AACN ACNPC-AG (AGACNP) Certification
Exam 2026/2027 | Actual Questions &
Verified Answers | PSI Proctored Prep Study
Guide PDF
• This study guide contains 200 high-yield multiple-choice questions with verified
answers and detailed EXPERT RATIONALE designed to mirror the PSI-proctored
AACN ACNPC-AG (AGACNP) Certification Exam format for 2026/2027.
• Each question includes five answer options (A–E), a clearly highlighted correct
answer with EXPERT RATIONALE — use active recall by attempting each question
before revealing the answer for maximum retention.
AACN ACNPC-AG (AGACNP) CERTIFICATION EXAM 2026/2027 | 200 Practice
Questions with Verified Answers
1. A 68-year-old male presents with crushing substernal chest pain radiating
to the left arm, diaphoresis, and nausea for the past 2 hours. 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. Right coronary artery
EXPERT RATIONALE: ST elevation in leads II, III, and aVF is characteristic of an inferior
STEMI, 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, and the SA/AV
nodes in most patients.
,2. A patient admitted with acute decompensated heart failure has a BNP of
1,850 pg/mL. Which hemodynamic finding is most consistent with this
presentation?
A. Decreased pulmonary capillary wedge pressure
B. Increased cardiac output
C. Decreased systemic vascular resistance
D. Elevated pulmonary capillary wedge pressure
E. Decreased central venous pressure
Correct Answer: D. Elevated pulmonary capillary wedge pressure
EXPERT RATIONALE: In acute decompensated heart failure, elevated BNP reflects
ventricular wall stress due to volume overload. The pulmonary capillary wedge pressure
(PCWP) is elevated (>18 mmHg), reflecting increased left ventricular end-diastolic
pressure and pulmonary congestion.
3. A patient on telemetry shows a rhythm with no visible P waves, irregularly
irregular QRS complexes, and a ventricular rate of 138 bpm. The most
appropriate initial pharmacologic intervention is:
A. Amiodarone 150 mg IV bolus
B. Adenosine 6 mg rapid IV push
C. Diltiazem 0.25 mg/kg IV bolus
D. Digoxin 0.5 mg IV
E. Lidocaine 1 mg/kg IV
Correct Answer: C. Diltiazem 0.25 mg/kg IV bolus
EXPERT RATIONALE: The rhythm described is atrial fibrillation with rapid ventricular
response. Initial management focuses on rate control. Diltiazem, a non-dihydropyridine
calcium channel blocker, is a first-line agent for acute rate control in hemodynamically
stable patients with AF with RVR.
,4. A 72-year-old woman with a history of hypertension presents with a blood
pressure of 220/118 mmHg, severe headache, blurred vision, and papilledema.
This presentation is consistent with:
A. Hypertensive urgency
B. Hypertensive encephalopathy
C. Ischemic stroke
D. Hypertensive emergency
E. Subarachnoid hemorrhage
Correct Answer: D. Hypertensive emergency
EXPERT RATIONALE: Hypertensive emergency is defined as severely elevated blood
pressure (typically >180/120 mmHg) with evidence of end-organ damage. This patient
has papilledema and neurological symptoms, confirming end-organ involvement.
Immediate IV antihypertensive therapy is required.
5. Which of the following is the most appropriate initial management for a
patient presenting with cardiac tamponade?
A. Diuresis with furosemide
B. Emergent pericardiocentesis
C. IV fluid resuscitation followed by diuresis
D. Norepinephrine infusion
E. Emergent surgical pericardiotomy only
Correct Answer: B. Emergent pericardiocentesis
EXPERT RATIONALE: Cardiac tamponade is a life-threatening emergency caused by
accumulation of fluid in the pericardial space, compressing the heart. The definitive
treatment is emergent pericardiocentesis to relieve the pressure. IV fluids may be used as
a temporizing measure but do not treat the underlying cause.
, 6. A patient has the following Swan-Ganz catheter readings: CO 2.8 L/min,
PCWP 22 mmHg, SVR 1,800 dynes/sec/cm⁻⁵. Which condition does this best
describe?
A. Distributive shock
B. Hypovolemic shock
C. Cardiogenic shock
D. Obstructive shock
E. Neurogenic shock
Correct Answer: C. Cardiogenic shock
EXPERT RATIONALE: Cardiogenic shock is characterized by low cardiac output, elevated
PCWP (reflecting volume backup from a failing left ventricle), and elevated SVR
(compensatory vasoconstriction). This hemodynamic profile — low CO, high PCWP, high
SVR — is the classic presentation of cardiogenic shock.
7. A 65-year-old male with known CAD presents with new onset exertional
chest pain. Stress testing reveals ST depression of 2 mm in leads V4–V6 at
moderate workload. The next most appropriate step is:
A. Increase beta-blocker dose and retest in 6 months
B. Start aspirin and nitroglycerin PRN only
C. Refer for cardiac catheterization
D. Order cardiac MRI
E. Initiate thrombolytic therapy
Correct Answer: C. Refer for cardiac catheterization
EXPERT RATIONALE: Significant ST depression (≥2 mm) at moderate workload on stress
testing is a high-risk finding suggesting significant coronary artery disease. Cardiac
Exam 2026/2027 | Actual Questions &
Verified Answers | PSI Proctored Prep Study
Guide PDF
• This study guide contains 200 high-yield multiple-choice questions with verified
answers and detailed EXPERT RATIONALE designed to mirror the PSI-proctored
AACN ACNPC-AG (AGACNP) Certification Exam format for 2026/2027.
