AACN ACNPC-AG Certification Exam Complete 175 Questions AACN Exam Review with Answers and | Exams Gerontology

ACNPC-AG Adult -Gerontology Acute Care Nurse

Practitioner Certification AACN ACNPC-AG Certification

Exam Complete 175 Questions AACN Exam Review with

Answers and Rationales | 100% Pass Guaranteed | Graded

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2025-2026

AACN ACNPC-AG Certification Exam

Adult-Gerontology Acute. Care Nurse Practitioner

Certification ACNPC-AG

AACN American Association of Critical-Care Nurses

American Nurses Association

AACN ACNPC-AG Complete 175 Questions and Answers

This is the Actual AACN ACNPC-AG Exam for March 2025

Proctored Via PSI

1. postoperative assessment is performed on a patient who

underwent a lumbar 4/5 laminectomy and discectomy 2 hours

ago. Preoperatively, she had pain in her right hip and leg with

numbness of her right foot, but no weakness. At the time of the

examination, her motor strength is 5/5 in all extremities, and she

has not voided postoperatively. She is concerned that the

numbness in her foot has not resolved. Which of the following is

an ACNP's best action? A Reassure her that numbness often

persists postoperatively. B. Scan her bladder to assess for cauda

equina syndrome. C. Obtain a CT scan of her lumbar spine to

evaluate for hematoma. D. Administer steroids for nerve root

radiculopathy.

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ACNPC-AG Adult -Gerontology Acute Care Nurse

Practitioner Certification AACN ACNPC-AG Certification

Exam Complete 175 Questions AACN Exam Review with

Answers and Rationales | 100% Pass Guaranteed | Graded

A+ |

AACN ACNPC-AG Certification Exam

Adult-Gerontology Acute. Care Nurse Practitioner

Certification ACNPC-AG

AACN American Association of Critical-Care Nurses

American Nurses Association

AACN ACNPC-AG Complete 175 Questions and Answers

This is the Actual AACN ACNPC-AG Exam for March 2025

Proctored Via PSI

1. postoperative assessment is performed on a patient who

underwent a lumbar 4/5 laminectomy and discectomy 2 hours

ago. Preoperatively, she had pain in her right hip and leg with

numbness of her right foot, but no weakness. At the time of the

examination, her motor strength is 5/5 in all extremities, and she

has not voided postoperatively. She is concerned that the

numbness in her foot has not resolved. Which of the following is

an ACNP's best action? A Reassure her that numbness often

persists postoperatively. B. Scan her bladder to assess for cauda

equina syndrome. C. Obtain a CT scan of her lumbar spine to

evaluate for hematoma. D. Administer steroids for nerve root

radiculopathy.

2. It is important to emphasize which of the following when

providing smoking cessation education to a patient after

coronary stent placement? A. Patients with atherosclerosis are

more likely to develop lung disease within 5 years. B. Within 3

years of cessation, coronary artery disease risk improves., C.

Nicotinand clopidogrel (Plavix) may produce adverse effects. D.

Most patients find it easy to quit smoking after stent placement.

3. patient has subcutaneous gas on CT scan in the left foot with

erythema extending up the lower extremity. The vascular

surgeon is requesting a CT angiography of the lower extremity to

assess vascular status prior to operative intervention. Which

laboratory data is most concerning for ordering this test?

Remaining: 2 A. hemoglobin 7 g/dL B. lactate 2 mmol/L C. WBC

15/mm³ D. creatinine 1.9 mg/dL

4. A patient's laboratory results show a potassium level of 8.0, and

an ECG reveals peaked T waves. In addition to 25 g dextrose 50%,

which of the following is the be emergency treatment? B. calcium

gluconate 10 mL, regular insulin 10 units A. sodium polystyrene

sulfonate resin (Kayexalate) 25 g, regular insulin 20 units C

calcium chloride 10 mL, regular insulin 20 units D. magnesium

sulfate 1 g, regular insulin 10 units

5. A patient was in a 45 mph rollover MVC. His GCS was 7, and he

was intubated by EMS at the scene. He presents to the

emergency department with BP 76/54 and HR 90 after 2 L of

normal saline. The airway is maintained with an endotracheal

tube. Initially, there are bilateral breath sounds, pulses 1+

throughout, and his skin is cool. External bleeding is controlled

and the GCS is now 3T. Secondary examination shows Grey

Turner's sign and a positive abdominal FAST examination. Which

of the following is the correct disposition for this patient? A.

9. An Bo-year-old patient with a pelvic fracture develops mild

dyspnea, hypoxia, altered mental status, and a petechial rash the

day following the trauma. The m hely diagnosis is A. fat

embolism. B. allergic drug reaction. CC. congestive heart failure.

O pulmonary edema.

10. patient presents after being intubated in the field status

post fall with numerous visible injuries. The most appropriate

initial assessment is LISA/Canada -1077508234 Coba 11617 564

5062 Maquest Bras End Beasdon 미 A. peripheral pulses. B. breath

sounds. C. level of consciousness. D. pupillary response.

11. A patient with ARDS is receiving mechanical ventilation.

Arterial blood gas results are: PH PaCO2 7.28 PaO2 56 mm Hg

HCO3 57 mm Hg SaO2 18 mEq/L 84% Ventilator settings are as

follows: FIO2 Rate 70% 15 breaths/minute Tidal volume 600 mL

PEEP 5 cm H2O Which of the following adjustments should an

ACNP make to optimize oxygenation? A. Increase tidal volume. B.

Decrease FiO2 C. Increase PEEP D. Decrease respiratory rate.

