Free ACNPC-AG certification exam Practice Questions

Sample Practice Questions

Try these 10 sample questions from the ACNPC-AG certification exam practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 68-year-old patient has a regular wide-complex tachycardia at 190/min with a palpable pulse. Blood pressure is 72/40 mm Hg and confusion began with the arrhythmia. Which electrical intervention is indicated?

   1. A.Deliver synchronized cardioversion.Correct answer: A
   2. B.Deliver an unsynchronized shock.
   3. C.Initiate transcutaneous pacing.
   4. D.Initiate transvenous pacing.

   Explanation: The AHA recommends "Synchronized cardioversion" for hemodynamically unstable wide-complex tachycardia. This patient has a pulse and a regular monomorphic rhythm with arrhythmia-related hypoperfusion. Unsynchronized shock is used for VF or sustained polymorphic VT; pacing treats selected bradyarrhythmias.

   Reference: 2025 AHA Guidelines: Adult Advanced Life Support — Wide-Complex Tachycardia, recommendation 1

2. 2An alert adult with severe anemia understands the benefits and risks of transfusion and consistently refuses it. The patient's family demands transfusion. Which principle should guide the ACNP's response?

   1. A.The family's substituted judgment controls the decision.
   2. B.The patient's informed refusal controls the decision.Correct answer: B
   3. C.The clinician's best-interest judgment controls the decision.
   4. D.The designated proxy's preference controls the decision.

   Explanation: The AMA states, "A patient who has decision-making capacity may accept or refuse any recommended medical intervention." The patient has capacity for this decision; family, proxy, and substituted best-interest decisions do not override the patient’s informed refusal.

   Reference: AMA Code of Medical Ethics: Patient Rights — Patient Rights, decision-making right

3. 3After termination of a brief ventricular arrhythmia, a patient has recurrent self-terminating torsades de pointes and a QTc of 540 ms. Which IV medication can help suppress recurrence?

   1. A.Procainamide
   2. B.MagnesiumCorrect answer: B
   3. C.Diltiazem
   4. D.Adenosine

   Explanation: The AHA states, "Magnesium may be considered" for recurrent polymorphic VT associated with a long QT interval. The prolonged QT distinguishes torsades from polymorphic VT with a normal QT. Procainamide can prolong QT; diltiazem and adenosine do not suppress this ventricular arrhythmia.

   Reference: 2025 AHA Guidelines: Adult Advanced Life Support — Polymorphic Ventricular Tachycardia, recommendation 2

4. 4An unidentified unconscious adult requires immediate treatment for a life-threatening hemorrhage. There is no available surrogate or known advance directive, and delay would endanger the patient. Which consent basis permits immediate intervention?

   1. A.The patient's express oral consent
   2. B.The designated surrogate's authorization
   3. C.The patient's written informed consent
   4. D.The emergency exception to prior informed consentCorrect answer: D

   Explanation: The AMA states that in an urgent emergency without patient capacity or an available surrogate, clinicians "may initiate treatment without prior informed consent." This is the emergency exception. Express oral consent, written consent, and surrogate authorization require participation that is unavailable here. The patient or surrogate should be informed as soon as possible and consent obtained for ongoing care.

   Reference: AMA Code of Medical Ethics: Informed Consent — Opinion 2.1.1, emergency exception

5. 5A hemodynamically stable adult has a regular narrow-complex tachycardia at 180/min. A properly performed vagal maneuver does not terminate it. The patient has no active bronchospasm. Which rapid IV medication is recommended for acute termination?

   1. A.Lidocaine
   2. B.Atropine
   3. C.AdenosineCorrect answer: C
   4. D.Magnesium

   Explanation: The AHA states, "Adenosine is recommended" for acute treatment of regular narrow-complex tachycardia. It transiently blocks AV nodal conduction. Lidocaine treats selected ventricular arrhythmias, atropine treats symptomatic bradycardia, and magnesium treats torsades recurrence.

