1|Page
ANCC AGACNP - FRANCES GUIDE
NEWEST EXAM 2026 |150 QUESTIONS
AND CORRECT DETAILED ANSWERS |
RATED A + | REVISED
1. A 78-year-old patient with chronic heart failure presents with
sudden weight gain and dyspnea. Which initial intervention is most
appropriate?
A. Start oral prednisone
B. Increase the dose of diuretics
C. Prescribe a beta-blocker immediately
D. Initiate intravenous antibiotics
Rationale: Rapid weight gain and dyspnea in heart failure
indicate fluid overload. Diuretic adjustment is first-line
management to relieve congestion.
2. A patient with COPD reports increased sputum production and
purulent color change. Which treatment is recommended first?
A. Bronchodilator adjustment
B. Antibiotic therapy targeting likely pathogens
C. High-dose corticosteroids
D. Oxygen titration only
Rationale: Acute exacerbation with purulent sputum is often
bacterial; targeted antibiotics are indicated along with usual
bronchodilator therapy.
3. Which lab result most indicates acute kidney injury in an elderly
patient?
A. Sodium 138 mEq/L
B. Serum creatinine rise from baseline of 0.9 to 1.6 mg/dL
C. Hemoglobin 13 g/dL
D. Serum albumin 3.5 g/dL
Rationale: A sudden rise in creatinine signals acute kidney
,2|Page
injury; electrolyte and hematologic parameters may remain
stable initially.
4. A patient on warfarin develops an INR of 5.2 without bleeding.
What is the best immediate action?
A. Stop warfarin permanently
B. Hold the next one or two doses and monitor INR
C. Administer intravenous vitamin K immediately
D. Switch to heparin
Rationale: An INR >4.5 without bleeding requires temporary
cessation and monitoring. Vitamin K is reserved for bleeding or
very high INR.
5. An 82-year-old male presents with altered mental status, fever, and
urinary incontinence. Which diagnosis is most likely?
A. Stroke
B. Pneumonia
C. Urinary tract infection
D. Hypoglycemia
Rationale: In older adults, UTIs often present with confusion,
fever, and incontinence rather than classic dysuria.
6. A patient with atrial fibrillation reports palpitations and shortness
of breath. ECG shows rapid ventricular rate. First-line management
includes:
A. Immediate cardioversion in all cases
B. Rate control with beta-blockers or calcium channel blockers
C. Starting digoxin in isolation
D. Prescribing anticoagulants immediately
Rationale: Hemodynamically stable patients with AF should
receive rate control first; anticoagulation is secondary for stroke
prevention.
7. Which vaccine is most important for a 70-year-old patient with
COPD?
A. MMR
B. Varicella
C. Pneumococcal polysaccharide vaccine
D. HPV vaccine
,3|Page
Rationale: Older adults with chronic lung disease are at
increased risk for pneumococcal infections; vaccination is
strongly recommended.
8. A patient presents with acute decompensated heart failure. Which
sign warrants immediate hospitalization?
A. Mild ankle edema
B. Pulmonary edema with hypoxemia
C. Stable blood pressure at baseline
D. Fatigue only
Rationale: Pulmonary edema with hypoxemia indicates life-
threatening decompensation, requiring inpatient management.
9. A 75-year-old patient presents with chest pain and shortness of
breath. Troponin is mildly elevated. The best next step is:
A. Discharge with oral nitrates
B. Cardiology consultation for NSTEMI management
C. Initiate antibiotics
D. Echocardiogram only
Rationale: Elevated troponin with symptoms suggests NSTEMI;
cardiology intervention and guideline-based treatment are
required.
10. In older adults, which drug is most likely to cause orthostatic
hypotension?
A. Acetaminophen
B. Alpha-blockers
C. Levothyroxine
D. Proton pump inhibitors
Rationale: Alpha-blockers can reduce vascular tone,
predisposing elderly patients to falls due to orthostatic
hypotension.
11. A 79-year-old patient with a history of hypertension presents
with sudden right-sided weakness and slurred speech. Blood
pressure is 190/100 mmHg. What is the priority intervention?
, 4|Page
A. Administer aspirin immediately
B. Obtain emergent CT scan to differentiate ischemic vs
hemorrhagic stroke
C. Start IV labetalol to lower BP rapidly
D. Schedule MRI for next week
Rationale: Rapid neuro assessment and imaging are critical to
determine stroke type before initiating any treatment, as
management differs for ischemic versus hemorrhagic stroke.
12. An elderly patient with chronic kidney disease stage 4
presents with hyperkalemia (K+ 6.5 mEq/L). Which is the most
appropriate immediate action?
A. Oral potassium binder only
B. IV calcium gluconate and insulin with glucose
C. Increase dietary potassium intake
D. Start furosemide at home
Rationale: Severe hyperkalemia is life-threatening; IV calcium
stabilizes the myocardium, and insulin shifts potassium
intracellularly.
13. A patient with COPD exacerbation shows SpO₂ 86% on
room air. What is the next step?
A. Encourage deep breathing only
B. Administer supplemental oxygen to maintain SpO₂ 88–92%
C. Provide high-flow oxygen to 100%
D. Start antibiotics immediately without oxygen
Rationale: COPD patients are at risk of hypercapnia; oxygen
should be titrated to 88–92% to improve oxygenation without
depressing respiratory drive.
14. A 74-year-old patient on chronic corticosteroids presents
with fever and hypotension. Which is the most likely concern?
