ANCC AGACNP Adult-Gerontology Acute Care
Nurse Practitioner Board Exam Study Guide PDF |
Advanced Pathophysiology, Acute & Critical
Care Management, Diagnostic Interpretation,
Pharmacologic Treatment Plans, Evidence-Based
Practice & ANCC Certification Prep Bundle
Question 1: A 68-year-old male with a history of COPD presents to the emergency department with
acute dyspnea, tachypnea, and use of accessory muscles. Arterial blood gas reveals pH 7.28, PaCO2 68
mm Hg, PaO2 52 mm Hg, HCO3 30 mEq/L. Which interpretation is most accurate?
A. Acute respiratory alkalosis
B. Acute metabolic acidosis
C. Acute-on-chronic respiratory acidosis
D. Compensated metabolic alkalosis
CORRECT ANSWER: C. Acute-on-chronic respiratory acidosis
RATIONALE: The elevated PaCO2 with low pH indicates respiratory acidosis; the elevated HCO3
suggests chronic compensation from underlying COPD, while the pH remains acidotic, indicating an
acute exacerbation.
Question 2: An AGACNP is managing a 72-year-old female with septic shock secondary to pneumonia.
Despite 30 mL/kg crystalloid resuscitation, her MAP remains 58 mm Hg. Which vasopressor is first-line
per Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Vasopressin
CORRECT ANSWER: C. Norepinephrine
RATIONALE: Norepinephrine is the recommended first-line vasopressor for septic shock due to its
alpha-adrenergic effects that increase systemic vascular resistance and improve mean arterial pressure.
Question 3: A 55-year-old male with end-stage renal disease on hemodialysis presents with
hyperkalemia (K+ 6.8 mEq/L) and peaked T waves on ECG. Which intervention should be administered
first?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Insulin with dextrose
D. Albuterol nebulizer
CORRECT ANSWER: B. Calcium gluconate
,RATIONALE: Calcium gluconate stabilizes the cardiac membrane and is administered first in severe
hyperkalemia with ECG changes to prevent life-threatening arrhythmias, before agents that shift
potassium intracellularly.
Question 4: An AGACNP evaluates a 63-year-old female post-coronary artery bypass graft who
develops sudden hypotension, muffled heart sounds, and jugular venous distention. Which diagnostic
test is most appropriate to confirm the suspected condition?
A. Chest X-ray
B. 12-lead ECG
C. Bedside echocardiogram
D. D-dimer assay
CORRECT ANSWER: C. Bedside echocardiogram
RATIONALE: The triad of hypotension, muffled heart sounds, and JVD suggests cardiac tamponade;
bedside echocardiography rapidly confirms pericardial effusion with right heart compression.
Question 5: A 70-year-old male with atrial fibrillation on warfarin presents with acute left-sided
weakness and aphasia. CT head shows no hemorrhage. His INR is 2.4. What is the most appropriate
acute intervention?
A. Administer vitamin K
B. Initiate IV heparin infusion
C. Administer IV alteplase if within time window
D. Hold warfarin and observe
CORRECT ANSWER: C. Administer IV alteplase if within time window
RATIONALE: For acute ischemic stroke with INR ≤3.0 and no contraindications, IV alteplase is indicated
if administered within 4.5 hours of symptom onset; warfarin at therapeutic INR does not preclude
thrombolysis.
Question 6: An AGACNP is caring for a 58-year-old female with acute pancreatitis. Which laboratory
finding is most specific for diagnosis?
A. Elevated amylase
B. Elevated lipase
C. Leukocytosis
D. Hyperglycemia
CORRECT ANSWER: B. Elevated lipase
RATIONALE: Lipase is more specific than amylase for acute pancreatitis, remains elevated longer, and is
less likely to be elevated in non-pancreatic conditions.
Question 7: A 65-year-old male with COPD is admitted with community-acquired pneumonia. Which
antibiotic regimen is most appropriate for empiric coverage?
