AACN ACCNS-AG Adult-Gerontology Acute Care CNS

Per the NACNS Statement on CNS Practice, which of the following is NOT one of the three spheres of impact in CNS practice?

• APatient/family sphere
• BNurses and nursing practice sphere
• COrganization/system sphere
• DPhysician collaboration sphere

The AACN Synergy Model matches patient/family characteristics with how many Nurse Competencies?

• AFive
• BSix
• CEight
• DTen

An 82-year-old admitted for hip fracture suddenly becomes inattentive, fluctuating in alertness with disorganized thinking. Which validated tool BEST identifies the likely syndrome?

• AMini-Mental State Examination (MMSE)
• BConfusion Assessment Method (CAM)
• CGeriatric Depression Scale-15
• DMorse Falls Scale

Per the Surviving Sepsis Campaign Hour-1 bundle, which intervention is recommended for adult patients with sepsis-induced hypotension?

• ABegin colloid resuscitation at 10 mL/kg
• BAdminister 30 mL/kg crystalloid IV fluids
• CStart vasopressors before fluid resuscitation
• DWait for lactate result before fluid administration

The ABCDEF bundle for ICU liberation includes all the following EXCEPT:

• AAssess, prevent, and manage pain
• BBoth spontaneous awakening and breathing trials
• CDaily chlorhexidine bathing
• DEarly mobility and exercise

A CNS leads a unit-based effort to redesign the discharge process to reduce 30-day readmissions for heart failure patients. Which CNS sphere of impact is the PRIMARY focus?

• APatient/family sphere
• BNurses and nursing practice sphere
• COrganization/system sphere
• DInterprofessional sphere

Per the 2023 AGS Beers Criteria, which medication class should generally be AVOIDED in older adults due to increased risk of delirium and falls?

• AACE inhibitors
• BFirst-generation antihistamines (e.g., diphenhydramine)
• CStatins
• DLoop diuretics

Which of the following BEST describes how the CNS role differs from the NP role under the APRN Consensus Model?

• ACNSs cannot prescribe medications in any U.S. state
• BCNSs focus on systems improvement and indirect care alongside direct care, while NPs prim…
• COnly NPs are recognized as APRNs under the Consensus Model
• DCNSs do not require graduate education

A 76-year-old on warfarin presents with melena, BP 88/52, HR 118, Hgb 7.2 g/dL. INR is 5.8. Which intervention should the CNS recommend FIRST?

• AHold warfarin and recheck INR in 24 hours
• BAdminister 4-factor prothrombin complex concentrate (PCC) and IV vitamin K, with crystall…
• CGive fresh frozen plasma alone, then transfer to ICU
• DAdminister IV protamine sulfate

A CNS is asked to reduce CAUTI rates in a 24-bed ICU. Which intervention has the STRONGEST evidence base?

• ARoutine antimicrobial-coated catheters for all ICU patients
• BDaily review of catheter necessity with prompt removal when not indicated
• CRoutine bladder irrigation with normal saline
• DSwitching to suprapubic catheters by default

Which CNS activity BEST exemplifies the 'nurses and nursing practice' sphere of impact?

• APerforming a bedside heart-failure teach-back with a patient and caregiver
• BCoaching staff RNs on a new sepsis screening competency and auditing adherence
• CRevising hospital throughput policy with the executive team
• DIndependently managing a patient's mechanical ventilation settings

Which question structure follows the PICOT format MOST correctly?

• AWhat is the best way to prevent falls in older adults?
• BDoes using purposeful rounding reduce falls?
• CIn hospitalized adults >=65 (P), does hourly purposeful rounding (I) compared with usual…
• DAre older adults at higher risk of falls than younger adults?

An 84-year-old with severe dementia and metastatic lung cancer is admitted with aspiration pneumonia. The family asks about a feeding tube. Which CNS response BEST integrates evidence and goals-of-care?

• ARecommend immediate PEG placement to prevent malnutrition
• BExplain that in advanced dementia, PEG tubes have not been shown to prolong survival, pre…
• CDefer entirely to the family without discussion
• DState that hospice automatically refuses feeding tubes

Per IHI/AACN guidance, which element is part of the central line-associated bloodstream infection (CLABSI) prevention bundle?

• ARoutine guidewire exchange of central lines every 7 days
• BFemoral site preference in adults
• CMaximal sterile barrier precautions during insertion and chlorhexidine skin antisepsis
• DDaily systemic antibiotic prophylaxis for all central lines

A 70-year-old with septic shock has MAP 58 mmHg after 30 mL/kg crystalloid. Which vasopressor should be started FIRST?

• ADopamine
• BPhenylephrine
• CNorepinephrine
• DVasopressin

Which finding BEST distinguishes ARDS from cardiogenic pulmonary edema per the Berlin definition?

• ABilateral infiltrates on chest imaging
• BPaO2/FiO2 <=300 with PEEP/CPAP >=5
• CRespiratory failure not fully explained by cardiac failure or fluid overload, within 1 we…
• DHypoxemia requiring oxygen

An ARDS patient (PaO2/FiO2 = 110) is intubated. Which mechanical ventilation strategy is supported by the strongest evidence?

