Practitioner Certification Exam Practice

Adult-Gerontology Acute Care Nurse Practitioner Certification Exam Practice Test Questions And Correct Answers (Verified Answers) Plus Rationales 2026 Q&A | Instant Download Pdf

• A 72-year-old male presents with shortness of breath, jugular venous

distention, and bilateral pitting edema. Which medication is most appropriate to reduce his preload?

• Lisinopril
• Furosemide
• Metoprolol
• Digoxin

Rationale: Furosemide is a loop diuretic that reduces preload by decreasing

intravascular volume through diuresis, improving symptoms of volume overload.

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• A patient in septic shock has a mean arterial pressure (MAP) of 55

mmHg despite fluid resuscitation. The next step is to initiate:

• Norepinephrine
• Dopamine
• Epinephrine
• Vasopressin

Rationale: Norepinephrine is the first-line vasopressor for septic shock to

restore adequate perfusion pressure when fluids alone are insufficient.

• In managing acute decompensated heart failure, which laboratory test

best differentiates between cardiac and non-cardiac causes of dyspnea?

• D-dimer
• Troponin I
• B-type natriuretic peptide (BNP)
• Creatine kinase

Rationale: BNP is released in response to ventricular stretch and volume

overload, helping to distinguish cardiac from pulmonary causes of dyspnea.

4. The hallmark of delirium in older adults is:

• Memory loss
• Gradual cognitive decline
• Acute onset of confusion with fluctuating course 2 / 4

• Visual hallucinations

Rationale: Delirium presents acutely with fluctuating levels of

consciousness and inattention, differentiating it from dementia.

• A 68-year-old with COPD presents with respiratory acidosis. The ABG

shows pH 7.30, PaCO₂ 60 mmHg, HCO₃⁻ 28. The best intervention is:

• Initiate noninvasive positive pressure ventilation (BiPAP)
• Increase IV fluids
• Begin antibiotics
• Administer bronchodilator only

Rationale: BiPAP improves ventilation, reducing CO₂ retention and

correcting acidosis in acute COPD exacerbations.

6. The most common pathogen in hospital-acquired pneumonia is:

• Streptococcus pneumoniae
• Pseudomonas aeruginosa
• Haemophilus influenzae
• Mycoplasma pneumoniae

Rationale: Pseudomonas aeruginosa is frequently isolated in hospital-

acquired and ventilator-associated pneumonias, especially in critically ill patients.

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• A patient with atrial fibrillation develops acute chest pain and

hypotension. The first diagnostic test should be:

• 12-lead ECG
• Troponin
• Chest X-ray
• Echocardiogram

Rationale: A 12-lead ECG identifies acute ischemic changes or arrhythmia-

related hemodynamic compromise requiring urgent management.

• Which medication should be avoided in a patient with decompensated

heart failure?

• Furosemide
• Diltiazem
• Digoxin
• Hydralazine

Rationale: Calcium channel blockers like diltiazem can worsen heart failure

by decreasing myocardial contractility.

9. The earliest sign of sepsis in older adults may be:

• Fever
• Altered mental status
• Tachycardia
• Hypotension
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