ANCC AGACNP Frances Guide Review – 500+ Practice Questions &
Answers (2026)
Practice Questions 1–250
Questions 1–50: Critical Care Hemodynamics & Shock
1. A 72-year-old patient with septic shock is started on
norepinephrine. What is the primary desired effect of this
medication?
A) Increased cardiac contractility
B) Vasoconstriction and increased mean arterial pressure (MAP)
C) Bronchodilation
D) Diuresis
Answer B: Vasoconstriction and increased mean arterial pressure
(MAP)
,Rationale: Norepinephrine is a potent alpha-1 agonist causing
vasoconstriction, which increases systemic vascular resistance and
MAP. ---
2. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m²
and a pulmonary artery wedge pressure (PAWP) of 22 mmHg.
Which medication is most appropriate?
A) Norepinephrine
B) Dobutamine
C) Phenylephrine
D) Vasopressin
Answer B: Dobutamine
Rationale: Dobutamine is a positive inotrope that increases cardiac
contractility and cardiac index in cardiogenic shock with elevated
filling pressures. ---
3. Which hemodynamic parameter is most indicative of adequate
tissue perfusion in a patient with septic shock?
A) Central venous pressure (CVP) 12 mmHg
,B) Central venous oxygen saturation (ScvO₂) ≥ 70%
C) Heart rate 110 bpm
D) Mean arterial pressure (MAP) 60 mmHg
Answer B: Central venous oxygen saturation (ScvO₂) ≥ 70%
Rationale: ScvO₂ reflects the balance between oxygen delivery and
consumption; ≥70% indicates adequate tissue perfusion. ---
4. A patient with distributive shock has a systemic vascular
resistance (SVR) of 400 dynes·sec/cm⁵. Which vasopressor is first-
line?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Answer B: Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock
to increase SVR and MAP. ---
, 5. Which of the following findings is consistent with obstructive
shock?
A) Low cardiac output, low SVR
B) Low cardiac output, high CVP, and evidence of mechanical
obstruction
C) High cardiac output, low SVR
D) Normal cardiac output, normal SVR
Answer B: Low cardiac output, high CVP, and evidence of
mechanical obstruction
Rationale: Obstructive shock (e.g., PE, cardiac tamponade) presents
with low cardiac output and elevated CVP due to impaired filling. ---
6. A patient with septic shock has a serum lactate of 4.5 mmol/L.
What is the recommended initial fluid resuscitation strategy?
A) 500 mL of 0.9% normal saline bolus
B) 30 mL/kg crystalloid bolus
C) 1 L of lactated Ringer's over 4 hours
D) 250 mL of albumin
Answer B: 30 mL/kg crystalloid bolus
Answers (2026)
Practice Questions 1–250
Questions 1–50: Critical Care Hemodynamics & Shock
1. A 72-year-old patient with septic shock is started on
norepinephrine. What is the primary desired effect of this
medication?
A) Increased cardiac contractility
B) Vasoconstriction and increased mean arterial pressure (MAP)
C) Bronchodilation
D) Diuresis
Answer B: Vasoconstriction and increased mean arterial pressure
(MAP)
,Rationale: Norepinephrine is a potent alpha-1 agonist causing
vasoconstriction, which increases systemic vascular resistance and
MAP. ---
2. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m²
and a pulmonary artery wedge pressure (PAWP) of 22 mmHg.
Which medication is most appropriate?
A) Norepinephrine
B) Dobutamine
C) Phenylephrine
D) Vasopressin
Answer B: Dobutamine
Rationale: Dobutamine is a positive inotrope that increases cardiac
contractility and cardiac index in cardiogenic shock with elevated
filling pressures. ---
3. Which hemodynamic parameter is most indicative of adequate
tissue perfusion in a patient with septic shock?
A) Central venous pressure (CVP) 12 mmHg
,B) Central venous oxygen saturation (ScvO₂) ≥ 70%
C) Heart rate 110 bpm
D) Mean arterial pressure (MAP) 60 mmHg
Answer B: Central venous oxygen saturation (ScvO₂) ≥ 70%
Rationale: ScvO₂ reflects the balance between oxygen delivery and
consumption; ≥70% indicates adequate tissue perfusion. ---
4. A patient with distributive shock has a systemic vascular
resistance (SVR) of 400 dynes·sec/cm⁵. Which vasopressor is first-
line?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Answer B: Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock
to increase SVR and MAP. ---
, 5. Which of the following findings is consistent with obstructive
shock?
A) Low cardiac output, low SVR
B) Low cardiac output, high CVP, and evidence of mechanical
obstruction
C) High cardiac output, low SVR
D) Normal cardiac output, normal SVR
Answer B: Low cardiac output, high CVP, and evidence of
mechanical obstruction
Rationale: Obstructive shock (e.g., PE, cardiac tamponade) presents
with low cardiac output and elevated CVP due to impaired filling. ---
6. A patient with septic shock has a serum lactate of 4.5 mmol/L.
What is the recommended initial fluid resuscitation strategy?
A) 500 mL of 0.9% normal saline bolus
B) 30 mL/kg crystalloid bolus
C) 1 L of lactated Ringer's over 4 hours
D) 250 mL of albumin
Answer B: 30 mL/kg crystalloid bolus