12. A patient presents with shortness of breath, fever,

productive cough, and lethargy. The patient recently completed 6

weeks of IV antibiotics for asfoomywills and was undergoing

wound care in a skilled nursing facility prior to transfer to the

hospital. Initial vital signs and laboratory results while receiving

oxygen at 2 Limun via nasal cannula are below: BP 136/87 HR 105

18 RR T 100.7 F (38.2° C) SpOz 92% WBC 17.3/mm³ Procalcitonin

11.4 ng/mL Lactic acid 1.0 mmol/L The most appropriate

treatment plan for this patient includes orders for A. an ABG and

albuterol every 4 hours. B. a chest CT and blood culture. C. a

chest x-ray and blood and sputum cultures. Da 30 mL/kg normal

saline bolus IV and repeat lactic acid

13. Anurse indicates that she is very interested in finding new

ways to help heart failure patients. To best foster the nurse's

initiative, an ACNP A. offer to lend the nurse a book on heart

failure. B. invite the nurse to go with her to a local Heart Failure

Society meeting C. give the nurse a new patient education

pamphlet. D. tell the nurse about a new home monitoring

program for heart failure patients.

An alert patient presents with chest pain and palpitations. The patient becomes unresponsive and pubeless following is the most appropriate initial treatment? A. cardioversion B. IV push magnesium C defibrillation D. amiodarone (Cordarome) drap
An ACNP observes a nurse instilling normal saline solution when performing tracheal suctioning. Which of the following is the most appropriate response? A. Ask the nurse manager to counsel the nurse on proper suctioning procedure. B. Discuss the observations with the medical director. C. Ask a respiratory therapist to review the procedure with the nurse. D. Discuss the research findings regarding suctioning with the nurse.
A patient complains of chest pain that began 3 hours ago A 12-lead ECG shows a STEMI. Assuming that the patient has no allergies medications, which of the following is most appropriate? A. argatroban B. eptifibatide C bivalirudin D. reteplase
Following a witnessed seizure, a patient is alert and oriented, has no focal neurologic deficits, but complains of a headache. There is no history of a previous seizure. Which of the following diagnostic tests is most appropriate to further evaluate his symptoms? A. positron emission tomography (PET) scan B. cerebral angiogram C. CT scan of the brain with/without contrast D. electroencephalogram (EEG)
A patient who is obtunded has an intracranial pressure monitor in place. Vital signs are as follows: BP 89/57 HR 107 MAP 68 mm Hg ICP 25 mm Hg CPP 43 mm Hg Which therapy should be implemented to optimize cerebral perfusion pressure? A. dopamine (Intropin) B norepinephrine (Levophed) C. mannitol (Osmitrol) D. propofol (Diprivan)
A patient has an ejection fraction of 27%. Which of the following is the best treatment for primary prevention of sudden death? A. implantable cardiac defibrillator B. beta-blockers C. bi-ventricular pacemaker D. class III anti-arrhythmics
A patient is admitted after experiencing a syncopal episode. According to the family who witnessed the event, there was no incontinence or tanice movement. The patient is now complaining of feeling lightheaded, and the following rhythm is observed: The most appropriate initial therapy includes A. a cardiology consult. B. transvenous pacemaker placement. C. immediate cardioversion. D. external pacemaker placement.
caregiver expresses feelings of frustration with their hospitalized family member who has dementia. How might the ACNP respond initially? A. "I don't understand why are you frustrated because they cannot help it, and they need your help." B. "There are excellent nursing facilities in the community if you feel caring for them is too much." C. "This certainly brought changes to your life, what sort of things are frustrating you?" D. "Unfortunately, frustration is very common when caring for family but you'll move past these feelings soon."

patient has inflammation of the skin and subcutaneous tissues associated with local pain, tenderness, swelling, and erythema of the left lower extremily. the following is the best choice of medication? A. acyclovir B. metronidazole C. amphotericin B D. penicillin
An ACNP is counseling a patient who is non-adherent with CPAP therapy for obstructive sleep apnea, The ACNP educates the patient on the importem of CPAP stating that non- compliance may lead to A. cardiac disease. B. peripheral neuropathy. C hepatic failure. D. pulmonary fibrosis.
A patient with multiple myeloma is admitted for preparation of hematopoietic stem cell transplant. Which of the following medications for stem cell mobilization should the ACNP order? A. colony-stimulating factor B. erythropoietin C. tyrosine kinase inhibitor D. monoclonal antibody
A patient with no previous medical history is admitted for acute onset left-sided weakness. The patient reports recent sweats and chills with malaise for the past 12 weeks. WBC is elevated, and the patient is febrile. On examination, an ACNP notices a diastolic murmur at the left lower sternal border. Which diagnostic test should be done first? A lumbar puncture B. chest x-ray C. transthoracic echocardiogram D. non-contrast head CT
A patient is receiving mechanical ventilation for acute respiratory failure secondary to pneumonia. The respiratory therapist reports thickened secretlions regu frequent suctioning and increased positive inspiratory pressure and plateau pressures. A chest radiograph shows bilateral infiltrates and a wedge-shaped opacification of the right middle lobe without air bronchograms. Which diagnostic intervention is the most beneficial for the ACNP to order next? A. endobronchial ultrasound B. CT chest with contrast C. bedside thoracentesis D. flexible bronchoscopy
A patient's wife wants everything done for her husband who has been unresponsive and bedridden from a stroke 6 years ago The patient has had multiple admissions. During the current admission, he experienced two episodes of lower Gi bleeding that required blood transfusions. A hemicolectomy is required, but the surgeon declines to operate, believing the patient would not survive the procedure. Which of the following is most appropriate at this time? A. Contact the hospital's patient advocate. B. Refer to adult protective services. C. Suggest the family obtain a second opinion. D. Request an ethics consult.
A patient diagnosed with sepsis of unknown origin was recently admitted. The patient has received IV vancomycin (Mencucing and gr addition to 1 L of normal saline bolus. Vital signs are as follows: BP RR 82/54 25 Pulse T 110 102.3° F (39.1" C) 5a02 96% on 2 L nasal cannula CVP 6 mm Hg The most appropriate intervention is to A add antifungal coverage B. perform emergent intubation C. repeat 1 L normal saline bolus. D. start sorepinephrine (Levuphed).
PSI An ACNP is caring for a patient who has undergone a hip replacement. The patient has a patient-controlled analgesia for pain control. She is lethargic, but sell complaining of pain when awakened. Her oxygen saturation is 89% when she is sleeping. The best option for the ACNP is to A. tell her that the amount of pain medication cannot be increased due to her decreased oxygen saturation. B. place the patient on noninvasive positive pressure ventilation. C. add an anxiolytic medication to decrease her perception of pain. A D. encourage use of nonpharmacological pain control measures in addition to current medication
A patient who sustained burns to 30% of total body surface area was admitted 24 hours ago. The patient has been adequately fluid resuscitated and has no signs of abdominal

