AACN ACNPC-AG (AGACNP) Certification Exam
2026 – Actual Questions & Verified Answers |
PSI Proctored Prep + Latest Updated Study
Guide
AACN ACNPC-AG (AGACNP) Certification Exam 2026
Actual Questions & Verified Answers | PSI Proctored Prep
QUESTION 1
A 68-year-old male with a history of COPD presents with worsening dyspnea, increased
sputum production, and a change in sputum color to yellow-green. His SpO₂ is 88% on
room air. Which of the following is the MOST appropriate initial management?
A. Administer high-flow oxygen at 10 L/min via non-rebreather mask
B. Obtain chest X-ray and discharge with oral antibiotics
C. Initiate controlled oxygen therapy targeting SpO₂ 88–92%, bronchodilators,
and systemic corticosteroids
D. Immediately intubate and initiate mechanical ventilation
E. Administer IV furosemide to reduce pulmonary congestion
CORRECT ANSWER: C
RATIONALE: In COPD exacerbations, controlled oxygen therapy targeting SpO₂
88–92% is essential to avoid hypercapnic respiratory failure caused by suppression of
the hypoxic drive. High-flow oxygen can dangerously elevate CO₂ levels.
Bronchodilators (short-acting beta-agonists and anticholinergics) relieve bronchospasm,
and systemic corticosteroids reduce airway inflammation and shorten recovery time.
Antibiotics are added when purulent sputum or signs of infection are present, as in this
case, but the question asks for initial management priorities. Intubation is premature
without first attempting non-invasive measures.
QUESTION 2
A 72-year-old female presents with sudden-onset severe headache described as "the
worst headache of my life," neck stiffness, and photophobia. CT of the head is negative.
What is the NEXT best step?
A. Administer sumatriptan for migraine management
,B. Order an MRI of the brain with contrast
C. Perform a lumbar puncture to evaluate for xanthochromia
D. Discharge with analgesics and neurology follow-up
E. Initiate empiric IV antibiotics for bacterial meningitis
CORRECT ANSWER: C
RATIONALE: A "thunderclap" headache — sudden, severe, and described as the
worst of one's life — is classic for subarachnoid hemorrhage (SAH). A negative CT does
not rule out SAH, especially if performed hours after onset. Lumbar puncture (LP) is the
gold standard next step, looking for xanthochromia (yellowish discoloration of CSF from
hemoglobin breakdown), which confirms SAH even when CT is negative. Sumatriptan is
contraindicated without ruling out hemorrhagic causes. Empiric antibiotics are indicated
when bacterial meningitis is strongly suspected, but LP must be done to guide diagnosis
and treatment.
QUESTION 3
Which of the following hemodynamic parameters is MOST consistent with cardiogenic
shock?
A. Decreased SVR, increased cardiac output, decreased PCWP
B. Increased SVR, increased cardiac output, decreased PCWP
C. Increased SVR, decreased cardiac output, increased PCWP
D. Decreased SVR, decreased cardiac output, decreased PCWP
E. Normal SVR, normal cardiac output, increased PCWP
CORRECT ANSWER: C
RATIONALE: Cardiogenic shock results from the heart's inability to pump sufficient
blood to meet the body's metabolic demands. The classic hemodynamic profile
includes: decreased cardiac output (due to pump failure), increased systemic vascular
resistance (SVR) as a compensatory response by the peripheral vasculature to maintain
perfusion pressure, and increased pulmonary capillary wedge pressure (PCWP) due to
fluid backing up behind the failing left ventricle. This distinguishes cardiogenic shock
from distributive shock (e.g., sepsis), which shows decreased SVR and increased CO.
,QUESTION 4
A 55-year-old male with no cardiac history presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery
CORRECT ANSWER: C
RATIONALE: ST elevation in leads II, III, and aVF represents an inferior wall
myocardial infarction (MI). The inferior wall of the left ventricle is predominantly supplied
by the right coronary artery (RCA) in approximately 85% of individuals (right-dominant
circulation). The RCA also supplies the SA node and AV node, which is why inferior MI
is commonly associated with bradyarrhythmias and heart blocks. The LAD supplies the
anterior wall (V1–V4), the left circumflex supplies the lateral wall (I, aVL, V5–V6), and
the left main supplies both LAD and circumflex territories.
