Adult-Gerontology Acute Care
Adult-Gerontology Acute Care is a trademark of its owner, which is not affiliated with and does not endorse Test Treasure Publication or TTP Prep.
Adult-Gerontology Acute Care is a trademark of its owner, which is not affiliated with and does not endorse Test Treasure Publication or TTP Prep.
10 sample questions for the Adult-Gerontology Acute Care, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.
Sections covered on the exam: Mixed Domains, Professionalrole · Policyandadvocacy, Professionalrole · Relationshipsandcommunication, Professionalrole · Scopeandstandards, Professionalrole · Researchandebp, Professionalrole · Qualityandsafety, Core Competencies, Professionalrole · Patienteducation, Clinical Practice.
Question 1 · Mixed Domains
A 29-year-old woman is brought to the ED after fainting at home. She reports 1 day of left lower abdominal pain; her last menstrual period was 7 weeks ago. BP is 78/46 mm Hg and HR 132/min. The abdomen is distended with diffuse tenderness and rebound. Serum hCG is 4,800 mIU/mL. Bedside ultrasound shows an empty uterus and a large volume of free fluid in the hepatorenal space. Two large-bore IVs are placed, and uncrossmatched blood is being transfused. Which is the most appropriate next step?
Answer: C. Emergent surgical management in the operating room
An hCG level above the discriminatory zone with no intrauterine pregnancy, together with hemoperitoneum extending to the hepatorenal space, indicates a ruptured ectopic pregnancy. She is in hemorrhagic shock, so the only appropriate course is resuscitation with blood products while moving immediately to the operating room for laparoscopy or laparotomy and salpingectomy. Methotrexate is limited to hemodynamically stable patients with an unruptured ectopic pregnancy and no signs of intraperitoneal bleeding; it takes days to work and cannot stop active hemorrhage. Serial hCG measurement is used to follow stable pregnancies of unknown location, not an unstable patient. Transport to radiology for further imaging delays definitive hemorrhage control and exposes her to decompensation outside a resuscitation area. Rh status should be checked, with anti-D immune globulin given if she is Rh negative.
Question 2 · Professionalrole · Scopeandstandards
A 69-year-old man with atrial fibrillation is on the medical ward after warfarin was held 5 days ago for a colonoscopy. A nurse notices a new right facial droop; he was last known well 50 minutes earlier. He wrinkles both sides of his forehead symmetrically and closes both eyes tightly, but the right nasolabial fold is flattened and the right corner of the mouth droops. Right hand grip is mildly weak. Fingerstick glucose is 132 mg/dL. Which is the most appropriate next step?
Answer: A. Activate the stroke team and obtain an emergent noncontrast head CT
The forehead receives motor input from both cerebral hemispheres, so a unilateral upper motor neuron lesion weakens the lower face but spares forehead wrinkling and eye closure. Together with ipsilateral hand weakness, this points to an acute cortical or subcortical stroke in a patient with atrial fibrillation whose anticoagulation was interrupted. He is within the thrombolysis window, so the priority is a stroke alert with emergent noncontrast CT to exclude hemorrhage and assess eligibility for reperfusion therapy. Bell palsy is a lower motor neuron lesion of the facial nerve that paralyzes the entire half of the face, including the forehead, so treating with corticosteroids with or without an antiviral would miss a time-sensitive stroke. An outpatient MRI of the internal auditory canals evaluates peripheral facial nerve lesions and would dangerously delay care.
Question 3 · Professionalrole · Relationshipsandcommunication
A 52-year-old man with newly diagnosed metastatic pancreatic cancer is told by the AGACNP that his biopsy confirms malignancy. He becomes quiet, looks down, and says, 'I just started a new job. I thought I would finally have time with my grandkids.' Which response by the NP is most appropriate?
Answer: D. 'It sounds like this news is a real shock, especially with everything you had been looking forward to.'
