AACN ACNPC-AG CERTIFICATION PRACTICE
EXAM 2026 | AGACNP PSI PROCTORED Q&A
WITH RATIONALES
• This 200-question practice exam mirrors the AACN ACNPC-AG PSI proctored
format, covering all high-yield domains tested in the 2026 certification — use it for
timed self-assessment, targeted weak-area review, and EXPERT RATIONALE-based
learning to maximize retention before exam day.
• Each question includes five options (A–E), a bolded correct answer, and a detailed
EXPERT RATIONALE to reinforce clinical reasoning across cardiovascular,
pulmonary, neurological, renal, endocrine, hematology, infectious disease, GI,
multisystem, pharmacology, ethics, and critical care procedures.
AACN ACNPC-AG CERTIFICATION PRACTICE EXAM 2026
AGACNP PSI PROCTORED Q&A WITH EXPERT RATIONALE — 200 QUESTIONS
1. A 68-year-old male presents with crushing chest pain radiating to the left
arm, diaphoresis, and an ECG showing 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. Left main coronary artery
D. **Right coronary artery**
E. Posterior descending artery
Correct Answer: D. Right coronary artery
, EXPERT RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior MI,
which is most commonly caused by occlusion of the right coronary artery (RCA). The
RCA supplies the inferior wall of the left ventricle, the right ventricle, the SA node (in
~60% of people), and the AV node (in ~85–90% of people), which is why inferior MI
often presents with bradyarrhythmias.
2. A 55-year-old female with COPD presents in acute respiratory failure with a
pH of 7.22, PaCO₂ of 72 mmHg, PaO₂ of 54 mmHg, and HCO₃⁻ of 28 mEq/L. What
is the correct interpretation of these ABG results?
A. Metabolic acidosis with respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Mixed metabolic and respiratory alkalosis
D. Metabolic alkalosis with respiratory compensation
E. **Acute-on-chronic respiratory acidosis**
Correct Answer: E. Acute-on-chronic respiratory acidosis
EXPERT RATIONALE: The elevated PaCO₂ (72 mmHg), low pH (7.22), and
elevated bicarbonate (28 mEq/L) indicate respiratory acidosis with partial metabolic
compensation. The elevated HCO₃⁻ suggests a chronic component (renal
compensation), but the pH remains acidotic, indicating an acute exacerbation on
top of chronic CO₂ retention — classic for COPD exacerbation (acute-on-chronic
respiratory acidosis).
,3. A 72-year-old patient post-CABG develops sudden hypotension, elevated
JVP, muffled heart sounds, and a narrow pulse pressure. Which intervention is
most immediately indicated?
A. Immediate chest X-ray
B. Administer IV furosemide
C. Initiate norepinephrine infusion
D. Perform emergent intubation
E. **Perform emergency pericardiocentesis**
Correct Answer: E. Perform emergency pericardiocentesis
EXPERT RATIONALE: The classic triad of Beck's triad (hypotension, muffled
heart sounds, elevated JVP) combined with a narrow pulse pressure describes
cardiac tamponade. In a post-cardiac surgery patient, this is a surgical emergency.
Pericardiocentesis is the immediate treatment to relieve pericardial pressure and
restore cardiac output.
4. A patient in the MICU has a pulmonary artery catheter. The following
values are obtained: CO 2.8 L/min, PCWP 22 mmHg, SVR 1,800 dynes/sec/cm⁻⁵.
What type of shock does this represent?
A. Distributive shock
B. Obstructive shock
, C. Hemorrhagic shock
D. Neurogenic shock
E. **Cardiogenic shock**
Correct Answer: E. Cardiogenic shock
EXPERT RATIONALE: Cardiogenic shock is characterized by a low cardiac output
(CO <4 L/min), elevated PCWP (>18 mmHg indicating fluid backup/pulmonary
congestion), and elevated SVR (>1,200 dynes/sec/cm⁻⁵ as the body compensates
with vasoconstriction). This pattern — low CO, high PCWP, high SVR — is the
hallmark of cardiogenic shock, distinguishing it from distributive shock (high CO,
low SVR).
5. A 60-year-old male with a history of hypertension presents with a sudden-
onset severe "tearing" chest pain radiating to the back. BP is 190/110 mmHg
in the right arm and 140/80 mmHg in the left arm. CT angiography is ordered.
What is the most likely diagnosis?
