AGACNP-BC® Actual Exam: 150 Verified Acute Care
Practice Questions and Answers, Detailed Rationales, and
Hemodynamic Mastery Guide | pdf
The Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC®) certification exam with this high-
yield question bank. This resource provides 150+ verified practice questions covering critical
care, hemodynamics, shock states, advanced pharmacology, and neuro-emergencies. Each
question includes a bolded answer and a detailed italicized rationale, offering an intense
review of ANCC blueprint topics. Ideal for final preparation, this guide ensures mastery of life-
saving interventions and diagnostic criteria required for success in acute and critical care
environments.
Block 1: Hemodynamics and Cardiology
1. A patient in the ICU has the following PAC numbers: CVP 18, PCWP 22, CI 1.8,
SVR 1800. What is the diagnosis?
A. Septic Shock
B. Cardiogenic Shock
C. Hypovolemic Shock
D. Anaphylactic Shock
Answer: B. Cardiogenic Shock
Rationale: High preload (CVP/PCWP) and low Cardiac Index (CI) with high
afterload (SVR) indicate pump failure.
2. Which hemodynamic parameter is the best indicator of Left Ventricular end-
diastolic pressure?
A. CVP
B. PCWP (Wedge)
C. MAP
D. SVR
Answer: B. PCWP (Wedge)
Rationale: The Pulmonary Capillary Wedge Pressure indirectly measures the
pressure in the left atrium and left ventricle at the end of diastole.
,3. A patient with a STEMI develops a new holosystolic murmur at the apex. What
is the most likely complication?
A. Ventricular Septal Rupture
B. Acute Mitral Regurgitation
C. Aortic Stenosis
D. Pericarditis
Answer: B. Acute Mitral Regurgitation
Rationale: Post-MI papillary muscle rupture causes acute mitral regurgitation,
heard best at the apex.
4. What is the target Mean Arterial Pressure (MAP) for a patient in septic shock
according to Surviving Sepsis guidelines?
A. > 55 mmHg
B. > 60 mmHg
C. > 65 mmHg
D. > 70 mmHg
Answer: C. > 65 mmHg
Rationale: A MAP of 65 is the minimum pressure required to perfuse vital organs
in shock.
5. Which medication is the first-line vasopressor for Septic Shock?
A. Dopamine
B. Vasopressin
C. Norepinephrine (Levophed)
D. Phenylephrine
Answer: C. Norepinephrine (Levophed)
Rationale: Norepinephrine is the gold standard for sepsis due to its potent alpha-1
and mild beta-1 effects.
6. A patient is in Torsades de Pointes. The patient has a pulse but is hypotensive.
What is the drug of choice?
A. Amiodarone
B. Magnesium Sulfate IV
C. Adenosine
D. Lidocaine
Answer: B. Magnesium Sulfate IV
Rationale: Magnesium (usually 1-2g) is the specific treatment for this polymorphic
ventricular tachycardia.
,7. "Equalization of pressures" (CVP = PAD = PCWP) is a classic hemodynamic
finding in:
A. Pulmonary Embolism
B. Cardiac Tamponade
C. Left Heart Failure
D. Hypovolemia
Answer: B. Cardiac Tamponade
Rationale: Fluid in the pericardial sac compresses the heart equally, causing
diastolic pressures to equalize.
8. Which EKG finding is most specific for a "Saddle" Pulmonary Embolism?
A. Sinus Tachycardia
B. S1Q3T3 pattern
C. Right Bundle Branch Block
D. ST depression in V1-V3
Answer: B. S1Q3T3 pattern
Rationale: Though Sinus Tachycardia is most common, S1Q3T3 indicates acute
right heart strain characteristic of a large PE.
9. A patient with an Inferior Wall MI (Leads II, III, aVF) is hypotensive. Which
medication should be AVOIDED?