The NURSE mnemonic (Name, Understand, Respect, Support, Explore) guides empathic responses to emotion. Naming the emotion ('a real shock') and linking it to what matters to him acknowledges his loss and invites him to share more, which builds trust and helps him process information before planning. Premature reassurance about hope and treatment dismisses the emotion and may feel false. Moving immediately to logistics answers a cognitive question he did not ask, a common pitfall when clinicians are uncomfortable with emotion; the information will not be retained while he is overwhelmed. Claiming to know exactly how he feels and shifting focus to the clinician's own experience is presumptuous and redirects attention away from the patient.
Question 4 · Professionalrole · Researchandebp
A multicenter randomized trial compares a conservative oxygen target (SpO2 90% to 94%) with a liberal target (SpO2 above 96%) in mechanically ventilated adults. The primary outcome, 90-day mortality, yields a hazard ratio of 0.86 (95% confidence interval, 0.71 to 1.04) favoring the conservative strategy. Which interpretation is most accurate?
Answer: C. The difference in mortality is not statistically significant at the 0.05 level because the confidence interval includes 1.0
For ratio measures (hazard ratios, relative risks, odds ratios), 1.0 is the line of no effect. A 95% confidence interval that includes 1.0 (here 0.71 to 1.04) indicates the result is not statistically significant at the 0.05 level; the true effect could range from a 29% reduction to a 4% increase in mortality hazard. A point estimate below 1.0 alone does not establish a significant reduction. The upper limit exceeding 1.0 does not show harm; it means harm cannot be excluded. A nonsignificant result is not proof of equivalence, which requires a trial designed for equivalence or noninferiority with prespecified margins; absence of evidence of a difference is not evidence of no difference.
Question 5 · Professionalrole · Researchandebp
A guideline panel uses the GRADE approach to rate the certainty of evidence that a new anticoagulant reversal strategy reduces 30-day mortality. The body of evidence consists of 4 randomized controlled trials. The panel judges risk of bias to be serious because outcome assessors were unblinded and there was substantial loss to follow-up, and judges imprecision to be serious because the pooled confidence interval is wide. Inconsistency, indirectness, and publication bias are judged not serious. What is the overall certainty of evidence?
Answer: D. Low
In GRADE, evidence from randomized controlled trials starts at high certainty, whereas observational evidence starts at low. Certainty is rated down one level for each serious concern (two for very serious) across five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Here, two domains, risk of bias and imprecision, are each judged serious, so certainty drops two levels from high to low. Rating the evidence high ignores the identified limitations. Moderate would reflect only one serious concern. Very low would require three levels of downgrading (or a very serious concern plus another serious one). Low certainty means the true effect may be substantially different from the estimate, which typically supports a conditional (weak) recommendation.
Question 6 · Mixed Domains
A 36-year-old woman had a diagnostic lumbar puncture with a 20-gauge cutting needle 4 days ago to evaluate for idiopathic intracranial hypertension; opening pressure was normal. Since the next day she has had a bifrontal headache that is severe when upright and nearly resolves within 15 minutes of lying flat. Oral fluids, caffeine, and acetaminophen for 72 hours have not helped, and she cannot sit up to eat. She is afebrile with a normal neurologic examination and no meningismus. Which is the most appropriate next step?
Answer: A. Autologous epidural blood patch
The orthostatic headache that began within days of dural puncture and resolves when she lies flat is classic post-dural puncture headache from CSF leakage and intracranial hypotension. Her risk was increased by female sex, younger age, and a cutting needle. After failure of 24 to 72 hours of conservative management, an epidural blood patch is the definitive treatment, relieving symptoms in most patients by sealing the dural defect. Bed rest neither prevents nor treats post-dural puncture headache. Imaging is reserved for atypical features such as fever, focal deficits, seizures, or loss of the positional component that raise concern for subdural hematoma, meningitis, or venous thrombosis, none of which is present. Triptans are migraine therapies and have no established role in post-dural puncture headache.
Question 7 · Professionalrole · Scopeandstandards
A community hospital's small pediatric unit is short- staffed overnight. The nursing supervisor asks an AGACNP who covers the adult medical floors to assume primary management of a 9-year-old admitted with diabetic ketoacidosis on an insulin infusion until the pediatric hospitalist arrives in the morning. What is the most appropriate response?
