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ANCC AGACNP Certification Exam
Actual Exam 2026/2027 | Complete
Practice Questions with Verified Answers
| Already Graded A+ (Brand New!!)
SECTION 1: ASSESSMENT & DIAGNOSIS (45 Questions)
Case Study 1: Acute Shortness of Breath
Scenario: A 72-year-old male with history of COPD and hypertension presents to the ED with
acute onset shortness of breath, chest pain, and O2 sat 84% on room air. Vital signs: HR 118, BP
98/62, RR 32, Temp 37.2°C. Physical exam reveals decreased breath sounds on the right, JVD,
and P2 accentuation.
Q1: Which diagnostic test should be performed first to evaluate for pulmonary embolism?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. V/Q scan
Correct Answer: C. [CORRECT]
Rationale: In a patient with high pre-test probability for PE (tachycardia, hypotension,
hypoxemia, signs of right heart strain including JVD and P2 accentuation), CT pulmonary
angiography is the first-line diagnostic test providing definitive diagnosis with high sensitivity
and specificity. D-dimer is only useful in low-risk patients to rule out PE.
Q2: The patient's ECG shows sinus tachycardia with S1Q3T3 pattern. What does this finding
indicate?
A. Left ventricular hypertrophy
B. Right ventricular strain
C. Anterior wall MI
D. Pericarditis
,2
Correct Answer: B. [CORRECT]
Rationale: The S1Q3T3 pattern (prominent S wave in lead I, Q wave in lead III, inverted T wave
in lead III) is a classic ECG finding of acute right ventricular strain caused by pulmonary
embolism, reflecting acute right heart pressure overload from pulmonary artery obstruction.
Q3: Which laboratory finding would be most consistent with massive pulmonary embolism?
A. Elevated BNP with normal troponin
B. Elevated troponin with elevated BNP
C. Normal BNP with elevated D-dimer
D. Elevated creatinine with normal BNP
Correct Answer: B. [CORRECT]
Rationale: Massive PE causes both right ventricular myocardial ischemia (elevated troponin) and
right ventricular dysfunction with wall stress (elevated BNP). This combination indicates
significant hemodynamic compromise and right heart failure requiring aggressive intervention.
Q4: What is the priority intervention if the patient becomes hypotensive with systolic BP 70
mmHg?
A. Administer heparin bolus
B. Systemic thrombolysis
C. CT angiography confirmation
D. Inferior vena cava filter placement
Correct Answer: B. [CORRECT]
Rationale: Systemic thrombolysis is indicated for massive PE with hemodynamic instability
(systolic BP <90 mmHg). The benefit of clot dissolution outweighs bleeding risk when there is
imminent cardiovascular collapse.
Q5: A 58-year-old female presents with acute chest pain, ST elevation in V1-V4, and BP 88/56
mmHg. Heart rate is 110 bpm. What is the priority assessment before reperfusion therapy?
A. Peak troponin level
B. Aortic dissection screening
C. Left ventricular ejection fraction
D. Complete blood count
Correct Answer: B. [CORRECT]
,3
Rationale: Before anticoagulation and reperfusion therapy for STEMI, aortic dissection must be
excluded, especially with chest pain and hypotension. Stanford Type A dissection involving the
ascending aorta can present with ST elevation and requires immediate surgical intervention
rather than anticoagulation.
Q6: In interpreting arterial blood gas results: pH 7.32, PaCO2 28 mmHg, HCO3 14 mEq/L, what
acid-base disorder is present?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis with metabolic acidosis
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B. [CORRECT]
Rationale: The low pH indicates acidosis. The low HCO3 (14) indicates metabolic acidosis as the
primary disorder. The low PaCO2 (28) demonstrates appropriate respiratory compensation
through hyperventilation (Winters formula: expected PaCO2 = 1.5 × HCO3 + 8 ± 2 = 29 ± 2).
Q7: A patient with diabetic ketoacidosis has the following ABG: pH 7.15, PaCO2 20 mmHg,
HCO3 6 mEq/L. What is the expected respiratory response?
A. Inadequate compensation
B. Appropriate compensation
C. Respiratory alkalosis primary
D. Mixed disorder
Correct Answer: B. [CORRECT]
Rationale: Using Winters formula for metabolic acidosis compensation: expected PaCO2 = 1.5 ×
6 + 8 ± 2 = 15-19 mmHg. The measured PaCO2 of 20 mmHg is within acceptable range,
indicating appropriate respiratory compensation through Kussmaul respirations.
