Page 1 of 57
ANCC AGACNP FRANCES GUIDE REVIEW
2026 COMPLETE (110) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
AGACNP
Prepare for the ANCC AGACNP Frances Guide Review with practice
questions covering Critical care hemodynamics, mechanical ventilation
and respiratory failure, neurological emergencies, advanced health
assessment, acute and critical care management, diagnostic reasoning,
pharmacologic therapies, evidence-based practice, and the management
of complex adult-gerontology conditions. This study guide helps reinforce
essential Adult-Gerontology Acute Care Nurse Practitioner concepts and
supports effective ANCC certification exam preparation. Suitable for
AGACNP students, nurse practitioners, and advanced nursing
professionals preparing for ANCC certification.
MULTIPLE CHOICE.
1. A 72-year-old with septic shock is started on norepinephrine.
What is the primary desired effect of this medication?
A. Increased cardiac contractility
B. Vasoconstriction and increased mean arterial pressure (MAP)
C. Bronchodilation
D. Diuresis
Correct answer: B. Vasoconstriction and increased mean arterial
pressure (MAP)
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Rationale: Norepinephrine is a potent alpha-1 agonist causing
vasoconstriction, which increases systemic vascular resistance
and MAP. It has some beta-1 effects but is used primarily for
vasopressor support in septic shock.
2. A patient with acute respiratory distress syndrome (ARDS) has a
PaO₂/FiO₂ ratio of 180. Which Berlin classification does this
represent?
A. Mild ARDS
B. Moderate ARDS
C. Severe ARDS
D. No ARDS
Correct answer: B. Moderate ARDS
Rationale: Berlin definition: mild ARDS (PaO₂/FiO₂ 200–300),
moderate (100–200), severe (<100) with PEEP ≥5 cm H₂O. 180
indicates moderate ARDS.
3. Which of the following is the most appropriate initial fluid
resuscitation in a patient with severe sepsis without
contraindications?
A. 5% albumin
B. 6% hydroxyethyl starch
C. 30 mL/kg crystalloid
D. 500 mL of packed red blood cells
Correct answer: C. 30 mL/kg crystalloid
Rationale: Surviving Sepsis Campaign guidelines recommend at
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least 30 mL/kg of intravenous crystalloid within the first 3 hours
of sepsis recognition. Starch solutions are not recommended;
albumin may be used in select cases but is not first-line.
4. A client with acute decompensated heart failure has a pulmonary
artery catheter. Which finding best indicates improved
hemodynamics after diuretic therapy?
A. Increased central venous pressure (CVP)
B. Decreased pulmonary artery occlusion pressure (PAOP)
C. Decreased cardiac index
D. Increased systemic vascular resistance (SVR)
Correct answer: B. Decreased pulmonary artery occlusion
pressure (PAOP)
Rationale: PAOP (also called pulmonary capillary wedge
pressure) reflects left ventricular filling pressure. Diuretic
therapy reduces preload, lowering PAOP. Improved
hemodynamics would show decreased PAOP with stable or
increased cardiac index.
5. The Frances Guide emphasizes that the AGACNP’s full scope of
practice is best demonstrated by:
A. Joining a hospital committee
B. Billing for independent services
C. Petitioning the state legislature
D. Publishing research articles
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Correct answer: B. Billing for independent services
Rationale: Billing for services you are qualified to perform is a
tangible, direct demonstration of your full scope of practice. It
shows that the NP can manage patient care autonomously and
impacts financial recognition of the role.
6. A patient with a traumatic brain injury (TBI) has an intracranial
pressure (ICP) of 24 mm Hg. The nurse practitioner should first:
A. Administer hypertonic saline
B. Elevate the head of the bed to 30 degrees
C. Start a propofol infusion
D. Notify the neurosurgeon
Correct answer: B. Elevate the head of the bed to 30 degrees
Rationale: First-line, non-invasive intervention for elevated ICP
is head of bed elevation to 30 degrees to promote venous
drainage. Hypertonic saline, sedation, and notification are
appropriate after this initial step.
7. In a patient with anaphylaxis, which medication should be
administered first?
