ACNPC-AG® Adult-Gerontology Acute Care
NP Exam Questions and Answers Latest
Version Graded A+
Question 1
A patient with chronic kidney disease has potassium 6.8 mEq/L and peaked T waves on ECG.
What medication should be administered first to stabilize the cardiac membrane?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
C. Insulin with glucose
D. Furosemide
Correct Answer: B. IV calcium gluconate
Rationale:
Calcium gluconate does not lower potassium but immediately stabilizes myocardial membranes
and reduces the risk of fatal arrhythmias. Potassium-lowering treatments follow.
Question 2
A patient receiving unfractionated heparin develops a platelet count drop from 220,000/mm³ to
80,000/mm³ after 6 days of therapy. What is the most appropriate action?
A. Increase the heparin dose
B. Stop heparin and evaluate for HIT
C. Administer vitamin K
D. Continue therapy and monitor
Correct Answer: B. Stop heparin and evaluate for HIT
Rationale:
A platelet decrease greater than 50% after heparin exposure suggests heparin-induced
thrombocytopenia (HIT). Heparin must be discontinued immediately and alternative
anticoagulation considered.
,Question 3
A mechanically ventilated patient suddenly becomes hypotensive with absent breath sounds on
the right side and tracheal deviation. Which condition should the AG-ACNP suspect?
A. Pulmonary embolism
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Correct Answer: B. Tension pneumothorax
Rationale:
Classic findings include sudden respiratory deterioration, unilateral absent breath sounds,
hypotension, and tracheal deviation. This is a medical emergency requiring immediate
decompression.
Question 4
A 72-year-old patient with a history of heart failure presents with worsening dyspnea, orthopnea,
and bilateral crackles. Oxygen saturation is 86% on room air. Which intervention should the AG-
ACNP implement first?
A. Administer IV furosemide
B. Place the patient in high-Fowler position and apply oxygen
C. Obtain a BNP level
D. Restrict oral fluids
Correct Answer: B. Place the patient in high-Fowler position and apply oxygen
Rationale:
The priority is stabilization using the ABC approach (airway, breathing, circulation). Positioning
improves lung expansion and oxygen therapy treats hypoxemia. Diuretics and diagnostics are
important but follow immediate respiratory support.
Question 5
A 65-year-old patient presents with fever, confusion, tachycardia, and hypotension. Lactate is 5
mmol/L. Which diagnosis is most likely?
,A. Cardiogenic shock
B. Septic shock
C. Neurogenic shock
D. Hypovolemic shock
Correct Answer: B. Septic shock
Rationale:
Sepsis with hypotension and elevated lactate indicates tissue hypoperfusion and septic shock.
Early management includes cultures, antibiotics, and fluid resuscitation.
Question 6
A patient with COPD exacerbation has a pH of 7.28 and PaCO₂ of 65 mmHg. How should this
ABG be interpreted?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis
D. Metabolic alkalosis
Correct Answer: C. Acute respiratory acidosis
Rationale:
Low pH indicates acidosis, and elevated PaCO₂ indicates respiratory cause. COPD patients
commonly develop CO₂ retention resulting in respiratory acidosis.
Question 7
A patient receiving vancomycin develops rising serum creatinine levels. Which adverse effect
should the AG-ACNP suspect?
A. Hepatotoxicity
B. Nephrotoxicity
C. Ototoxicity only
D. Bone marrow suppression
Correct Answer: B. Nephrotoxicity
Rationale:
Vancomycin can cause kidney injury, especially at high trough levels or when combined with
other nephrotoxic medications. Renal function and drug levels require monitoring.
, Question 8
A patient admitted with acute ischemic stroke develops worsening neurological deficits. Which
imaging study should be obtained urgently?
A. MRI with contrast
B. Noncontrast CT of the head
C. Carotid ultrasound
D. EEG
Correct Answer: B. Noncontrast CT of the head
Rationale:
A noncontrast CT rapidly differentiates ischemic stroke from hemorrhagic stroke and guides
acute treatment decisions.
Question 9
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 5. What therapy is indicated?
A. Aspirin only
B. No treatment
C. Oral anticoagulation
D. Rate control only
Correct Answer: C. Oral anticoagulation
Rationale:
A CHA₂DS₂-VASc score ≥2 in most adults indicates significant stroke risk requiring
anticoagulation unless contraindicated.
Question 10
A patient with acute pancreatitis has severe abdominal pain radiating to the back and elevated
lipase. Which management approach is appropriate?