ileus. Vital signs are within normal range without use of vasopressors, and nutritional therapy is being considered. The best choice of nutrition for this patient is A. waiting an additional 12-24 hours to ensure no vasopressor use is needed prior to starting nutrition. B. 25 kcal/kg body weight with additional kcal to account for the burn surface area. C. 20 kcal/kg body weight enteral tube feedings with supplemental glucose and fat. D. total parenteral nutrition with additional trace elements and antioxidants.

The day before anticipated discharge from the hospital, a patient receives a routine influenza vaccination. The next morning, the patient reports his arms feel they "have weights on them," and he is unable to move his feet. The ACNP should order A. an assessment by physical therapy. B. isolation precautions. C prednisone (Deltasone) 40 mg IV once. D. IV immunoglobulin 400 mg/kg/day for 5 days.
An elderly Vietnamese hese patient presents with a cough, fever, and generalized malaise. There is no interpreter available, and the patient's medical history is taken from a family spokesperson who has limited English skills. On examination, large, round, raised reddened areas associated with ecchymosis are noted. Which of the following should an ACNP expect as the most likely cause? A. elder abuse by family members B. traumatic injury to the patient that was previously undisclosed C. cupping to open the body's meridians D. abnormal bleeding from altered eating patterns
A patient with a known L5/S1 herniated disc with left leg radiculopathy presents after developing a sudden onset of worsening pain while defecating. The pabes numbness in the perianal region, severe left leg pain, and 5/5 strength bilaterally. The ally. The left dorsal and plantar flexions are now 0/5. An ACNP has given a steroid balus and ordered an MRI of the lumbar spine. Which of the following is an appropriate consultation for the ACNP to make? A. neurosurgery to evaluate need for surgery B. neurology to evaluate new weakness/sensory loss C. physical medicine for nerve testing D. interventional radiology for epidural steroids
A patient is admitted following a blunt chest trauma. The patient develops tachycardia, a narrow pulse pressure, hypotension, and distant heart sounds. Which of the following provides the most diagnostic information? A. PA catheter placement B. an echocardiogram C pleural chest tube placement D. a portable chest x-ray
patient presents with a 3-day history of worsening abdominal pain. On examination, the abdomen is distended, no bowel sounds tenderness is present. Upright and supine films of the abdomen reveal free air under the diaphragm. Based on these findings, which of the wingthe likely diagnosis? A. acute diverticulitis Bacute pancreatitis C. small bowel obstruction D. perforated viscus
A patient presents after a penetrating injury to the right chest. A tracheal shift to the left is noted. The patient demonstrates dyspnea and tachypnea, oxygenation is poor, and blood pressure is slowly decreasing. The immediate action required is to A. insert a chest tube. B. obtain a chest x-ray. C. intubate the patient. D. obtain a chest CT scan.
A patient with a history of first-degree AV heart block has undergone a TAVR via right femoral artery access. Vital signs are as follows: BP 122/68 57 HR RR T 28 98° F (37° C) SpO2 92% via 8 L/min face mask A second-degree AV block type II is noted 2 hours post procedure. Which intervention is most likely? A. CABG B. pacemaker C. left heart catheterization D. pharmacological management
Following resection of an acoustic neuroma, a patient's original complaints of nausea, dizziness, and blurred vision have resolved. Prior to discharge, the palend states,

following should the ACNP do next? A. Request that the product be reviewed at the product-evaluation committee. B. Contact the sales representative to order the product for the hospital. C. Distribute the product samples to senior nursing staff to get their input. D. Provide the promotional literature to the nurse manager.

