Acute Care Nurse Practitioner (ACNP) Exam
2025/2026 | Verifi ed Questions with Correct
Answers
Cardiovascular
1. A 68-year-old male with STEMI develops hypotension, jugular venous distention, and
muffled heart sounds. What is the priority intervention?
Answer: Pericardiocentesis
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) suggests cardiac
tamponade. Immediate decompression via pericardiocentesis is life-saving.
2. Post-cardiac arrest, a patient has a temperature of 35.5°C (95.9°F) and remains
unresponsive. What should the ACNP do?
Answer: Initiate targeted temperature management (32–36°C)
Rationale: Mild therapeutic hypothermia improves neurological outcomes after cardiac
arrest by reducing cerebral oxygen demand.
3. Which ECG finding is most specific for acute pericarditis?
Answer: Diffuse ST-segment elevation with PR depression
Rationale: Unlike STEMI (localized ST elevation), pericarditis causes global injury pattern.
4. A patient with heart failure on furosemide develops muscle cramps and a serum K+ of 3.1
mEq/L. What is the best next step?
Answer: IV potassium replacement and hold furosemide
Rationale: Hypokalemia increases arrhythmia risk; correct potassium before re-dosing loop
diuretics.
5. What medication reduces mortality in chronic HFrEF and should be started before
discharge?
Answer: Beta-blocker (carvedilol, metoprolol succinate, bisoprolol)
Rationale: Beta-blockers reduce sympathetic activation, reverse remodeling, and decrease
sudden death.
,6. Which finding in a hypertensive emergency requires immediate IV antihypertensive
therapy?
Answer: Acute kidney injury with creatinine 3.5 mg/dL
Rationale: Hypertensive emergency with end-organ damage (kidney, brain, heart) mandates
urgent blood pressure reduction.
7. A patient with atrial fibrillation and CHA₂DS₂-VASc score of 4 is on warfarin. INR is 1.2.
What should be done?
Answer: Administer enoxaparin and increase warfarin dose
Rationale: Subtherapeutic INR in high-risk AF requires bridging with LMWH until INR >2.0.
8. Which vasopressor is preferred in cardiogenic shock?
Answer: Norepinephrine
Rationale: Norepinephrine increases BP without excessive tachycardia; dobutamine may be
added for low cardiac output.
9. A patient 3 days post-MI has a harsh holosystolic murmur at the apex. What is the most
likely diagnosis?
Answer: Mitral regurgitation from papillary muscle rupture
Rationale: Papillary muscle rupture typically occurs 2–7 days post-MI, causing acute severe
MR.
10. Which lab value is most predictive of poor outcome in acute heart failure?
Answer: Elevated B-type natriuretic peptide (BNP) > 1000 pg/mL
Rationale: BNP correlates with ventricular wall stress and prognosis.
11. A patient with aortic stenosis and syncope during exercise requires what intervention?
Answer: Urgent surgical aortic valve replacement
Rationale: Symptomatic severe aortic stenosis (syncope, angina, HF) has poor survival
without valve replacement.
12. Which antiarrhythmic is contraindicated in patients with structural heart disease?
Answer: Flecainide
,Rationale: Class Ic agents increase mortality in patients with prior MI or reduced EF.
13. A patient with acute limb ischemia has a pulseless, mottled leg. What is the first step?
Answer: Urgent vascular surgery consult for embolectomy
Rationale: Time to revascularization determines limb salvage (usually <6 hours).
14. Which medication is first-line for rate control in acute atrial fibrillation with rapid
ventricular response and HF?
Answer: Digoxin
Rationale: Beta-blockers and calcium channel blockers may worsen decompensated HF;
digoxin is safer.
15. A post-op patient develops chest pain, hypoxemia, and ECG showing S1Q3T3 pattern.
What is the best test?
Answer: CT pulmonary angiography
Rationale: S1Q3T3 suggests acute cor pulmonale from PE; CTPA is diagnostic.
16. Which lipid-lowering therapy reduces cardiovascular events most in acute coronary
syndrome?
Answer: High-intensity statin (atorvastatin 80 mg)
Rationale: Statins stabilize plaque, reduce inflammation, and lower LDL, improving
outcomes independent of baseline LDL.
