CRITICAL CARE CONCEPTS/RESPIRATORY/ACNPC EXAM 2025 WITH
ACCURATE SOLUTIONS GUARANTEED PASS.
ACNPC-AG Respiratory Domain Practice Exam (70 Questions)
Focus: ARDS, ventilator management, pulmonary embolism, respiratory failure, and related
interventions.
Format: ACNPC-AG-style multiple choice, single best answer.
Q1.
A patient with severe ARDS on mechanical ventilation has a PaO₂ of 54 mmHg on FiO₂ 0.9. Which
ventilator change is most appropriate to improve oxygenation while minimizing barotrauma?
A. Increase tidal volume from 6 to 8 mL/kg
B. Increase PEEP
C. Increase respiratory rate
D. Switch to high-flow nasal cannula
Rationale: In ARDS, increasing PEEP can improve alveolar recruitment and oxygenation while
avoiding volutrauma from high tidal volumes.
Strategy: Remember the ARDSnet low-tidal-volume + higher-PEEP protocol.
Q2.
A patient in the ICU develops acute hypoxemia with sudden hypotension and tachycardia. You
suspect pulmonary embolism. The most appropriate initial diagnostic test is:
A. Pulmonary angiography
B. CT pulmonary angiography
C. V/Q scan
D. Echocardiogram
Rationale: CT pulmonary angiography is the gold standard for acute PE diagnosis in hemodynamically
stable patients.
Strategy: On ACNPC-AG, identify first-line, most accessible imaging.
Q3.
While managing a ventilated patient with COPD exacerbation, auto-PEEP is suspected. Which
adjustment is most appropriate?
A. Decrease respiratory rate
B. Increase tidal volume
C. Increase inspiratory time
D. Increase PEEP to 20 cmH₂O
,Rationale: Decreasing respiratory rate increases expiratory time, reducing dynamic hyperinflation.
Strategy: Recognize obstructive disease = allow more exhalation time.
Q4.
In ARDS, which PaO₂/FiO₂ ratio indicates severe disease?
A. <300
B. <200
C. <100
D. <50
Rationale: ARDS classification: Mild = 200–300, Moderate = 100–200, Severe = <100.
Strategy: Keep Berlin criteria numbers memorized.
Q5.
A patient with pneumonia on a ventilator has plateau pressures >30 cmH₂O. What is the best
adjustment?
A. Increase tidal volume
B. Decrease tidal volume
C. Increase FiO₂
D. Increase PEEP
Rationale: High plateau pressures suggest risk for barotrauma; lowering tidal volume helps protect
the lungs.
Strategy: Always think lung-protective ventilation.
Q6.
Which finding is most characteristic of tension pneumothorax?
A. Bilateral rales
B. Dullness to percussion
C. Tracheal deviation away from affected side
D. Midline trachea with wheezing
Rationale: Tracheal deviation + hypotension + absent breath sounds = emergency needle
decompression.
Strategy: Emergencies require rapid recognition & intervention.
Q7.
The primary mechanism of hypoxemia in ARDS is:
A. Hypoventilation
B. Low inspired oxygen
C. Shunt
D. Diffusion impairment
, Rationale: Alveolar flooding/collapse causes shunt — blood passes through without oxygenation.
Strategy: Match pathophysiology with cause.
Q8.
In managing a mechanically ventilated patient with ARDS, which FiO₂ level should be targeted long-
term to minimize oxygen toxicity?
A. 1.0
B. 0.9
C. ≤0.6
D. 0.8
Rationale: High FiO₂ >0.6 for prolonged periods risks oxygen toxicity.
Strategy: Use PEEP to keep FiO₂ ≤0.6 whenever possible.
Q9.
Which lab result supports a diagnosis of respiratory alkalosis?
A. pH 7.28, PaCO₂ 60 mmHg
B. pH 7.52, PaCO₂ 28 mmHg
C. pH 7.30, PaCO₂ 55 mmHg
D. pH 7.40, PaCO₂ 40 mmHg
Rationale: High pH + low PaCO₂ = respiratory alkalosis.
Strategy: ACNPC-AG expects fast ABG interpretation.
Q10.
In ventilator weaning, which parameter suggests readiness?
A. Rapid shallow breathing index (RSBI) >105
B. FiO₂ 0.8 with PaO₂ 65 mmHg
C. RSBI <105
D. Vital capacity <10 mL/kg
Rationale: RSBI <105 is associated with successful extubation.
Strategy: Memorize key weaning thresholds.
ACNPC-AG Respiratory Domain Practice – Questions 11–30
Q11.
A patient with ARDS on pressure-control ventilation has worsening hypoxemia. PEEP is currently 10
cm H₂O. Which adjustment is most appropriate to improve oxygenation?