QUESTION 5
A patient on mechanical ventilation develops sudden hypotension, absent breath
sounds on the left, tracheal deviation to the right, and jugular venous distension. What is
the MOST likely diagnosis?
A. Massive pulmonary embolism
B. Hemothorax
C. Tension pneumothorax
D. Cardiac tamponade
E. Right mainstem bronchus intubation
CORRECT ANSWER: C
RATIONALE: Tension pneumothorax is a life-threatening emergency characterized
by air accumulating under pressure in the pleural space, collapsing the lung and shifting
mediastinal structures. The classic triad includes absent breath sounds on the affected
, side, tracheal deviation away from the affected side, and jugular venous distension due
to impaired venous return. Hypotension results from decreased cardiac output.
Treatment is immediate needle decompression at the 2nd intercostal space,
midclavicular line, followed by chest tube insertion. Cardiac tamponade also causes
JVD and hypotension but does not cause absent breath sounds or tracheal deviation.
QUESTION 6
A 78-year-old with CKD stage 4 presents with peaked T waves, widened QRS, and a
serum potassium of 7.2 mEq/L. Which intervention should be performed FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Initiate hemodialysis immediately
C. Administer IV calcium gluconate
D. Administer IV sodium bicarbonate
E. Give insulin and dextrose
CORRECT ANSWER: C
RATIONALE: In severe hyperkalemia with cardiac manifestations (peaked T waves,
widened QRS, sine wave pattern), the FIRST and most urgent intervention is IV calcium
gluconate. Calcium stabilizes the cardiac membrane and reduces the risk of fatal
arrhythmias within minutes. It does NOT lower serum potassium but protects the heart
while other measures are implemented. Subsequent treatment includes insulin +
dextrose (shifts K⁺ into cells), sodium bicarbonate (alkalinization shifts K⁺ intracellularly),
and definitive removal via Kayexalate or hemodialysis. Hemodialysis is the most
effective elimination method but takes longer to initiate.
QUESTION 7
Which of the following is the GOLD STANDARD diagnostic test for pulmonary
embolism?
A. Ventilation-perfusion (V/Q) scan
B. D-dimer assay
C. CT pulmonary angiography (CTPA)
D. Echocardiography
2026 – Actual Questions & Verified Answers |
PSI Proctored Prep + Latest Updated Study
Guide
AACN ACNPC-AG (AGACNP) Certification Exam 2026
Actual Questions & Verified Answers | PSI Proctored Prep
QUESTION 1
A 68-year-old male with a history of COPD presents with worsening dyspnea, increased
sputum production, and a change in sputum color to yellow-green. His SpO₂ is 88% on
room air. Which of the following is the MOST appropriate initial management?
A. Administer high-flow oxygen at 10 L/min via non-rebreather mask
B. Obtain chest X-ray and discharge with oral antibiotics
C. Initiate controlled oxygen therapy targeting SpO₂ 88–92%, bronchodilators,
and systemic corticosteroids
D. Immediately intubate and initiate mechanical ventilation
E. Administer IV furosemide to reduce pulmonary congestion
CORRECT ANSWER: C
RATIONALE: In COPD exacerbations, controlled oxygen therapy targeting SpO₂
88–92% is essential to avoid hypercapnic respiratory failure caused by suppression of
the hypoxic drive. High-flow oxygen can dangerously elevate CO₂ levels.
Bronchodilators (short-acting beta-agonists and anticholinergics) relieve bronchospasm,
and systemic corticosteroids reduce airway inflammation and shorten recovery time.
Antibiotics are added when purulent sputum or signs of infection are present, as in this
case, but the question asks for initial management priorities. Intubation is premature
without first attempting non-invasive measures.
QUESTION 2
A 72-year-old female presents with sudden-onset severe headache described as "the
worst headache of my life," neck stiffness, and photophobia. CT of the head is negative.
What is the NEXT best step?
A. Administer sumatriptan for migraine management
,B. Order an MRI of the brain with contrast
C. Perform a lumbar puncture to evaluate for xanthochromia
D. Discharge with analgesics and neurology follow-up
E. Initiate empiric IV antibiotics for bacterial meningitis
CORRECT ANSWER: C
RATIONALE: A "thunderclap" headache — sudden, severe, and described as the
worst of one's life — is classic for subarachnoid hemorrhage (SAH). A negative CT does
not rule out SAH, especially if performed hours after onset. Lumbar puncture (LP) is the
gold standard next step, looking for xanthochromia (yellowish discoloration of CSF from
hemoglobin breakdown), which confirms SAH even when CT is negative. Sumatriptan is
contraindicated without ruling out hemorrhagic causes. Empiric antibiotics are indicated
when bacterial meningitis is strongly suspected, but LP must be done to guide diagnosis
and treatment.