17. A patient with septic shock and low BP on norepinephrine has a cardiac index of 4.5
L/min/m². What is the likely cause of hypotension?
Answer: Distributive shock with vasodilation
Rationale: High cardiac index but low BP indicates vasoplegia; add vasopressin.
18. Which physical exam finding suggests severe aortic regurgitation?
Answer: Head bobbing with each heartbeat (de Musset's sign)
Rationale: De Musset's sign reflects hyperdynamic circulation from large stroke volume.
19. A patient with pacemaker presents with hiccups and diaphragm pacing. What is the likely
problem?
, Answer: Lead perforation into phrenic nerve
Rationale: Diaphragmatic stimulation occurs with right ventricular lead perforation; requires
interrogation and repositioning.
20. Which diuretic is most effective in acute decompensated HF with renal impairment?
Answer: Continuous infusion furosemide
Rationale: Continuous infusion avoids ototoxicity and maintains steady diuresis in poor renal
perfusion.
Pulmonary
21. Which ventilator setting improves oxygenation in ARDS?
Answer: Higher PEEP (positive end-expiratory pressure)
Rationale: PEEP recruits alveoli, reduces shunting, and improves PaO₂/FiO₂ ratio.
22. A patient with COPD exacerbation has pH 7.25, PaCO₂ 70 mm Hg, PaO₂ 55 mm Hg. What
is the best next step?
Answer: Non-invasive ventilation (BiPAP)
Rationale: NIV reduces work of breathing and intubation risk in hypercapnic respiratory
failure.
23. Which finding on chest x-ray in a ventilated patient suggests pneumothorax?
Answer: Deep sulcus sign
Rationale: Deep lucency in costophrenic angle indicates supine pneumothorax.
24. A patient with massive hemoptysis (500 mL) from a cavitary lung lesion. What is the
priority?
Answer: Protect airway (position bleeding side down, intubate if needed)
Rationale: Asphyxiation is immediate risk; bronchial artery embolization can follow.
25. Which asthma medication reduces mortality and should be used in all persistent
asthma?
Answer: Inhaled corticosteroid (ICS)
2025/2026 | Verifi ed Questions with Correct
Answers
Cardiovascular
1. A 68-year-old male with STEMI develops hypotension, jugular venous distention, and
muffled heart sounds. What is the priority intervention?
Answer: Pericardiocentesis
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) suggests cardiac
tamponade. Immediate decompression via pericardiocentesis is life-saving.
2. Post-cardiac arrest, a patient has a temperature of 35.5°C (95.9°F) and remains
unresponsive. What should the ACNP do?
Answer: Initiate targeted temperature management (32–36°C)
Rationale: Mild therapeutic hypothermia improves neurological outcomes after cardiac
arrest by reducing cerebral oxygen demand.
3. Which ECG finding is most specific for acute pericarditis?
Answer: Diffuse ST-segment elevation with PR depression
Rationale: Unlike STEMI (localized ST elevation), pericarditis causes global injury pattern.
4. A patient with heart failure on furosemide develops muscle cramps and a serum K+ of 3.1
mEq/L. What is the best next step?
Answer: IV potassium replacement and hold furosemide
Rationale: Hypokalemia increases arrhythmia risk; correct potassium before re-dosing loop
diuretics.
5. What medication reduces mortality in chronic HFrEF and should be started before
discharge?
Answer: Beta-blocker (carvedilol, metoprolol succinate, bisoprolol)
Rationale: Beta-blockers reduce sympathetic activation, reverse remodeling, and decrease
sudden death.
,6. Which finding in a hypertensive emergency requires immediate IV antihypertensive
therapy?
Answer: Acute kidney injury with creatinine 3.5 mg/dL
Rationale: Hypertensive emergency with end-organ damage (kidney, brain, heart) mandates
urgent blood pressure reduction.
7. A patient with atrial fibrillation and CHA₂DS₂-VASc score of 4 is on warfarin. INR is 1.2.
What should be done?
Answer: Administer enoxaparin and increase warfarin dose
Rationale: Subtherapeutic INR in high-risk AF requires bridging with LMWH until INR >2.0.
