Acute Care Nurse Practitioner (ACNP) Test Review

The Acute Care Nurse Practitioner is a specialized certification. It enables the Nurse Practitioner to practice in a multitude of settings, providing care to adults who suffer from acute or chronic illnesses. The Nurse Practitioner with this certification can examine patients, order and interpret diagnostic studies, diagnose disease, and provide medical treatment. Specific limitations on prescribing privileges vary from state to state.

To become eligible to sit for the ACNP exam, a person must be a licensed RN and a graduate of an accredited nurse practitioner program with an acute care nurse practitioner track. The person must have a Master's Degree in Nursing.

Once the registration paperwork has been completed, there is a 90-day time period open for the ACNP exam to be completed. The cost ranges from $230-$370 depending on ANA membership and other possible discounts that can be applied.

The ACNP exam contains 175 questions that are multiple-choice format. Of these questions, 25 are used for fact finding to help with future ACNP exam preparation. Examinees are allowed 3-1/2 hours to complete the test, which allows just over 1 minute per question.

Approximately 50% of the ACNP exam focuses on clinical decision-making and is divided amongst the various body systems. The remainder of the ACNP exam focuses on principles of patient care from a nurse practitioner standpoint along with issues of diversity and collaboration for patient care.

Acute Care Nurse Practitioner

Recertification must be performed every 5 years in order to maintain current Acute Care Nurse Practitioner certification. There are certain requirements that must be met in order to renew the ACNP certification. The ACNP must have worked in their specialty for at least 2,000 hours over the past 5 years with at least 400 of those hours being in the previous 1 year before certification renewal. An alternative to taking the ACNP exam over again would be to acquire at least 150 continuing education (CE) credit hours through education materials. These are available through literature, lectures and conferences, or teaching in the classroom, or through professional journal writings or editing.

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Acute Care Nurse Practitioner Practice Questions

1. A patient has chest pain, dyspnea, and hypotension. A 12-lead ECG shows atrial rates of 250 with regular ventricular rates of 100. P waves are saw-toothed (referred to as F waves), QRS shape and duration (0.4 to 0.11 seconds) is normal, PR interval is hard to calculate because of F waves, and the P:QRS ratio is 2-4:1. Which of the following diagnoses fits this profile?

  1. Premature atrial contraction
  2. Premature junctional contraction
  3. Atrial fibrillation
  4. Atrial flutter

2. 28-year-old female who had gastric bypass surgery (Roux-en-Y) complains of bloating, abdominal cramping, nausea, and vomiting within minutes after eating. Her typical meal consists of a small potato, 3 ounces of meat, half a slice of white bread, half a banana, a small piece of cake, and 8 ounces of sweetened iced tea. Which of the following is indicated as an initial treatment?

  1. Acarbose to delay carbohydrate absorption
  2. Octreotide acetate to slow intestinal emptying
  3. Increased protein, reduced carbohydrates, and avoiding drinking during meals
  4. Decreased protein, increased carbohydrates, and a glass of juice or milk

3. A 75-year-old male is receiving warfarin after the insertion of an aortic stent for aortic aneurysm. The patient states he usually takes a number of vitamins and herbal preparations. Which of the following should the patient avoid?

  1. St. John's wort
  2. Melatonin
  3. Echinacea
  4. Vitamin B complex

4. A 26-year-old female with sickle cell disease states she has had numbness and aching in her right arm for about 24 hours and now has increased pain with fever. She states she has no appetite and feels increasingly anxious. Which type of crisis is consistent with these symptoms?

  1. Hemolytic
  2. Sequestrating
  3. Aplastic
  4. Vaso-occlusive

5. A 24-year-old female requires emergent treatment for benzodiazepine toxicity resulting from ingestion of large quantities of diazepam combined with alcohol and a combination of other unknown narcotic drugs. She exhibits pronounced lethargy, alterations in mental status, and hypotension. Treatment should include:

  1. Naloxone
  2. Flumazenil
  3. Forced diuresis
  4. Hemodialysis

Acute Care Nurse Practitioner Answer Key

1. Answer: D

Atrial flutter (AF) occurs when the atrial rate is faster (usually 250-400 beats per minute) than the atrioventricular (AV) node conduction rate so not all of the beats are conducted into the ventricles (ventricular rate 75-150). The beats are effectively blocked at the AV node, preventing ventricular fibrillation although some extra ventricular impulses may go through. AF is caused by the same conditions that cause atrial fibrillation: coronary artery disease, valvular disease, pulmonary disease, heavy alcohol ingestion, and cardiac surgery. Treatment includes: Cardioversion if condition is unstable. Medications to slow ventricular rate and conduction through AV node: Cardizem, Calan. Medications to convert to sinus rhythm: Corvert, Cardioquin, Norpace, Cordarone.

2. Answer: C

Dumping syndrome usually responds to a change in dietary habits and is most often caused by carbohydrate intake, so increasing protein, reducing carbohydrates, and avoiding drinking fluids with meals may relieve symptoms. Acarbose is sometimes used with late onset dumping syndrome (occurring 1 to 3 hours after eating) if other methods are ineffective. Octreotide requires injections and is used only for intractable symptoms because of adverse effects, such as diarrhea, distention, and cholelithiasis.

3. Answer: A

St. John's wort may interact with antibiotics, birth control pills, antidepressants, warfarin, anticonvulsants, MAO inhibitors, antivirals, immunosuppressants, and migraine drugs. Melatonin may interact with NSAIDS, antihypertensives, steroids, and anti-anxiety medications. Echinacea may interact with immunosuppressants and steroids. Vitamin B complex is safe to take with warfarin, as it does not affect the INR; however, multivitamins with vitamin K may. If patients take a multivitamin during warfarin therapy, they should do so daily and not intermittently so that intake of vitamin K does not fluctuate. Vitamin C should be limited to 500 mg daily and vitamin E to 400 IU daily.

4. Answer: D

These symptoms are consistent with vaso-occlusive crisis. The 4 phases of vasoocclusive pain include: Prodromal: (one day prior to pain onset) Numbness, aching, paresthesia Initial/Infarctive: Fever, pain, anxiety, anorexia Established/Post-infarctive: (up to 4 or 5 days) Severe pain with inflammation, swelling, joint effusions, arthralgia Resolving: Decrease in pain over 24-48 hours Bone is the most common site for vaso-occlusion, but it can occur in the abdomen, brain, chest, or organs (liver, kidneys). When extremities are involved, patients may develop dactylitis with swelling and pain in hands or feet.

5. Answer: A

Benzodiazepine toxicity is treated with naloxone with co-ingestions. Flumazenil is usually contraindicated because of potential complications and is used only with pure benzodiazepine ingestion. Forced diuresis and hemodialysis have minimal effect on clearance of benzodiazepines. IV fluids are used to treat hypotension. Gastric emptying is usually avoided as it is only useful if done within one hour of ingestion. Primary care is supportive with monitoring of CNS and respiratory depression and treatment as indicated.

Acute Care Nurse Practitioner (ACNP) Test Blueprint and Breakdown


Last Updated: 12/14/2017

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