• Each question includes five answer options (A–E), a clearly highlighted correct
answer with EXPERT RATIONALE — use active recall by attempting each question
before revealing the answer for maximum retention.
AACN ACNPC-AG (AGACNP) CERTIFICATION EXAM 2026/2027 | 200 Practice
Questions with Verified Answers
1. A 68-year-old male presents with crushing substernal chest pain radiating
to the left arm, diaphoresis, and nausea for the past 2 hours. 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. Right coronary artery
EXPERT RATIONALE: ST elevation in leads II, III, and aVF is characteristic of an inferior
STEMI, 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, and the SA/AV
nodes in most patients.
,2. A patient admitted with acute decompensated heart failure has a BNP of
1,850 pg/mL. Which hemodynamic finding is most consistent with this
presentation?
A. Decreased pulmonary capillary wedge pressure
B. Increased cardiac output
C. Decreased systemic vascular resistance
D. Elevated pulmonary capillary wedge pressure
E. Decreased central venous pressure
Correct Answer: D. Elevated pulmonary capillary wedge pressure
EXPERT RATIONALE: In acute decompensated heart failure, elevated BNP reflects
ventricular wall stress due to volume overload. The pulmonary capillary wedge pressure
(PCWP) is elevated (>18 mmHg), reflecting increased left ventricular end-diastolic
pressure and pulmonary congestion.
3. A patient on telemetry shows a rhythm with no visible P waves, irregularly
irregular QRS complexes, and a ventricular rate of 138 bpm. The most
appropriate initial pharmacologic intervention is:
A. Amiodarone 150 mg IV bolus
B. Adenosine 6 mg rapid IV push
C. Diltiazem 0.25 mg/kg IV bolus
D. Digoxin 0.5 mg IV
E. Lidocaine 1 mg/kg IV
Correct Answer: C. Diltiazem 0.25 mg/kg IV bolus
EXPERT RATIONALE: The rhythm described is atrial fibrillation with rapid ventricular
response. Initial management focuses on rate control. Diltiazem, a non-dihydropyridine
calcium channel blocker, is a first-line agent for acute rate control in hemodynamically
stable patients with AF with RVR.
,4. A 72-year-old woman with a history of hypertension presents with a blood
pressure of 220/118 mmHg, severe headache, blurred vision, and papilledema.
This presentation is consistent with:
A. Hypertensive urgency
B. Hypertensive encephalopathy
C. Ischemic stroke
D. Hypertensive emergency
E. Subarachnoid hemorrhage
Correct Answer: D. Hypertensive emergency
EXPERT RATIONALE: Hypertensive emergency is defined as severely elevated blood
pressure (typically >180/120 mmHg) with evidence of end-organ damage. This patient
has papilledema and neurological symptoms, confirming end-organ involvement.
Immediate IV antihypertensive therapy is required.
5. Which of the following is the most appropriate initial management for a
patient presenting with cardiac tamponade?
A. Diuresis with furosemide
B. Emergent pericardiocentesis
C. IV fluid resuscitation followed by diuresis
D. Norepinephrine infusion
E. Emergent surgical pericardiotomy only
Correct Answer: B. Emergent pericardiocentesis
EXPERT RATIONALE: Cardiac tamponade is a life-threatening emergency caused by
accumulation of fluid in the pericardial space, compressing the heart. The definitive
treatment is emergent pericardiocentesis to relieve the pressure. IV fluids may be used as
a temporizing measure but do not treat the underlying cause.
, 6. A patient has the following Swan-Ganz catheter readings: CO 2.8 L/min,
PCWP 22 mmHg, SVR 1,800 dynes/sec/cm⁻⁵. Which condition does this best
describe?
A. Distributive shock
B. Hypovolemic shock
C. Cardiogenic shock
D. Obstructive shock
E. Neurogenic shock
Correct Answer: C. Cardiogenic shock
EXPERT RATIONALE: Cardiogenic shock is characterized by low cardiac output, elevated
PCWP (reflecting volume backup from a failing left ventricle), and elevated SVR
(compensatory vasoconstriction). This hemodynamic profile — low CO, high PCWP, high
SVR — is the classic presentation of cardiogenic shock.
7. A 65-year-old male with known CAD presents with new onset exertional
chest pain. Stress testing reveals ST depression of 2 mm in leads V4–V6 at
moderate workload. The next most appropriate step is:
A. Increase beta-blocker dose and retest in 6 months
B. Start aspirin and nitroglycerin PRN only
C. Refer for cardiac catheterization
D. Order cardiac MRI
E. Initiate thrombolytic therapy
Correct Answer: C. Refer for cardiac catheterization
EXPERT RATIONALE: Significant ST depression (≥2 mm) at moderate workload on stress
testing is a high-risk finding suggesting significant coronary artery disease. Cardiac
