ADULT GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
(AGACNP-BC) BOARD CERTIFICATION 2026/2027 ANCC EXAM AND
STUDY GUIDE COMPLETE EXAM ACCURATE QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES (DETAILED
SOLUTIONS) CURRENTLY UPDATED VERSION 2026 EDITION
|ALREADY GRADED A+ (BRAND NEW!) FULL REVISED EXAM
|GUARANTEED SUCCESS
1. A 68-year-old male is admitted with acute onset of dyspnea, tachypnea, and
hypoxia (SpO2 88% on room air). Lung auscultation reveals absent breath sounds
on the right side. Percussion is hyper resonant on the right. What is the most
immediate intervention?
A) Obtain a stat chest x-ray
B) Perform needle decompression at the second intercostal space, midclavicular
line CORRECT ANSWER
C) Administer albuterol nebulizer
D) Obtain arterial blood gas
Rationale: The presentation is consistent with a tension pneumothorax (absent
breath sounds, hyper resonance, hypoxia, respiratory distress). Needle
decompression is the immediate life-saving intervention to release trapped
intrapleural air before chest tube placement. Waiting for imaging would delay
critical care and could lead to cardiac arrest.
2. A 74-year-old woman presents with acute confusion, fever (38.9°C), and
hypotension (BP 90/60 mm Hg). Her white blood cell count is 18,000/all with 15%
bands. Urinalysis shows moderate leukocyte esterase and nitrites. What is the
most likely diagnosis?
A) Acute ischemic stroke
B) Urinary tract infection with sepsis CORRECT ANSWER
,C) Delirium due to electrolyte imbalance
D) Subdural hematoma
Rationale: The triad of fever, hypotension, and altered mental status in an older
adult with urinary findings indicates urosepsis. The presence of bands (left shift)
supports a bacterial infection. Delirium is often the presenting symptom of sepsis
in elderly patients.
3. A 72-year-old patient with a history of heart failure with reduced ejection
fraction (Here) is being discharged. Which medication has been shown to reduce
mortality and should be prioritized for initiation?
A) Furosemide
B) Sacubitril/valsartan CORRECT ANSWER
C) Metoprolol succinate
D) Spironolactone
Rationale: In the PARADIGM-HF trial, sacubitril/valsartan (an ARNI) was shown to
be superior to enalapril in reducing mortality and hospitalizations in patients with
Here. While beta-blockers and spironolactone are also guideline-directed therapy,
ARNI therapy is a preferred first-line agent in many current protocols.
4. A 65-year-old male with a history of COPD presents with worsening dyspnea,
increased purulent sputum, and a fever of 38.3°C. He is alert and has an increased
work of breathing. What is the most appropriate next step in management?
A) Obtain a sputum culture before starting antibiotics
B) Initiate antibiotics and systemic corticosteroids CORRECT ANSWER
C) Administer high-flow oxygen to achieve SpO2 > 96%
,D) Perform a chest x-ray before starting treatment
Rationale: This patient meets criteria for an acute exacerbation of COPD
(AECOPD) with increased sputum purulence and fever, indicating the need for
antibiotics. Systemic corticosteroids are indicated to reduce airway inflammation.
Oxygen should be titrated to 88-92% to avoid suppressing the hypoxic drive.
While a chest x-ray is important, it should not delay treatment.
5. A 78-year-old patient is 3 days’ post-operative from a hip fracture repair. She
suddenly becomes short of breath and tachycardia. Her SpO2 is 85% on room air.
What is the priority diagnostic test?
A) D-dimer
B) CT pulmonary angiography (CTPA) CORRECT ANSWER
C) Ventilation-perfusion (V/Q) scan
D) Lower extremity venous duplex
Rationale: In a post-operative patient with a high pretest probability for
pulmonary embolism (PE), CTPA is the gold standard diagnostic test to confirm
the diagnosis quickly. A D-dimer is sensitive but not specific; in a high-probability
scenario, a negative result does not rule out PE, and a positive result requires
imaging anyway.
6. An 80-year-old woman with a history of heart failure is admitted with dyspnea,
jugular venous distention, and bilateral lower extremity edema. What is the most
appropriate initial diagnostic test to guide diuresis?
A) Brain natriuretic peptide (BNP)
B) Echocardiogram
C) Central venous pressure monitoring
, D) Serum creatinine and electrolytes CORRECT ANSWER
Rationale: Before initiating diuresis, baseline renal function and electrolytes must
be assessed to guide therapy and avoid complications such as acute kidney injury
or electrolyte abnormalities like hypokalemia or hypomagnesemia. BNP confirms
volume overload but does not guide daily management.
7. A 58-year-old patient is admitted with altered mental status, asterisks, and
jaundice. Laboratory results: AST 150 U/L, ALT 100 U/L, alkaline phosphatase 90
U/L, total bilirubin 6.5 mg/ld., ammonia 180 mg/ld. What is the most likely
diagnosis?
A) Acute cholecystitis
B) Hepatic encephalopathy secondary to cirrhosis CORRECT ANSWER
C) Acute viral hepatitis
D) Biliary obstruction
Rationale: The triad of altered mental status, asterisks (a flapping tremor), and
elevated ammonia in a patient with evidence of chronic liver disease (elevated
bilirubin and relatively low transaminases) points to hepatic encephalopathy.
Acute viral hepatitis typically presents with much higher transaminases (often
>1000).
8. A 70-year-old male presents with a 2-day history of severe headache, neck
stiffness, and fever. Kerning and Brzezinski signs are positive. What is the priority
diagnostic test?