A. Immediate surgery for all cases
B. Aggressive IV fluids and pain control
C. High-fat diet initiation
D. Routine antibiotics
NP Exam Questions and Answers Latest
Version Graded A+
Question 1
A patient with chronic kidney disease has potassium 6.8 mEq/L and peaked T waves on ECG.
What medication should be administered first to stabilize the cardiac membrane?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
C. Insulin with glucose
D. Furosemide
Correct Answer: B. IV calcium gluconate
Rationale:
Calcium gluconate does not lower potassium but immediately stabilizes myocardial membranes
and reduces the risk of fatal arrhythmias. Potassium-lowering treatments follow.
Question 2
A patient receiving unfractionated heparin develops a platelet count drop from 220,000/mm³ to
80,000/mm³ after 6 days of therapy. What is the most appropriate action?
A. Increase the heparin dose
B. Stop heparin and evaluate for HIT
C. Administer vitamin K
D. Continue therapy and monitor
Correct Answer: B. Stop heparin and evaluate for HIT
Rationale:
A platelet decrease greater than 50% after heparin exposure suggests heparin-induced
thrombocytopenia (HIT). Heparin must be discontinued immediately and alternative
anticoagulation considered.
,Question 3
A mechanically ventilated patient suddenly becomes hypotensive with absent breath sounds on
the right side and tracheal deviation. Which condition should the AG-ACNP suspect?
A. Pulmonary embolism
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
Correct Answer: B. Tension pneumothorax
Rationale:
Classic findings include sudden respiratory deterioration, unilateral absent breath sounds,
hypotension, and tracheal deviation. This is a medical emergency requiring immediate
decompression.
Question 4
A 72-year-old patient with a history of heart failure presents with worsening dyspnea, orthopnea,
and bilateral crackles. Oxygen saturation is 86% on room air. Which intervention should the AG-
ACNP implement first?
A. Administer IV furosemide
B. Place the patient in high-Fowler position and apply oxygen
C. Obtain a BNP level
D. Restrict oral fluids
Correct Answer: B. Place the patient in high-Fowler position and apply oxygen
Rationale:
The priority is stabilization using the ABC approach (airway, breathing, circulation). Positioning
improves lung expansion and oxygen therapy treats hypoxemia. Diuretics and diagnostics are
important but follow immediate respiratory support.
Question 5
A 65-year-old patient presents with fever, confusion, tachycardia, and hypotension. Lactate is 5
mmol/L. Which diagnosis is most likely?
,A. Cardiogenic shock
B. Septic shock
C. Neurogenic shock
D. Hypovolemic shock
Correct Answer: B. Septic shock
Rationale:
Sepsis with hypotension and elevated lactate indicates tissue hypoperfusion and septic shock.
Early management includes cultures, antibiotics, and fluid resuscitation.
Question 6
A patient with COPD exacerbation has a pH of 7.28 and PaCO₂ of 65 mmHg. How should this
ABG be interpreted?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Acute respiratory acidosis
D. Metabolic alkalosis
Correct Answer: C. Acute respiratory acidosis
Rationale:
Low pH indicates acidosis, and elevated PaCO₂ indicates respiratory cause. COPD patients
commonly develop CO₂ retention resulting in respiratory acidosis.
Question 7
A patient receiving vancomycin develops rising serum creatinine levels. Which adverse effect
should the AG-ACNP suspect?
A. Hepatotoxicity
B. Nephrotoxicity
C. Ototoxicity only
D. Bone marrow suppression
Correct Answer: B. Nephrotoxicity
Rationale:
Vancomycin can cause kidney injury, especially at high trough levels or when combined with
other nephrotoxic medications. Renal function and drug levels require monitoring.
, Question 8
A patient admitted with acute ischemic stroke develops worsening neurological deficits. Which
imaging study should be obtained urgently?
A. MRI with contrast
B. Noncontrast CT of the head
C. Carotid ultrasound
D. EEG
Correct Answer: B. Noncontrast CT of the head
Rationale:
A noncontrast CT rapidly differentiates ischemic stroke from hemorrhagic stroke and guides
acute treatment decisions.
Question 9
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 5. What therapy is indicated?
A. Aspirin only
B. No treatment
C. Oral anticoagulation
D. Rate control only
Correct Answer: C. Oral anticoagulation
Rationale:
A CHA₂DS₂-VASc score ≥2 in most adults indicates significant stroke risk requiring
anticoagulation unless contraindicated.
Question 10
A patient with acute pancreatitis has severe abdominal pain radiating to the back and elevated
lipase. Which management approach is appropriate?
A. Immediate surgery for all cases
B. Aggressive IV fluids and pain control
C. High-fat diet initiation
D. Routine antibiotics