8. Which vasopressor is preferred in cardiogenic shock?
Answer: Norepinephrine
Rationale: Norepinephrine increases BP without excessive tachycardia; dobutamine may be
added for low cardiac output.
9. A patient 3 days post-MI has a harsh holosystolic murmur at the apex. What is the most
likely diagnosis?
Answer: Mitral regurgitation from papillary muscle rupture
Rationale: Papillary muscle rupture typically occurs 2–7 days post-MI, causing acute severe
MR.
10. Which lab value is most predictive of poor outcome in acute heart failure?
Answer: Elevated B-type natriuretic peptide (BNP) > 1000 pg/mL
Rationale: BNP correlates with ventricular wall stress and prognosis.
11. A patient with aortic stenosis and syncope during exercise requires what intervention?
Answer: Urgent surgical aortic valve replacement
Rationale: Symptomatic severe aortic stenosis (syncope, angina, HF) has poor survival
without valve replacement.
12. Which antiarrhythmic is contraindicated in patients with structural heart disease?
Answer: Flecainide
,Rationale: Class Ic agents increase mortality in patients with prior MI or reduced EF.
13. A patient with acute limb ischemia has a pulseless, mottled leg. What is the first step?
Answer: Urgent vascular surgery consult for embolectomy
Rationale: Time to revascularization determines limb salvage (usually <6 hours).
14. Which medication is first-line for rate control in acute atrial fibrillation with rapid
ventricular response and HF?
Answer: Digoxin
Rationale: Beta-blockers and calcium channel blockers may worsen decompensated HF;
digoxin is safer.
15. A post-op patient develops chest pain, hypoxemia, and ECG showing S1Q3T3 pattern.
What is the best test?
Answer: CT pulmonary angiography
Rationale: S1Q3T3 suggests acute cor pulmonale from PE; CTPA is diagnostic.
16. Which lipid-lowering therapy reduces cardiovascular events most in acute coronary
syndrome?
Answer: High-intensity statin (atorvastatin 80 mg)
Rationale: Statins stabilize plaque, reduce inflammation, and lower LDL, improving
outcomes independent of baseline LDL.
17. A patient with septic shock and low BP on norepinephrine has a cardiac index of 4.5
L/min/m². What is the likely cause of hypotension?
Answer: Distributive shock with vasodilation
Rationale: High cardiac index but low BP indicates vasoplegia; add vasopressin.
18. Which physical exam finding suggests severe aortic regurgitation?
Answer: Head bobbing with each heartbeat (de Musset's sign)
Rationale: De Musset's sign reflects hyperdynamic circulation from large stroke volume.
19. A patient with pacemaker presents with hiccups and diaphragm pacing. What is the likely
problem?
, Answer: Lead perforation into phrenic nerve
Rationale: Diaphragmatic stimulation occurs with right ventricular lead perforation; requires
interrogation and repositioning.
20. Which diuretic is most effective in acute decompensated HF with renal impairment?
Answer: Continuous infusion furosemide
Rationale: Continuous infusion avoids ototoxicity and maintains steady diuresis in poor renal
perfusion.
Pulmonary
21. Which ventilator setting improves oxygenation in ARDS?
Answer: Higher PEEP (positive end-expiratory pressure)
Rationale: PEEP recruits alveoli, reduces shunting, and improves PaO₂/FiO₂ ratio.
22. A patient with COPD exacerbation has pH 7.25, PaCO₂ 70 mm Hg, PaO₂ 55 mm Hg. What
is the best next step?
Answer: Non-invasive ventilation (BiPAP)
Rationale: NIV reduces work of breathing and intubation risk in hypercapnic respiratory
failure.
23. Which finding on chest x-ray in a ventilated patient suggests pneumothorax?
Answer: Deep sulcus sign
Rationale: Deep lucency in costophrenic angle indicates supine pneumothorax.
24. A patient with massive hemoptysis (500 mL) from a cavitary lung lesion. What is the
priority?
Answer: Protect airway (position bleeding side down, intubate if needed)
Rationale: Asphyxiation is immediate risk; bronchial artery embolization can follow.
25. Which asthma medication reduces mortality and should be used in all persistent
asthma?
Answer: Inhaled corticosteroid (ICS)