SATA Question 1: ABG Interpretation
Q8: ABG results: pH 7.25, PaCO2 60 mmHg, PaO2 55 mmHg, HCO3 24 mEq/L. Which
conditions are consistent with these findings? Select all that apply.
A. Acute respiratory acidosis
B. COPD exacerbation
C. Opioid overdose
, 4
D. Diabetic ketoacidosis
E. Pulmonary embolism
F. Severe asthma exacerbation
Correct Answers: A, B, C, E, F. [CORRECT]
Rationale: This ABG shows acute respiratory acidosis (low pH, elevated PaCO2 with normal
bicarbonate indicating no metabolic compensation yet). Causes include COPD exacerbation with
CO2 retention, opioid overdose causing central hypoventilation, massive pulmonary embolism
causing respiratory failure, and severe asthma exacerbation with ventilatory impairment.
Diabetic ketoacidosis causes metabolic acidosis with low bicarbonate and compensatory
respiratory alkalosis.
Case Study 2: Acute Abdominal Pain
Scenario: A 67-year-old male with atrial fibrillation on warfarin presents with acute onset severe
abdominal pain out of proportion to exam findings. Vital signs: HR 118, BP 94/58, RR 24, Temp
38.1°C. Abdomen is soft with mild diffuse tenderness but no rebound or guarding. Lactate is 6.2
mmol/L.
Q9: What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Ruptured abdominal aortic aneurysm
D. Small bowel obstruction
Correct Answer: B. [CORRECT]
Rationale: Acute mesenteric ischemia classically presents with severe abdominal pain out of
proportion to physical exam findings ("pain out of proportion"), particularly in patients with
atrial fibrillation (embolic source) or hypercoagulable states. Elevated lactate indicates tissue
ischemia.
Q10: What is the diagnostic test of choice?
A. CT abdomen with IV contrast
B. CT abdomen without contrast
C. Mesenteric angiography
D. Exploratory laparotomy
Correct Answer: A. [CORRECT]
ANCC AGACNP Certification Exam
Actual Exam 2026/2027 | Complete
Practice Questions with Verified Answers
| Already Graded A+ (Brand New!!)
SECTION 1: ASSESSMENT & DIAGNOSIS (45 Questions)
Case Study 1: Acute Shortness of Breath
Scenario: A 72-year-old male with history of COPD and hypertension presents to the ED with
acute onset shortness of breath, chest pain, and O2 sat 84% on room air. Vital signs: HR 118, BP
98/62, RR 32, Temp 37.2°C. Physical exam reveals decreased breath sounds on the right, JVD,
and P2 accentuation.
Q1: Which diagnostic test should be performed first to evaluate for pulmonary embolism?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. V/Q scan
Correct Answer: C. [CORRECT]
Rationale: In a patient with high pre-test probability for PE (tachycardia, hypotension,
hypoxemia, signs of right heart strain including JVD and P2 accentuation), CT pulmonary
angiography is the first-line diagnostic test providing definitive diagnosis with high sensitivity
and specificity. D-dimer is only useful in low-risk patients to rule out PE.
Q2: The patient's ECG shows sinus tachycardia with S1Q3T3 pattern. What does this finding
indicate?
A. Left ventricular hypertrophy
B. Right ventricular strain
C. Anterior wall MI
D. Pericarditis
,2
Correct Answer: B. [CORRECT]
Rationale: The S1Q3T3 pattern (prominent S wave in lead I, Q wave in lead III, inverted T wave
in lead III) is a classic ECG finding of acute right ventricular strain caused by pulmonary
embolism, reflecting acute right heart pressure overload from pulmonary artery obstruction.
Q3: Which laboratory finding would be most consistent with massive pulmonary embolism?
A. Elevated BNP with normal troponin
B. Elevated troponin with elevated BNP
C. Normal BNP with elevated D-dimer
D. Elevated creatinine with normal BNP
Correct Answer: B. [CORRECT]
Rationale: Massive PE causes both right ventricular myocardial ischemia (elevated troponin) and
right ventricular dysfunction with wall stress (elevated BNP). This combination indicates
significant hemodynamic compromise and right heart failure requiring aggressive intervention.