ACCURATE SOLUTIONS GUARANTEED PASS.
ACNPC-AG Respiratory Domain Practice Exam (70 Questions)
Focus: ARDS, ventilator management, pulmonary embolism, respiratory failure, and related
interventions.
Format: ACNPC-AG-style multiple choice, single best answer.
Q1.
A patient with severe ARDS on mechanical ventilation has a PaO₂ of 54 mmHg on FiO₂ 0.9. Which
ventilator change is most appropriate to improve oxygenation while minimizing barotrauma?
A. Increase tidal volume from 6 to 8 mL/kg
B. Increase PEEP
C. Increase respiratory rate
D. Switch to high-flow nasal cannula
Rationale: In ARDS, increasing PEEP can improve alveolar recruitment and oxygenation while
avoiding volutrauma from high tidal volumes.
Strategy: Remember the ARDSnet low-tidal-volume + higher-PEEP protocol.
Q2.
A patient in the ICU develops acute hypoxemia with sudden hypotension and tachycardia. You
suspect pulmonary embolism. The most appropriate initial diagnostic test is:
A. Pulmonary angiography
B. CT pulmonary angiography
C. V/Q scan
D. Echocardiogram
Rationale: CT pulmonary angiography is the gold standard for acute PE diagnosis in hemodynamically
stable patients.
Strategy: On ACNPC-AG, identify first-line, most accessible imaging.
Q3.
While managing a ventilated patient with COPD exacerbation, auto-PEEP is suspected. Which
adjustment is most appropriate?
A. Decrease respiratory rate
B. Increase tidal volume
C. Increase inspiratory time
D. Increase PEEP to 20 cmH₂O
,Rationale: Decreasing respiratory rate increases expiratory time, reducing dynamic hyperinflation.
Strategy: Recognize obstructive disease = allow more exhalation time.
Q4.
In ARDS, which PaO₂/FiO₂ ratio indicates severe disease?
A. <300
B. <200
C. <100
D. <50
Rationale: ARDS classification: Mild = 200–300, Moderate = 100–200, Severe = <100.
Strategy: Keep Berlin criteria numbers memorized.
Q5.
A patient with pneumonia on a ventilator has plateau pressures >30 cmH₂O. What is the best
adjustment?
A. Increase tidal volume
B. Decrease tidal volume
C. Increase FiO₂
D. Increase PEEP
Rationale: High plateau pressures suggest risk for barotrauma; lowering tidal volume helps protect
the lungs.
Strategy: Always think lung-protective ventilation.
Q6.
Which finding is most characteristic of tension pneumothorax?
A. Bilateral rales
B. Dullness to percussion
C. Tracheal deviation away from affected side
D. Midline trachea with wheezing
Rationale: Tracheal deviation + hypotension + absent breath sounds = emergency needle
decompression.
Strategy: Emergencies require rapid recognition & intervention.
Q7.
The primary mechanism of hypoxemia in ARDS is:
A. Hypoventilation
B. Low inspired oxygen
C. Shunt
D. Diffusion impairment
, Rationale: Alveolar flooding/collapse causes shunt — blood passes through without oxygenation.
Strategy: Match pathophysiology with cause.
Q8.
In managing a mechanically ventilated patient with ARDS, which FiO₂ level should be targeted long-
term to minimize oxygen toxicity?
A. 1.0
B. 0.9
C. ≤0.6
D. 0.8
Rationale: High FiO₂ >0.6 for prolonged periods risks oxygen toxicity.
Strategy: Use PEEP to keep FiO₂ ≤0.6 whenever possible.
Q9.
Which lab result supports a diagnosis of respiratory alkalosis?
A. pH 7.28, PaCO₂ 60 mmHg
B. pH 7.52, PaCO₂ 28 mmHg
C. pH 7.30, PaCO₂ 55 mmHg
D. pH 7.40, PaCO₂ 40 mmHg
Rationale: High pH + low PaCO₂ = respiratory alkalosis.
Strategy: ACNPC-AG expects fast ABG interpretation.
Q10.
In ventilator weaning, which parameter suggests readiness?
A. Rapid shallow breathing index (RSBI) >105
B. FiO₂ 0.8 with PaO₂ 65 mmHg
C. RSBI <105
D. Vital capacity <10 mL/kg
Rationale: RSBI <105 is associated with successful extubation.
Strategy: Memorize key weaning thresholds.
ACNPC-AG Respiratory Domain Practice – Questions 11–30
Q11.
A patient with ARDS on pressure-control ventilation has worsening hypoxemia. PEEP is currently 10
cm H₂O. Which adjustment is most appropriate to improve oxygenation?