• ATidal volume 10-12 mL/kg actual body weight
• BTidal volume 4-6 mL/kg predicted body weight with plateau pressure <30 cm H2O
• CPressure support of 25 cm H2O without PEEP
• DVolume-control 8 mL/kg ideal body weight with PEEP 0

A CNS reviews a patient who has been NPO for 6 days post-laparotomy with TPN. The CNS notes phosphorus 1.4 mg/dL, magnesium 1.3 mg/dL, and potassium 2.9 mEq/L on day 2 of feeding restart. What is this MOST consistent with?

• ARefeeding syndrome
• BTumor lysis syndrome
• CDiabetic ketoacidosis
• DHyperosmolar hyperglycemic state

Which of the following is the MOST appropriate fall-risk screening tool for hospitalized adults?

• ABraden Scale
• BMorse Falls Scale
• CGlasgow Coma Scale
• DRASS

A 78-year-old immobilized post-stroke develops a deep wound exposing muscle. According to the NPIAP staging system, this is which pressure injury stage?

• AStage 2
• BStage 3
• CStage 4
• DUnstageable

An ICU CNS proposes hourly purposeful rounding to reduce falls. The team requests evidence quality. Which study design provides the HIGHEST level of evidence?

• AExpert opinion from a national society
• BSingle-center randomized controlled trial
• CSystematic review with meta-analysis of RCTs
• DRetrospective case series

A 68-year-old presents with crushing chest pain, ST-elevation in leads II, III, aVF, and BP 82/48. Which finding should the CNS anticipate as MOST important to the management plan?

• AHigh-dose nitroglycerin to reduce preload
• BRight ventricular involvement requiring volume loading and avoidance of nitrates
• CRoutine beta-blocker bolus to slow heart rate
• DLoop diuretic for pulmonary congestion

Which of the following BEST describes 'cultural humility' as applied to CNS practice?

• AAttaining mastery of a checklist of cultural facts about each ethnic group
• BA lifelong process of self-reflection, learning from patients, and addressing power imbal…
• CInsisting that patients adopt the dominant culture for safety
• DUsing interpreters only when language is unintelligible

Per CDC/SHEA guidance, which is the SINGLE most effective intervention to prevent ventilator-associated pneumonia (VAP)?

• ARoutine endotracheal tube changes every 48 hours
• BDaily SAT/SBT, head-of-bed 30-45 degrees, oral care with chlorhexidine, and minimizing du…
• CRoutine prophylactic IV antibiotics
• DContinuous lateral rotation therapy for all ventilated patients

An adult with diabetic ketoacidosis (DKA) presents with glucose 612, pH 7.10, bicarb 8, K+ 3.2 mEq/L. Which intervention should occur BEFORE starting insulin infusion?

• ABegin sodium bicarbonate IV infusion
• BReplace potassium because K+ <3.5 mEq/L
• CAdminister high-dose IV steroids
• DPlace a central line

Which AACN Synergy Model patient/family characteristic describes the patient's ability to return to a restorative level of functioning?

• AStability
• BResiliency
• CVulnerability
• DPredictability

An 82-year-old presents with sudden left-sided weakness, NIHSS 14, last-known-well 90 minutes ago. Non-contrast CT shows no hemorrhage. BP 178/96. Which next step is MOST appropriate?

• ABegin aspirin 325 mg PO immediately
• BInitiate IV thrombolysis (alteplase or tenecteplase) per inclusion criteria after BP cont…
• CDefer to neurology and observe for 24 hours
• DStart heparin infusion

Which of the following is a STOPP criterion (Screening Tool of Older Persons' Prescriptions)?

• ARecommend statin therapy in older adults with established CVD
• BAvoid long-term benzodiazepines in patients at risk of falls
• CInitiate calcium and vitamin D in osteoporosis
• DAdd ACE inhibitor in heart failure with reduced ejection fraction

A CNS finds that a unit's central line dressing change adherence is 56%. After implementing a checklist and just-in-time coaching, the rate is 92% three months later. Which model BEST describes this work?

• ADiffusion of Innovations theory
• BPDSA (Plan-Do-Study-Act) cycle for quality improvement
• CKuhlmann's stages of grief
• DWatson's theory of human caring

An 88-year-old with severe end-stage COPD (FEV1 22%) is hospitalized with respiratory failure. Patient has DNR/DNI in advance directive but family insists on intubation. Which is the MOST appropriate CNS-led action?

• AOverride the advance directive and follow family wishes
• BConvene urgent goals-of-care conversation with family, palliative care, and intensivist;…
• CRefer the case directly to ethics without family discussion
• DSedate the patient to allow time for family decision-making

Which assessment is MOST appropriate for screening cognitive impairment in 3 minutes at the bedside in an older adult?

• AMini-Cog (3-item recall + clock drawing)
• BMMSE (full Folstein examination)
• CMontreal Cognitive Assessment (MoCA)
• DConfusion Assessment Method (CAM)

Which CNS activity BEST illustrates 'systems thinking' per the AACN Synergy Model?