A. Normal Saline bolus
B. Nitroglycerin
C. Norepinephrine
D. Aspirin
Answer: B. Nitroglycerin
Rationale: Inferior MIs often involve the Right Ventricle (RV). RV MIs are preload-
dependent; Nitroglycerin reduces preload and can cause profound hypotension.
10. What is the reversal agent for the anticoagulant Heparin?
A. Vitamin K
B. Protamine Sulfate
C. Idarucizumab
D. Andexanet Alfa
Answer: B. Protamine Sulfate
Rationale: Protamine neutralizes heparin 1:1.
11. A patient with an S3 heart sound and frothy pink sputum likely has:
A. Pneumonia
, B. Acute Pulmonary Edema (CHF)
C. Pulmonary Fibrosis
D. ARDS
Answer: B. Acute Pulmonary Edema (CHF)
Rationale: S3 is a ventricular gallop indicating fluid overload, and pink frothy
sputum is pathognomonic for pulmonary edema.
12. Which valvular disorder is associated with a "harsh systolic crescendo-
decrescendo" murmur at the right upper sternal border?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: B. Aortic Stenosis
Rationale: Aortic Stenosis is the most common systolic murmur in the elderly.
13. A patient’s EKG shows a "sawtooth" p-wave pattern. This is:
A. Atrial Fibrillation
B. Atrial Flutter
C. SVT
D. Ventricular Tachycardia
Answer: B. Atrial Flutter
Rationale: Atrial flutter is characterized by regular, rapid "F" (flutter) waves.
14. What is the definitive treatment for a patient in Ventricular Fibrillation?
A. Amiodarone 300mg
B. Synchronized Cardioversion
C. Defibrillation
D. Epinephrine 1mg
Answer: C. Defibrillation
Rationale: "V-fib you Defib." Cardioversion is for rhythms with a pulse.
15. A patient with Wolff-Parkinson-White (WPW) syndrome in A-fib should NOT
receive which medication?
A. Procainamide
B. Diltiazem or Digoxin
C. Amiodarone
D. Beta-blockers
Answer: B. Diltiazem or Digoxin
Practice Questions and Answers, Detailed Rationales, and
Hemodynamic Mastery Guide | pdf
The Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC®) certification exam with this high-
yield question bank. This resource provides 150+ verified practice questions covering critical
care, hemodynamics, shock states, advanced pharmacology, and neuro-emergencies. Each
question includes a bolded answer and a detailed italicized rationale, offering an intense
review of ANCC blueprint topics. Ideal for final preparation, this guide ensures mastery of life-
saving interventions and diagnostic criteria required for success in acute and critical care
environments.
Block 1: Hemodynamics and Cardiology
1. A patient in the ICU has the following PAC numbers: CVP 18, PCWP 22, CI 1.8,
SVR 1800. What is the diagnosis?
A. Septic Shock
B. Cardiogenic Shock
C. Hypovolemic Shock
D. Anaphylactic Shock
Answer: B. Cardiogenic Shock
Rationale: High preload (CVP/PCWP) and low Cardiac Index (CI) with high
afterload (SVR) indicate pump failure.
2. Which hemodynamic parameter is the best indicator of Left Ventricular end-
diastolic pressure?
A. CVP
B. PCWP (Wedge)
C. MAP
D. SVR
Answer: B. PCWP (Wedge)
Rationale: The Pulmonary Capillary Wedge Pressure indirectly measures the
pressure in the left atrium and left ventricle at the end of diastole.
,3. A patient with a STEMI develops a new holosystolic murmur at the apex. What
is the most likely complication?
A. Ventricular Septal Rupture
B. Acute Mitral Regurgitation
C. Aortic Stenosis
D. Pericarditis
Answer: B. Acute Mitral Regurgitation
Rationale: Post-MI papillary muscle rupture causes acute mitral regurgitation,
heard best at the apex.
4. What is the target Mean Arterial Pressure (MAP) for a patient in septic shock
according to Surviving Sepsis guidelines?
