BARKLEY ACUTE CARE NURSE PRACTITIONER
(ACNP) CERTIFICATION REVIEW 100 Comprehensive
Board-Style Questions with Verified Answers & Rationales
SECTION 1: SHOCK STATES & HEMODYNAMICS (Questions
1-15)
Question 1
A 74-year-old male with a history of CHF presents with an audible S3 gallop and
increased jugular venous distention. This finding most likely indicates:
A) Left ventricular hypertrophy
B) Fluid volume overload
C) Right bundle branch block
D) Normal aging
Answer: B) Fluid volume overload
Rationale: The S3 heart sound is a classic sign of fluid volume overload in heart failure
patients, caused by blood rushing into a distended ventricle during early diastole . This
finding, combined with JVD, indicates elevated filling pressures and volume overload.
Question 2
Which vasopressor is considered first-line for a patient in septic shock who remains
hypotensive despite adequate fluid resuscitation?
A) Epinephrine
B) Norepinephrine
C) Phenylephrine
D) Dopamine
,Answer: B) Norepinephrine
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock to
achieve a target MAP of ≥65 mmHg due to its potent alpha-1 vasoconstrictive effects .
Question 3
What are the expected hemodynamic lab values in hypovolemic shock?
A) CO/CI high, CVP high, SVR low, SvO2 high
B) CO/CI low, CVP low, SVR high, SvO2 low
C) CO/CI low, CVP high, SVR high, SvO2 low
D) CO/CI high, CVP low, SVR low, SvO2 low
Answer: B) CO/CI low, CVP low, SVR high, SvO2 low
Rationale: Hypovolemic shock results from a loss of 20% of circulating blood volume.
Key lab findings include low cardiac output (CO), low central venous pressure (CVP),
high systemic vascular resistance (SVR) due to compensatory vasoconstriction, and low
mixed venous oxygen saturation (SvO2) .
Question 4
A patient with cardiogenic shock would most likely demonstrate which hemodynamic
profile?
A) CO/CI low, CVP high, PCWP high, SVR high, SvO2 low
B) CO/CI low, CVP low, PCWP low, SVR high, SvO2 low
C) CO/CI high, CVP low, PCWP low, SVR low, SvO2 high
D) CO/CI low, CVP normal, PCWP normal, SVR low, SvO2 low
,Answer: A) CO/CI low, CVP high, PCWP high, SVR high, SvO2 low
Rationale: Cardiogenic shock is characterized by low cardiac output, elevated filling
pressures (CVP and PCWP), compensatory high SVR, and low SvO2 indicating impaired
oxygen delivery .
Question 5
Which of the following is the most common cause of cardiogenic shock?
A) Pericardial tamponade
B) Myocardial infarction
C) Massive pulmonary embolism
D) Tension pneumothorax
Answer: B) Myocardial infarction
Rationale: MI is the most common cause of cardiogenic shock, resulting from loss of
effective contractile function leading to impaired cardiac output and reduced tissue
perfusion .
Question 6
What are the hemodynamic characteristics of obstructive shock?
A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
B) CO low, CVP high, PCWP high, SVR high, SvO2 low
C) CO low, CVP low, PCWP low, SVR high, SvO2 low
D) CO high, CVP low, PCWP low, SVR low, SvO2 high
, Answer: A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
Rationale: Obstructive shock results from impaired ventricular filling due to mechanical
obstruction (e.g., massive PE, tension pneumothorax, cardiac tamponade).
Hemodynamics show low CO, elevated CVP, normal or low PCWP, high SVR, and high
SvO2 due to impaired oxygen extraction .
Question 7
A patient with anaphylactic shock requires immediate management. Which of the
following is the MOST important initial intervention?
A) IV glucocorticosteroids
B) Diphenhydramine 25-75 mg IV
C) Epinephrine 0.3-0.5 mg SQ or IM
D) Inhaled beta-agonist for bronchospasm
Answer: C) Epinephrine 0.3-0.5 mg SQ or IM
Rationale: In anaphylactic shock, epinephrine is the first-line treatment, especially if
there is respiratory distress, stridor, or wheezing. It reverses vasodilation,
bronchoconstriction, and capillary leak .
Question 8
A patient with septic shock should receive antibiotics within which time frame?