,A. Azithromycin alone
B. Ceftriaxone plus azithromycin
C. Vancomycin plus piperacillin-tazobactam
D. Ciprofloxacin alone
CORRECT ANSWER: B. Ceftriaxone plus azithromycin
RATIONALE: For hospitalized patients with CAP and comorbidities like COPD, guidelines recommend
beta-lactam plus macrolide combination to cover typical and atypical pathogens.
Question 8: An AGACNP assesses a 74-year-old female with acute confusion, fever, and hypotension.
Urinalysis shows nitrites and leukocyte esterase. Which intervention is priority?
A. Obtain blood cultures
B. Administer broad-spectrum antibiotics
C. Insert indwelling urinary catheter
D. Order CT head
CORRECT ANSWER: B. Administer broad-spectrum antibiotics
RATIONALE: In suspected sepsis from UTI, early antibiotic administration within one hour is critical to
reduce mortality; cultures should be obtained first but not delay treatment.
Question 9: A 60-year-old male with known coronary artery disease presents with substernal chest
pain radiating to the left arm. ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Posterior descending artery
CORRECT ANSWER: C. Right coronary artery
RATIONALE: Inferior wall MI (leads II, III, aVF) is most commonly caused by occlusion of the right
coronary artery, which supplies the inferior myocardium.
Question 10: An AGACNP is managing a 52-year-old female with diabetic ketoacidosis. Initial labs:
glucose 480 mg/dL, pH 7.18, bicarbonate 10 mEq/L, potassium 5.2 mEq/L. After initiating IV fluids and
insulin infusion, when should potassium replacement begin?
A. Immediately
B. When potassium drops below 5.0 mEq/L
C. When potassium drops below 4.0 mEq/L
D. Only if ECG changes occur
CORRECT ANSWER: C. When potassium drops below 4.0 mEq/L
, RATIONALE: Insulin drives potassium intracellularly; replacement is initiated when serum potassium
falls below 4.0 mEq/L to prevent hypokalemia-induced arrhythmias, even if initial levels are normal or
elevated.
Question 11: A 67-year-old male with heart failure with reduced ejection fraction presents with acute
decompensation. Which medication should be avoided during acute management?
A. IV furosemide
B. IV nitroglycerin
C. Oral metoprolol succinate
D. IV morphine
CORRECT ANSWER: C. Oral metoprolol succinate
RATIONALE: Beta-blockers should not be initiated or up-titrated during acute decompensated heart
failure as they may worsen hemodynamics; they are resumed once the patient is euvolemic and stable.
Question 12: An AGACNP evaluates a 71-year-old female with sudden onset severe headache,
photophobia, and nuchal rigidity. Non-contrast CT head is negative. What is the next diagnostic step?
A. MRI brain with contrast
B. Lumbar puncture
C. CT angiography
D. Serum procalcitonin
CORRECT ANSWER: B. Lumbar puncture
RATIONALE: When subarachnoid hemorrhage is suspected and non-contrast CT is negative, lumbar
puncture is indicated to assess for xanthochromia or elevated RBCs consistent with SAH.
Question 13: A 59-year-old male with cirrhosis presents with hematemesis. Endoscopy confirms
esophageal varices. Which medication is first-line for acute variceal bleeding?
A. Pantoprazole
B. Octreotide
C. Vasopressin
D. Propranolol
CORRECT ANSWER: B. Octreotide
RATIONALE: Octreotide reduces splanchnic blood flow and portal pressure, and is first-line
pharmacologic therapy for acute variceal hemorrhage, typically combined with endoscopic band
ligation.
Question 14: An AGACNP is caring for a 64-year-old female with acute ischemic stroke. Blood pressure
is 210/110 mm Hg. She is not a candidate for thrombolysis. What is the target BP reduction in the first
24 hours?
