AACN ACNPC-AG (AGACNP) Certification Exam
Questions & Verified Answers
1: Which assessment finding is most indicative of hypovolemic shock?
A. Warm, flushed skin
B. Bounding pulses
C. Tachycardia and hypotension
D. Bradycardia and hypertension
CORRECT ANSWER: C. Tachycardia and hypotension
Rationale: Hypovolemic shock results from fluid loss, leading to decreased preload,
compensatory tachycardia, and hypotension. Skin is typically cool and clammy, not warm.
2: What is the priority intervention for a patient with acute respiratory distress and SpO2 85%
on room air?
A. Obtain arterial blood gas
B. Apply supplemental oxygen
C. Order chest X-ray
D. Administer bronchodilator
CORRECT ANSWER: B. Apply supplemental oxygen
Rationale: According to the ABCs (Airway, Breathing, Circulation), correcting hypoxemia with
supplemental oxygen is the immediate priority before diagnostic tests or medications.
3: Which medication is contraindicated in acute decompensated heart failure with
hypotension?
A. Furosemide
B. Nitroglycerin
C. Dobutamine
D. Metoprolol
CORRECT ANSWER: D. Metoprolol
Rationale: Beta-blockers like metoprolol are negative inotropes and can worsen hypotension
and cardiogenic shock in acute decompensated heart failure; they are typically held until the
patient is stabilized.
4: What is the target mean arterial pressure (MAP) for vasopressor therapy in septic shock?
,A. >55 mmHg
B. >65 mmHg
C. >75 mmHg
D. >85 mmHg
CORRECT ANSWER: B. >65 mmHg
Rationale: Surviving Sepsis Campaign guidelines recommend targeting a MAP of ≥65 mmHg
during vasopressor therapy for septic shock to ensure adequate organ perfusion.
5: Which ECG finding is most specific for acute myocardial infarction?
A. Sinus tachycardia
B. ST-segment elevation in contiguous leads
C. First-degree AV block
D. Premature atrial contractions
CORRECT ANSWER: B. ST-segment elevation in contiguous leads
Rationale: ST-segment elevation in contiguous leads is the hallmark ECG finding of acute ST-
elevation myocardial infarction (STEMI), indicating acute coronary occlusion.
6: What is the first-line treatment for anaphylaxis?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine
D. Albuterol
CORRECT ANSWER: C. Epinephrine
Rationale: Epinephrine is the first-line, life-saving treatment for anaphylaxis, acting rapidly to
reverse bronchospasm, vasodilation, and increased vascular permeability.
7: Which lab value is most critical to monitor in a patient receiving heparin?
A. PT/INR
B. aPTT
C. Platelet count
D. Hemoglobin
CORRECT ANSWER: B. aPTT
,Rationale: The activated partial thromboplastin time (aPTT) is used to monitor the therapeutic
effect of unfractionated heparin. Platelet count is monitored for heparin-induced
thrombocytopenia (HIT).
8: What is the priority assessment for a patient with a new tracheostomy?
A. Speech ability
B. Cuff pressure and airway patency
C. Incision site appearance
D. Nutritional status
CORRECT ANSWER: B. Cuff pressure and airway patency
Rationale: Ensuring a patent airway and appropriate cuff pressure (20-30 cm H2O) is the
immediate priority to prevent complications like aspiration, tracheal damage, or accidental
decannulation.
9: Which finding suggests increased intracranial pressure (ICP)?
A. Tachycardia and hypertension
B. Bradycardia, hypertension, and irregular respirations (Cushing's triad)
C. Fever and nuchal rigidity
D. Photophobia and headache
CORRECT ANSWER: B. Bradycardia, hypertension, and irregular respirations (Cushing's triad)
Rationale: Cushing's triad is a late sign of increased ICP, indicating brainstem herniation and
requiring immediate intervention.
10: What is the initial fluid of choice for resuscitation in septic shock?
A. 5% Albumin
B. Normal Saline or Lactated Ringer's
C. Dextrose 5% in water
D. Hypertonic saline
CORRECT ANSWER: B. Normal Saline or Lactated Ringer's
Rationale: Crystalloids (normal saline or balanced solutions like Lactated Ringer's) are the first-
line fluids for initial resuscitation in septic shock per Surviving Sepsis guidelines.
11: Which medication is used to reverse opioid overdose?
A. Flumazenil
B. Naloxone
, C. Physostigmine
D. Vitamin K
CORRECT ANSWER: B. Naloxone
Rationale: Naloxone is a competitive opioid receptor antagonist that rapidly reverses respiratory
depression and sedation from opioid overdose.
12: What is the priority intervention for a patient with suspected tension pneumothorax?
A. Chest X-ray
B. Needle decompression
C. Intubation
D. CT scan
CORRECT ANSWER: B. Needle decompression
Rationale: Tension pneumothorax is a clinical diagnosis and a life-threatening emergency
requiring immediate needle decompression (2nd ICS, midclavicular line) before imaging.
13: Which lab finding is most indicative of acute kidney injury (AKI)?
A. Elevated BUN and creatinine
B. Low urine sodium
C. High urine specific gravity
D. Elevated potassium only
CORRECT ANSWER: A. Elevated BUN and creatinine
Rationale: AKI is defined by an acute increase in serum creatinine and/or decrease in urine
output. Elevated BUN and creatinine are key diagnostic markers.
14: What is the target blood glucose range for critically ill patients?
A. 80-110 mg/dL
B. 140-180 mg/dL
C. 180-200 mg/dL
D. <140 mg/dL
CORRECT ANSWER: B. 140-180 mg/dL
Rationale: Most critical care guidelines recommend a target glucose range of 140-180 mg/dL to
balance risks of hyperglycemia and hypoglycemia.
