Page 1 of 47
BARKLEY SHOCK STATE AG-ACNP 2026
REVIEW EXAM COMPLETE (130) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED
EXPLANATIONS|GUARANTEED PASS.
BARKLEY
Prepare for the Barkley Shock State AG-ACNP Exam Review with
practice questions covering shock classifications, hemodynamic
monitoring, critical care interventions, pharmacology, patient
assessment, and acute care management. This study guide helps
reinforce essential advanced practice nursing concepts and supports
effective exam preparation. Designed to improve clinical decision-
making and boost confidence in managing critically ill patients.
Suitable for AG-ACNP, nursing, and acute care healthcare students and
professionals.
MULTIPLE CHOICE.
SECTION 1: DISTRIBUTIVE SHOCK – SEPTIC (Questions 1-40)
1. A 72-year-old male with a PMH of DM type 2 presents with fever, hypotension
(MAP 55 mmHg), and altered mental status. Initial lactate is 4.8 mmol/L. What is
the FIRST intervention within the first hour?
• A) Obtain blood cultures then administer broad-spectrum antibiotics
• B) Administer 30 mL/kg crystalloid then reassess
• C) Start norepinephrine before fluids
• D) Administer hydrocortisone 100 mg IV
Answer: B
Rationale: The Surviving Sepsis Campaign (2021) recommends 30 mL/kg IV crystalloid
within 3 hours of identification. Fluids are first-line; vasopressors are added if MAP
remains <65 after adequate fluid resuscitation. Antibiotics within 1 hour after cultures,
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but fluid is simultaneous priority.
2. Which vasopressor is the FIRST-LINE agent for septic shock?
• A) Dopamine
• B) Epinephrine
• C) Norepinephrine
• D) Vasopressin
Answer: C
Rationale: Norepinephrine is the first-line vasopressor (strong recommendation) to
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achieve MAP ≥65 mmHg. It increases SVR with minimal chronotropic effect. Vasopressin
is adjunctive (0.03 U/min); dopamine is no longer preferred.
3. A patient with septic shock remains hypotensive (MAP 60 mmHg) after 3L of
crystalloid. What is the NEXT step?
• A) Give furosemide 40 mg IV
• B) Start norepinephrine IV infusion
• C) Transfuse 2 units PRBCs
• D) Administer albumin 5%
Answer: B
Rationale: After inadequate response to fluids, vasopressors are indicated.
Norepinephrine is first-line. Albumin is second-line; furosemide is contraindicated in
hypotension; PRBCs only if Hgb <7.
4. What is the target MAP for septic shock resuscitation?
• A) 50-55 mmHg
• B) 65-70 mmHg
• C) 80-85 mmHg
• D) >90 mmHg
Answer: B
Rationale: Guidelines recommend initial MAP target of ≥65 mmHg. Higher targets (80-
85) do not improve mortality and increase risk of atrial fibrillation.
5. A 68-year-old with septic shock has a ScvO2 of 55% after fluids and
vasopressors. What intervention is indicated?
• A) Increase norepinephrine
• B) Transfuse PRBCs to Hgb >7
• C) Start dobutamine
• D) Decrease PEEP
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Answer: C
Rationale: Surviving Sepsis Guidelines: If ScvO2 <70% after adequate volume and MAP,
add dobutamine (or consider RBC transfusion if Hgb <7). Dobutamine increases oxygen
delivery.
6. Which biomarker is most specific for bacterial sepsis?
• A) CRP
• B) Troponin I
• C) Procalcitonin (PCT)
• D) BNP
Answer: C
Rationale: Procalcitonin rises within 3-6 hours of bacterial infection, correlates with
severity, and helps guide antibiotic discontinuation. CRP is less specific.
7. A patient with septic shock has a rising lactate despite MAP >70 mmHg. What is
the most likely cause?
• A) Overtreatment with fluids
• B) Ongoing tissue hypoperfusion
• C) Liver failure impairing lactate clearance
• D) Rhabdomyolysis
Answer: C
Rationale: Lactate elevation in sepsis is due to both increased production and
decreased clearance (especially hepatic dysfunction). Normal MAP does not guarantee
normal microcirculation.