A newly hired ACNP often hears staff members refer to patients in a derogatory fashion. Which of the following actions is most appropriate A. Address with the staff appropriate ways to discuss patients. B. Use the same terms for patients to be accepted by the staff. C. Report the staff members to their supervisor. D. Tell the staff their behavior is not acceptable.
A patient presents to the emergency department with new complaints of shortness of breath upon exertion and 2+ lower extremity pitting edema for 2 days. The patient currently takes a diuretic twice daily. Which of the following is the most appropriate intervention? A. Initiate 1000-mL/24-hr fluid restriction. B. Initiate ultra-filtration. C. Administer IV furosemide (Lasix) D. Administer metolazone (Zaroxolyn).
Which is the most common cause of progressive impairment of memory and dementia? A. Alzheimer's disease B. Parkinson's disease C. vascular dementia D. Huntington's disease
An elderly patient is being returned to his board and care facility after an episode of decompensated heart failure. The facility is serving tien a high-sodium diet and not weighing him every day. The best way to address these issues is to A. report the facility to Social Services for malpractice and possible neglect. B. refer the situation to the social worker to discuss other options with the family. C. inform the patient's family of the discovery and suggest they find a new facility in which to place him. D. contact the owner of the facility and offer to provide education on care of heart failure patients and low-sodium food options
A 66-year-old patient with a history of coronary artery disease and type 2 diabetes has an elevated TSH level. An ACNP plans to begin levothyroxine (Synthroid). The most appropriate starting dose for this patient is A. 50 meg daily. B. 100 mcg daily. C. 150 meg daily. D. 200 mcg daily.
A 40 year old suspected of drug overdose is brought to the clinic with delirium. The patient has a temperature of 100.1° F (37.83° C), RR of 28, and HR of 110 Physical examination reveals dilated and unresponsive pupils. The patient's skin is dry and flushed. Which of the following drug classifications is must likely causing these effects? A. benzodiazepines 8. muscarinics C. anticholinergics D. narcotics
An adult man experiences an anoxic brain injury after being stabbed by his future father- in-law. Underlying conflicts between the two familles are now surfacing af the bedside. The most appropriate action by an ACNP is to A. arrange to have the families meet with a hospital counselor. B. accept this as a predicted outcome of a very difficult situation. C let them know that if this continues, they will not be allowed to visit D. separate the families during visiting hours to avoid the fighting.
A patient sustained a bilateral lower extremity crush injury. The creatinine level has risen from 0.9 to 3.1 despite aggressive hydration to maintaine greater than 80 mL/hr. Which of the following therapeutic interventions will help prevent further renal damage? A. Begin an angiotensin-converting enzyme inhibitor. B. Acidify the urine. C. Force diuresis to keep the patient negative by 1.5 L/day. D. Administer bicarbonate IV infusion.

patient is applying for a life insurance policy and needs to undergo a thorough physical examination and laboratory work for the application. On the patient's third visit to the office, it is noted on all three visits the patient has been febrile. During the third visit while discussing recent history, the patient states he was put on antibiotics prior to a dental procedure. What test is important to order to workup the fever of unknown origin? A echocardiogram B urinalysis C. chest x-ray D. ECG
A 60-kg patient in acute renal failure is starting enteral tube feedings. A dietitian recommends a renal formula that is 2 kcal/mL. Which of the following is the most appropriate goal rate for the patient? A. 40 mL/hr B. 70 mL/hr C 100 mL/hr D. 130 mL/hr
A patient is brought to the trauma unit unresponsive. A friend reports the patient injected himself with heroin and then was found still sleeping on the floor approximately 18 hours later. A urinary catheter is draining dark tea-colored urine. Which laboratory information in most pertinent to help guide treatment? A. lactate B. WBC C. Na D. creatinine kinase
A patient is admitted with a TIA with aspirin as a home medication. CTA results indicated 50% occlusion of the left ICA. Adding which medication is the safest and most effective way to significantly reduce the risk of subsequent ischemic stroke? A statin B. anticoagulant C. calcium channel blocker D. beta-blocker
A frail, elderly patient is admitted after sustaining a fall from standing, sustaining left rib fractures 2, 3, 4, and 5, laterally. The patient denies pain at the time of admission, and the family is wondering why an admission is necessary. An ACNP's best response is that A. the patient is at high risk for complications such as pneumonia and respiratory failure. B. the team is concerned with managing the patient's other multiple medical problems. C. Medicare recommends this level of care for all elderly patients who fall. D. the team is concerned with other injuries that have not yet been identified.
Which patient is at the greatest risk for hepatorenal syndrome? A. a patient who sustains a Grade I liver laceration in an MVC B. a patient with a high Model for End-Stage Liver Disease (MELD) score C. a patient with alcoholic cirrhosis without ascites D. a patient who ran a marathon and develops rhabdomyolysis
PSI A 26-year-old patient with sickle cell nephropathy is admitted with evidence of end- stage renal disease. In discussing treatment options with the patient and family, the patient's partner inquires about organ donation. Which is the ACNP's best response? A. "It is not a possibility; only deceased donors can make kidney donations." B. "You cannot donate your kidney because you will need to act as the caregiver." C "It is a possibility, but as a living donor, you will have to undergo a health assessment." D. "You can donate your kidney if you want to and I will contact the transplant team."
A.65-year-old woman is brought to the emergency department with altered mental status, headaches, and lethargy. Her family reports that the only new event thes past week is that she had her windows replaced in her 50-year-old house. Which of the following is the most likely differential diagnosis? A. encephalitis B. bacterial meningitis C. carbon monoxide poisoning D. urinary tract infection
A 45-year-old male is receiving atorvastatin (Lipitor) 80 mg following CABG. The patient reports muscle aches, and urine output has decreased to 5 mL/hr over the past 3 hours. Which of the following should the ACNP do next? A. Discontinue atorvastatin (Lipitor) and obtain a urinalysis, CK, and basic metabolic panel. B. Switch to simvastatin (Zocor) and obtain a urinalysis, CK, and basic metabolic panel. C. Discontinue