A. Acute MI
B. Pulmonary embolism
C. Pericarditis
D. Esophageal rupture
E. **Aortic dissection**
EXAM 2026 | AGACNP PSI PROCTORED Q&A
WITH RATIONALES
• This 200-question practice exam mirrors the AACN ACNPC-AG PSI proctored
format, covering all high-yield domains tested in the 2026 certification — use it for
timed self-assessment, targeted weak-area review, and EXPERT RATIONALE-based
learning to maximize retention before exam day.
• Each question includes five options (A–E), a bolded correct answer, and a detailed
EXPERT RATIONALE to reinforce clinical reasoning across cardiovascular,
pulmonary, neurological, renal, endocrine, hematology, infectious disease, GI,
multisystem, pharmacology, ethics, and critical care procedures.
AACN ACNPC-AG CERTIFICATION PRACTICE EXAM 2026
AGACNP PSI PROCTORED Q&A WITH EXPERT RATIONALE — 200 QUESTIONS
1. A 68-year-old male presents with crushing chest pain radiating to the left
arm, diaphoresis, and an ECG showing 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. Left main coronary artery
D. **Right coronary artery**
E. Posterior descending artery
Correct Answer: D. Right coronary artery
, EXPERT RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior MI,
which is most commonly caused by occlusion of the right coronary artery (RCA). The
RCA supplies the inferior wall of the left ventricle, the right ventricle, the SA node (in
~60% of people), and the AV node (in ~85–90% of people), which is why inferior MI
often presents with bradyarrhythmias.
2. A 55-year-old female with COPD presents in acute respiratory failure with a
pH of 7.22, PaCO₂ of 72 mmHg, PaO₂ of 54 mmHg, and HCO₃⁻ of 28 mEq/L. What
is the correct interpretation of these ABG results?
A. Metabolic acidosis with respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Mixed metabolic and respiratory alkalosis
D. Metabolic alkalosis with respiratory compensation
E. **Acute-on-chronic respiratory acidosis**
Correct Answer: E. Acute-on-chronic respiratory acidosis
EXPERT RATIONALE: The elevated PaCO₂ (72 mmHg), low pH (7.22), and
elevated bicarbonate (28 mEq/L) indicate respiratory acidosis with partial metabolic
compensation. The elevated HCO₃⁻ suggests a chronic component (renal
compensation), but the pH remains acidotic, indicating an acute exacerbation on
top of chronic CO₂ retention — classic for COPD exacerbation (acute-on-chronic
respiratory acidosis).
,3. A 72-year-old patient post-CABG develops sudden hypotension, elevated
JVP, muffled heart sounds, and a narrow pulse pressure. Which intervention is
most immediately indicated?
A. Immediate chest X-ray
B. Administer IV furosemide
C. Initiate norepinephrine infusion
D. Perform emergent intubation
E. **Perform emergency pericardiocentesis**
Correct Answer: E. Perform emergency pericardiocentesis
EXPERT RATIONALE: The classic triad of Beck's triad (hypotension, muffled
heart sounds, elevated JVP) combined with a narrow pulse pressure describes
cardiac tamponade. In a post-cardiac surgery patient, this is a surgical emergency.
Pericardiocentesis is the immediate treatment to relieve pericardial pressure and
restore cardiac output.
4. A patient in the MICU has a pulmonary artery catheter. The following
values are obtained: CO 2.8 L/min, PCWP 22 mmHg, SVR 1,800 dynes/sec/cm⁻⁵.
What type of shock does this represent?
A. Distributive shock
B. Obstructive shock
, C. Hemorrhagic shock
D. Neurogenic shock
E. **Cardiogenic shock**
Correct Answer: E. Cardiogenic shock
EXPERT RATIONALE: Cardiogenic shock is characterized by a low cardiac output
(CO <4 L/min), elevated PCWP (>18 mmHg indicating fluid backup/pulmonary
congestion), and elevated SVR (>1,200 dynes/sec/cm⁻⁵ as the body compensates
with vasoconstriction). This pattern — low CO, high PCWP, high SVR — is the
hallmark of cardiogenic shock, distinguishing it from distributive shock (high CO,
low SVR).
5. A 60-year-old male with a history of hypertension presents with a sudden-
onset severe "tearing" chest pain radiating to the back. BP is 190/110 mmHg
in the right arm and 140/80 mmHg in the left arm. CT angiography is ordered.
What is the most likely diagnosis?
A. Acute MI
B. Pulmonary embolism
C. Pericarditis
D. Esophageal rupture
E. **Aortic dissection**