8. When should empiric antibiotics be administered in septic shock?
• A) Within 1 hour of recognition
• B) Within 3 hours
• C) After blood culture results return
BARKLEY SHOCK STATE AG-ACNP 2026
REVIEW EXAM COMPLETE (130) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED
EXPLANATIONS|GUARANTEED PASS.
BARKLEY
Prepare for the Barkley Shock State AG-ACNP Exam Review with
practice questions covering shock classifications, hemodynamic
monitoring, critical care interventions, pharmacology, patient
assessment, and acute care management. This study guide helps
reinforce essential advanced practice nursing concepts and supports
effective exam preparation. Designed to improve clinical decision-
making and boost confidence in managing critically ill patients.
Suitable for AG-ACNP, nursing, and acute care healthcare students and
professionals.
MULTIPLE CHOICE.
SECTION 1: DISTRIBUTIVE SHOCK – SEPTIC (Questions 1-40)
1. A 72-year-old male with a PMH of DM type 2 presents with fever, hypotension
(MAP 55 mmHg), and altered mental status. Initial lactate is 4.8 mmol/L. What is
the FIRST intervention within the first hour?
• A) Obtain blood cultures then administer broad-spectrum antibiotics
• B) Administer 30 mL/kg crystalloid then reassess
• C) Start norepinephrine before fluids
• D) Administer hydrocortisone 100 mg IV
Answer: B
Rationale: The Surviving Sepsis Campaign (2021) recommends 30 mL/kg IV crystalloid
within 3 hours of identification. Fluids are first-line; vasopressors are added if MAP
remains <65 after adequate fluid resuscitation. Antibiotics within 1 hour after cultures,
, Page 2 of 47
but fluid is simultaneous priority.
2. Which vasopressor is the FIRST-LINE agent for septic shock?
• A) Dopamine
• B) Epinephrine
• C) Norepinephrine
• D) Vasopressin
Answer: C
Rationale: Norepinephrine is the first-line vasopressor (strong recommendation) to
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achieve MAP ≥65 mmHg. It increases SVR with minimal chronotropic effect. Vasopressin
is adjunctive (0.03 U/min); dopamine is no longer preferred.
3. A patient with septic shock remains hypotensive (MAP 60 mmHg) after 3L of
crystalloid. What is the NEXT step?
• A) Give furosemide 40 mg IV
• B) Start norepinephrine IV infusion
• C) Transfuse 2 units PRBCs
• D) Administer albumin 5%
Answer: B
Rationale: After inadequate response to fluids, vasopressors are indicated.
Norepinephrine is first-line. Albumin is second-line; furosemide is contraindicated in
hypotension; PRBCs only if Hgb <7.
4. What is the target MAP for septic shock resuscitation?
• A) 50-55 mmHg
• B) 65-70 mmHg
• C) 80-85 mmHg
• D) >90 mmHg
Answer: B
Rationale: Guidelines recommend initial MAP target of ≥65 mmHg. Higher targets (80-
85) do not improve mortality and increase risk of atrial fibrillation.
5. A 68-year-old with septic shock has a ScvO2 of 55% after fluids and
vasopressors. What intervention is indicated?
• A) Increase norepinephrine
• B) Transfuse PRBCs to Hgb >7
• C) Start dobutamine
• D) Decrease PEEP
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Answer: C
Rationale: Surviving Sepsis Guidelines: If ScvO2 <70% after adequate volume and MAP,
add dobutamine (or consider RBC transfusion if Hgb <7). Dobutamine increases oxygen
delivery.
6. Which biomarker is most specific for bacterial sepsis?
• A) CRP
• B) Troponin I
• C) Procalcitonin (PCT)
• D) BNP
Answer: C
Rationale: Procalcitonin rises within 3-6 hours of bacterial infection, correlates with
severity, and helps guide antibiotic discontinuation. CRP is less specific.
7. A patient with septic shock has a rising lactate despite MAP >70 mmHg. What is
the most likely cause?
• A) Overtreatment with fluids
• B) Ongoing tissue hypoperfusion
• C) Liver failure impairing lactate clearance
• D) Rhabdomyolysis
Answer: C
Rationale: Lactate elevation in sepsis is due to both increased production and
decreased clearance (especially hepatic dysfunction). Normal MAP does not guarantee
normal microcirculation.
8. When should empiric antibiotics be administered in septic shock?
• A) Within 1 hour of recognition
• B) Within 3 hours
• C) After blood culture results return
