ANCC AGACNP Sample Exam Questions and Answers
(Actual ANCC Adult-Gerontology Acute Care Nurse Practitioner exam.)
Question 1: Advanced Pathophysiology
A 72-year-old male presents with acute shortness of breath, orthopnea, and bilateral
crackles. BNP is elevated. Which diagnosis is most consistent?
A. COPD exacerbation
• B. Acute decompensated heart failure
C. Pulmonary embolism
D. Pneumonia
Rationale: Elevated BNP and orthopnea strongly indicate heart failure rather than
obstructive or infectious causes.
Question 2: Pharmacology
Which medication is contraindicated in a patient with decompensated systolic heart
failure?
A. ACE inhibitor
B. Loop diuretic
• C. Non-dihydropyridine calcium channel blocker (e.g., diltiazem)
D. Beta-blocker (carvedilol)
Rationale: These agents depress myocardial contractility and worsen systolic
dysfunction.
Question 3: Diagnostics
A patient with sepsis develops hypotension despite fluids. Which diagnostic test best
confirms septic shock?
A. Chest X-ray
B. Serum lactate >2 mmol/L
• C. Persistent hypotension requiring vasopressors
D. Blood cultures positive for gram-negative rods
Rationale: Septic shock is defined by hypotension unresponsive to fluids plus
vasopressor need.
Question 4: Acute & Critical Care Management
Which intervention is first-line in acute STEMI management?
A. Oxygen therapy
B. Morphine administration
• C. Immediate reperfusion (PCI or thrombolysis)
D. Beta-blocker initiation
Rationale: Time-to-reperfusion is the most critical determinant of survival in STEMI.
Question 5: Professional Practice
An AGACNP is asked to prescribe opioids for a patient with chronic pain outside their
, hospital role. Which principle applies?
A. Beneficence
B. Autonomy
• C. Scope of practice and legal boundaries
D. Nonmaleficence
Rationale: Professional practice requires adherence to licensure and role boundaries.
Question 6: Pulmonary
A patient with ARDS is on mechanical ventilation. Which strategy improves survival?
A. High tidal volume ventilation
• B. Low tidal volume ventilation (6 mL/kg IBW)
C. High FiO₂ >80%
D. Routine corticosteroids
Rationale: Lung-protective ventilation reduces ventilator-induced lung injury.
Question 7: Cardiology
Which finding most strongly suggests cardiac tamponade?
A. Crackles in lungs
B. Hypertension
• C. Pulsus paradoxus
D. Elevated troponin
Rationale: Tamponade classically presents with hypotension, JVD, muffled heart
sounds, and pulsus paradoxus.
Question 8: Renal
Which lab abnormality is most consistent with acute tubular necrosis?
A. Hypokalemia
• B. Elevated creatinine with muddy brown casts
C. Hypernatremia
D. Low BUN
Rationale: Muddy brown granular casts are hallmark of ATN.
Question 9: Endocrine
A patient with DKA presents with K+ of 5.8. What is the correct management step
before insulin?
A. Administer insulin immediately
• B. Check renal function and monitor potassium closely
C. Give IV potassium
D. Restrict fluids
Rationale: Serum K+ may be falsely elevated; insulin will drive K+ intracellularly, risking
hypokalemia.
Question 10: Neurology
Which is the most sensitive early sign of increased ICP?
A. Bradycardia
• B. Altered mental status
(Actual ANCC Adult-Gerontology Acute Care Nurse Practitioner exam.)
Question 1: Advanced Pathophysiology
A 72-year-old male presents with acute shortness of breath, orthopnea, and bilateral
crackles. BNP is elevated. Which diagnosis is most consistent?
A. COPD exacerbation
• B. Acute decompensated heart failure
C. Pulmonary embolism
D. Pneumonia
Rationale: Elevated BNP and orthopnea strongly indicate heart failure rather than
obstructive or infectious causes.
Question 2: Pharmacology
Which medication is contraindicated in a patient with decompensated systolic heart
failure?
A. ACE inhibitor
B. Loop diuretic
• C. Non-dihydropyridine calcium channel blocker (e.g., diltiazem)
D. Beta-blocker (carvedilol)
Rationale: These agents depress myocardial contractility and worsen systolic
dysfunction.
Question 3: Diagnostics
A patient with sepsis develops hypotension despite fluids. Which diagnostic test best
confirms septic shock?
A. Chest X-ray
B. Serum lactate >2 mmol/L
• C. Persistent hypotension requiring vasopressors
D. Blood cultures positive for gram-negative rods
Rationale: Septic shock is defined by hypotension unresponsive to fluids plus
vasopressor need.
Question 4: Acute & Critical Care Management
Which intervention is first-line in acute STEMI management?
A. Oxygen therapy
B. Morphine administration
• C. Immediate reperfusion (PCI or thrombolysis)
D. Beta-blocker initiation
Rationale: Time-to-reperfusion is the most critical determinant of survival in STEMI.
Question 5: Professional Practice
An AGACNP is asked to prescribe opioids for a patient with chronic pain outside their
, hospital role. Which principle applies?
A. Beneficence
B. Autonomy
• C. Scope of practice and legal boundaries
D. Nonmaleficence
Rationale: Professional practice requires adherence to licensure and role boundaries.
Question 6: Pulmonary
A patient with ARDS is on mechanical ventilation. Which strategy improves survival?
A. High tidal volume ventilation
• B. Low tidal volume ventilation (6 mL/kg IBW)
C. High FiO₂ >80%
D. Routine corticosteroids
Rationale: Lung-protective ventilation reduces ventilator-induced lung injury.
Question 7: Cardiology
Which finding most strongly suggests cardiac tamponade?
A. Crackles in lungs
B. Hypertension
• C. Pulsus paradoxus
D. Elevated troponin
Rationale: Tamponade classically presents with hypotension, JVD, muffled heart
sounds, and pulsus paradoxus.
Question 8: Renal
Which lab abnormality is most consistent with acute tubular necrosis?
A. Hypokalemia
• B. Elevated creatinine with muddy brown casts
C. Hypernatremia
D. Low BUN
Rationale: Muddy brown granular casts are hallmark of ATN.
Question 9: Endocrine
A patient with DKA presents with K+ of 5.8. What is the correct management step
before insulin?
A. Administer insulin immediately
• B. Check renal function and monitor potassium closely
C. Give IV potassium
D. Restrict fluids
Rationale: Serum K+ may be falsely elevated; insulin will drive K+ intracellularly, risking
hypokalemia.
Question 10: Neurology
Which is the most sensitive early sign of increased ICP?
A. Bradycardia
• B. Altered mental status