A. Viral infection
B. Adrenal crisis
C. Myocardial infarction
D. Dehydration only
Rationale: Chronic steroid use suppresses adrenal function;
ANCC AGACNP - FRANCES GUIDE
NEWEST EXAM 2026 |150 QUESTIONS
AND CORRECT DETAILED ANSWERS |
RATED A + | REVISED
1. A 78-year-old patient with chronic heart failure presents with
sudden weight gain and dyspnea. Which initial intervention is most
appropriate?
A. Start oral prednisone
B. Increase the dose of diuretics
C. Prescribe a beta-blocker immediately
D. Initiate intravenous antibiotics
Rationale: Rapid weight gain and dyspnea in heart failure
indicate fluid overload. Diuretic adjustment is first-line
management to relieve congestion.
2. A patient with COPD reports increased sputum production and
purulent color change. Which treatment is recommended first?
A. Bronchodilator adjustment
B. Antibiotic therapy targeting likely pathogens
C. High-dose corticosteroids
D. Oxygen titration only
Rationale: Acute exacerbation with purulent sputum is often
bacterial; targeted antibiotics are indicated along with usual
bronchodilator therapy.
3. Which lab result most indicates acute kidney injury in an elderly
patient?
A. Sodium 138 mEq/L
B. Serum creatinine rise from baseline of 0.9 to 1.6 mg/dL
C. Hemoglobin 13 g/dL
D. Serum albumin 3.5 g/dL
Rationale: A sudden rise in creatinine signals acute kidney
,2|Page
injury; electrolyte and hematologic parameters may remain
stable initially.
4. A patient on warfarin develops an INR of 5.2 without bleeding.
What is the best immediate action?
A. Stop warfarin permanently
B. Hold the next one or two doses and monitor INR
C. Administer intravenous vitamin K immediately
D. Switch to heparin
Rationale: An INR >4.5 without bleeding requires temporary
cessation and monitoring. Vitamin K is reserved for bleeding or
very high INR.
5. An 82-year-old male presents with altered mental status, fever, and
urinary incontinence. Which diagnosis is most likely?
A. Stroke
B. Pneumonia
C. Urinary tract infection
D. Hypoglycemia
Rationale: In older adults, UTIs often present with confusion,
fever, and incontinence rather than classic dysuria.
6. A patient with atrial fibrillation reports palpitations and shortness
of breath. ECG shows rapid ventricular rate. First-line management
includes:
A. Immediate cardioversion in all cases
B. Rate control with beta-blockers or calcium channel blockers
C. Starting digoxin in isolation
D. Prescribing anticoagulants immediately
Rationale: Hemodynamically stable patients with AF should
receive rate control first; anticoagulation is secondary for stroke
prevention.
7. Which vaccine is most important for a 70-year-old patient with
COPD?
A. MMR
B. Varicella
C. Pneumococcal polysaccharide vaccine
D. HPV vaccine
,3|Page
Rationale: Older adults with chronic lung disease are at
increased risk for pneumococcal infections; vaccination is
strongly recommended.
8. A patient presents with acute decompensated heart failure. Which
sign warrants immediate hospitalization?
A. Mild ankle edema
B. Pulmonary edema with hypoxemia
C. Stable blood pressure at baseline
D. Fatigue only
Rationale: Pulmonary edema with hypoxemia indicates life-
threatening decompensation, requiring inpatient management.
9. A 75-year-old patient presents with chest pain and shortness of
breath. Troponin is mildly elevated. The best next step is:
A. Discharge with oral nitrates
B. Cardiology consultation for NSTEMI management
C. Initiate antibiotics
D. Echocardiogram only
Rationale: Elevated troponin with symptoms suggests NSTEMI;
cardiology intervention and guideline-based treatment are
required.
10. In older adults, which drug is most likely to cause orthostatic
hypotension?
A. Acetaminophen
B. Alpha-blockers
C. Levothyroxine
D. Proton pump inhibitors
Rationale: Alpha-blockers can reduce vascular tone,
predisposing elderly patients to falls due to orthostatic
hypotension.
11. A 79-year-old patient with a history of hypertension presents
with sudden right-sided weakness and slurred speech. Blood
pressure is 190/100 mmHg. What is the priority intervention?
, 4|Page
A. Administer aspirin immediately
B. Obtain emergent CT scan to differentiate ischemic vs
hemorrhagic stroke
C. Start IV labetalol to lower BP rapidly
D. Schedule MRI for next week
Rationale: Rapid neuro assessment and imaging are critical to
determine stroke type before initiating any treatment, as
management differs for ischemic versus hemorrhagic stroke.
12. An elderly patient with chronic kidney disease stage 4
presents with hyperkalemia (K+ 6.5 mEq/L). Which is the most
appropriate immediate action?
A. Oral potassium binder only
B. IV calcium gluconate and insulin with glucose
C. Increase dietary potassium intake
D. Start furosemide at home
Rationale: Severe hyperkalemia is life-threatening; IV calcium
stabilizes the myocardium, and insulin shifts potassium
intracellularly.
13. A patient with COPD exacerbation shows SpO₂ 86% on
room air. What is the next step?
A. Encourage deep breathing only
B. Administer supplemental oxygen to maintain SpO₂ 88–92%
C. Provide high-flow oxygen to 100%
D. Start antibiotics immediately without oxygen
Rationale: COPD patients are at risk of hypercapnia; oxygen
should be titrated to 88–92% to improve oxygenation without
depressing respiratory drive.
14. A 74-year-old patient on chronic corticosteroids presents
with fever and hypotension. Which is the most likely concern?
A. Viral infection
B. Adrenal crisis
C. Myocardial infarction
D. Dehydration only
Rationale: Chronic steroid use suppresses adrenal function;