An ACNP observes several nurses incorrectly obtaining PAOP readings. Which of the following should the ACNP do? A. Perform the PAOP measurements. B. Discuss observations with the unit's charge nurse. C. Ask the charge nurse to perform PAOP measurements. D. Discuss observations with the unit's medical director.
A patient has heart failure and end-stage renal failure. Because the patient is indigent, getting the necessary medical care in a timely manner is a challenge. An ACNP enlists the help of social service and pastoral care, and discusses the issue with a primary care provider, reinforcing the patient's right to care. This is primarily an example of A. exemplifying the values of justice and dignity. B. providing excellence in patient care. C. ensuring the goals of the hospital are met. D. evaluating care delivery models to improve outcome data.
An asymptomatic patient has the following laboratory results: Na 123, urine sodium 8, and low serum osmolality. Which of the following is the most appropriate intervention? A. 0.45% saline at 200 mL/hr B. free water restriction C. 250 ml 10% mannitol (Osmitrol) IV D. 3% saline at 50 mL/hr
An ACNP notices that an increasing number of patients with indwelling urinary catheters are developing urinary tract infections, Length of stay date indicates tha admitted patients are older, have more comorbid illnesses, and stay longer compared to patients from the previous year. The ACNP decides to search the iterature to evaluate the hospital data. Which of the following is an appropriate search strategy? A. patient risk factors associated with urinary tract infections B indications for indwelling urinary catheter use C. influence of nursing care on urinary tract infections D. association of duration of catheter use and urinary tract infections
A 26-year-old woman admitted in septic shock requires intubation and multiple vasoactive drips. After stabilization, the family asks about her chances of survival. Which of the following statements is most appropriate? A. "She is young; she will recover." B. "She is stable now, but I am not sure what will happen over the next few days." C. "I can arrange for the chaplain to speak with your family." D. "The physician will meet with your family and will be able to answer your questions."
A patient is admitted with a suspected intentional overdose of acetaminophen. The initial acetaminophen level was 60 mcg/ml. Which of the following information is necessary for therapy to begin? A. time of acetaminophen ingestion B. baseline kidney function C. baseline hepatic function D. amount of acetaminophen ingested
A patient in the ICU has been diagnosed with septic shock and has been receiving mechanical ventilation for 24 hours. The patient has new development of bil infiltrates on chest x-ray and a P/F ratio of 180. Current ventilator settings are; Mode Assist control F102 60% 20 RR Tidal volume 500 ml. (8 mL/kg) PEEP 8 cm H2O Which of the following ventilatory changes should be implemented? A Increase the tidal volume to 10 ml/kg and decrease PEEP to 5 cm H2O. B. Decrease tidal volume to 6 ml/kg and increase PEEP to 12 cm H2O. C. Decrease FiO2 to 55% and increase RR to 24 D. Increase the Fio, to 80% and decrease the RR to 16.
A department is expanding to hire four additional ACNPs who have a variety of specialty experience. The most appropriate course of action should include which of the following? A. Collect a series of articles to educate the new ACNPs. B. Develop a manual that includes all of the necessary protocols for the department. C. Refer the ACNPs to staff

development for their specific educational needs D. Develop a preceptor program based on each individual's needs.

A 75 year old is admitted after an MVC. Assessment reveals a "seat belt sign," narrowing pulse pressure, and JVD. The ECG reveals sinun beycardia of 50/min. The patient has a Glasgow Coma Scale score of 15. Which of the following should an ACNP consider? A. level of consciousness B. home medications C. mechanism of injury D. past surgical procedures
A patient presents with increasing shortness of breath 4 weeks after CABG. Vital signs include: BP HR 95/50 115 RR 27 SpO2 92% The ACNP detects pulsus paradoxus. An ECG reveals electrical alternans, What is the next most appropriate order? A. nitroglycerin 0.4 mg SL B. CT scan of the chest C. furosemide 40 mg IV D. bedside echocardiogram
A patient had a right subclavian central venous catheter placed prior to surgery. Chest x- ray demonstrates a small pneumothorax Pusleperately, the patient develops shortness of breath, tachypnea, hypoxia, tachycardia, and subsequently, hypotension. An ACNP should immediately insert a A. 14-gauge angiocath in the 2nd intercostal space, midclavicular line. B. 22-gauge angiocath in the 2nd intercostal space, midclavicular line. C. 18-French pigtail in the 5th intercostal space, mid-axillary line. D. 36-French chest tube in the 5th intercostal space, mid-axillary line.
A patient is admitted with a 4-day history of exertional chest pain. The pain does not radiate and is not associated with shortness of breath or diaphoresis. Prier medical history is significant for hypertension, hyperlipidemia, and tobacco abuse. The patient did not have ischemic ECG changes and CPK/troponin was negative. Which of the following diagnostic tests should an ACNP order next? A. C-reactive protein Bechocardiogram C. exercise stress test D. sedimentation rate
A patient with a past medical history of COPD, HLD, hypertension, diabetes, and coronary artery disease with stent placement presents with altered mental status and productive cough. With oxygen at 4 L/min via nasal cannula, initial vital signs and laboratory data are as follows: BP HR RR T 115 34 102.3" F (39.1° C) SpO2 92% Na K+ 128 mEq/L 4.9 mEq/L CO2 92 mEq/L 14 mm Hg BUN Cr PLT 42 mg/dL 1.87 mg/dL 510 WBCS 82/37 19.2 کھا In addition to sputum and blood cultures, the ACNP should order A. NS TV at 50 mL/hr. pulmonary function test, and ceftriaxone and azithromycin. Ba 30 mL/kg TV bolus of NS, chest radiograph, and ceftriaxone and azithromycin. Ca 30 mlka IV bolus of NS, chest radiograph, and doxvovcline.
A patient with heart failure presents to the emergency department with a decreased level of consciousness. Laboratory work reveals a serum Na 128, high serum osmolality, and elevated urine Nat. The most likely cause is A. volume depletion due to diuretics. B. adrenal insufficiency. C. syndrome of inappropriate antidiuretic hormone (SIADH) D. renal failure.
A patient who is currently undergoing treatment for breast cancer is admitted after an unwitnessed syncopal episode at home. The events are reported to be occurring more frequently and with greater severity. The ACNP is notified of the patient having a severe headache and intractable vomiting, unrelieved by PRN acetaminophen and ondansetron. The following vital signs and laboratory results are obtained: BP HR RR T 178/64 63 21 SpO2 97.8° F (36.5° C) 98% on room air WBC 11.2/mm³ Hgb 9.7 g/dL BUN 18 mg/dl. Creatinine 0.9 mg/dL Lactic acid 3.5 mmol/L The first intervention by the ACNP are to

to start intravenous morphine B. discuss with the patient his pain experiences and possible treatment options C. collaborate with the staff nurse about the differences in perception of pain for this patient and design a plan of care. D. consult Social Services to arrange discharge since the patient is refusing care.

