AACN AGACNP Exam Prep 2026: Updated
Practice Questions with Comprehensive
Rationales
QUESTION 1
Cushing's Syndrome/Disease – Answer
cortisol excess typically caused by pituitary adenoma 60-70% of cases.
Central obesity w/ extremity wasting.
Dorsocervical fat pad.
Rounded facies.
Spontaneous bruising.
Purple striae.
Hyperpigmentation.
Poor wound healing / skin infections.
Dexamethasone suppression test: 1 mg dexamethasone at 2300 hours and
measure serum cortisol at 0800.
Remove sources of excess and manage consequences (HTN, hypokalemia,
hyperglycemia).
QUESTION 2
Addison’s disease – Answer
Primary – Caused by damage to the adrenal cortex (autoimmune, TB, metastatic
disease, deposition diseases, and drug induced) leading to a decrease in cortisol
production.
Secondary – Caused by pituitary failure to release ACTH (in any hypopituitary
disorder) causing a decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol
production from induced corticosteroid suppression.
QUESTION 3
Diabetes Insipidus (DI) – Answer
Insufficient ADH (central DI) or decreased sensitivity to ADH (nephrogenic DI).
Nephron cannot conserve water → large volume of dilute urine, polydipsia,
,hypernatremia.
Diagnosis: water deprivation test; treatment: desmopressin (central), thiazides
(nephrogenic).
QUESTION 4
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – Answer
Excess ADH → water retention, hyponatremia, concentrated urine, fluid overload.
Common causes: small cell lung cancer, CNS disorders, drugs (SSRIs,
carbamazepine).
Treatment: fluid restriction, hypertonic saline if severe, demeclocycline.
QUESTION 5
Pheochromocytoma – Answer
Catecholamine-secreting tumor (adrenal medulla).
Classic triad: episodic headache, diaphoresis, tachycardia.
Severe hypertension (paroxysmal or sustained).
Diagnosis: plasma metanephrines or 24-hour urinary metanephrines.
Definitive treatment: surgical resection after alpha-blockade
(phenoxybenzamine).
QUESTION 6
Hyperaldosteronism (Conn’s Syndrome) – Answer
Excess aldosterone → hypertension, hypokalemia, metabolic alkalosis, low renin.
Common cause: adrenal adenoma.
Diagnosis: elevated aldosterone-to-renin ratio.
Treatment: spironolactone or eplerenone; surgery for adenoma.
QUESTION 7
Thyroid Storm – Answer
Life-threatening hypermetabolic state in uncontrolled hyperthyroidism.
Symptoms: fever >38.5°C, tachycardia, agitation, delirium, nausea, vomiting,
heart failure.
Treatment: beta-blocker (propranolol), antithyroid drugs (PTU preferred), iodine,
corticosteroids, supportive care.
QUESTION 8
Myxedema Coma – Answer
Severe hypothyroidism with altered mental status, hypothermia, bradycardia,
, hypotension, hyponatremia, hypoventilation.
Precipitating factors: infection, cold exposure, sedatives.
Treatment: IV levothyroxine (plus liothyronine in some protocols), supportive
measures, slow rewarming.
QUESTION 9
Diabetic Ketoacidosis (DKA) – Answer
Hyperglycemia, anion gap metabolic acidosis, ketonemia, dehydration.
Treatment: IV fluids, insulin infusion, potassium replacement, monitor glucose
and electrolytes.
Correct acidosis; bicarbonate rarely needed.
QUESTION 10
Hyperosmolar Hyperglycemic State (HHS) – Answer
Severe hyperglycemia (>600 mg/dL), hyperosmolality, dehydration, minimal
ketosis.
Often in type 2 diabetes.
Treatment: IV fluids (first), insulin infusion, electrolyte repletion; slower
correction than DKA.
QUESTION 11
Adrenal Crisis – Answer
Acute adrenal insufficiency with hypotension, hyponatremia, hyperkalemia,
hypoglycemia, shock.
Treatment: IV hydrocortisone 100 mg bolus, then 50-100 mg q6h; aggressive fluid
resuscitation with NS.
QUESTION 12
Acromegaly – Answer
Excess growth hormone in adults → coarse facial features, enlarged hands/feet,
macroglossia, organomegaly, hypertension, diabetes.
Diagnosis: elevated IGF-1, failure of GH suppression after oral glucose load.
Treatment: transsphenoidal surgery, octreotide, pegvisomant.
QUESTION 13
Hyperparathyroidism – Answer
Elevated PTH → hypercalcemia, hypophosphatemia, nephrolithiasis, bone pain,
“stones, bones, groans, psychiatric overtones.”
