcium gluconate
B. Oral potassium binder only
C. IV furosemide
D. Observation and repeat labs
Answer: A
Rationale: IV calcium gluconate stabilizes the cardiac membrane in
hyperkalemia. This is emergent management. Other interventions (insulin/glucose,
beta-agonist, dialysis) follow for potassium reduction.
7. Which of the following is the preferred first-line empiric antibiotic for a
suspected hospital-acquired pneumonia in a mechanically ventilated patient?
A. Vancomycin alone
B. Piperacillin-tazobactam plus vancomycin
C. Azithromycin alone
D. Ceftriaxone alone
Answer: B
Rationale: Combination therapy covering Pseudomonas and MRSA is
recommended empirically for ventilator-associated or hospital-acquired pneumonia
in high-risk patients. Narrowing is done after cultures.
, 8. A patient with septic shock is on norepinephrine infusion. MAP remains 58
mmHg despite fluids. Next best step:
A. Add vasopressin
B. Increase fluid bolus
C. Switch to dopamine
D. Start corticosteroids immediately
Answer: A
Rationale: Vasopressin is recommended as a second agent in septic shock
refractory to norepinephrine to maintain MAP ≥65 mmHg. Dopamine is less
preferred due to arrhythmia risk. Fluids may worsen overload, steroids are
adjunctive.
9. A 66-year-old male presents with acute confusion, fever, and a WBC of
22,000/mm³. CXR shows no infiltrates. Urinalysis reveals positive nitrites and
leukocyte esterase. Which is the most appropriate diagnosis?
A. Urinary tract infection with sepsis
B. Community-acquired pneumonia
C. Viral gastroenteritis
D. Meningitis
Answer: A
Rationale: Older adults may present with altered mental status and UTI without
localizing urinary symptoms. Positive nitrites and leukocyte esterase plus systemic
signs support UTI with systemic involvement.
10. In ARDS, lung-protective ventilation is defined as:
A. Tidal volume 10–12 mL/kg of ideal body weight
B. Tidal volume 6 mL/kg of ideal body weight
C. High-frequency oscillatory ventilation in all patients
D. Pressure-controlled ventilation only
Answer: B