A patient was admitted 3 days ago with an intracranial hemorrhage. Intake and output for the last 24 hours shows a total of 2 L. intake and a total urine output of 5.5 L. Laboratory evaluation is significant for the following: NA C 155 mEq/L 115 mmol/L Creatinine 0.85 mg/dL BUN 15 mg/dl. Urine specific gravity 1.001 The treatment plan will require A strict fluid restriction B. furosemide, C. fludrocortisone D. vasopressin.
PSI An ACNP is called to the bedside of a patient who has just returned to the unit following an esophagogastroduodenoscopy (EGD). The patient received moderate sedation with midazolam (Versed). The patient is somnolent with a respiratory rate of 4. Which of the following is the most appropriate intial response? A. Order flumazenil (Romazicon). B. Order naloxone (Narcan). C: Initiate noninvasive positive pressure ventilation. D. Intubate and institute mechanical ventilation.
An ACNP admits a patient who does not speak English. Using an interpreter, the ACNP identifies health practices that incorporate home remedies. Which of the following is the best way to meet the patient's needs? A. Leave handouts about complementary therapies in the staff lounge. B. Identify a family member who speaks English to be the healthcare proxy. C. Tell the patient and family that only home remedies with evidence- based support will be allowed D. Facilitate an inservice on non-fraditional medicine
patient sustained a severe traumatic brain injury. A parenchymal intracranial pressure monitor has just been set up. The patient is sedated and installed. The following results are obtained: HR PaO2 96 mm Hg PaCO2 ICP 34 mm Hg 27 mm Hg MAP 80 mm Hg CPP 94 53 mm Hg Which of the following should an ACNP do first? A. Adjust ventilator settings to decrease the PaCO2 to 25 mm Hg. B. Administer mannitol (Osmitrol) 1 g/kg bolus. C Order dexamethasone (Decadron) 10 mg IV. D Infuse D5W 1 LIV fluid bolus.
patient had a coronary artery bypass 3 days ago and the epicardial pacing wires were removed this morning. On physical examination, the patient is in mild distress. HR has increased to 130 with distant heart sounds. The patient has JVD. Which of the following is the best diagnostic test for this patient? A. chest x-ray B. echocardiogram CCT of the chest D. 12-lead ECG
Prior to placing an enteric feeding tube, which of the following laboratory results is of concern? A. WBC 9.0 B. RBC 6.1 C. prealbumin 3.0 D. platelet count 15
patient who just began a strenuous exercise regimen yesterday presents to the hospital with malaise, low-grade fever, and muscle aches. Which laboratory result would cause an ACNP the most concern? A. calcium of 8.1 mEq/L B. WBC of 15/mm³ C sodium of 130 mEq/L D creatinine of 2.4 mg/dL
PSI A patient is receiving dual antiplatelet therapy with aspirin and clopidogrel (Plavix). The patient has a splenic laceration and ongoing blood loss. An ACNP should order which of the following STAT? A. prothrombin complex concentrate (PCC) B. intravenous phytonadione (Mephyton) C. platelet transfusion D. fresh frozen plasma (FFP)
PSI A patient presents with several days of fever and flu-like symptoms, now with painful blisters affecting the oral mucosa. Medical history is significant for lupus and

bipolar disorder for which lamotrigine (Lamictal) was started 3 weeks ago. The most likely diagnosis is A. a staphylococcal infection. B. Stevens-Johnson syndrome. C. herpes zoster. D. viral influenza.

