ACNPC-AG Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Start an IV nitroglycerin infusion for ongoing ischemic pain: Incorrect. Nitrates reduce preload, which the preload-dependent right ventricle needs; they caused this hypotension and are contraindicated in RV infarction.

Give IV furosemide for the elevated jugular venous pressure: Incorrect. JVD here reflects RV failure, not volume overload; diuresis further lowers preload and worsens hypotension.

Give an IV normal saline bolus to support RV preload: Correct. Inferior STEMI with V4R elevation, hypotension, clear lungs and JVD indicates RV infarction; cautious isotonic fluid boluses maintain RV filling while reperfusion is arranged.

Give IV metoprolol to reduce myocardial oxygen demand: Incorrect. Beta-blockers are avoided in hypotension and possible low-output states; they could precipitate shock.

RV infarct triad: hypotension, clear lungs, elevated JVP. Treat with volume, avoid nitrates/diuretics/morphine, and reperfuse promptly; add inotropes if fluids fail.

Answer: A

440 mL: Correct. Predicted body weight for a man = 50 + 2.3 × (70 − 60) = 73 kg; 6 mL/kg × 73 kg ≈ 440 mL.

660 mL: Incorrect. This is 6 mL/kg of actual body weight (110 kg); lung size correlates with height, not weight, so actual weight overestimates tidal volume.

730 mL: Incorrect. This is 10 mL/kg of predicted body weight, a traditional volume shown to increase mortality in ARDS.

880 mL: Incorrect. This is 8 mL/kg of actual body weight and would produce injurious volumes and plateau pressures.

ARDS: VT 4–8 mL/kg PBW (start at 6), plateau pressure ≤30 cm H₂O. PBW (men) = 50 + 2.3 × (height in inches − 60); women = 45.5 + 2.3 × (height − 60).

Answer: B

Fluid restriction to 800 mL/day and discontinue sertraline: Incorrect. Fluid restriction is appropriate for chronic, mildly symptomatic SIADH but works too slowly for hyponatremia causing seizures.

A 100-mL bolus of 3% saline, repeated if symptoms persist: Correct. Severe symptomatic hyponatremia calls for 100 mL of 3% saline over about 10 minutes (up to 3 doses) to raise sodium 4–6 mEq/L, while keeping the 24-hour rise within safe limits.

0.9% saline at 150 mL/h to raise sodium gradually: Incorrect. In SIADH, isotonic saline can worsen hyponatremia because the kidneys excrete the sodium and retain the free water.

Oral tolvaptan with unrestricted fluids: Incorrect. Vaptans are not used for emergent, seizure-causing hyponatremia and carry overcorrection risk.

Severe symptoms (seizure, coma) → 3% saline boluses for a quick 4–6 mEq/L rise; limit correction to about 8 (high-risk) to 10 mEq/L in 24 hours to avoid osmotic demyelination.

Answer: A

Give IV labetalol to lower BP below 185/110, then give thrombolysis: Correct. BP must be lowered to below 185/110 mm Hg before IV thrombolysis and kept below 180/105 for 24 hours afterward; she is otherwise eligible.

Give thrombolysis now, since BP will fall as the stroke is treated: Incorrect. Giving a thrombolytic with BP above 185/110 markedly raises the risk of symptomatic intracranial hemorrhage.

Withhold thrombolysis permanently because of the elevated BP: Incorrect. Elevated BP that can be safely lowered is not a reason to permanently exclude a patient from reperfusion therapy.

Lower BP to below 140/90 with nicardipine before considering treatment: Incorrect. Aggressive lowering to normal levels can reduce perfusion to the ischemic penumbra; the pre-treatment target is below 185/110.

Acute ischemic stroke: before IV alteplase/tenecteplase BP <185/110; after, <180/105 for 24 h. Not a thrombolysis candidate → permissive hypertension up to 220/120.

Answer: C

Dopamine: Incorrect. Dopamine causes more tachyarrhythmias than norepinephrine and is no longer recommended as first-line in septic shock.

Phenylephrine: Incorrect. Phenylephrine is a pure alpha agonist that can lower cardiac output; it is not first-line in septic shock.

Norepinephrine: Correct. Norepinephrine is the first-line vasopressor for septic shock, titrated to a MAP of 65 mm Hg or higher; vasopressin can be added if needs escalate.

Epinephrine: Incorrect. Epinephrine is an add-on agent; as first-line it can raise lactate and cause tachyarrhythmias.

Septic shock: cultures, antibiotics within 1 h, 30 mL/kg crystalloid, norepinephrine for MAP ≥65; add vasopressin when norepinephrine is about 0.25–0.5 mcg/kg/min.

Answer: B

Use the grandson, since family translation builds trust and saves clinic time: Incorrect. Antibiotic prophylaxis does not prevent CAUTI and promotes resistance and C. difficile infection.

Implement a nurse-driven protocol for daily review and removal of catheters: Correct. Nurse-driven removal protocols with daily indication review shorten catheter duration, the main modifiable CAUTI risk factor, and work at the system level.

Send routine urine cultures every 3 days on all catheterized patients: Incorrect. Routine screening cultures detect asymptomatic bacteriuria, leading to overtreatment without reducing true infections.

Replace all indwelling catheters every 72 hours: Incorrect. Routine catheter changes at fixed intervals are not recommended and do not reduce infection; removing unneeded catheters does.

CAUTI prevention: avoid unnecessary catheters, insert aseptically, maintain a closed system, and remove promptly; nurse-driven removal protocols are a key systems strategy.