AGACNP-BC® CERTIFICATION
EXAMINATION
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Adult-Gerontology Acute Care Nurse Practitioner
Certification (AGACNP-BC®) Examination
2026/2027 Academic Year
Comprehensive Acute/Critical Care Advanced Practice Competency Assessment
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175 Multiple-Choice Questions (150 Scored + 25 Pretest)
Testing Time: 3.5 Hours (210 Minutes) | Computer-Based | Pearson VUE
American Nurses Credentialing Center (ANCC)
American Nurses Association
, AGACNP-BC® Certification Exam | 2026/2027
EXAMINATION INSTRUCTIONS AND SPECIFICATIONS
• Total Questions: 175 multiple-choice questions (MCQ) — 150 scored items + 25 pretest items
(unscored, for future exam development)
• Format: Single-best-answer MCQ with four options (A, B, C, D); select-all-that-apply (SATA) items
clearly marked with multiple correct responses
• Testing Time: 3.5 hours (210 minutes), computer-based, proctored at Pearson VUE testing centers
• Passing Score: Criterion-referenced standard set via Modified Angoff methodology; results reported
as Pass/Fail with domain-level diagnostic feedback per ANCC policy
• Calculator Policy: On-screen calculator provided for dosage calculations and numerical items
• Eligibility: Current RN license, completion of accredited graduate/post-graduate AGACNP program,
500 supervised clinical hours in adult-gerontology acute care, application submission with fees
• Content Distribution: Assessment & Diagnosis (24%), Planning & Implementation (28%),
Evaluation of Outcomes (16%), Professional Role & Practice (32%) per ANCC AGACNP-BC®
Examination Blueprint
Domains Covered:
1. Assessment & Diagnosis of Acute/Critical Conditions (Q1–42)
2. Advanced Pharmacotherapeutics in Acute Care (Q43–59)
3. Procedural Skills & Critical Interventions (Q60–75)
4. Complex Chronic Disease Exacerbation Management (Q76–91)
5. Ethical, Legal & Professional Practice in Acute Settings (Q92–110)
6. Interprofessional Collaboration & Systems Leadership (Q111–128)
7. Evidence Synthesis & Practice Translation (Q129–147)
8. Evaluation of Outcomes (Q148–175)
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DOMAIN 1: ASSESSMENT & DIAGNOSIS OF ACUTE/CRITICAL CONDITIONS
Questions 1–42 | ANCC Blueprint: Assessment & Diagnosis (24%)
This domain evaluates competency in rapid assessment frameworks (ABCDE/primary-secondary survey),
complex differential diagnosis of acute versus chronic exacerbation versus new pathology, diagnostic test
interpretation including ABGs, cardiac enzymes, imaging, and laboratory data in critical illness, and risk
stratification using validated tools such as SOFA, APACHE II, and MEWS for identifying acute
deterioration.
1. A 68-year-old male is brought to the emergency department after a high-speed motor
vehicle collision. He is unresponsive, has noisy breathing with gurgling sounds, and his
oxygen saturation is 82% on room air. According to the ABCDE primary survey framework,
what is the most appropriate immediate intervention?
A. Perform a jaw thrust and suction the oropharynx to secure the airway
B. Administer 100% oxygen via non-rebreather mask
C. Establish bilateral needle decompression of the chest
D. Initiate rapid infusion of isotonic crystalloid
Correct Answer: A
Rationale: In the ABCDE framework, Airway is the first priority. The patient has signs of airway
compromise (gurgling sounds indicating fluid or debris in the oropharynx, unresponsiveness, and
severe hypoxemia). The jaw thrust maneuver with suctioning addresses the immediate airway
obstruction before proceeding to breathing and circulation interventions. Oxygen administration and IV
access are important but secondary to securing a patent airway.
Page 2
, AGACNP-BC® Certification Exam | 2026/2027
2. A 74-year-old female presents to the emergency department with acute onset severe
dyspnea, respiratory rate of 34 breaths/min, and SpO2 of 85% on 4L nasal cannula. On
assessment, she has absent breath sounds on the right, tracheal deviation to the left, and
jugular venous distension. During the primary survey, which finding identifies the most
immediately life-threatening condition requiring intervention?