Practice Questions with Comprehensive
Rationales
QUESTION 1
Cushing's Syndrome/Disease – Answer
cortisol excess typically caused by pituitary adenoma 60-70% of cases.
Central obesity w/ extremity wasting.
Dorsocervical fat pad.
Rounded facies.
Spontaneous bruising.
Purple striae.
Hyperpigmentation.
Poor wound healing / skin infections.
Dexamethasone suppression test: 1 mg dexamethasone at 2300 hours and
measure serum cortisol at 0800.
Remove sources of excess and manage consequences (HTN, hypokalemia,
hyperglycemia).
QUESTION 2
Addison’s disease – Answer
Primary – Caused by damage to the adrenal cortex (autoimmune, TB, metastatic
disease, deposition diseases, and drug induced) leading to a decrease in cortisol
production.
Secondary – Caused by pituitary failure to release ACTH (in any hypopituitary
disorder) causing a decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol
production from induced corticosteroid suppression.
QUESTION 3
Diabetes Insipidus (DI) – Answer
Insufficient ADH (central DI) or decreased sensitivity to ADH (nephrogenic DI).
Nephron cannot conserve water → large volume of dilute urine, polydipsia,
,hypernatremia.
Diagnosis: water deprivation test; treatment: desmopressin (central), thiazides
(nephrogenic).
QUESTION 4
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) – Answer
Excess ADH → water retention, hyponatremia, concentrated urine, fluid overload.
Common causes: small cell lung cancer, CNS disorders, drugs (SSRIs,
carbamazepine).
Treatment: fluid restriction, hypertonic saline if severe, demeclocycline.
QUESTION 5
Pheochromocytoma – Answer
Catecholamine-secreting tumor (adrenal medulla).
Classic triad: episodic headache, diaphoresis, tachycardia.
Severe hypertension (paroxysmal or sustained).
Diagnosis: plasma metanephrines or 24-hour urinary metanephrines.
Definitive treatment: surgical resection after alpha-blockade
(phenoxybenzamine).
QUESTION 6
Hyperaldosteronism (Conn’s Syndrome) – Answer
Excess aldosterone → hypertension, hypokalemia, metabolic alkalosis, low renin.
Common cause: adrenal adenoma.
Diagnosis: elevated aldosterone-to-renin ratio.
Treatment: spironolactone or eplerenone; surgery for adenoma.
QUESTION 7
Thyroid Storm – Answer
Life-threatening hypermetabolic state in uncontrolled hyperthyroidism.
Symptoms: fever >38.5°C, tachycardia, agitation, delirium, nausea, vomiting,
heart failure.
Treatment: beta-blocker (propranolol), antithyroid drugs (PTU preferred), iodine,
corticosteroids, supportive care.
QUESTION 8
Myxedema Coma – Answer
Severe hypothyroidism with altered mental status, hypothermia, bradycardia,
, hypotension, hyponatremia, hypoventilation.
Precipitating factors: infection, cold exposure, sedatives.
Treatment: IV levothyroxine (plus liothyronine in some protocols), supportive
measures, slow rewarming.
QUESTION 9
Diabetic Ketoacidosis (DKA) – Answer
Hyperglycemia, anion gap metabolic acidosis, ketonemia, dehydration.
Treatment: IV fluids, insulin infusion, potassium replacement, monitor glucose
and electrolytes.
Correct acidosis; bicarbonate rarely needed.
QUESTION 10
Hyperosmolar Hyperglycemic State (HHS) – Answer
Severe hyperglycemia (>600 mg/dL), hyperosmolality, dehydration, minimal
ketosis.
Often in type 2 diabetes.
Treatment: IV fluids (first), insulin infusion, electrolyte repletion; slower
correction than DKA.
QUESTION 11
Adrenal Crisis – Answer
Acute adrenal insufficiency with hypotension, hyponatremia, hyperkalemia,
hypoglycemia, shock.
Treatment: IV hydrocortisone 100 mg bolus, then 50-100 mg q6h; aggressive fluid
resuscitation with NS.
QUESTION 12
Acromegaly – Answer
Excess growth hormone in adults → coarse facial features, enlarged hands/feet,
macroglossia, organomegaly, hypertension, diabetes.
Diagnosis: elevated IGF-1, failure of GH suppression after oral glucose load.
Treatment: transsphenoidal surgery, octreotide, pegvisomant.
QUESTION 13
Hyperparathyroidism – Answer
Elevated PTH → hypercalcemia, hypophosphatemia, nephrolithiasis, bone pain,
“stones, bones, groans, psychiatric overtones.”