A. > 55 mmHg
B. > 60 mmHg
C. > 65 mmHg
D. > 70 mmHg
Answer: C. > 65 mmHg
Rationale: A MAP of 65 is the minimum pressure required to perfuse vital organs
in shock.
5. Which medication is the first-line vasopressor for Septic Shock?
A. Dopamine
B. Vasopressin
C. Norepinephrine (Levophed)
D. Phenylephrine
Answer: C. Norepinephrine (Levophed)
Rationale: Norepinephrine is the gold standard for sepsis due to its potent alpha-1
and mild beta-1 effects.
6. A patient is in Torsades de Pointes. The patient has a pulse but is hypotensive.
What is the drug of choice?
A. Amiodarone
B. Magnesium Sulfate IV
C. Adenosine
D. Lidocaine
Answer: B. Magnesium Sulfate IV
Rationale: Magnesium (usually 1-2g) is the specific treatment for this polymorphic
ventricular tachycardia.
,7. "Equalization of pressures" (CVP = PAD = PCWP) is a classic hemodynamic
finding in:
A. Pulmonary Embolism
B. Cardiac Tamponade
C. Left Heart Failure
D. Hypovolemia
Answer: B. Cardiac Tamponade
Rationale: Fluid in the pericardial sac compresses the heart equally, causing
diastolic pressures to equalize.
8. Which EKG finding is most specific for a "Saddle" Pulmonary Embolism?
A. Sinus Tachycardia
B. S1Q3T3 pattern
C. Right Bundle Branch Block
D. ST depression in V1-V3
Answer: B. S1Q3T3 pattern
Rationale: Though Sinus Tachycardia is most common, S1Q3T3 indicates acute
right heart strain characteristic of a large PE.
9. A patient with an Inferior Wall MI (Leads II, III, aVF) is hypotensive. Which
medication should be AVOIDED?
A. Normal Saline bolus
B. Nitroglycerin
C. Norepinephrine
D. Aspirin
Answer: B. Nitroglycerin
Rationale: Inferior MIs often involve the Right Ventricle (RV). RV MIs are preload-
dependent; Nitroglycerin reduces preload and can cause profound hypotension.
10. What is the reversal agent for the anticoagulant Heparin?
A. Vitamin K
B. Protamine Sulfate
C. Idarucizumab
D. Andexanet Alfa
Answer: B. Protamine Sulfate
Rationale: Protamine neutralizes heparin 1:1.
11. A patient with an S3 heart sound and frothy pink sputum likely has:
A. Pneumonia
, B. Acute Pulmonary Edema (CHF)
C. Pulmonary Fibrosis
D. ARDS
Answer: B. Acute Pulmonary Edema (CHF)
Rationale: S3 is a ventricular gallop indicating fluid overload, and pink frothy
sputum is pathognomonic for pulmonary edema.
12. Which valvular disorder is associated with a "harsh systolic crescendo-
decrescendo" murmur at the right upper sternal border?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: B. Aortic Stenosis
Rationale: Aortic Stenosis is the most common systolic murmur in the elderly.
13. A patient’s EKG shows a "sawtooth" p-wave pattern. This is:
A. Atrial Fibrillation
B. Atrial Flutter
C. SVT
D. Ventricular Tachycardia
Answer: B. Atrial Flutter
Rationale: Atrial flutter is characterized by regular, rapid "F" (flutter) waves.
14. What is the definitive treatment for a patient in Ventricular Fibrillation?
A. Amiodarone 300mg
B. Synchronized Cardioversion
C. Defibrillation
D. Epinephrine 1mg
Answer: C. Defibrillation
Rationale: "V-fib you Defib." Cardioversion is for rhythms with a pulse.
15. A patient with Wolff-Parkinson-White (WPW) syndrome in A-fib should NOT
receive which medication?
A. Procainamide
B. Diltiazem or Digoxin
C. Amiodarone
D. Beta-blockers
Answer: B. Diltiazem or Digoxin
