AACN ACNPC-AG CERTIFICATION REVIEW EXAM ADULT
GERONTOLOGY ACUTE CARE NP QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES GRADED A+
LATEST 2026-2027
1. A 68-year-old male with a history of COPD is admitted with acute
exacerbation. He is tachypneic, using accessory muscles, and has an oxygen
saturation of 88% on 2 L nasal cannula. Which is the most appropriate initial
management?
A. Initiate noninvasive positive pressure ventilation (NIPPV)
B. Increase supplemental oxygen to 6 L/min via nasal cannula
C. Immediate intubation and mechanical ventilation
D. Administer intravenous corticosteroids only
Answer: A
Rationale: Acute exacerbation of COPD with hypoxemia and increased work
of breathing warrants NIPPV to reduce work of breathing and avoid
intubation. Simply increasing oxygen may worsen hypercapnia. Intubation is
reserved for those failing NIPPV. Corticosteroids alone are insufficient in
acute respiratory distress.
2. A patient presents with sepsis secondary to pneumonia. Initial labs show
lactate 4.2 mmol/L and BP 88/52 mmHg. According to current sepsis
guidelines, what is the first-line intervention?
A. Start broad-spectrum IV antibiotics and fluid resuscitation
B. Obtain cultures only, hold fluids until source control
C. Immediate vasopressors without fluids
D. Begin corticosteroids immediately
Answer: A
Rationale: Early broad-spectrum antibiotics and aggressive fluid
resuscitation are the cornerstone of sepsis management. Vasopressors are added
if hypotension persists after fluids. Delaying antibiotics increases mortality.
,3. A 72-year-old female with atrial fibrillation is admitted with rapid ventricular
response and acute decompensated heart failure. She is hypotensive and
dyspneic. Which agent is contraindicated?
A. IV diltiazem
B. IV digoxin
C. IV amiodarone
D. IV furosemide
Answer: A
Rationale: Calcium channel blockers such as diltiazem are contraindicated in
hypotensive patients with acute decompensated heart failure due to negative
inotropic effects. Digoxin may help control rate, amiodarone is safe for
rate/rhythm control, and furosemide treats volume overload.
4. A patient develops acute hypoxemia after initiation of enteral feeding via NG
tube. CXR shows right lower lobe infiltrate. The most likely cause is:
A. Pulmonary embolism
B. Aspiration pneumonia
C. Heart failure exacerbation
D. Pneumothorax
Answer: B
Rationale: Acute hypoxemia following enteral feeding with localized infiltrate
is consistent with aspiration pneumonia. Risk factors include altered mental
status or impaired swallowing.
5. A 65-year-old male presents with acute chest pain and ST-elevation in leads
II, III, aVF. Which coronary artery is most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Posterior descending artery
,Answer: B
Rationale: Inferior STEMI (leads II, III, aVF) is usually due to right
coronary artery (RCA) occlusion. LAD occlusion causes anterior STEMI
(V1–V4), and circumflex occlusion often causes lateral wall changes.
6. A 70-year-old male with chronic kidney disease stage 4 develops
hyperkalemia (K+ 6.8 mmol/L) with peaked T waves on ECG. Immediate
management should include:
A. IV calcium gluconate
B. Oral potassium binder only
C. IV furosemide
D. Observation and repeat labs
Answer: A
Rationale: IV calcium gluconate stabilizes the cardiac membrane in
hyperkalemia. This is emergent management. Other interventions
(insulin/glucose, beta-agonist, dialysis) follow for potassium reduction.
7. Which of the following is the preferred first-line empiric antibiotic for a
suspected hospital-acquired pneumonia in a mechanically ventilated patient?
A. Vancomycin alone
B. Piperacillin-tazobactam plus vancomycin
C. Azithromycin alone
D. Ceftriaxone alone
Answer: B
Rationale: Combination therapy covering Pseudomonas and MRSA is
recommended empirically for ventilator-associated or hospital-acquired
pneumonia in high-risk patients. Narrowing is done after cultures.
, 8. A patient with septic shock is on norepinephrine infusion. MAP remains 58
mmHg despite fluids. Next best step:
A. Add vasopressin
B. Increase fluid bolus
C. Switch to dopamine
D. Start corticosteroids immediately
Answer: A
Rationale: Vasopressin is recommended as a second agent in septic
shock refractory to norepinephrine to maintain MAP ≥65 mmHg.
Dopamine is less preferred due to arrhythmia risk. Fluids may worsen
overload, steroids are adjunctive.
9. A 66-year-old male presents with acute confusion, fever, and a WBC of
22,000/mm³. CXR shows no infiltrates. Urinalysis reveals positive nitrites
and leukocyte esterase. Which is the most appropriate diagnosis?
A. Urinary tract infection with sepsis
B. Community-acquired pneumonia
C. Viral gastroenteritis
D. Meningitis
Answer: A
Rationale: Older adults may present with altered mental status and UTI
without localizing urinary symptoms. Positive nitrites and leukocyte esterase plus
systemic signs support UTI with systemic involvement.
