AACN ACNPC-AG (AGACNP) CERTIFICATION EXAM PSI PROCTORED PREP QUESTIONS WITH CORRECT ANSWERS AND RATIONALE

AACN ACNPC-AG (AGACNP) CERTIFICATION EXAM PSI PROCTORED PREP QUESTIONS WITH CORRECT ANSWERS AND RATIONALE 1. A 68-year-old male with COPD presents with acute respiratory distress. ABG on 4 L nasal cannula: pH 7.28, PaCO2 68, PaO2 55, HCO3 26. Which intervention is most appropriate first? A. Increase oxygen to 6 L nasal cannula B. Initiate BiPAP ventilation C. Intubate and initiate mechanical ventilation D. Administer intravenous magnesium sulfate Correct Answer: B Rationale: The ABG shows acute-on-chronic hypercapnic respiratory failure. BiPAP is first-line to avoid intubation in an alert, hemodynamically stable patient. 2. A 54-year-old female post-cardiac arrest has GCS 8. Targeted temperature management is initiated. Which core temperature range is recommended for the first 24 hours? A. 32–34°C B. 33–36°C C. 35–37°C D. 30–32°C Correct Answer: B Rationale: Current guidelines recommend maintaining core temperature between 33–36°C for at least 24 hours after cardiac arrest. 3. A 72-year-old with septic shock on norepinephrine 0.2 mcg/kg/min has MAP 58 mm Hg, CVP 8 mm Hg, ScvO2 60%. What is the most appropriate next step? A. Add dobutamine B. Give a 500 mL fluid bolus C. Increase norepinephrine to 0.3 mcg/kg/min D. Start vasopressin at 0.04 units/min Correct Answer: D Rationale: Vasopressin is added when norepinephrine doses exceed 0.1–0.2 mcg/kg/min and target MAP is not achieved despite adequate filling. 4. A 45-year-old man with acute pancreatitis develops fever, hypotension, and desaturation on day 5. Lipase is declining. What is the most likely diagnosis? A. Infected pancreatic necrosis B. Acute respiratory distress syndrome C. Sepsis from cholangitis D. Pulmonary embolism Correct Answer: B Rationale: ARDS commonly complicates severe pancreatitis days after onset, even as pancreatic enzymes normalize. 5. A 62-year-old woman with atrial fibrillation on warfarin has INR 4.2 and an acute ischemic stroke 2 hours ago. No hemorrhage on CT. What is the most appropriate management? A. Administer IV alteplase B. Give vitamin K 10 mg IV C. Give fresh frozen plasma D. Hold warfarin and monitor INR Correct Answer: A Rationale: For INR ≤ 4.5, IV alteplase is not contraindicated if otherwise eligible within 4.5 hours of symptom onset. 6. A 78-year-old male presents with syncope. ECG shows sinus bradycardia at 42 bpm, intermittent 3-second pauses. Troponin is normal. He is asymptomatic now. What is the next step? A. Atropine 0.5 mg IV B. Transcutaneous pacing C. Dopamine infusion D. Observation with telemetry Correct Answer: D Rationale: Asymptomatic bradycardia with pauses less than 3 seconds does not require immediate intervention. 7. A 55-year-old female with cirrhosis and ascites develops altered mental status, fever, and abdominal pain. Paracentesis shows PMN 450 cells/mm³. What is the first-line antibiotic regimen? A. Oral norfloxacin B. IV cefotaxime C. IV metronidazole D. IV vancomycin Correct Answer: B Rationale: Spontaneous bacterial peritonitis (PMN ≥ 250) is treated with IV third-generation cephalosporin like cefotaxime. 8. A 70-year-old post-op day 2 after colectomy has new-onset confusion, temperature 38.5°C, heart rate 110, blood pressure 100/60, respiratory rate 24. What is the most appropriate next step? A. Order head CT B. Administer lorazepam C. Draw blood cultures and start broad-spectrum antibiotics D. Increase IV fluids to 200 mL/hr Correct Answer: C Rationale: Post-op fever with tachycardia, tachypnea, and hypotension suggests sepsis. Blood cultures and antibiotics are priority. 9. A 49-year-old male with sudden severe headache, neck stiffness, and photophobia. CT head is normal. What is the most appropriate next diagnostic test? A. MRI brain B. Lumbar puncture C. CT angiography D. EEG Correct Answer: B Rationale: Normal CT with suspected subarachnoid hemorrhage or meningitis requires lumbar puncture, especially for xanthochromia or CSF analysis. 10. A 66-year-old female with COPD on home oxygen presents with increased sputum purulence and dyspnea. She is afebrile. Exam: diffuse wheezing. What is the most appropriate initial treatment? A. Levofloxacin 750 mg daily B. Prednisone 40 mg daily C. Albuterol and ipratropium nebulizers D. Piperacillin-tazobactam IV Correct Answer: C Rationale: Acute exacerbation of COPD without pneumonia is initially treated with bronchodilators. Antibiotics and steroids are added based on severity. 11. A 60-year-old male with acute onset chest pain radiating to the back. Blood pressure 100/60 in right arm, 90/50 in left arm. Chest x-ray shows widened mediastinum. What is the most appropriate next step? A. Administer aspirin and heparin B. CT angiography of chest C. Transthoracic echocardiogram D. STAT ECG Correct Answer: B Rationale: Suspected aortic dissection requires CT angiography for definitive diagnosis. Anticoagulation is contraindicated. 12. A 52-year-old female with known heart failure with reduced ejection fraction (30%) presents with worsening dyspnea, JVP 14 cm, crackles, and 2+ pitting edema. Creatinine is 1.6 mg/dL (baseline 1.0). Which medication should be held? A. Metoprolol succinate B. Furosemide C. Lisinopril D. Spironolactone Correct Answer: C Rationale: ACE inhibitor should be held in acute decompensated heart failure with worsening renal function to avoid further kidney injury. 13. A 35-year-old male with traumatic brain injury has ICP 22 mm Hg, CPP 60 mm Hg. What is the first-line intervention? A. Mannitol 1 g/kg IV B. Hyperventilation to PaCO2 30 C. Elevate head of bed to 30 degrees D. Administer 3% saline bolus Correct Answer: C Rationale: Head of bed elevation to 30 degrees is the initial non-invasive maneuver to lower ICP. 14. A 74-year-old male with acute kidney injury, urine output 0.3 mL/kg/hr, urine sodium 10 mEq/L, FeNa 1%. What is the most likely diagnosis? A. Acute tubular necrosis B. Prerenal azotemia C. Postrenal obstruction D. Interstitial nephritis