AGACNP-BC sample questions

Question 1

A 68-year-old female is admitted to the intensive care unit 48 hours following emergency laparotomy for perforated diverticulitis with feculent peritonitis. Over the past 6 hours, she developed severe respiratory distress, tachypnea to 38 breaths/min, and confusion. She was promptly intubated. A chest radiograph demonstrates diffuse bilateral alveolar infiltrates with air bronchograms sparing the cardiophrenic angles. Arterial blood gas on volume control ventilation (tidal volume 6 mL/kg predicted body weight, positive end-expiratory pressure 14 cm H2O, FiO2 0.80) reveals: pH 7.27, PaCO2 49 mmHg, PaO2 78 mmHg, and HCO3- 22 mEq/L.

Bedside transthoracic echocardiography demonstrates normal left ventricular systolic function with an ejection fraction of 62%, normal left ventricular filling pressures, and no valvular disease. Her calculated PaO2/FiO2 ratio is 97.5 mmHg, fulfilling Berlin criteria for severe acute respiratory distress syndrome (ARDS).

Which pathophysiologic process is the predominant mechanism causing this patient's severe, refractory hypoxemia?

```mermaid
flowchart LR
A[Endothelial/Epithelial Injury] --> B[Increased Permeability]
B --> C[Alveolar Flooding & Collapse]
C --> D[Intrapulmonary Shunting]
D --> E[Refractory Hypoxemia]
```

Accepted Answer

Intrapulmonary right-to-left shunting through flooded, collapsed, and non-aerated alveolar units

Answer

Severe alveolar hypoventilation induced by central respiratory depression and diaphragmatic splinting

Answer

Alveolar dead-space ventilation resulting from diffuse microvascular pulmonary arterial thrombosis

Answer

Pure diffusion limitation across the proteinaceous exudative alveolar-capillary membrane barrier

Question 2

A critically ill 64-year-old male with septic shock secondary to hospital-acquired pseudomonal pneumonia is prescribed intravenous piperacillin-tazobactam. The AGACNP orders an extended infusion protocol. Which pharmacokinetic-pharmacodynamic (PK/PD) index best predicts bactericidal efficacy and clinical eradication for beta-lactam antimicrobials?

Accepted Answer

Percentage of the dosing interval during which free drug concentration remains above the minimum inhibitory concentration (%fT > MIC)

Answer

Ratio of the 24-hour area under the concentration-time curve to the minimum inhibitory concentration (AUC24/MIC)

Answer

Ratio of maximum peak serum concentration to the minimum inhibitory concentration (Cmax/MIC)

Answer

Post-antibiotic persistent leukocyte suppression index independent of serum drug threshold

Question 3

A 23-year-old male polytrauma patient with severe traumatic brain injury and multiple extremity fractures exhibits persistently subtherapeutic vancomycin troughs despite standard high-dose therapy. A 24-hour measured creatinine clearance reveals 195 mL/min/1.73 m2, confirming augmented renal clearance (ARC). Which TWO clinical factors most frequently drive augmented renal clearance in critically ill acute care patients? (Select TWO)

Accepted Answer

Hyperdynamic systemic circulation with elevated cardiac output and increased renal blood flow

Accepted Answer

Systemic inflammatory response combined with massive fluid resuscitation and inotropic support

Answer

Pre-existing microvascular nephrosclerosis secondary to poorly controlled diabetes mellitus

Answer

Advanced biological age greater than 75 years

Answer

Severe intra-abdominal hypertension with renal parenchymal venous congestion

Question 4

A 56-year-old male with decompensated alcoholic cirrhosis and spontaneous bacterial peritonitis has a serum albumin level of 1.7 g/dL. When administering highly protein-bound antimicrobials or antiepileptics (such as ceftriaxone or phenytoin), which pharmacokinetic consequence directly results from this patient's severe hypoalbuminemia?

Accepted Answer

An increased unbound (free) drug fraction, expanding the apparent volume of distribution and increasing drug clearance

Answer

Decreased glomerular filtration rate specific to the unbound solute molecule, resulting in progressive drug accumulation

Answer

Competitive inhibition of renal organic anion transporters, leading to prolonged elimination half-life

Answer

A decreased unbound drug fraction, leading to markedly diminished peripheral tissue penetration

Question 5

During morning rounds in the cardiac intensive care unit, an AGACNP performs a cardiovascular physical assessment on a 72-year-old patient with end-stage heart failure. Which combination of bedside physical findings most specifically reflects advanced cardiogenic hypoperfusion (the "cold" clinical phenotype)?

Accepted Answer

Narrow proportional pulse pressure (< 25%), cool mottled distal extremities, delayed capillary refill, and resting tachycardia

Answer

Isolated systolic hypertension, rapid capillary refill (< 1 second), hyperdynamic apical impulse, and diaphoresis

Answer

Prominent jugular venous cannon a-waves, bibasilar crackles, warm lower extremities, and bounding radial pulses

Answer

Brisk bounding carotid upstrokes, wide pulse pressure (> 60 mmHg), warm extremities, and flushed facies

Question 6

An AGACNP evaluates an acute spinal cord injury patient in the neuro-intensive care unit. While assessing deep tendon reflexes and upper motor neuron pathway integrity, the practitioner tests for ankle clonus. Which examination technique correctly elicits this physical sign?

Accepted Answer

Supporting the knee in slight flexion, sharply dorsiflexing the foot, and maintaining firm continuous pressure in dorsiflexion

Answer

Percussing the Achilles tendon directly with a neurological reflex hammer while the patient's foot hangs in passive plantarflexion

Answer

Stroking the lateral plantar surface of the foot firmly from the heel forward toward the base of the fourth toe with a wooden applicator

Answer

Compressing the gastrocnemius muscle belly firmly between the thumb and fingers while palpating the posterior tibial pulse

Free AGACNP-BC sample questions

An AGACNP evaluates an acute spinal cord injury patient in the neuro-intensive care unit. While assessing deep tendon reflexes and upper motor neuron pathway integrity, the practitioner tests for ankle clonus. Which examination technique correctly elicits this physical sign?

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