AGACNP ADULT-GERONTOLOGY ACUTE CARE NURSE
PRACTITIONER CERTIFICATION EXAM PRACTICE
QUESTIONS & ANSWERS WITH RATIONALES 200-
QUESTION COMPREHENSIVE STUDY GUIDE 2025–2026
EXAM PREPARATION
1. Cardiogenic Shock
A 72-year-old patient presents with acute myocardial infarction. Blood pressure is 78/46 mmHg, heart
rate is 118 bpm, and urine output is 15 mL/hr. Which intervention is the highest priority?
A. Administer IV furosemide
B. Initiate vasopressor therapy as ordered
C. Encourage oral fluids
D. Obtain a chest radiograph
Answer: B
Rationale: The patient demonstrates cardiogenic shock with hypotension and poor perfusion.
Stabilizing circulation and maintaining organ perfusion is the immediate priority.
2. Pulmonary Embolism
A hospitalized patient suddenly develops dyspnea, pleuritic chest pain, tachycardia, and hypoxemia.
Which diagnosis should be suspected first?
A. Acute asthma exacerbation
B. Pulmonary embolism
C. Community-acquired pneumonia
D. Congestive heart failure
Answer: B
Rationale: Sudden onset dyspnea, chest pain, tachycardia, and hypoxemia are classic findings
associated with pulmonary embolism.
3. Sepsis Management
A patient meets criteria for septic shock. Which action should occur within the initial hour?
A. Delay antibiotics until culture results return
B. Administer broad-spectrum antibiotics
,C. Restrict IV fluids
D. Schedule elective CT imaging
Answer: B
Rationale: Early broad-spectrum antibiotic administration significantly improves survival in septic
shock.
4. Ventilator Management
A mechanically ventilated patient develops increasing peak airway pressures. The AGACNP should
assess first for:
A. Hyperglycemia
B. Airway obstruction or secretions
C. Deep vein thrombosis
D. Hypocalcemia
Answer: B
Rationale: Elevated peak pressures often indicate increased airway resistance due to secretions,
bronchospasm, or obstruction.
5. Acute Kidney Injury
Which laboratory finding is most concerning in acute kidney injury?
A. Potassium 6.5 mEq/L
B. Sodium 136 mEq/L
C. Glucose 110 mg/dL
D. Calcium 9.0 mg/dL
Answer: A
Rationale: Severe hyperkalemia can cause life-threatening cardiac arrhythmias.
6. Stroke Evaluation
A patient presents with acute unilateral weakness and aphasia that began 45 minutes ago. Which
diagnostic study should be obtained immediately?
A. MRI with contrast
B. EEG
C. Non-contrast CT scan of the head
D. Carotid ultrasound
Answer: C
,Rationale: Non-contrast CT rapidly differentiates ischemic from hemorrhagic stroke.
7. Atrial Fibrillation
A patient develops new-onset atrial fibrillation with rapid ventricular response at 170 bpm and
becomes hypotensive. The priority intervention is:
A. Oral beta-blocker therapy
B. Synchronized cardioversion
C. Observation only
D. Digoxin administration next week
Answer: B
Rationale: Unstable atrial fibrillation requires immediate synchronized cardioversion.
8. Acute Respiratory Distress Syndrome (ARDS)
Which ventilator strategy is recommended for ARDS?
A. High tidal volume ventilation
B. Low tidal volume ventilation
C. Elimination of PEEP
D. High oxygen only
Answer: B
Rationale: Lung-protective ventilation with low tidal volumes reduces ventilator-induced lung injury.
9. Ethical Practice
A competent patient refuses a life-saving treatment. The AGACNP should:
A. Override the patient's wishes
B. Obtain a court order immediately
C. Respect the patient's decision after ensuring informed refusal
D. Ask family members to decide
Answer: C
Rationale: Competent adults retain the right to refuse treatment, even when refusal may result in
death.
10. Delirium in Older Adults
, An 81-year-old ICU patient becomes acutely confused and agitated overnight. What is the most likely
diagnosis?
A. Dementia
B. Delirium
C. Depression
D. Schizophrenia
Answer: B
Rationale: Delirium presents with an acute change in cognition and fluctuating mental status.
11. A patient with inferior wall MI develops bradycardia with a heart rate of 38 bpm and hypotension.
First-line treatment?
A. Epinephrine infusion
B. Atropine IV
C. Defibrillation
D. Adenosine
Answer: B
Rationale: Symptomatic bradycardia associated with inferior wall MI is typically treated initially with
atropine.
12. Which assessment finding is most indicative of right-sided heart failure?
A. Pulmonary crackles
B. Orthopnea
C. Jugular venous distention
D. Pink frothy sputum
Answer: C
Rationale: JVD reflects systemic venous congestion and is a hallmark of right-sided heart failure.
13. A patient with COPD experiences worsening respiratory distress. Which ABG finding indicates
acute respiratory acidosis?
