AACN ACNPC-AG CERTIFICATION PSI PROCTORED ACTUAL EXAM
AMERICAN ASSOCIATION OF CRITICAL-CARE NURSES (AACN) AGACNP
(ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
140 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze complex acute care scenarios to formulate differential diagnoses and management plans
2 Interpret advanced diagnostic data to guide interventions in critically ill adults
3 Evaluate ethical and palliative considerations in acute care decision-making
4 AACN ACNPC
5 AG Certification PSI Proctored ACTUAL EXAM American Association of Critical
6 Care Nurses
7 AACN
8 AGACNP
9 Adult
10 Gerontology Acute Care Nurse Practitioner Certification PRACTICE EXAM Questions And Correct
Answers
11 Verified Answers
12 Plus Rationales
13 Foundations of Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
14 Applied Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
15 Advanced Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
16 Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification Review
Page 1
,Q1 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with septic shock has a ScvO2 of 55% despite fluid resuscitation and
norepinephrine at 15 mcg/min. Which intervention directly addresses the most
likely cause?
A. Add vasopressin to increase mean arterial pressure.
B. Transfuse packed red blood cells to a hemoglobin of 10 g/dL.
C. Start dobutamine at 5 mcg/kg/min to augment cardiac output. CORRECT
D. Administer stress-dose hydrocortisone to improve vascular tone.
RATIONALE: Low ScvO2 (<70%) indicates inadequate oxygen delivery relative to demand, often
due to low cardiac output or anemia. Dobutamine increases cardiac output, improving oxygen
delivery. Vasopressin and hydrocortisone address vascular tone, not flow. Transfusion may help if
hemoglobin is low, but not specified.
Q2 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
In a patient with acute respiratory distress syndrome (ARDS) on volume-controlled
ventilation, plateau pressure is 32 cm H2O and driving pressure is 16 cm H2O.
Which adjustment best adheres to lung-protective ventilation?
A. Increase PEEP to 15 cm H2O to improve oxygenation.
B. Decrease tidal volume from 6 to 4 mL/kg predicted body weight. CORRECT
C. Switch to pressure-regulated volume control mode.
D. Increase respiratory rate to maintain minute ventilation.
RATIONALE: Driving pressure (plateau - PEEP) >15 cm H2O is associated with increased
mortality in ARDS. Reducing tidal volume lowers plateau and driving pressure, enhancing lung
protection. Increasing PEEP may improve oxygenation but can worsen driving pressure if plateau
rises. Mode change or rate adjustment do not directly reduce driving pressure.
Page 2
,Q3 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with cirrhosis and acute kidney injury has a serum sodium of 128 mEq/L.
Which factor most critically influences the rate of sodium correction?
A. Concurrent use of lactulose
B. Chronic hyponatremia duration CORRECT
C. Presence of hepatic encephalopathy
D. Urine output over the past 24 hours
RATIONALE: In chronic hyponatremia, rapid correction risks osmotic demyelination syndrome.
The duration of hyponatremia determines the safe correction rate. Lactulose can affect volume
status but not directly the correction rate. Encephalopathy and urine output are important but not
the primary determinant of correction speed.
Q4 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with subarachnoid hemorrhage develops acute vasospasm confirmed by
transcranial Doppler. Which intervention is the first-line therapy to improve
cerebral perfusion?
A. Induce hypertension with norepinephrine to maintain systolic BP >180 mm Hg CORRECT
B. Administer oral nimodipine 60 mg every 4 hours
C. Initiate continuous EEG monitoring for seizure detection
D. Perform endovascular angioplasty with intra-arterial vasodilators
RATIONALE: Triple-H therapy (hypertension, hypervolemia, hemodilution) is first-line for
vasospasm; induced hypertension improves cerebral blood flow. Nimodipine is prophylactic, not
therapeutic for established vasospasm. EEG monitoring is adjunctive. Angioplasty is reserved for
refractory cases.
Page 3
, Q5 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with hyperkalemia (K+ 6.8 mEq/L) has ECG changes showing peaked T
waves. Which medication should be administered first to stabilize the cardiac
membrane?
A. Calcium gluconate 10% 10 mL IV over 2 minutes CORRECT
B. Sodium bicarbonate 50 mEq IV push
C. Albuterol 10 mg nebulized
D. Insulin 10 units IV with dextrose 50%
RATIONALE: Calcium gluconate immediately antagonizes the effects of hyperkalemia on the
myocardial cell membrane, reducing arrhythmia risk. Insulin, bicarbonate, and albuterol shift
potassium into cells but take longer to act. Calcium is the priority in the presence of ECG
changes.
Q6 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient presents with a toxic ingestion, and the poison control center
recommends alkalinization of the urine. Which agent is most appropriate for this
purpose?
A. Furosemide
B. Sodium bicarbonate CORRECT
C. Acetazolamide
D. Ammonium chloride
RATIONALE: Urine alkalinization is achieved with sodium bicarbonate infusion, which increases
urine pH and enhances excretion of weak acids like salicylates and phenobarbital. Furosemide
does not alkalinize urine. Acetazolamide causes metabolic acidosis, and ammonium chloride
acidifies urine.