   Reference: 2025 AHA Guidelines: Adult Advanced Life Support — Regular Narrow-Complex Tachycardia, recommendation 2

6. 6A patient considering a nonemergent operation asks to consult another surgeon before deciding. Which patient right directly supports facilitating that request?

   1. A.The right to obtain a second opinionCorrect answer: A
   2. B.The right to designate a surrogate
   3. C.The right to receive a record amendment
   4. D.The right to receive an itemized bill

   Explanation: The AMA explicitly identifies the right "To obtain a second opinion." Consultation with another surgeon before this nonemergent decision exercises that right; the other options describe different patient requests.

   Reference: AMA Code of Medical Ethics: Patient Rights — Patient Rights, second-opinion right

7. 7A patient suddenly becomes unresponsive and pulseless. CPR is underway and the monitor confirms ventricular fibrillation. A defibrillator is immediately available. Which electrical intervention should the ACNP direct?

   1. A.Apply synchronized cardioversion.
   2. B.Begin transcutaneous pacing.
   3. C.Insert a temporary pacing wire.
   4. D.Deliver an unsynchronized shock.Correct answer: D

   Explanation: The AHA emphasizes that "early defibrillation is critical to survival" in VF/pulseless VT. Ventricular fibrillation requires an unsynchronized shock while interruptions in compressions are minimized. Synchronization cannot reliably target VF, and pacing does not terminate it.

   Reference: 2025 AHA Guidelines: Adult Advanced Life Support — Defibrillation, synopsis

8. 8A patient's designated surrogate must decide about prolonged ventilation after the patient loses decision-making capacity. The record documents the patient's previous values and preferences about life support. Which decision standard should the ACNP help the surrogate apply?

   1. A.The surrogate's own preferred quality-of-life standard
   2. B.The clinician's usual treatment-selection standard
   3. C.Substituted judgment based on the patient's preferencesCorrect answer: C
   4. D.Best interests without reference to prior preferences

   Explanation: The AMA advises clinicians to "Assist the surrogate to make decisions in keeping with the standard of substituted judgment" using the patient’s previously expressed preferences and values. A best-interest standard applies when those preferences are unknown and cannot reasonably be inferred; neither the surrogate’s nor the clinician’s personal preferences control.

   Reference: AMA Code of Medical Ethics: Decisions for Adult Patients Who Lack Capacity — Opinion 2.1.2, substituted judgment and best interests

9. 9During resuscitation, an adult remains pulseless with an organized rhythm on the monitor. High-quality CPR and evaluation of reversible causes are underway. Which vasopressor should be administered as soon as feasible?

   1. A.EpinephrineCorrect answer: A
   2. B.Phenylephrine
   3. C.Norepinephrine
   4. D.Vasopressin

   Explanation: For a nonshockable arrest rhythm, the AHA advises giving "epinephrine as soon as feasible." Pulseless electrical activity is a nonshockable rhythm. Phenylephrine and norepinephrine are not the standard arrest vasopressor, and vasopressin offers no advantage as a substitute.

   Reference: 2025 AHA Guidelines: Adult Advanced Life Support — Vasopressor Medications During Cardiac Arrest, recommendation 3

10. 10An ACNP is deciding how HIPAA's minimum necessary standard applies to several proposed disclosures of patient information. Which disclosure falls under the treatment-purpose exception to that standard?

    1. A.Records sent to an insurer to process a payment claim
    2. B.Records sent to a contractor to prepare a billing claim
    3. C.Records sent to an external reviewer for a quality audit
    4. D.Records sent to a nephrologist to provide patient careCorrect answer: D

    Explanation: HHS states that "where protected health information is disclosed to, or requested by, health care providers for treatment purposes, the minimum necessary standard does not apply." Sending records to the treating nephrologist fits this exception. Payment processing, billing services, and quality-audit disclosures do not qualify for the treatment-purpose exception.

    Reference: HHS: Minimum Necessary Requirement — Uses and Disclosures of, and Requests for, Protected Health Information