A. Reduce by 50% immediately
B. Reduce by 15% in first hour
Nurse Practitioner Board Exam Study Guide PDF |
Advanced Pathophysiology, Acute & Critical
Care Management, Diagnostic Interpretation,
Pharmacologic Treatment Plans, Evidence-Based
Practice & ANCC Certification Prep Bundle
Question 1: A 68-year-old male with a history of COPD presents to the emergency department with
acute dyspnea, tachypnea, and use of accessory muscles. Arterial blood gas reveals pH 7.28, PaCO2 68
mm Hg, PaO2 52 mm Hg, HCO3 30 mEq/L. Which interpretation is most accurate?
A. Acute respiratory alkalosis
B. Acute metabolic acidosis
C. Acute-on-chronic respiratory acidosis
D. Compensated metabolic alkalosis
CORRECT ANSWER: C. Acute-on-chronic respiratory acidosis
RATIONALE: The elevated PaCO2 with low pH indicates respiratory acidosis; the elevated HCO3
suggests chronic compensation from underlying COPD, while the pH remains acidotic, indicating an
acute exacerbation.
Question 2: An AGACNP is managing a 72-year-old female with septic shock secondary to pneumonia.
Despite 30 mL/kg crystalloid resuscitation, her MAP remains 58 mm Hg. Which vasopressor is first-line
per Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Vasopressin
CORRECT ANSWER: C. Norepinephrine
RATIONALE: Norepinephrine is the recommended first-line vasopressor for septic shock due to its
alpha-adrenergic effects that increase systemic vascular resistance and improve mean arterial pressure.
Question 3: A 55-year-old male with end-stage renal disease on hemodialysis presents with
hyperkalemia (K+ 6.8 mEq/L) and peaked T waves on ECG. Which intervention should be administered
first?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Insulin with dextrose
D. Albuterol nebulizer
CORRECT ANSWER: B. Calcium gluconate
,RATIONALE: Calcium gluconate stabilizes the cardiac membrane and is administered first in severe
hyperkalemia with ECG changes to prevent life-threatening arrhythmias, before agents that shift
potassium intracellularly.
Question 4: An AGACNP evaluates a 63-year-old female post-coronary artery bypass graft who
develops sudden hypotension, muffled heart sounds, and jugular venous distention. Which diagnostic
test is most appropriate to confirm the suspected condition?
A. Chest X-ray
B. 12-lead ECG
C. Bedside echocardiogram
D. D-dimer assay
CORRECT ANSWER: C. Bedside echocardiogram
RATIONALE: The triad of hypotension, muffled heart sounds, and JVD suggests cardiac tamponade;
bedside echocardiography rapidly confirms pericardial effusion with right heart compression.
Question 5: A 70-year-old male with atrial fibrillation on warfarin presents with acute left-sided
weakness and aphasia. CT head shows no hemorrhage. His INR is 2.4. What is the most appropriate
acute intervention?
A. Administer vitamin K
B. Initiate IV heparin infusion
C. Administer IV alteplase if within time window
D. Hold warfarin and observe
CORRECT ANSWER: C. Administer IV alteplase if within time window
RATIONALE: For acute ischemic stroke with INR ≤3.0 and no contraindications, IV alteplase is indicated
if administered within 4.5 hours of symptom onset; warfarin at therapeutic INR does not preclude
thrombolysis.
Question 6: An AGACNP is caring for a 58-year-old female with acute pancreatitis. Which laboratory
finding is most specific for diagnosis?
A. Elevated amylase
B. Elevated lipase
C. Leukocytosis
D. Hyperglycemia
CORRECT ANSWER: B. Elevated lipase
RATIONALE: Lipase is more specific than amylase for acute pancreatitis, remains elevated longer, and is
less likely to be elevated in non-pancreatic conditions.
Question 7: A 65-year-old male with COPD is admitted with community-acquired pneumonia. Which
antibiotic regimen is most appropriate for empiric coverage?