patient with a traumatic brain injury has the following vital signs: BP HR RR T SpO2 138/75 87 20 98.5° F (36.9° C) 97% Two hours later vital signs are: BP HR RR T 178/67 53 12 SpO2 98.7° F (37.1° C) 98% The priority intervention is A. 0.9% sodium chloride bolus. B. DDAVP (synthetic vasopressin). C. mannitol (Osmitrol). D. 3% sodium chloride infusion.
A patient with COPD was recently extubated after 3 weeks of mechanical ventilation for hypercapnic respiratory failure. This was the patient's fourth intubation in the last 2 years for the same diagnosis. The patient will benefit most from A. steroids. B. oxygen therapy. C. noninvasive ventilation. D. nebulizers.
A patient describes a history of recurrent episodes of transient lightheadedness that is relieved with activity. The cardiac monitor shows normal sinus rhythm. The working diagnosis is vasovagal syncope. Which of the following is the most appropriate test to confirm this diagnosis? A. transthoracic echocardiogram B. tilt table study C. MUGA scan D. carotid duplex study
An ACNP has been asked to develop a smoking cessation protocol in collaboration with the cardiac rehabilitation staff. The protocol should include orders for A. a bupropion (Zyban) prescription for 12 months. B. statin therapy until nicotine replacement is discontinued C. a baseline chest x-ray. D. nicotine replacement therapy for 2 months.
Which of the following would be expected in a patient with ascites who develops oliguria, hyponatremia, and a low urine sodium? A. increased serum creatinine B. decreased calcium C. decreased ALT D. increased AST
An ACNP caring for a patient with sickle cell disease must be aware of which of the following complications of this hemoglobinopathy? A. Renal infarction from the sickling can produce hypotension, which may compromise the coronary circulation. B. Iron overload can result from repeated transfusions due to decreased erythrocyte production and increased erythrocyte consumption C. Chronic hypoxemia and anemia can produce a high-output state that leads to heart failure. D. Combined heart-liver transplantation is needed in many cases of sickle cell disease.
A patient presents with syncope, fatigue, headaches, and dyspnea on exertion. On physical examination, the patient has a decreased sense of vibration and position. Past history is significant for a gastrectomy. The ACNP should expect maintenance treatment to include A. RBC transfusion every 2 months. B. vitamin B12, 1 mg IM monthly. C folic acid 5 mg PO daily. D. ferrous sulfate 325 mg daily.
A patient with COPD presents with symptoms of dyspnea, increased oxygen requirements, and wheezing. Which of the following initial diagnostic tests should be ordered? A. arterial blood gas analysis and pulmonary angiogram B. lower extremity Doppler and ventilation/perfusion (V/Q) scan C. CBC with differential and basic chemistry D. chest x-ray and sputum culture
A patient presents with a persistent fever of 104° F (40° C) and general malaise. The patient is found to be bacteremic with blood cultures positive for Streptococcus viridans. The patient reports an intermittent history of IV drug abuse, and is noted to have

PSI A patient experiences a stroke after aortic valve repair and is transferred to rehabilitation. Two days after transfer, she develops a severe headache and in emergently readmitted and sent for a head CT accompanied by an ACNP. The patient is requesting something to alleviate her headache. The most appropriate responses A. "As soon as we get back to the floor, we will give you something for that headache." B. "I'll prescribe a pain medication you can take now that won't interfere with the evaluation of your headache." C "Your symptoms are expected. Don't be afraid." A D. "We need to determine the source of your headache before giving you medication."
A patient is being evaluated prior to an elective repair of an abdominal aortic aneurysm, The patient's history includes controlled hypertension and Type 2 diabetes. Which of the following medications provides the best cardiac protection perioperatively? A. lisinopril (Zestril) B. diltiazem (Cardizem CD) C nitroglycerin transdermal (Nitro- Dur) D. metoprolol (Toprol XL)
During hospitalization for a COPD exacerbation, a patient has prednisone 10 mg daily for 10 days added to the treatment regimen. The nurse discharging the patient asks an ACNP if the patient should be taught about adrenal suppression with steroid use. Which of the following is the best response to give the nurse? A. Adrenal suppression is not a concern in patients taking steroids for COPD. B. The duration of treatment is too short to cause adrenal suppression. C. The patient's primary care provider will monitor for adrenal suppression. D. The dose is too low to cause adrenal suppression.
A patient has been in the ICU for 5 days following bowel perforation and sepsis. Despite aggressive pulmonary therapy, arterial blood gas results reveal refractory hypoxemia. The most recent chest x-ray shows bilateral pulmonary infiltrates, Treatment for this patient should include A. an emergent tracheostomy. B. the delivery of oxygen via non-rebreather mask. C noninvasive ventilatory support. D. intubation and mechanical ventilation.
Which of the following diagnostic tests should an ACNP order for a patient with suspected adrenal insufficiency? A. testosterone level B. cosyntropin (Cortrosyn) stimulation test CC. thyroid function panel D. dexamethasone (Decadron) suppression test
patient complains of sudden onset of left scapular pain that is "ripping or tearing pain" that started suddenly this moming. During a CT scan, the patient has increasing pain and becomes hypertensive. The priority in caring for this patient is A. transthoracic echocardiogram. B. immediate surgical consult. C pain control with opioid analgesia. D. blood pressure control with IV beta-blockers
Which of the following is appropriate initial treatment for a fernale patient with dysuria? A. valacyclovir (Valtrex) for 10 days B. phenazopyridine (Pyridium) for 7 days C. trimethoprim/sulfamethoxazole (Bactrim) for 3 days D. doxycycline (Doryx) for 7 days
A patient who has been chronically if with peripheral vascular disease has expressed wishes to the nurses that she does not want to go on van concerned because the patient's significant other wants them to do something to make the patient better. A collaborative approach to the patience fatize মোমে should include which of the following? A. Allow the patient to be autonomous and focus on patient wishes B. Provide comfort measures for the patient C. Convene an interdisciplinary conference involving the patient and family D. Concede to the wishes of the patient's significant other

