AGACNP ADULT-GERONTOLOGY ACUTE CARE NURSE
PRACTITIONER CERTIFICATION EXAM 2025–2026 COMPLETE
PRACTICE EXAM WITH 100 QUESTIONS, ANSWER KEY, AND
DETAILED RATIONALES
1. A patient presents with chest pain and ST-segment elevation in leads V1–V4. Which area of the
heart is affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall
D. Posterior wall
Answer: C. Anterior wall
Rationale: Leads V1–V4 reflect the anterior wall of the left ventricle, usually supplied by the left
anterior descending artery.
2. Which assessment finding is most consistent with cardiogenic shock?
A. Warm, flushed skin
B. Elevated cardiac output
C. Pulmonary congestion and low cardiac output
D. Wide pulse pressure
Answer: C. Pulmonary congestion and low cardiac output
Rationale: Cardiogenic shock results from pump failure, causing poor tissue perfusion and increased
filling pressures.
3. A septic patient remains hypotensive after adequate fluid resuscitation. Which medication is first-
line?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Dobutamine
Answer: B. Norepinephrine
Rationale: Norepinephrine is recommended as the initial vasopressor in septic shock.
4. Which ECG finding is characteristic of hyperkalemia?
,A. Delta waves
B. Peaked T waves
C. U waves
D. Prolonged QT interval
Answer: B. Peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves and may progress to widened QRS complexes.
5. A patient develops sudden unilateral absence of breath sounds and hypotension while mechanically
ventilated. What is the priority diagnosis?
A. Atelectasis
B. Pulmonary embolism
C. Tension pneumothorax
D. Pneumonia
Answer: C. Tension pneumothorax
Rationale: Positive pressure ventilation increases the risk of tension pneumothorax, which requires
immediate decompression.
6. Which arterial blood gas result indicates respiratory acidosis?
A. pH 7.31, PaCO₂ 55 mmHg
B. pH 7.50, PaCO₂ 30 mmHg
C. pH 7.29, HCO₃ 18 mEq/L
D. pH 7.45, HCO₃ 30 mEq/L
Answer: A
Rationale: Low pH with elevated PaCO₂ indicates respiratory acidosis.
7. Which medication is commonly used to reverse opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Vitamin K
Answer: B. Naloxone
Rationale: Naloxone competitively antagonizes opioid receptors and rapidly reverses opioid-induced
respiratory depression.
, 8. A patient with atrial fibrillation develops hypotension and altered mental status. What is the next
intervention?
A. Oral beta blocker
B. Synchronized cardioversion
C. Adenosine
D. Observation
Answer: B. Synchronized cardioversion
Rationale: Unstable tachyarrhythmias require immediate synchronized cardioversion.
9. Which laboratory finding is most suggestive of disseminated intravascular coagulation (DIC)?
A. Elevated platelets
B. Increased fibrinogen
C. Elevated D-dimer and thrombocytopenia
D. Elevated hemoglobin
Answer: C
Rationale: DIC involves widespread coagulation activation resulting in low platelets and elevated
fibrin degradation products.
10. The most common cause of acute pancreatitis is:
A. Hypercalcemia
B. Gallstones
C. Trauma
D. Infection
Answer: B. Gallstones
Rationale: Gallstones and alcohol use account for the majority of acute pancreatitis cases.
11. Which finding suggests increased intracranial pressure?
A. Bradycardia, hypertension, irregular respirations
B. Tachycardia and hypotension
C. Fever and tachypnea
D. Bradycardia and hypothermia
Answer: A
Rationale: Cushing's triad consists of bradycardia, hypertension, and irregular respirations.
PRACTITIONER CERTIFICATION EXAM 2025–2026 COMPLETE
PRACTICE EXAM WITH 100 QUESTIONS, ANSWER KEY, AND
DETAILED RATIONALES
1. A patient presents with chest pain and ST-segment elevation in leads V1–V4. Which area of the
heart is affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall
D. Posterior wall
Answer: C. Anterior wall
Rationale: Leads V1–V4 reflect the anterior wall of the left ventricle, usually supplied by the left
anterior descending artery.
2. Which assessment finding is most consistent with cardiogenic shock?
A. Warm, flushed skin
B. Elevated cardiac output
C. Pulmonary congestion and low cardiac output
D. Wide pulse pressure
Answer: C. Pulmonary congestion and low cardiac output
Rationale: Cardiogenic shock results from pump failure, causing poor tissue perfusion and increased
filling pressures.
3. A septic patient remains hypotensive after adequate fluid resuscitation. Which medication is first-
line?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Dobutamine
Answer: B. Norepinephrine
Rationale: Norepinephrine is recommended as the initial vasopressor in septic shock.
4. Which ECG finding is characteristic of hyperkalemia?
,A. Delta waves
B. Peaked T waves
C. U waves
D. Prolonged QT interval
Answer: B. Peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves and may progress to widened QRS complexes.
5. A patient develops sudden unilateral absence of breath sounds and hypotension while mechanically
ventilated. What is the priority diagnosis?
A. Atelectasis
B. Pulmonary embolism
C. Tension pneumothorax
D. Pneumonia
Answer: C. Tension pneumothorax
Rationale: Positive pressure ventilation increases the risk of tension pneumothorax, which requires
immediate decompression.
6. Which arterial blood gas result indicates respiratory acidosis?
A. pH 7.31, PaCO₂ 55 mmHg
B. pH 7.50, PaCO₂ 30 mmHg
C. pH 7.29, HCO₃ 18 mEq/L
D. pH 7.45, HCO₃ 30 mEq/L
Answer: A
Rationale: Low pH with elevated PaCO₂ indicates respiratory acidosis.
7. Which medication is commonly used to reverse opioid overdose?
A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Vitamin K
Answer: B. Naloxone
Rationale: Naloxone competitively antagonizes opioid receptors and rapidly reverses opioid-induced
respiratory depression.
, 8. A patient with atrial fibrillation develops hypotension and altered mental status. What is the next
intervention?
A. Oral beta blocker
B. Synchronized cardioversion
C. Adenosine
D. Observation
Answer: B. Synchronized cardioversion
Rationale: Unstable tachyarrhythmias require immediate synchronized cardioversion.
9. Which laboratory finding is most suggestive of disseminated intravascular coagulation (DIC)?
A. Elevated platelets
B. Increased fibrinogen
C. Elevated D-dimer and thrombocytopenia
D. Elevated hemoglobin
Answer: C
Rationale: DIC involves widespread coagulation activation resulting in low platelets and elevated
fibrin degradation products.
10. The most common cause of acute pancreatitis is:
A. Hypercalcemia
B. Gallstones
C. Trauma
D. Infection
Answer: B. Gallstones
Rationale: Gallstones and alcohol use account for the majority of acute pancreatitis cases.
11. Which finding suggests increased intracranial pressure?
A. Bradycardia, hypertension, irregular respirations
B. Tachycardia and hypotension
C. Fever and tachypnea
D. Bradycardia and hypothermia
Answer: A
Rationale: Cushing's triad consists of bradycardia, hypertension, and irregular respirations.