Answer: D. Decline to assume management because the child is outside the adult-gerontology population focus, while helping to arrange pediatric-qualified coverage
An APRN's scope is defined by role and population focus under the Consensus Model and state regulation. The adult-gerontology population spans young adults (including late adolescents) through older adults; a 9-year-old falls outside it. Pediatric DKA carries distinct risks, such as cerebral edema, that require pediatric-specific competencies. The NP should decline to assume management while advocating for safe coverage (pediatric hospitalist, pediatric NP, or transfer); in a true emergency any clinician may provide immediate life-saving care, but assuming ongoing primary management is different. Similarity of adult protocols does not confer competence or legal authority. Physician availability by phone does not expand an NP's population focus. Staffing shortages do not change legal scope.
Question 8 · Professionalrole · Scopeandstandards
An AGACNP has practiced for 4 years in a state that grants full practice authority. She accepts a hospitalist position in a state whose nurse practice act requires NPs to maintain a written collaborative practice agreement with a physician for prescribing. The hospital's bylaws allow NPs to admit patients. Which requirement governs her ability to prescribe in the new state?
Answer: A. She must execute a collaborative practice agreement that meets the new state's requirements before prescribing
Scope of practice and practice authority for APRNs are determined by the laws and regulations of the state in which care is delivered. In a reduced-practice state that requires a collaborative agreement for prescribing, the NP must have a compliant agreement in place before prescribing, regardless of prior independent practice elsewhere. Some states offer transition-to-practice pathways to full authority, but experience in another state does not automatically confer an exemption unless the state's statute specifically provides one. National certification is a requirement for licensure in most states but does not grant practice authority or override state law. Hospital bylaws govern credentialing and privileges within the facility and cannot expand the practice authority granted by the state.
Question 9 · Clinical Practice
A 59-year-old man with alcohol-related cirrhosis and ascites is admitted with fever, diffuse abdominal tenderness, and new confusion. BP is 108/64 mm Hg. Diagnostic paracentesis shows an ascitic neutrophil count of 420 cells/mm3; Gram stain is negative. Serum creatinine is 1.4 mg/dL (baseline 0.9 mg/dL) and total bilirubin is 4.2 mg/dL. He takes furosemide and spironolactone. Which management plan is most appropriate?
Answer: C. IV ceftriaxone plus IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3, holding diuretics
An ascitic neutrophil count of 250 cells/mm3 or higher establishes spontaneous bacterial peritonitis, which is treated immediately with a third-generation cephalosporin such as ceftriaxone or cefotaxime without waiting for culture. He has creatinine above 1 mg/dL and bilirubin above 4 mg/dL, the criteria that identify a high risk of hepatorenal syndrome, so IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 is indicated because it reduces renal failure and mortality. Diuretics should be held because of the acute kidney injury. Ceftriaxone without albumin omits a proven mortality benefit. Oral fluoroquinolones are for uncomplicated SBP or prophylaxis, not a patient with encephalopathy and AKI, and large-volume paracentesis during active SBP with AKI risks worsening renal function. Delaying antibiotics increases mortality.
Question 10 · Professionalrole · Patienteducation
A 55-year-old man who is a retired aerospace engineer is being discharged after a pulmonary embolism with a new prescription for apixaban. He speaks fluent English and tells the AGACNP, 'You don't need to simplify anything for me; I'm used to technical material.' Which approach reflects health literacy universal precautions?
Answer: B. Use plain language, focus on key actions, and confirm understanding as she would with every patient, while adding technical detail he requests
Health literacy universal precautions (AHRQ) assume that any patient may have difficulty understanding health information, especially under the stress of illness, so clinicians use clear communication strategies with every patient: plain language, a focus on the few most important actions, and confirmation of understanding. Education level and occupation do not reliably predict health literacy, and even highly educated patients misunderstand medical information when ill or anxious. Offering additional technical detail on request respects his preference without abandoning clarity. Replacing plain-language materials with prescribing information and journal articles buries key safety messages. Skipping confirmation of understanding based on education is exactly what universal precautions seek to avoid. Screening before using clear communication misses many patients and adds burden without benefit.
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