A. Respiratory rate of 34 breaths/min
B. Tracheal deviation to the left with absent right breath sounds
C. Jugular venous distension
D. SpO2 of 85% on 4L nasal cannula
Correct Answer: B
Rationale: The combination of absent breath sounds on one side with tracheal deviation to the opposite
side is the classic presentation of tension pneumothorax, which is an immediately life-threatening
condition in the 'B' (Breathing) phase of the primary survey. Tension pneumothorax causes mediastinal
shift, compromising venous return and cardiac output. This requires immediate needle decompression
before chest radiograph. While hypoxemia and JVD are concerning, the tracheal deviation with absent
breath sounds identifies the specific life-threatening pathology.
3. (SATA) A 71-year-old male with a history of COPD and heart failure is being evaluated in
the ICU for acute respiratory distress. During the primary survey, which of the following
findings indicate a compromised airway requiring immediate intervention? (Select All
That Apply)
☐ A. Stridor with inspiration
☐ B. Inability to swallow secretions with pooling of oral secretions
☐ C. Hoarse voice following thermal injury to the face
☐ D. Respiratory rate of 22 breaths/min with use of accessory muscles
Correct Answer: A, B, C
Rationale: Stridor indicates partial upper airway obstruction and is an airway emergency. Inability to
swallow secretions with pooling suggests loss of protective airway reflexes, posing an aspiration risk
requiring immediate airway protection. Hoarse voice following thermal injury suggests airway edema
or thermal injury to the upper airway that can rapidly progress to complete obstruction. While
accessory muscle use (option D) indicates increased work of breathing, it is a breathing problem, not an
airway problem, and is addressed in the 'B' phase of the primary survey.
4. A 63-year-old trauma patient has been stabilized through the primary survey with a
secured airway, bilateral breath sounds, and systolic blood pressure of 110 mmHg after 2
liters of crystalloid. During the secondary survey, which assessment component should be
performed next according to the systematic head-to-toe approach?
A. Complete neurological examination including cranial nerves and motor/sensory testing
B. Amplication of the primary survey with focused FAST examination
C. Reassessment of the ABCDEs to detect any deterioration
D. Detailed musculoskeletal examination of all extremities
Correct Answer: C
Rationale: Before proceeding with the secondary survey, it is essential to reassess the ABCDEs to ensure
the patient has not deteriorated after the initial interventions. The primary survey is a dynamic process,
and reassessment is critical to identify new or evolving life threats. Only after confirming continued
stability should the provider proceed with the head-to-toe secondary survey. The secondary survey
begins with a complete physical examination but only after the primary survey has been completed and
reassessed.
5. A 78-year-old female is found unresponsive in her nursing home room. Her Glasgow
Coma Scale score is 7 (E1V2M4). In the 'D' (Disability) component of the primary survey,
which assessment finding most urgently requires intervention before proceeding to 'E'
(Exposure)?
Page 3
, AGACNP-BC® Certification Exam | 2026/2027
A. Right pupil 5 mm and fixed, left pupil 3 mm and reactive
B. GCS motor response of 4 (withdrawal to pain)
C. GCS verbal response of 2 (incomprehensible sounds)
D. Bilateral equal and reactive pupils with GCS of 7
Correct Answer: A
Rationale: A unilateral fixed and dilated pupil (right pupil 5 mm and fixed) in the context of depressed
consciousness is a hallmark sign of uncal herniation from increased intracranial pressure. This is a
neurosurgical emergency requiring immediate intervention with mannitol or hypertonic saline,
elevation of the head of bed, and emergent neurosurgical consultation. While a GCS of 7 indicates severe
brain injury requiring airway protection, the asymmetric pupillary findings specifically indicate
herniation, which is rapidly fatal without intervention.
6. A 66-year-old male presents to the emergency department with a core temperature of
30.2°C (86.4°F) after being found unconscious in a snowbank for an unknown duration.
During the 'E' (Exposure/Environment) component of the primary survey, which
rewarming strategy is most appropriate for this patient?