Q4: What is the priority intervention if the patient becomes hypotensive with systolic BP 70
mmHg?
A. Administer heparin bolus
B. Systemic thrombolysis
C. CT angiography confirmation
D. Inferior vena cava filter placement
Correct Answer: B. [CORRECT]
Rationale: Systemic thrombolysis is indicated for massive PE with hemodynamic instability
(systolic BP <90 mmHg). The benefit of clot dissolution outweighs bleeding risk when there is
imminent cardiovascular collapse.
Q5: A 58-year-old female presents with acute chest pain, ST elevation in V1-V4, and BP 88/56
mmHg. Heart rate is 110 bpm. What is the priority assessment before reperfusion therapy?
A. Peak troponin level
B. Aortic dissection screening
C. Left ventricular ejection fraction
D. Complete blood count
Correct Answer: B. [CORRECT]
,3
Rationale: Before anticoagulation and reperfusion therapy for STEMI, aortic dissection must be
excluded, especially with chest pain and hypotension. Stanford Type A dissection involving the
ascending aorta can present with ST elevation and requires immediate surgical intervention
rather than anticoagulation.
Q6: In interpreting arterial blood gas results: pH 7.32, PaCO2 28 mmHg, HCO3 14 mEq/L, what
acid-base disorder is present?
A. Respiratory acidosis with metabolic compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis with metabolic acidosis
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B. [CORRECT]
Rationale: The low pH indicates acidosis. The low HCO3 (14) indicates metabolic acidosis as the
primary disorder. The low PaCO2 (28) demonstrates appropriate respiratory compensation
through hyperventilation (Winters formula: expected PaCO2 = 1.5 × HCO3 + 8 ± 2 = 29 ± 2).
Q7: A patient with diabetic ketoacidosis has the following ABG: pH 7.15, PaCO2 20 mmHg,
HCO3 6 mEq/L. What is the expected respiratory response?
A. Inadequate compensation
B. Appropriate compensation
C. Respiratory alkalosis primary
D. Mixed disorder
Correct Answer: B. [CORRECT]
Rationale: Using Winters formula for metabolic acidosis compensation: expected PaCO2 = 1.5 ×
6 + 8 ± 2 = 15-19 mmHg. The measured PaCO2 of 20 mmHg is within acceptable range,
indicating appropriate respiratory compensation through Kussmaul respirations.
SATA Question 1: ABG Interpretation
Q8: ABG results: pH 7.25, PaCO2 60 mmHg, PaO2 55 mmHg, HCO3 24 mEq/L. Which
conditions are consistent with these findings? Select all that apply.
A. Acute respiratory acidosis
B. COPD exacerbation
C. Opioid overdose
, 4
D. Diabetic ketoacidosis
E. Pulmonary embolism
F. Severe asthma exacerbation
Correct Answers: A, B, C, E, F. [CORRECT]
Rationale: This ABG shows acute respiratory acidosis (low pH, elevated PaCO2 with normal
bicarbonate indicating no metabolic compensation yet). Causes include COPD exacerbation with
CO2 retention, opioid overdose causing central hypoventilation, massive pulmonary embolism
causing respiratory failure, and severe asthma exacerbation with ventilatory impairment.
Diabetic ketoacidosis causes metabolic acidosis with low bicarbonate and compensatory
respiratory alkalosis.
Case Study 2: Acute Abdominal Pain
Scenario: A 67-year-old male with atrial fibrillation on warfarin presents with acute onset severe
abdominal pain out of proportion to exam findings. Vital signs: HR 118, BP 94/58, RR 24, Temp
38.1°C. Abdomen is soft with mild diffuse tenderness but no rebound or guarding. Lactate is 6.2
mmol/L.
Q9: What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute mesenteric ischemia
C. Ruptured abdominal aortic aneurysm
D. Small bowel obstruction
Correct Answer: B. [CORRECT]
Rationale: Acute mesenteric ischemia classically presents with severe abdominal pain out of
proportion to physical exam findings ("pain out of proportion"), particularly in patients with
atrial fibrillation (embolic source) or hypercoagulable states. Elevated lactate indicates tissue
ischemia.
Q10: What is the diagnostic test of choice?
A. CT abdomen with IV contrast
B. CT abdomen without contrast
C. Mesenteric angiography
D. Exploratory laparotomy
Correct Answer: A. [CORRECT]
