ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER (AGACNP-BC) BOARD
CERTIFICATION – ANCC COMPREHENSIVE EXAM 200+ PRACTICE QUESTIONS AND
CORRECT DETAILED ANSWERS
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1. A 78-year-old male patient with heart failure develops a bacterial urinary tract infection
secondary to an indwelling Foley catheter. The patient has a known history of allergy to
penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is:
a) Cephalexin (Keflex)
b) Ciprofloxacin (Cipro)
c) Doxycycline (Vibramycin)
d) Tetracycline (Sumycin)
Answer: b) Ciprofloxacin (Cipro)
Explanation: Cephalosporins have cross-reactivity with penicillins and should be avoided in
patients with true penicillin allergy. Tetracyclines can cause severe side effects and are not first-
line for UTIs in elderly patients. Fluoroquinolones such as ciprofloxacin are appropriate for
complicated UTIs in patients with penicillin and sulfa allergies, though renal function must be
monitored .
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2. A female patient is receiving adjuvant chemotherapy for breast cancer and has been given
information about her treatment regimen, expected side effects, and symptom management.
Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute
care nurse practitioner?
,a) Alopecia
b) Fatigue
c) Fever
d) Nausea
Answer: c) Fever
Explanation: Fever in a patient receiving chemotherapy is a medical emergency that may
indicate neutropenia and infection. Alopecia, fatigue, and nausea are expected side effects of
chemotherapy but do not require emergent evaluation. A neutropenic fever requires immediate
assessment and possible hospitalization .
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3. A patient with hydrocephalus secondary to a subarachnoid hemorrhage has developed an
intracranial pressure of 25 mm Hg. The acute care nurse practitioner's intervention is to:
a) Hyperventilate to reach a PCO2 of 30 mm Hg
b) Order dexamethasone (Decadron) 4 mg IV
c) Perform a ventriculostomy and drainage of cerebrospinal fluid
d) Prescribe mannitol (Osmitrol) 100 g IV
Answer: c) Perform a ventriculostomy and drainage of cerebrospinal fluid
Explanation: Normal ICP is 5-15 mm Hg. An ICP of 25 mm Hg is elevated and requires
intervention. While mannitol and hyperventilation are temporizing measures, ventriculostomy
,with CSF drainage is the definitive treatment for hydrocephalus, allowing direct monitoring and
management of ICP .
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4. Which medication is used with caution in older adults due to the potential for confusion and
delirium?
a) Fluoxetine (Prozac)
b) Haloperidol (Haldol)
c) Lorazepam (Ativan)
d) Phenelzine (Nardil)
Answer: c) Lorazepam (Ativan)
Explanation: Benzodiazepines such as lorazepam are on the Beers Criteria for potentially
inappropriate medication use in older adults due to their association with increased risk of
cognitive impairment, delirium, falls, and fractures. They should be used with extreme caution
in the elderly population .
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5. Which of the following best describes the ethical principle of confidentiality?
a) Respecting an individual's thoughts and actions
b) Producing the greatest good for the greatest number
c) Protecting private information disclosed during the healthcare relationship
, d) Being truthful and honest with patients
Answer: c) Protecting private information disclosed during the healthcare relationship
Explanation: Confidentiality is the ethical duty to protect private patient information. Autonomy
respects individual thoughts and actions; utilitarianism focuses on the greatest good; veracity
refers to truthfulness .
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6. A 57-year-old male patient arrives at the emergency department with substernal chest pain.
An electrocardiogram reveals ST segment depression in leads V3 and V4. Before administering
nitrates, an acute care nurse practitioner assesses the patient's use of:
a) Angiotensin-converting enzyme inhibitors
b) Aspirin
c) Beta-blockers
d) Phosphodiesterase inhibitors
Answer: d) Phosphodiesterase inhibitors
Explanation: Phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil) used for erectile
dysfunction can cause severe hypotension and even death when combined with nitrates. This is
a critical safety assessment before nitrate administration .