A) CT head without contrast CORRECT ANSWER
B) Lumbar puncture
C) Blood cultures
(AGACNP-BC) BOARD CERTIFICATION 2026/2027 ANCC EXAM AND
STUDY GUIDE COMPLETE EXAM ACCURATE QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES (DETAILED
SOLUTIONS) CURRENTLY UPDATED VERSION 2026 EDITION
|ALREADY GRADED A+ (BRAND NEW!) FULL REVISED EXAM
|GUARANTEED SUCCESS
1. A 68-year-old male is admitted with acute onset of dyspnea, tachypnea, and
hypoxia (SpO2 88% on room air). Lung auscultation reveals absent breath sounds
on the right side. Percussion is hyper resonant on the right. What is the most
immediate intervention?
A) Obtain a stat chest x-ray
B) Perform needle decompression at the second intercostal space, midclavicular
line CORRECT ANSWER
C) Administer albuterol nebulizer
D) Obtain arterial blood gas
Rationale: The presentation is consistent with a tension pneumothorax (absent
breath sounds, hyper resonance, hypoxia, respiratory distress). Needle
decompression is the immediate life-saving intervention to release trapped
intrapleural air before chest tube placement. Waiting for imaging would delay
critical care and could lead to cardiac arrest.
2. A 74-year-old woman presents with acute confusion, fever (38.9°C), and
hypotension (BP 90/60 mm Hg). Her white blood cell count is 18,000/all with 15%
bands. Urinalysis shows moderate leukocyte esterase and nitrites. What is the
most likely diagnosis?
A) Acute ischemic stroke
B) Urinary tract infection with sepsis CORRECT ANSWER
,C) Delirium due to electrolyte imbalance
D) Subdural hematoma
Rationale: The triad of fever, hypotension, and altered mental status in an older
adult with urinary findings indicates urosepsis. The presence of bands (left shift)
supports a bacterial infection. Delirium is often the presenting symptom of sepsis
in elderly patients.
3. A 72-year-old patient with a history of heart failure with reduced ejection
fraction (Here) is being discharged. Which medication has been shown to reduce
mortality and should be prioritized for initiation?
A) Furosemide
B) Sacubitril/valsartan CORRECT ANSWER
C) Metoprolol succinate
D) Spironolactone
Rationale: In the PARADIGM-HF trial, sacubitril/valsartan (an ARNI) was shown to
be superior to enalapril in reducing mortality and hospitalizations in patients with
Here. While beta-blockers and spironolactone are also guideline-directed therapy,
ARNI therapy is a preferred first-line agent in many current protocols.
4. A 65-year-old male with a history of COPD presents with worsening dyspnea,
increased purulent sputum, and a fever of 38.3°C. He is alert and has an increased
work of breathing. What is the most appropriate next step in management?
A) Obtain a sputum culture before starting antibiotics
B) Initiate antibiotics and systemic corticosteroids CORRECT ANSWER
C) Administer high-flow oxygen to achieve SpO2 > 96%
,D) Perform a chest x-ray before starting treatment
Rationale: This patient meets criteria for an acute exacerbation of COPD
(AECOPD) with increased sputum purulence and fever, indicating the need for
antibiotics. Systemic corticosteroids are indicated to reduce airway inflammation.
Oxygen should be titrated to 88-92% to avoid suppressing the hypoxic drive.
While a chest x-ray is important, it should not delay treatment.
5. A 78-year-old patient is 3 days’ post-operative from a hip fracture repair. She
suddenly becomes short of breath and tachycardia. Her SpO2 is 85% on room air.
What is the priority diagnostic test?
A) D-dimer
B) CT pulmonary angiography (CTPA) CORRECT ANSWER
C) Ventilation-perfusion (V/Q) scan
D) Lower extremity venous duplex
Rationale: In a post-operative patient with a high pretest probability for
pulmonary embolism (PE), CTPA is the gold standard diagnostic test to confirm
the diagnosis quickly. A D-dimer is sensitive but not specific; in a high-probability
scenario, a negative result does not rule out PE, and a positive result requires
imaging anyway.
6. An 80-year-old woman with a history of heart failure is admitted with dyspnea,
jugular venous distention, and bilateral lower extremity edema. What is the most
appropriate initial diagnostic test to guide diuresis?
A) Brain natriuretic peptide (BNP)
B) Echocardiogram
C) Central venous pressure monitoring
, D) Serum creatinine and electrolytes CORRECT ANSWER
Rationale: Before initiating diuresis, baseline renal function and electrolytes must
be assessed to guide therapy and avoid complications such as acute kidney injury
or electrolyte abnormalities like hypokalemia or hypomagnesemia. BNP confirms
volume overload but does not guide daily management.
7. A 58-year-old patient is admitted with altered mental status, asterisks, and
jaundice. Laboratory results: AST 150 U/L, ALT 100 U/L, alkaline phosphatase 90
U/L, total bilirubin 6.5 mg/ld., ammonia 180 mg/ld. What is the most likely
diagnosis?
A) Acute cholecystitis
B) Hepatic encephalopathy secondary to cirrhosis CORRECT ANSWER
C) Acute viral hepatitis
D) Biliary obstruction
Rationale: The triad of altered mental status, asterisks (a flapping tremor), and
elevated ammonia in a patient with evidence of chronic liver disease (elevated
bilirubin and relatively low transaminases) points to hepatic encephalopathy.
Acute viral hepatitis typically presents with much higher transaminases (often
>1000).
8. A 70-year-old male presents with a 2-day history of severe headache, neck
stiffness, and fever. Kerning and Brzezinski signs are positive. What is the priority
diagnostic test?
A) CT head without contrast CORRECT ANSWER
B) Lumbar puncture
C) Blood cultures