Page 4
AMERICAN ASSOCIATION OF CRITICAL-CARE NURSES (AACN) AGACNP
(ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
140 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze complex acute care scenarios to formulate differential diagnoses and management plans
2 Interpret advanced diagnostic data to guide interventions in critically ill adults
3 Evaluate ethical and palliative considerations in acute care decision-making
4 AACN ACNPC
5 AG Certification PSI Proctored ACTUAL EXAM American Association of Critical
6 Care Nurses
7 AACN
8 AGACNP
9 Adult
10 Gerontology Acute Care Nurse Practitioner Certification PRACTICE EXAM Questions And Correct
Answers
11 Verified Answers
12 Plus Rationales
13 Foundations of Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
14 Applied Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
15 Advanced Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
16 Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification Review
Page 1
,Q1 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with septic shock has a ScvO2 of 55% despite fluid resuscitation and
norepinephrine at 15 mcg/min. Which intervention directly addresses the most
likely cause?
A. Add vasopressin to increase mean arterial pressure.
B. Transfuse packed red blood cells to a hemoglobin of 10 g/dL.
C. Start dobutamine at 5 mcg/kg/min to augment cardiac output. CORRECT
D. Administer stress-dose hydrocortisone to improve vascular tone.
RATIONALE: Low ScvO2 (<70%) indicates inadequate oxygen delivery relative to demand, often
due to low cardiac output or anemia. Dobutamine increases cardiac output, improving oxygen
delivery. Vasopressin and hydrocortisone address vascular tone, not flow. Transfusion may help if
hemoglobin is low, but not specified.
Q2 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
In a patient with acute respiratory distress syndrome (ARDS) on volume-controlled
ventilation, plateau pressure is 32 cm H2O and driving pressure is 16 cm H2O.
Which adjustment best adheres to lung-protective ventilation?
A. Increase PEEP to 15 cm H2O to improve oxygenation.
B. Decrease tidal volume from 6 to 4 mL/kg predicted body weight. CORRECT
C. Switch to pressure-regulated volume control mode.
D. Increase respiratory rate to maintain minute ventilation.
RATIONALE: Driving pressure (plateau - PEEP) >15 cm H2O is associated with increased
mortality in ARDS. Reducing tidal volume lowers plateau and driving pressure, enhancing lung
protection. Increasing PEEP may improve oxygenation but can worsen driving pressure if plateau
rises. Mode change or rate adjustment do not directly reduce driving pressure.
Page 2
,Q3 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with cirrhosis and acute kidney injury has a serum sodium of 128 mEq/L.
Which factor most critically influences the rate of sodium correction?
A. Concurrent use of lactulose
B. Chronic hyponatremia duration CORRECT
C. Presence of hepatic encephalopathy
D. Urine output over the past 24 hours
RATIONALE: In chronic hyponatremia, rapid correction risks osmotic demyelination syndrome.
The duration of hyponatremia determines the safe correction rate. Lactulose can affect volume
status but not directly the correction rate. Encephalopathy and urine output are important but not
the primary determinant of correction speed.
Q4 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with subarachnoid hemorrhage develops acute vasospasm confirmed by
transcranial Doppler. Which intervention is the first-line therapy to improve
cerebral perfusion?
A. Induce hypertension with norepinephrine to maintain systolic BP >180 mm Hg CORRECT
B. Administer oral nimodipine 60 mg every 4 hours
C. Initiate continuous EEG monitoring for seizure detection
D. Perform endovascular angioplasty with intra-arterial vasodilators
RATIONALE: Triple-H therapy (hypertension, hypervolemia, hemodilution) is first-line for
vasospasm; induced hypertension improves cerebral blood flow. Nimodipine is prophylactic, not
therapeutic for established vasospasm. EEG monitoring is adjunctive. Angioplasty is reserved for
refractory cases.
Page 3
, Q5 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient with hyperkalemia (K+ 6.8 mEq/L) has ECG changes showing peaked T
waves. Which medication should be administered first to stabilize the cardiac
membrane?
A. Calcium gluconate 10% 10 mL IV over 2 minutes CORRECT
B. Sodium bicarbonate 50 mEq IV push
C. Albuterol 10 mg nebulized
D. Insulin 10 units IV with dextrose 50%
RATIONALE: Calcium gluconate immediately antagonizes the effects of hyperkalemia on the
myocardial cell membrane, reducing arrhythmia risk. Insulin, bicarbonate, and albuterol shift
potassium into cells but take longer to act. Calcium is the priority in the presence of ECG
changes.
Q6 ANALYZE COMPLEX ACUTE CARE SCENARIOS TO FORMULATE DIFFERENTIAL
DIAGNOSES AND MANAGEMENT PLANS
A patient presents with a toxic ingestion, and the poison control center
recommends alkalinization of the urine. Which agent is most appropriate for this
purpose?
A. Furosemide
B. Sodium bicarbonate CORRECT
C. Acetazolamide
D. Ammonium chloride
RATIONALE: Urine alkalinization is achieved with sodium bicarbonate infusion, which increases
urine pH and enhances excretion of weak acids like salicylates and phenobarbital. Furosemide
does not alkalinize urine. Acetazolamide causes metabolic acidosis, and ammonium chloride
acidifies urine.
Page 4