A. Passive external rewarming with warm blankets only
B. Active external rewarming with forced-air warming blanket and warm IV fluids
C. Active core rewarming with warm peritoneal lavage and consideration of extracorporeal membrane
oxygenation
D. Immersion in a warm water bath at 42°C
Correct Answer: C
Rationale: A core temperature below 30°C defines severe hypothermia and requires active core
rewarming methods. Passive external rewarming is inadequate, and active external rewarming alone
may cause core temperature afterdrop and arrhythmias by returning cold blood from the periphery to
the core. Active core rewarming techniques such as warm peritoneal or pleural lavage, warm IV fluids,
and extracorporeal rewarming (ECMO or cardiopulmonary bypass) are indicated for severe
hypothermia. Warm water immersion is contraindicated due to the risk of arrhythmia from rapid
temperature shifts and difficulty monitoring the patient.
7. A 72-year-old male with a history of severe aortic stenosis presents with acute onset
dyspnea, BP 88/52 mmHg, HR 118 bpm, and bilateral crackles to the apices. Pulmonary
artery catheter reveals a cardiac index of 1.6 L/min/m² and a pulmonary capillary wedge
pressure of 28 mmHg. In the 'C' (Circulation) phase of the primary survey, which
hemodynamic profile best characterizes this patient's condition?
A. Distributive shock with low SVR and high cardiac output
B. Cardiogenic shock with low cardiac output and elevated filling pressures
C. Hypovolemic shock with low filling pressures and low cardiac output
D. Obstructive shock with equalization of diastolic pressures
Correct Answer: B
Rationale: The patient presents with cardiogenic shock, evidenced by a cardiac index of 1.6 L/min/m²
(normal 2.5-4.0), elevated PCWP of 28 mmHg (normal 6-12), hypotension, tachycardia, and pulmonary
edema (bilateral crackles). In the setting of severe aortic stenosis, the fixed outflow obstruction limits
cardiac output, and the elevated filling pressures reflect left ventricular failure with pulmonary
congestion. Distributive shock features high cardiac output and low SVR. Hypovolemic shock presents
with low filling pressures. Obstructive shock shows equalization of diastolic pressures (as in
tamponade).
8. (SATA) A 69-year-old female arrives by ambulance after a fall from a second-story
window. During the primary survey, which of the following findings require immediate
life-saving intervention before proceeding to the next phase of assessment? (Select All That
Apply)
☐ A. Massive hemoptysis with oxygen saturation of 78%
☐ B. Open pneumothorax with a 4 cm chest wall defect
Page 4
EXAMINATION
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
Adult-Gerontology Acute Care Nurse Practitioner
Certification (AGACNP-BC®) Examination
2026/2027 Academic Year
Comprehensive Acute/Critical Care Advanced Practice Competency Assessment
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
175 Multiple-Choice Questions (150 Scored + 25 Pretest)
Testing Time: 3.5 Hours (210 Minutes) | Computer-Based | Pearson VUE
American Nurses Credentialing Center (ANCC)
American Nurses Association
, AGACNP-BC® Certification Exam | 2026/2027
EXAMINATION INSTRUCTIONS AND SPECIFICATIONS
• Total Questions: 175 multiple-choice questions (MCQ) — 150 scored items + 25 pretest items
(unscored, for future exam development)
• Format: Single-best-answer MCQ with four options (A, B, C, D); select-all-that-apply (SATA) items
clearly marked with multiple correct responses
• Testing Time: 3.5 hours (210 minutes), computer-based, proctored at Pearson VUE testing centers
• Passing Score: Criterion-referenced standard set via Modified Angoff methodology; results reported
as Pass/Fail with domain-level diagnostic feedback per ANCC policy
• Calculator Policy: On-screen calculator provided for dosage calculations and numerical items
• Eligibility: Current RN license, completion of accredited graduate/post-graduate AGACNP program,
500 supervised clinical hours in adult-gerontology acute care, application submission with fees
• Content Distribution: Assessment & Diagnosis (24%), Planning & Implementation (28%),
Evaluation of Outcomes (16%), Professional Role & Practice (32%) per ANCC AGACNP-BC®
Examination Blueprint
Domains Covered:
1. Assessment & Diagnosis of Acute/Critical Conditions (Q1–42)
2. Advanced Pharmacotherapeutics in Acute Care (Q43–59)
3. Procedural Skills & Critical Interventions (Q60–75)
4. Complex Chronic Disease Exacerbation Management (Q76–91)
5. Ethical, Legal & Professional Practice in Acute Settings (Q92–110)
6. Interprofessional Collaboration & Systems Leadership (Q111–128)
7. Evidence Synthesis & Practice Translation (Q129–147)
8. Evaluation of Outcomes (Q148–175)
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━━━━━━━━━━━
DOMAIN 1: ASSESSMENT & DIAGNOSIS OF ACUTE/CRITICAL CONDITIONS
Questions 1–42 | ANCC Blueprint: Assessment & Diagnosis (24%)
This domain evaluates competency in rapid assessment frameworks (ABCDE/primary-secondary survey),
complex differential diagnosis of acute versus chronic exacerbation versus new pathology, diagnostic test
interpretation including ABGs, cardiac enzymes, imaging, and laboratory data in critical illness, and risk
stratification using validated tools such as SOFA, APACHE II, and MEWS for identifying acute
deterioration.