10. In ARDS, lung-protective ventilation is defined as:
A. Tidal volume 10–12 mL/kg of ideal body weight
B. Tidal volume 6 mL/kg of ideal body weight
C. High-frequency oscillatory ventilation in all patients
D. Pressure-controlled ventilation only
Answer: B
GERONTOLOGY ACUTE CARE NP QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES GRADED A+
LATEST 2026-2027
1. A 68-year-old male with a history of COPD is admitted with acute
exacerbation. He is tachypneic, using accessory muscles, and has an oxygen
saturation of 88% on 2 L nasal cannula. Which is the most appropriate initial
management?
A. Initiate noninvasive positive pressure ventilation (NIPPV)
B. Increase supplemental oxygen to 6 L/min via nasal cannula
C. Immediate intubation and mechanical ventilation
D. Administer intravenous corticosteroids only
Answer: A
Rationale: Acute exacerbation of COPD with hypoxemia and increased work
of breathing warrants NIPPV to reduce work of breathing and avoid
intubation. Simply increasing oxygen may worsen hypercapnia. Intubation is
reserved for those failing NIPPV. Corticosteroids alone are insufficient in
acute respiratory distress.
2. A patient presents with sepsis secondary to pneumonia. Initial labs show
lactate 4.2 mmol/L and BP 88/52 mmHg. According to current sepsis
guidelines, what is the first-line intervention?
A. Start broad-spectrum IV antibiotics and fluid resuscitation
B. Obtain cultures only, hold fluids until source control
C. Immediate vasopressors without fluids
D. Begin corticosteroids immediately
Answer: A
Rationale: Early broad-spectrum antibiotics and aggressive fluid
resuscitation are the cornerstone of sepsis management. Vasopressors are added
if hypotension persists after fluids. Delaying antibiotics increases mortality.
,3. A 72-year-old female with atrial fibrillation is admitted with rapid ventricular
response and acute decompensated heart failure. She is hypotensive and
dyspneic. Which agent is contraindicated?
A. IV diltiazem
B. IV digoxin
C. IV amiodarone
D. IV furosemide
Answer: A
Rationale: Calcium channel blockers such as diltiazem are contraindicated in
hypotensive patients with acute decompensated heart failure due to negative
inotropic effects. Digoxin may help control rate, amiodarone is safe for
rate/rhythm control, and furosemide treats volume overload.
4. A patient develops acute hypoxemia after initiation of enteral feeding via NG
tube. CXR shows right lower lobe infiltrate. The most likely cause is:
A. Pulmonary embolism
B. Aspiration pneumonia
C. Heart failure exacerbation
D. Pneumothorax
Answer: B
Rationale: Acute hypoxemia following enteral feeding with localized infiltrate
is consistent with aspiration pneumonia. Risk factors include altered mental
status or impaired swallowing.
5. A 65-year-old male presents with acute chest pain and ST-elevation in leads
II, III, aVF. Which coronary artery is most likely occluded?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Posterior descending artery
,Answer: B
Rationale: Inferior STEMI (leads II, III, aVF) is usually due to right
coronary artery (RCA) occlusion. LAD occlusion causes anterior STEMI
(V1–V4), and circumflex occlusion often causes lateral wall changes.
6. A 70-year-old male with chronic kidney disease stage 4 develops
hyperkalemia (K+ 6.8 mmol/L) with peaked T waves on ECG. Immediate
management should include:
A. IV calcium gluconate
B. Oral potassium binder only
C. IV furosemide
D. Observation and repeat labs
Answer: A
Rationale: IV calcium gluconate stabilizes the cardiac membrane in
hyperkalemia. This is emergent management. Other interventions
(insulin/glucose, beta-agonist, dialysis) follow for potassium reduction.
7. Which of the following is the preferred first-line empiric antibiotic for a
suspected hospital-acquired pneumonia in a mechanically ventilated patient?
A. Vancomycin alone
B. Piperacillin-tazobactam plus vancomycin
C. Azithromycin alone
D. Ceftriaxone alone
Answer: B
Rationale: Combination therapy covering Pseudomonas and MRSA is
recommended empirically for ventilator-associated or hospital-acquired
pneumonia in high-risk patients. Narrowing is done after cultures.
, 8. A patient with septic shock is on norepinephrine infusion. MAP remains 58
mmHg despite fluids. Next best step:
A. Add vasopressin
B. Increase fluid bolus
C. Switch to dopamine
D. Start corticosteroids immediately
Answer: A
Rationale: Vasopressin is recommended as a second agent in septic
shock refractory to norepinephrine to maintain MAP ≥65 mmHg.
Dopamine is less preferred due to arrhythmia risk. Fluids may worsen
overload, steroids are adjunctive.
9. A 66-year-old male presents with acute confusion, fever, and a WBC of
22,000/mm³. CXR shows no infiltrates. Urinalysis reveals positive nitrites
and leukocyte esterase. Which is the most appropriate diagnosis?
A. Urinary tract infection with sepsis
B. Community-acquired pneumonia
C. Viral gastroenteritis
D. Meningitis
Answer: A
Rationale: Older adults may present with altered mental status and UTI
without localizing urinary symptoms. Positive nitrites and leukocyte esterase plus
systemic signs support UTI with systemic involvement.
10. In ARDS, lung-protective ventilation is defined as:
A. Tidal volume 10–12 mL/kg of ideal body weight
B. Tidal volume 6 mL/kg of ideal body weight
C. High-frequency oscillatory ventilation in all patients
D. Pressure-controlled ventilation only
Answer: B