An ACNP is preparing to discharge a patient with quadriplegia with a Stage 2 sacral decubitus ulcer. Which of the following should the ACNP place in the discharge instructions? A. Turn every 4 hours. B. Follow a high-protein diet. C. Cover wound with a moist, occlusive dressing. D. Restrict fluid to 1.5 L per day.
An ACNP is approached by the case manager who is concerned because a therapeutic device that has been ordered for a specific patient is not covered by some insurance companies. Improved outcomes are associated with this device, and several recent studies indicate the effectiveness of the device. Based on this information, the best course of action is A. stop using the device and order a different therapy device. B. discuss with the patient and the family regarding the benefits of the device. C. work with the case manager and insurance companies to provide coverage. D. order only devices that are covered by the patient's insurance.
A patient with myasthenia gravis is hospitalized for elective lumbar surgery Before prescribing an antiemetic, the ACNP should ask whether the patent has A. any new muscular weakness. B. muscle fasciculations. C. large surgical drain output. D. new radicular pain.
A patient has a hemoglobin A1C of 12.1%. Which of the following tests is indicated at this time? A. dilated eye examination B. echocardiogram C. ECG D. endoscopy
A 21-year-old man comes into the emergency department complaining of shortness of breath. He has no previous history of pulmonary disorders statist was sitting at a friend's house when he suddenly felt like he could not breathe, Current vital signs are as follows: BP Remaining 2 HR RR 119/70 75 20 SpO2 97% He has absent lung sounds on his left side. Which of the following should be the initial plan of action? A. Initiate 2 L oxygen by nasal cannula and monitor the oxygen saturation. B. Obtain a stat chest x-ray. C. Admit the patient for observation and continue to monitor vital signs every 4 hours D. Perform an emergency needle aspiration between the 4th and 5th intercostal space
An ACNP should order which of the following parenteral antibiotics to cover both Pseudomonas and anaerobes? A. metronidazole (Flagyl) and cefazolin (Ancef) B. piperacillin/tazobactam (Zosyn) C. levofloxacin (Levaquin) and azithromycin (Zithromax) D. cefazolin (Ancef)
An ACNP is caring for a patient who is actively dying. The patient's nurse is unable to be present with the patient and family. A. assist the nurse by performing some tasks for other patients. B. discuss the situation with the charge nurse. C. recruit other nurses to help the patient and family. D. explain to the patient and her family that the nurse has other responsibilities.
An ACNP is called to evaluate a patient who is agitated following extubation. Physical examination reveals stridor, nasal flaring, and cyanosis. Which of the following is most appropriate? A. intubation B. lorazepam (Ativan) IV C. albuterol (Proventil) nebulizer D. BIPAP
A 60-year-old patient with lupus who takes prednisone regularly should undergo what type of health screening? A. bone density B. cholesterol C. colon cancer D. depression
Following cardiac catheterization, a patient denies chest pain, but has low back pain, is tachycardic, and is restless. Which of the following is the most appropriate initial

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1. postoperative assessment is performed on a patient who

underwent a lumbar 4/5 laminectomy and discectomy 2 hours

ago. Preoperatively, she had pain in her right hip and leg with

numbness of her right foot, but no weakness. At the time of the

examination, her motor strength is 5/5 in all extremities, and she

has not voided postoperatively. She is concerned that the

numbness in her foot has not resolved. Which of the following is

an ACNP's best action? A Reassure her that numbness often

persists postoperatively. B. Scan her bladder to assess for cauda

equina syndrome. C. Obtain a CT scan of her lumbar spine to

evaluate for hematoma. D. Administer steroids for nerve root

radiculopathy.

2. It is important to emphasize which of the following when

providing smoking cessation education to a patient after

coronary stent placement? A. Patients with atherosclerosis are

more likely to develop lung disease within 5 years. B. Within 3

years of cessation, coronary artery disease risk improves., C.

Nicotinand clopidogrel (Plavix) may produce adverse effects. D.

Most patients find it easy to quit smoking after stent placement.

3. patient has subcutaneous gas on CT scan in the left foot with

erythema extending up the lower extremity. The vascular

surgeon is requesting a CT angiography of the lower extremity to

assess vascular status prior to operative intervention. Which

laboratory data is most concerning for ordering this test?

Remaining: 2 A. hemoglobin 7 g/dL B. lactate 2 mmol/L C. WBC

15/mm³ D. creatinine 1.9 mg/dL

4. A patient's laboratory results show a potassium level of 8.0, and

an ECG reveals peaked T waves. In addition to 25 g dextrose 50%,

which of the following is the be emergency treatment? B. calcium

gluconate 10 mL, regular insulin 10 units A. sodium polystyrene

sulfonate resin (Kayexalate) 25 g, regular insulin 20 units C

calcium chloride 10 mL, regular insulin 20 units D. magnesium

sulfate 1 g, regular insulin 10 units

5. A patient was in a 45 mph rollover MVC. His GCS was 7, and he

was intubated by EMS at the scene. He presents to the

emergency department with BP 76/54 and HR 90 after 2 L of

normal saline. The airway is maintained with an endotracheal

tube. Initially, there are bilateral breath sounds, pulses 1+

throughout, and his skin is cool. External bleeding is controlled

and the GCS is now 3T. Secondary examination shows Grey

Turner's sign and a positive abdominal FAST examination. Which

of the following is the correct disposition for this patient? A.

9. An Bo-year-old patient with a pelvic fracture develops mild

dyspnea, hypoxia, altered mental status, and a petechial rash the

day following the trauma. The m hely diagnosis is A. fat

embolism. B. allergic drug reaction. CC. congestive heart failure.

O pulmonary edema.

10. patient presents after being intubated in the field status

post fall with numerous visible injuries. The most appropriate

initial assessment is LISA/Canada -1077508234 Coba 11617 564

5062 Maquest Bras End Beasdon 미 A. peripheral pulses. B. breath

sounds. C. level of consciousness. D. pupillary response.

11. A patient with ARDS is receiving mechanical ventilation.

Arterial blood gas results are: PH PaCO2 7.28 PaO2 56 mm Hg

HCO3 57 mm Hg SaO2 18 mEq/L 84% Ventilator settings are as

follows: FIO2 Rate 70% 15 breaths/minute Tidal volume 600 mL

PEEP 5 cm H2O Which of the following adjustments should an

ACNP make to optimize oxygenation? A. Increase tidal volume. B.

Decrease FiO2 C. Increase PEEP D. Decrease respiratory rate.

12. A patient presents with shortness of breath, fever,

productive cough, and lethargy. The patient recently completed 6

weeks of IV antibiotics for asfoomywills and was undergoing