15: Which intervention is lung-protective for a patient with ARDS?
Questions & Verified Answers
1: Which assessment finding is most indicative of hypovolemic shock?
A. Warm, flushed skin
B. Bounding pulses
C. Tachycardia and hypotension
D. Bradycardia and hypertension
CORRECT ANSWER: C. Tachycardia and hypotension
Rationale: Hypovolemic shock results from fluid loss, leading to decreased preload,
compensatory tachycardia, and hypotension. Skin is typically cool and clammy, not warm.
2: What is the priority intervention for a patient with acute respiratory distress and SpO2 85%
on room air?
A. Obtain arterial blood gas
B. Apply supplemental oxygen
C. Order chest X-ray
D. Administer bronchodilator
CORRECT ANSWER: B. Apply supplemental oxygen
Rationale: According to the ABCs (Airway, Breathing, Circulation), correcting hypoxemia with
supplemental oxygen is the immediate priority before diagnostic tests or medications.
3: Which medication is contraindicated in acute decompensated heart failure with
hypotension?
A. Furosemide
B. Nitroglycerin
C. Dobutamine
D. Metoprolol
CORRECT ANSWER: D. Metoprolol
Rationale: Beta-blockers like metoprolol are negative inotropes and can worsen hypotension
and cardiogenic shock in acute decompensated heart failure; they are typically held until the
patient is stabilized.
4: What is the target mean arterial pressure (MAP) for vasopressor therapy in septic shock?
,A. >55 mmHg
B. >65 mmHg
C. >75 mmHg
D. >85 mmHg
CORRECT ANSWER: B. >65 mmHg
Rationale: Surviving Sepsis Campaign guidelines recommend targeting a MAP of ≥65 mmHg
during vasopressor therapy for septic shock to ensure adequate organ perfusion.
5: Which ECG finding is most specific for acute myocardial infarction?
A. Sinus tachycardia
B. ST-segment elevation in contiguous leads
C. First-degree AV block
D. Premature atrial contractions
CORRECT ANSWER: B. ST-segment elevation in contiguous leads
Rationale: ST-segment elevation in contiguous leads is the hallmark ECG finding of acute ST-
elevation myocardial infarction (STEMI), indicating acute coronary occlusion.
6: What is the first-line treatment for anaphylaxis?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine
D. Albuterol
CORRECT ANSWER: C. Epinephrine
Rationale: Epinephrine is the first-line, life-saving treatment for anaphylaxis, acting rapidly to
reverse bronchospasm, vasodilation, and increased vascular permeability.
7: Which lab value is most critical to monitor in a patient receiving heparin?
A. PT/INR
B. aPTT
C. Platelet count
D. Hemoglobin
CORRECT ANSWER: B. aPTT
,Rationale: The activated partial thromboplastin time (aPTT) is used to monitor the therapeutic
effect of unfractionated heparin. Platelet count is monitored for heparin-induced
thrombocytopenia (HIT).
8: What is the priority assessment for a patient with a new tracheostomy?
A. Speech ability
B. Cuff pressure and airway patency
C. Incision site appearance
D. Nutritional status
CORRECT ANSWER: B. Cuff pressure and airway patency
Rationale: Ensuring a patent airway and appropriate cuff pressure (20-30 cm H2O) is the
immediate priority to prevent complications like aspiration, tracheal damage, or accidental
decannulation.
9: Which finding suggests increased intracranial pressure (ICP)?
A. Tachycardia and hypertension
B. Bradycardia, hypertension, and irregular respirations (Cushing's triad)
C. Fever and nuchal rigidity
D. Photophobia and headache
CORRECT ANSWER: B. Bradycardia, hypertension, and irregular respirations (Cushing's triad)
Rationale: Cushing's triad is a late sign of increased ICP, indicating brainstem herniation and
requiring immediate intervention.
10: What is the initial fluid of choice for resuscitation in septic shock?
A. 5% Albumin
B. Normal Saline or Lactated Ringer's
C. Dextrose 5% in water
D. Hypertonic saline
CORRECT ANSWER: B. Normal Saline or Lactated Ringer's
Rationale: Crystalloids (normal saline or balanced solutions like Lactated Ringer's) are the first-
line fluids for initial resuscitation in septic shock per Surviving Sepsis guidelines.
11: Which medication is used to reverse opioid overdose?
A. Flumazenil
B. Naloxone
, C. Physostigmine
D. Vitamin K
CORRECT ANSWER: B. Naloxone
Rationale: Naloxone is a competitive opioid receptor antagonist that rapidly reverses respiratory
depression and sedation from opioid overdose.
12: What is the priority intervention for a patient with suspected tension pneumothorax?
A. Chest X-ray
B. Needle decompression
C. Intubation
D. CT scan
CORRECT ANSWER: B. Needle decompression
Rationale: Tension pneumothorax is a clinical diagnosis and a life-threatening emergency
requiring immediate needle decompression (2nd ICS, midclavicular line) before imaging.
13: Which lab finding is most indicative of acute kidney injury (AKI)?
A. Elevated BUN and creatinine
B. Low urine sodium
C. High urine specific gravity
D. Elevated potassium only
CORRECT ANSWER: A. Elevated BUN and creatinine
Rationale: AKI is defined by an acute increase in serum creatinine and/or decrease in urine
output. Elevated BUN and creatinine are key diagnostic markers.
14: What is the target blood glucose range for critically ill patients?
A. 80-110 mg/dL
B. 140-180 mg/dL
C. 180-200 mg/dL
D. <140 mg/dL
CORRECT ANSWER: B. 140-180 mg/dL
Rationale: Most critical care guidelines recommend a target glucose range of 140-180 mg/dL to
balance risks of hyperglycemia and hypoglycemia.
15: Which intervention is lung-protective for a patient with ARDS?