A. pH 7.28, PaCO₂ 60 mmHg
B. pH 7.48, PaCO₂ 30 mmHg
C. pH 7.40, PaCO₂ 40 mmHg
D. pH 7.50, HCO₃ 32 mEq/L
Answer: A
PRACTITIONER CERTIFICATION EXAM PRACTICE
QUESTIONS & ANSWERS WITH RATIONALES 200-
QUESTION COMPREHENSIVE STUDY GUIDE 2025–2026
EXAM PREPARATION
1. Cardiogenic Shock
A 72-year-old patient presents with acute myocardial infarction. Blood pressure is 78/46 mmHg, heart
rate is 118 bpm, and urine output is 15 mL/hr. Which intervention is the highest priority?
A. Administer IV furosemide
B. Initiate vasopressor therapy as ordered
C. Encourage oral fluids
D. Obtain a chest radiograph
Answer: B
Rationale: The patient demonstrates cardiogenic shock with hypotension and poor perfusion.
Stabilizing circulation and maintaining organ perfusion is the immediate priority.
2. Pulmonary Embolism
A hospitalized patient suddenly develops dyspnea, pleuritic chest pain, tachycardia, and hypoxemia.
Which diagnosis should be suspected first?
A. Acute asthma exacerbation
B. Pulmonary embolism
C. Community-acquired pneumonia
D. Congestive heart failure
Answer: B
Rationale: Sudden onset dyspnea, chest pain, tachycardia, and hypoxemia are classic findings
associated with pulmonary embolism.
3. Sepsis Management
A patient meets criteria for septic shock. Which action should occur within the initial hour?
A. Delay antibiotics until culture results return
B. Administer broad-spectrum antibiotics
,C. Restrict IV fluids
D. Schedule elective CT imaging
Answer: B
Rationale: Early broad-spectrum antibiotic administration significantly improves survival in septic
shock.
4. Ventilator Management
A mechanically ventilated patient develops increasing peak airway pressures. The AGACNP should
assess first for:
A. Hyperglycemia
B. Airway obstruction or secretions
C. Deep vein thrombosis
D. Hypocalcemia
Answer: B
Rationale: Elevated peak pressures often indicate increased airway resistance due to secretions,
bronchospasm, or obstruction.
5. Acute Kidney Injury
Which laboratory finding is most concerning in acute kidney injury?
A. Potassium 6.5 mEq/L
B. Sodium 136 mEq/L
C. Glucose 110 mg/dL
D. Calcium 9.0 mg/dL
Answer: A
Rationale: Severe hyperkalemia can cause life-threatening cardiac arrhythmias.
6. Stroke Evaluation
A patient presents with acute unilateral weakness and aphasia that began 45 minutes ago. Which
diagnostic study should be obtained immediately?
A. MRI with contrast
B. EEG
C. Non-contrast CT scan of the head
D. Carotid ultrasound
Answer: C
,Rationale: Non-contrast CT rapidly differentiates ischemic from hemorrhagic stroke.
7. Atrial Fibrillation
A patient develops new-onset atrial fibrillation with rapid ventricular response at 170 bpm and
becomes hypotensive. The priority intervention is:
A. Oral beta-blocker therapy
B. Synchronized cardioversion
C. Observation only
D. Digoxin administration next week
Answer: B
Rationale: Unstable atrial fibrillation requires immediate synchronized cardioversion.
8. Acute Respiratory Distress Syndrome (ARDS)
Which ventilator strategy is recommended for ARDS?
A. High tidal volume ventilation
B. Low tidal volume ventilation
C. Elimination of PEEP
D. High oxygen only
Answer: B
Rationale: Lung-protective ventilation with low tidal volumes reduces ventilator-induced lung injury.
9. Ethical Practice
A competent patient refuses a life-saving treatment. The AGACNP should:
A. Override the patient's wishes
B. Obtain a court order immediately
C. Respect the patient's decision after ensuring informed refusal
D. Ask family members to decide
Answer: C
Rationale: Competent adults retain the right to refuse treatment, even when refusal may result in
death.
10. Delirium in Older Adults
, An 81-year-old ICU patient becomes acutely confused and agitated overnight. What is the most likely
diagnosis?
A. Dementia
B. Delirium
C. Depression
D. Schizophrenia
Answer: B
Rationale: Delirium presents with an acute change in cognition and fluctuating mental status.
11. A patient with inferior wall MI develops bradycardia with a heart rate of 38 bpm and hypotension.
First-line treatment?
A. Epinephrine infusion
B. Atropine IV
C. Defibrillation
D. Adenosine
Answer: B
Rationale: Symptomatic bradycardia associated with inferior wall MI is typically treated initially with
atropine.
12. Which assessment finding is most indicative of right-sided heart failure?
A. Pulmonary crackles
B. Orthopnea
C. Jugular venous distention
D. Pink frothy sputum
Answer: C
Rationale: JVD reflects systemic venous congestion and is a hallmark of right-sided heart failure.
13. A patient with COPD experiences worsening respiratory distress. Which ABG finding indicates
acute respiratory acidosis?
A. pH 7.28, PaCO₂ 60 mmHg
B. pH 7.48, PaCO₂ 30 mmHg
C. pH 7.40, PaCO₂ 40 mmHg
D. pH 7.50, HCO₃ 32 mEq/L
Answer: A