A. Methylprednisolone IV
B. Diphenhydramine IV
C. Epinephrine IM
D. Albuterol nebulizer
Correct answer: C. Epinephrine IM
Rationale: Epinephrine IM (0.3-0.5 mg of 1:1000) is the first-line
ANCC AGACNP FRANCES GUIDE REVIEW
2026 COMPLETE (110) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
AGACNP
Prepare for the ANCC AGACNP Frances Guide Review with practice
questions covering Critical care hemodynamics, mechanical ventilation
and respiratory failure, neurological emergencies, advanced health
assessment, acute and critical care management, diagnostic reasoning,
pharmacologic therapies, evidence-based practice, and the management
of complex adult-gerontology conditions. This study guide helps reinforce
essential Adult-Gerontology Acute Care Nurse Practitioner concepts and
supports effective ANCC certification exam preparation. Suitable for
AGACNP students, nurse practitioners, and advanced nursing
professionals preparing for ANCC certification.
MULTIPLE CHOICE.
1. A 72-year-old with septic shock is started on norepinephrine.
What is the primary desired effect of this medication?
A. Increased cardiac contractility
B. Vasoconstriction and increased mean arterial pressure (MAP)
C. Bronchodilation
D. Diuresis
Correct answer: B. Vasoconstriction and increased mean arterial
pressure (MAP)
, Page 2 of 57
Rationale: Norepinephrine is a potent alpha-1 agonist causing
vasoconstriction, which increases systemic vascular resistance
and MAP. It has some beta-1 effects but is used primarily for
vasopressor support in septic shock.
2. A patient with acute respiratory distress syndrome (ARDS) has a
PaO₂/FiO₂ ratio of 180. Which Berlin classification does this
represent?
A. Mild ARDS
B. Moderate ARDS
C. Severe ARDS
D. No ARDS
Correct answer: B. Moderate ARDS
Rationale: Berlin definition: mild ARDS (PaO₂/FiO₂ 200–300),
moderate (100–200), severe (<100) with PEEP ≥5 cm H₂O. 180
indicates moderate ARDS.
3. Which of the following is the most appropriate initial fluid
resuscitation in a patient with severe sepsis without
contraindications?
A. 5% albumin
B. 6% hydroxyethyl starch
C. 30 mL/kg crystalloid
D. 500 mL of packed red blood cells
Correct answer: C. 30 mL/kg crystalloid
Rationale: Surviving Sepsis Campaign guidelines recommend at
, Page 3 of 57
least 30 mL/kg of intravenous crystalloid within the first 3 hours
of sepsis recognition. Starch solutions are not recommended;
albumin may be used in select cases but is not first-line.
4. A client with acute decompensated heart failure has a pulmonary
artery catheter. Which finding best indicates improved
hemodynamics after diuretic therapy?
A. Increased central venous pressure (CVP)
B. Decreased pulmonary artery occlusion pressure (PAOP)
C. Decreased cardiac index
D. Increased systemic vascular resistance (SVR)
Correct answer: B. Decreased pulmonary artery occlusion
pressure (PAOP)
Rationale: PAOP (also called pulmonary capillary wedge
pressure) reflects left ventricular filling pressure. Diuretic
therapy reduces preload, lowering PAOP. Improved
hemodynamics would show decreased PAOP with stable or
increased cardiac index.
5. The Frances Guide emphasizes that the AGACNP’s full scope of
practice is best demonstrated by:
A. Joining a hospital committee
B. Billing for independent services
C. Petitioning the state legislature
D. Publishing research articles
, Page 4 of 57
Correct answer: B. Billing for independent services
Rationale: Billing for services you are qualified to perform is a
tangible, direct demonstration of your full scope of practice. It
shows that the NP can manage patient care autonomously and
impacts financial recognition of the role.
6. A patient with a traumatic brain injury (TBI) has an intracranial
pressure (ICP) of 24 mm Hg. The nurse practitioner should first:
A. Administer hypertonic saline
B. Elevate the head of the bed to 30 degrees
C. Start a propofol infusion
D. Notify the neurosurgeon
Correct answer: B. Elevate the head of the bed to 30 degrees
Rationale: First-line, non-invasive intervention for elevated ICP
is head of bed elevation to 30 degrees to promote venous
drainage. Hypertonic saline, sedation, and notification are
appropriate after this initial step.
7. In a patient with anaphylaxis, which medication should be
administered first?
A. Methylprednisolone IV
B. Diphenhydramine IV
C. Epinephrine IM
D. Albuterol nebulizer
Correct answer: C. Epinephrine IM
Rationale: Epinephrine IM (0.3-0.5 mg of 1:1000) is the first-line