A) Within 1 hour of recognition
B) Within 3 hours of recognition
(ACNP) CERTIFICATION REVIEW 100 Comprehensive
Board-Style Questions with Verified Answers & Rationales
SECTION 1: SHOCK STATES & HEMODYNAMICS (Questions
1-15)
Question 1
A 74-year-old male with a history of CHF presents with an audible S3 gallop and
increased jugular venous distention. This finding most likely indicates:
A) Left ventricular hypertrophy
B) Fluid volume overload
C) Right bundle branch block
D) Normal aging
Answer: B) Fluid volume overload
Rationale: The S3 heart sound is a classic sign of fluid volume overload in heart failure
patients, caused by blood rushing into a distended ventricle during early diastole . This
finding, combined with JVD, indicates elevated filling pressures and volume overload.
Question 2
Which vasopressor is considered first-line for a patient in septic shock who remains
hypotensive despite adequate fluid resuscitation?
A) Epinephrine
B) Norepinephrine
C) Phenylephrine
D) Dopamine
,Answer: B) Norepinephrine
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock to
achieve a target MAP of ≥65 mmHg due to its potent alpha-1 vasoconstrictive effects .
Question 3
What are the expected hemodynamic lab values in hypovolemic shock?
A) CO/CI high, CVP high, SVR low, SvO2 high
B) CO/CI low, CVP low, SVR high, SvO2 low
C) CO/CI low, CVP high, SVR high, SvO2 low
D) CO/CI high, CVP low, SVR low, SvO2 low
Answer: B) CO/CI low, CVP low, SVR high, SvO2 low
Rationale: Hypovolemic shock results from a loss of 20% of circulating blood volume.
Key lab findings include low cardiac output (CO), low central venous pressure (CVP),
high systemic vascular resistance (SVR) due to compensatory vasoconstriction, and low
mixed venous oxygen saturation (SvO2) .
Question 4
A patient with cardiogenic shock would most likely demonstrate which hemodynamic
profile?
A) CO/CI low, CVP high, PCWP high, SVR high, SvO2 low
B) CO/CI low, CVP low, PCWP low, SVR high, SvO2 low
C) CO/CI high, CVP low, PCWP low, SVR low, SvO2 high
D) CO/CI low, CVP normal, PCWP normal, SVR low, SvO2 low
,Answer: A) CO/CI low, CVP high, PCWP high, SVR high, SvO2 low
Rationale: Cardiogenic shock is characterized by low cardiac output, elevated filling
pressures (CVP and PCWP), compensatory high SVR, and low SvO2 indicating impaired
oxygen delivery .
Question 5
Which of the following is the most common cause of cardiogenic shock?
A) Pericardial tamponade
B) Myocardial infarction
C) Massive pulmonary embolism
D) Tension pneumothorax
Answer: B) Myocardial infarction
Rationale: MI is the most common cause of cardiogenic shock, resulting from loss of
effective contractile function leading to impaired cardiac output and reduced tissue
perfusion .
Question 6
What are the hemodynamic characteristics of obstructive shock?
A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
B) CO low, CVP high, PCWP high, SVR high, SvO2 low
C) CO low, CVP low, PCWP low, SVR high, SvO2 low
D) CO high, CVP low, PCWP low, SVR low, SvO2 high
, Answer: A) CO low, CVP high, PCWP normal/low, SVR high, SvO2 high
Rationale: Obstructive shock results from impaired ventricular filling due to mechanical
obstruction (e.g., massive PE, tension pneumothorax, cardiac tamponade).
Hemodynamics show low CO, elevated CVP, normal or low PCWP, high SVR, and high
SvO2 due to impaired oxygen extraction .
Question 7
A patient with anaphylactic shock requires immediate management. Which of the
following is the MOST important initial intervention?
A) IV glucocorticosteroids
B) Diphenhydramine 25-75 mg IV
C) Epinephrine 0.3-0.5 mg SQ or IM
D) Inhaled beta-agonist for bronchospasm
Answer: C) Epinephrine 0.3-0.5 mg SQ or IM
Rationale: In anaphylactic shock, epinephrine is the first-line treatment, especially if
there is respiratory distress, stridor, or wheezing. It reverses vasodilation,
bronchoconstriction, and capillary leak .
Question 8
A patient with septic shock should receive antibiotics within which time frame?
A) Within 1 hour of recognition
B) Within 3 hours of recognition