• APerforming a focused respiratory assessment on a patient
• BMapping a patient's entire care trajectory across emergency, ICU, and rehab phases to ide…
• CCounseling a family about end-of-life options
• DDocumenting an antibiotic time-out

A 72-year-old admitted with acute kidney injury has rising creatinine, urine output <0.3 mL/kg/hr for 12 hours. Per KDIGO, which AKI stage applies?

• AStage 1
• BStage 2
• CStage 3
• DNot yet AKI

Which intervention has the STRONGEST evidence for reducing ICU delirium?

• AContinuous benzodiazepine infusions for all ventilated patients
• BImplementation of the ABCDEF bundle with daily SAT/SBT, light sedation targets, and early…
• CRoutine antipsychotic prophylaxis at ICU admission
• DStrict restriction of family visiting

A 75-year-old with frailty (Clinical Frailty Scale 6) presents with a hip fracture. Which CNS-led plan BEST aligns with evidence-based care?

• ADelay surgery until full medical optimization (>72 hours)
• BCoordinate co-management with orthogeriatrics, optimize within 48 hours, and pursue early…
• CManage non-operatively with bed rest
• DTransfer to long-term care without surgery

Which is the BEST initial reversal strategy for life-threatening bleeding in a patient on apixaban?

• AIV vitamin K and 4-factor PCC
• BAndexanet alfa (or 4-factor PCC if andexanet unavailable)
• CIdarucizumab
• DFresh frozen plasma alone

When orienting a new ICU nurse, the CNS uses Benner's Novice-to-Expert framework. A nurse who relies heavily on rules, has limited situational perception, and needs explicit guidance is at which stage?

• ANovice
• BCompetent
• CProficient
• DExpert

A 65-year-old with massive upper GI bleed has Hgb 5.8 g/dL, lactate 6.2, BP 78/40. Which transfusion approach is MOST appropriate?

• ARestrictive transfusion threshold of Hgb 7 g/dL with isolated PRBC transfusion
• BActivate massive transfusion protocol with balanced 1:1:1 ratio (PRBC:plasma:platelets) a…
• CCrystalloid resuscitation alone until Hgb <5 g/dL
• DTransfuse only platelets to address coagulopathy

Which CNS competency is MOST directly demonstrated by translating a new evidence-based protocol into bedside practice with audit/feedback?

• ACaring practices
• BFacilitation of learning
• CClinical judgment
• DResponse to diversity

A 70-year-old presents with crushing chest pain, ST-depression in V1-V4, troponin elevated. Which condition is MOST likely?

• ASTEMI of inferior wall
• BPosterior wall STEMI presenting as anterior ST-depression
• CPericarditis
• DPulmonary embolism

Per the AACN Synergy Model, when a patient has high vulnerability and low predictability, the nurse competency demand is:

• ALower because the patient is too ill to actively participate
• BHigher because complexity demands stronger clinical judgment, systems thinking, and advoc…
• CUnchanged regardless of patient characteristics
• DConcentrated only in clinical inquiry

An older adult with a UTI develops new agitation and refuses oral medications. Which approach is MOST consistent with evidence-based delirium management?

• AApply soft wrist restraints to prevent agitation-related injury
• BInitiate haloperidol 5 mg IM q4h scheduled
• CUse non-pharmacologic interventions first (orientation, family presence, sleep, mobility,…
• DAdminister diphenhydramine for sleep

Which CNS sphere is MOST involved when a CNS develops a sepsis-screening EHR alert with order-set integration that fires for all adult ED patients meeting criteria?

• APatient/family sphere
• BNurses and nursing practice sphere
• COrganization/system sphere
• DBedside competency sphere

A 78-year-old on metformin presents with lactate 8 mmol/L, pH 7.10, AKI with creatinine 3.4. Which is the MOST likely diagnosis?

• AMetformin-associated lactic acidosis (MALA) in setting of AKI
• BDKA
• CSalicylate toxicity
• DSeptic shock without metformin contribution

Which BEST describes the role of social determinants of health (SDOH) in CNS practice?

• ASDOH are psychological factors only
• BSDOH are the conditions in which people are born, grow, live, work, and age that drive he…
• CSDOH are addressed solely by social work and not within CNS scope
• DSDOH apply only to outpatient primary care, not acute care

A 76-year-old reports 8/10 cancer-related bone pain unrelieved by acetaminophen. Per WHO analgesic ladder, the next step is:

• AContinue acetaminophen at higher dose only
• BAdd a weak opioid (e.g., codeine, tramadol) or proceed directly to a strong opioid (e.g.,…
• CSwitch to ibuprofen alone
• DDefer until palliative care evaluation in 1 week

An ICU CNS coordinates a discharge for an older adult with HF who lives alone. Which intervention has the STRONGEST evidence for reducing 30-day HF readmissions?

• AStandard verbal discharge instructions only
• BMulticomponent transition program: medication reconciliation, teach-back education, sched…
• CRoutine readmission for IV diuretic 1 week post-discharge
• DMailing patient education brochures