QUESTION 3
Which of the following hemodynamic parameters is MOST consistent with cardiogenic
shock?
A. Decreased SVR, increased cardiac output, decreased PCWP
B. Increased SVR, increased cardiac output, decreased PCWP
C. Increased SVR, decreased cardiac output, increased PCWP
D. Decreased SVR, decreased cardiac output, decreased PCWP
E. Normal SVR, normal cardiac output, increased PCWP
CORRECT ANSWER: C
RATIONALE: Cardiogenic shock results from the heart's inability to pump sufficient
blood to meet the body's metabolic demands. The classic hemodynamic profile
includes: decreased cardiac output (due to pump failure), increased systemic vascular
resistance (SVR) as a compensatory response by the peripheral vasculature to maintain
perfusion pressure, and increased pulmonary capillary wedge pressure (PCWP) due to
fluid backing up behind the failing left ventricle. This distinguishes cardiogenic shock
from distributive shock (e.g., sepsis), which shows decreased SVR and increased CO.
,QUESTION 4
A 55-year-old male with no cardiac history presents with crushing substernal chest pain
radiating to the left arm for 45 minutes. ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery
CORRECT ANSWER: C
RATIONALE: ST elevation in leads II, III, and aVF represents an inferior wall
myocardial infarction (MI). The inferior wall of the left ventricle is predominantly supplied
by the right coronary artery (RCA) in approximately 85% of individuals (right-dominant
circulation). The RCA also supplies the SA node and AV node, which is why inferior MI
is commonly associated with bradyarrhythmias and heart blocks. The LAD supplies the
anterior wall (V1–V4), the left circumflex supplies the lateral wall (I, aVL, V5–V6), and
the left main supplies both LAD and circumflex territories.
QUESTION 5
A patient on mechanical ventilation develops sudden hypotension, absent breath
sounds on the left, tracheal deviation to the right, and jugular venous distension. What is
the MOST likely diagnosis?
A. Massive pulmonary embolism
B. Hemothorax
C. Tension pneumothorax
D. Cardiac tamponade
E. Right mainstem bronchus intubation
CORRECT ANSWER: C
RATIONALE: Tension pneumothorax is a life-threatening emergency characterized
by air accumulating under pressure in the pleural space, collapsing the lung and shifting
mediastinal structures. The classic triad includes absent breath sounds on the affected
, side, tracheal deviation away from the affected side, and jugular venous distension due
to impaired venous return. Hypotension results from decreased cardiac output.
Treatment is immediate needle decompression at the 2nd intercostal space,
midclavicular line, followed by chest tube insertion. Cardiac tamponade also causes
JVD and hypotension but does not cause absent breath sounds or tracheal deviation.
QUESTION 6
A 78-year-old with CKD stage 4 presents with peaked T waves, widened QRS, and a
serum potassium of 7.2 mEq/L. Which intervention should be performed FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Initiate hemodialysis immediately
C. Administer IV calcium gluconate
D. Administer IV sodium bicarbonate
E. Give insulin and dextrose
CORRECT ANSWER: C
RATIONALE: In severe hyperkalemia with cardiac manifestations (peaked T waves,
widened QRS, sine wave pattern), the FIRST and most urgent intervention is IV calcium
gluconate. Calcium stabilizes the cardiac membrane and reduces the risk of fatal
arrhythmias within minutes. It does NOT lower serum potassium but protects the heart
while other measures are implemented. Subsequent treatment includes insulin +
dextrose (shifts K⁺ into cells), sodium bicarbonate (alkalinization shifts K⁺ intracellularly),
and definitive removal via Kayexalate or hemodialysis. Hemodialysis is the most
effective elimination method but takes longer to initiate.
QUESTION 7
Which of the following is the GOLD STANDARD diagnostic test for pulmonary
embolism?
A. Ventilation-perfusion (V/Q) scan
B. D-dimer assay
C. CT pulmonary angiography (CTPA)
D. Echocardiography