,A. Azithromycin alone
B. Ceftriaxone plus azithromycin
C. Vancomycin plus piperacillin-tazobactam
D. Ciprofloxacin alone
CORRECT ANSWER: B. Ceftriaxone plus azithromycin
RATIONALE: For hospitalized patients with CAP and comorbidities like COPD, guidelines recommend
beta-lactam plus macrolide combination to cover typical and atypical pathogens.
Question 8: An AGACNP assesses a 74-year-old female with acute confusion, fever, and hypotension.
Urinalysis shows nitrites and leukocyte esterase. Which intervention is priority?
A. Obtain blood cultures
B. Administer broad-spectrum antibiotics
C. Insert indwelling urinary catheter
D. Order CT head
CORRECT ANSWER: B. Administer broad-spectrum antibiotics
RATIONALE: In suspected sepsis from UTI, early antibiotic administration within one hour is critical to
reduce mortality; cultures should be obtained first but not delay treatment.
Question 9: A 60-year-old male with known coronary artery disease presents with substernal chest
pain radiating to the left arm. ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Posterior descending artery
CORRECT ANSWER: C. Right coronary artery
RATIONALE: Inferior wall MI (leads II, III, aVF) is most commonly caused by occlusion of the right
coronary artery, which supplies the inferior myocardium.
Question 10: An AGACNP is managing a 52-year-old female with diabetic ketoacidosis. Initial labs:
glucose 480 mg/dL, pH 7.18, bicarbonate 10 mEq/L, potassium 5.2 mEq/L. After initiating IV fluids and
insulin infusion, when should potassium replacement begin?
A. Immediately
B. When potassium drops below 5.0 mEq/L
C. When potassium drops below 4.0 mEq/L
D. Only if ECG changes occur
CORRECT ANSWER: C. When potassium drops below 4.0 mEq/L
, RATIONALE: Insulin drives potassium intracellularly; replacement is initiated when serum potassium
falls below 4.0 mEq/L to prevent hypokalemia-induced arrhythmias, even if initial levels are normal or
elevated.
Question 11: A 67-year-old male with heart failure with reduced ejection fraction presents with acute
decompensation. Which medication should be avoided during acute management?
A. IV furosemide
B. IV nitroglycerin
C. Oral metoprolol succinate
D. IV morphine
CORRECT ANSWER: C. Oral metoprolol succinate
RATIONALE: Beta-blockers should not be initiated or up-titrated during acute decompensated heart
failure as they may worsen hemodynamics; they are resumed once the patient is euvolemic and stable.
Question 12: An AGACNP evaluates a 71-year-old female with sudden onset severe headache,
photophobia, and nuchal rigidity. Non-contrast CT head is negative. What is the next diagnostic step?
A. MRI brain with contrast
B. Lumbar puncture
C. CT angiography
D. Serum procalcitonin
CORRECT ANSWER: B. Lumbar puncture
RATIONALE: When subarachnoid hemorrhage is suspected and non-contrast CT is negative, lumbar
puncture is indicated to assess for xanthochromia or elevated RBCs consistent with SAH.
Question 13: A 59-year-old male with cirrhosis presents with hematemesis. Endoscopy confirms
esophageal varices. Which medication is first-line for acute variceal bleeding?
A. Pantoprazole
B. Octreotide
C. Vasopressin
D. Propranolol
CORRECT ANSWER: B. Octreotide
RATIONALE: Octreotide reduces splanchnic blood flow and portal pressure, and is first-line
pharmacologic therapy for acute variceal hemorrhage, typically combined with endoscopic band
ligation.
Question 14: An AGACNP is caring for a 64-year-old female with acute ischemic stroke. Blood pressure
is 210/110 mm Hg. She is not a candidate for thrombolysis. What is the target BP reduction in the first
24 hours?
A. Reduce by 50% immediately
B. Reduce by 15% in first hour