1. A 68-year-old male is brought to the emergency department after a high-speed motor
vehicle collision. He is unresponsive, has noisy breathing with gurgling sounds, and his
oxygen saturation is 82% on room air. According to the ABCDE primary survey framework,
what is the most appropriate immediate intervention?
A. Perform a jaw thrust and suction the oropharynx to secure the airway
B. Administer 100% oxygen via non-rebreather mask
C. Establish bilateral needle decompression of the chest
D. Initiate rapid infusion of isotonic crystalloid
Correct Answer: A
Rationale: In the ABCDE framework, Airway is the first priority. The patient has signs of airway
compromise (gurgling sounds indicating fluid or debris in the oropharynx, unresponsiveness, and
severe hypoxemia). The jaw thrust maneuver with suctioning addresses the immediate airway
obstruction before proceeding to breathing and circulation interventions. Oxygen administration and IV
access are important but secondary to securing a patent airway.
Page 2
, AGACNP-BC® Certification Exam | 2026/2027
2. A 74-year-old female presents to the emergency department with acute onset severe
dyspnea, respiratory rate of 34 breaths/min, and SpO2 of 85% on 4L nasal cannula. On
assessment, she has absent breath sounds on the right, tracheal deviation to the left, and
jugular venous distension. During the primary survey, which finding identifies the most
immediately life-threatening condition requiring intervention?
A. Respiratory rate of 34 breaths/min
B. Tracheal deviation to the left with absent right breath sounds
C. Jugular venous distension
D. SpO2 of 85% on 4L nasal cannula
Correct Answer: B
Rationale: The combination of absent breath sounds on one side with tracheal deviation to the opposite
side is the classic presentation of tension pneumothorax, which is an immediately life-threatening
condition in the 'B' (Breathing) phase of the primary survey. Tension pneumothorax causes mediastinal
shift, compromising venous return and cardiac output. This requires immediate needle decompression
before chest radiograph. While hypoxemia and JVD are concerning, the tracheal deviation with absent
breath sounds identifies the specific life-threatening pathology.
3. (SATA) A 71-year-old male with a history of COPD and heart failure is being evaluated in
the ICU for acute respiratory distress. During the primary survey, which of the following
findings indicate a compromised airway requiring immediate intervention? (Select All
That Apply)
☐ A. Stridor with inspiration
☐ B. Inability to swallow secretions with pooling of oral secretions
☐ C. Hoarse voice following thermal injury to the face
☐ D. Respiratory rate of 22 breaths/min with use of accessory muscles
Correct Answer: A, B, C
Rationale: Stridor indicates partial upper airway obstruction and is an airway emergency. Inability to
swallow secretions with pooling suggests loss of protective airway reflexes, posing an aspiration risk
requiring immediate airway protection. Hoarse voice following thermal injury suggests airway edema
or thermal injury to the upper airway that can rapidly progress to complete obstruction. While
accessory muscle use (option D) indicates increased work of breathing, it is a breathing problem, not an
airway problem, and is addressed in the 'B' phase of the primary survey.
4. A 63-year-old trauma patient has been stabilized through the primary survey with a
secured airway, bilateral breath sounds, and systolic blood pressure of 110 mmHg after 2
liters of crystalloid. During the secondary survey, which assessment component should be
performed next according to the systematic head-to-toe approach?