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CERTIFICATION – ANCC COMPREHENSIVE EXAM 200+ PRACTICE QUESTIONS AND
CORRECT DETAILED ANSWERS
---
1. A 78-year-old male patient with heart failure develops a bacterial urinary tract infection
secondary to an indwelling Foley catheter. The patient has a known history of allergy to
penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is:
a) Cephalexin (Keflex)
b) Ciprofloxacin (Cipro)
c) Doxycycline (Vibramycin)
d) Tetracycline (Sumycin)
Answer: b) Ciprofloxacin (Cipro)
Explanation: Cephalosporins have cross-reactivity with penicillins and should be avoided in
patients with true penicillin allergy. Tetracyclines can cause severe side effects and are not first-
line for UTIs in elderly patients. Fluoroquinolones such as ciprofloxacin are appropriate for
complicated UTIs in patients with penicillin and sulfa allergies, though renal function must be
monitored .
---
2. A female patient is receiving adjuvant chemotherapy for breast cancer and has been given
information about her treatment regimen, expected side effects, and symptom management.
Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute
care nurse practitioner?
,a) Alopecia
b) Fatigue
c) Fever
d) Nausea
Answer: c) Fever
Explanation: Fever in a patient receiving chemotherapy is a medical emergency that may
indicate neutropenia and infection. Alopecia, fatigue, and nausea are expected side effects of
chemotherapy but do not require emergent evaluation. A neutropenic fever requires immediate
assessment and possible hospitalization .
---
3. A patient with hydrocephalus secondary to a subarachnoid hemorrhage has developed an
intracranial pressure of 25 mm Hg. The acute care nurse practitioner's intervention is to:
a) Hyperventilate to reach a PCO2 of 30 mm Hg
b) Order dexamethasone (Decadron) 4 mg IV
c) Perform a ventriculostomy and drainage of cerebrospinal fluid
d) Prescribe mannitol (Osmitrol) 100 g IV
Answer: c) Perform a ventriculostomy and drainage of cerebrospinal fluid
Explanation: Normal ICP is 5-15 mm Hg. An ICP of 25 mm Hg is elevated and requires
intervention. While mannitol and hyperventilation are temporizing measures, ventriculostomy
,with CSF drainage is the definitive treatment for hydrocephalus, allowing direct monitoring and
management of ICP .
---
4. Which medication is used with caution in older adults due to the potential for confusion and
delirium?
a) Fluoxetine (Prozac)
b) Haloperidol (Haldol)
c) Lorazepam (Ativan)
d) Phenelzine (Nardil)
Answer: c) Lorazepam (Ativan)
Explanation: Benzodiazepines such as lorazepam are on the Beers Criteria for potentially
inappropriate medication use in older adults due to their association with increased risk of
cognitive impairment, delirium, falls, and fractures. They should be used with extreme caution
in the elderly population .
---
5. Which of the following best describes the ethical principle of confidentiality?
a) Respecting an individual's thoughts and actions
b) Producing the greatest good for the greatest number
c) Protecting private information disclosed during the healthcare relationship
, d) Being truthful and honest with patients
Answer: c) Protecting private information disclosed during the healthcare relationship
Explanation: Confidentiality is the ethical duty to protect private patient information. Autonomy
respects individual thoughts and actions; utilitarianism focuses on the greatest good; veracity
refers to truthfulness .
---
6. A 57-year-old male patient arrives at the emergency department with substernal chest pain.
An electrocardiogram reveals ST segment depression in leads V3 and V4. Before administering
nitrates, an acute care nurse practitioner assesses the patient's use of:
a) Angiotensin-converting enzyme inhibitors
b) Aspirin
c) Beta-blockers
d) Phosphodiesterase inhibitors
Answer: d) Phosphodiesterase inhibitors
Explanation: Phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil) used for erectile
dysfunction can cause severe hypotension and even death when combined with nitrates. This is
a critical safety assessment before nitrate administration .
---