A. Complete neurological examination including cranial nerves and motor/sensory testing
B. Amplication of the primary survey with focused FAST examination
C. Reassessment of the ABCDEs to detect any deterioration
D. Detailed musculoskeletal examination of all extremities
Correct Answer: C
Rationale: Before proceeding with the secondary survey, it is essential to reassess the ABCDEs to ensure
the patient has not deteriorated after the initial interventions. The primary survey is a dynamic process,
and reassessment is critical to identify new or evolving life threats. Only after confirming continued
stability should the provider proceed with the head-to-toe secondary survey. The secondary survey
begins with a complete physical examination but only after the primary survey has been completed and
reassessed.
5. A 78-year-old female is found unresponsive in her nursing home room. Her Glasgow
Coma Scale score is 7 (E1V2M4). In the 'D' (Disability) component of the primary survey,
which assessment finding most urgently requires intervention before proceeding to 'E'
(Exposure)?
Page 3
, AGACNP-BC® Certification Exam | 2026/2027
A. Right pupil 5 mm and fixed, left pupil 3 mm and reactive
B. GCS motor response of 4 (withdrawal to pain)
C. GCS verbal response of 2 (incomprehensible sounds)
D. Bilateral equal and reactive pupils with GCS of 7
Correct Answer: A
Rationale: A unilateral fixed and dilated pupil (right pupil 5 mm and fixed) in the context of depressed
consciousness is a hallmark sign of uncal herniation from increased intracranial pressure. This is a
neurosurgical emergency requiring immediate intervention with mannitol or hypertonic saline,
elevation of the head of bed, and emergent neurosurgical consultation. While a GCS of 7 indicates severe
brain injury requiring airway protection, the asymmetric pupillary findings specifically indicate
herniation, which is rapidly fatal without intervention.
6. A 66-year-old male presents to the emergency department with a core temperature of
30.2°C (86.4°F) after being found unconscious in a snowbank for an unknown duration.
During the 'E' (Exposure/Environment) component of the primary survey, which
rewarming strategy is most appropriate for this patient?
A. Passive external rewarming with warm blankets only
B. Active external rewarming with forced-air warming blanket and warm IV fluids
C. Active core rewarming with warm peritoneal lavage and consideration of extracorporeal membrane
oxygenation
D. Immersion in a warm water bath at 42°C
Correct Answer: C
Rationale: A core temperature below 30°C defines severe hypothermia and requires active core
rewarming methods. Passive external rewarming is inadequate, and active external rewarming alone
may cause core temperature afterdrop and arrhythmias by returning cold blood from the periphery to
the core. Active core rewarming techniques such as warm peritoneal or pleural lavage, warm IV fluids,
and extracorporeal rewarming (ECMO or cardiopulmonary bypass) are indicated for severe
hypothermia. Warm water immersion is contraindicated due to the risk of arrhythmia from rapid
temperature shifts and difficulty monitoring the patient.
7. A 72-year-old male with a history of severe aortic stenosis presents with acute onset
dyspnea, BP 88/52 mmHg, HR 118 bpm, and bilateral crackles to the apices. Pulmonary
artery catheter reveals a cardiac index of 1.6 L/min/m² and a pulmonary capillary wedge
pressure of 28 mmHg. In the 'C' (Circulation) phase of the primary survey, which
hemodynamic profile best characterizes this patient's condition?
A. Distributive shock with low SVR and high cardiac output
B. Cardiogenic shock with low cardiac output and elevated filling pressures
C. Hypovolemic shock with low filling pressures and low cardiac output
D. Obstructive shock with equalization of diastolic pressures
Correct Answer: B
Rationale: The patient presents with cardiogenic shock, evidenced by a cardiac index of 1.6 L/min/m²
(normal 2.5-4.0), elevated PCWP of 28 mmHg (normal 6-12), hypotension, tachycardia, and pulmonary
edema (bilateral crackles). In the setting of severe aortic stenosis, the fixed outflow obstruction limits
cardiac output, and the elevated filling pressures reflect left ventricular failure with pulmonary
congestion. Distributive shock features high cardiac output and low SVR. Hypovolemic shock presents
with low filling pressures. Obstructive shock shows equalization of diastolic pressures (as in
tamponade).
8. (SATA) A 69-year-old female arrives by ambulance after a fall from a second-story
window. During the primary survey, which of the following findings require immediate
life-saving intervention before proceeding to the next phase of assessment? (Select All That
Apply)
☐ A. Massive hemoptysis with oxygen saturation of 78%
☐ B. Open pneumothorax with a 4 cm chest wall defect
Page 4
