AACN ACNPC-AG AGACNP Certification Exam 2026/2027 –
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Examination Information
Total Questions: 50
Time Allowed: 150 minutes
Question Type: Single-best-answer multiple choice (4 options)
Target Candidate: Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) preparing
for AACN ACNPC-AG certification; typically 500+ hours of direct acute care experience
required
Passing Standard (practice): 75% correct (38 of 50 questions)
──────────────────────────────
EXAM STRUCTURE
──────────────────────────────
Domain 1: Clinical Judgment (25% — 13 questions)
Question 1
A 72-year-old man is admitted with acute-onset dyspnea, tachycardia, and hypotension.
He recently underwent total knee arthroplasty 5 days ago. Physical examination reveals
unilateral leg swelling and a PaO₂ of 58 mmHg on room air. CT pulmonary angiography
confirms bilateral pulmonary emboli. The AGACNP's immediate priority is:
A. Initiate therapeutic anticoagulation with unfractionated heparin
B. Obtain emergent surgical embolectomy consultation
C. Administer systemic thrombolysis with alteplase
D. Place an inferior vena cava filter
Correct Answer: A — Initiate therapeutic anticoagulation with unfractionated heparin
,Rationale: Hemodynamically stable patients with acute pulmonary embolism require
immediate therapeutic anticoagulation. Unfractionated heparin allows rapid attainment
of therapeutic levels and is easily reversible if bleeding complications arise. Systemic
thrombolysis is reserved for massive PE with hemodynamic instability; surgical
embolectomy and IVC filters are secondary interventions for contraindications to
anticoagulation or recurrent emboli despite adequate therapy.
Question 2
A 68-year-old woman with a history of atrial fibrillation on apixaban presents with a
sudden severe headache, vomiting, and declining consciousness. CT reveals a large
intracerebral hemorrhage with midline shift. The AGACNP's immediate management
priority is:
A. Administer intravenous vitamin K and 4-factor prothrombin complex concentrate
B. Reverse anticoagulation with idarucizumab
C. Initiate antihypertensive therapy targeting systolic BP <140 mmHg
D. Prepare for emergent decompressive craniectomy
Correct Answer: A — Administer intravenous vitamin K and 4-factor prothrombin
complex concentrate
Rationale: Apixaban is a factor Xa inhibitor; 4-factor prothrombin complex concentrate
(PCC) provides rapid reversal of factor Xa activity, and vitamin K supports sustained
hemostasis. Idarucizumab reverses dabigatran only. While blood pressure management
and neurosurgical consultation are important, reversing life-threatening anticoagulation
is the immediate priority in a patient with declining consciousness and mass effect.
Question 3
,A 59-year-old man with decompensated cirrhosis presents with massive hematemesis.
Vital signs show BP 82/50 mmHg, HR 128 bpm, RR 24/min. Two large-bore IVs are
established. The AGACNP's next immediate intervention is:
A. Administer intravenous octreotide and initiate antibiotic prophylaxis
B. Perform emergent endotracheal intubation for airway protection
C. Insert a nasogastric tube for gastric lavage and assessment
D. Begin transfusion of packed red blood cells with a target Hgb >10 g/dL
Correct Answer: A — Administer intravenous octreotide and initiate antibiotic
prophylaxis
Rationale: Variceal hemorrhage is the most likely cause in decompensated cirrhosis.
Octreotide reduces splanchnic blood flow and portal pressure, while prophylactic
antibiotics (ceftriaxone or norfloxacin) reduce infection risk and improve survival.
Endotracheal intubation is indicated for altered mental status or aspiration risk, not as a
routine intervention. Transfusion targets should be conservative (Hgb 7-8 g/dL) to avoid
increasing portal pressure. Nasogastric tube insertion is contraindicated in suspected
variceal bleeding.
Question 4
A 74-year-old woman with acute myocardial infarction develops cardiogenic shock.
Despite inotropic support, her cardiac index remains 1.8 L/min/m² with a pulmonary
capillary wedge pressure of 24 mmHg. The AGACNP recognizes that the next
evidence-based intervention is:
A. Initiation of intra-aortic balloon pump (IABP) counterpulsation
B. Initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO)
C. Addition of milrinone to augment inotropy
D. Emergent coronary artery bypass grafting
, Correct Answer: B — Initiation of venoarterial extracorporeal membrane oxygenation
(VA-ECMO)
Rationale: Refractory cardiogenic shock despite maximal medical therapy is an
indication for mechanical circulatory support. VA-ECMO provides both cardiac and
respiratory support, maintaining end-organ perfusion while definitive revascularization
or recovery occurs. IABP has been shown to provide no mortality benefit in cardiogenic
shock (IABP-SHOCK II trial). Milrinone would further reduce systemic vascular
resistance without addressing the underlying pump failure. CABG requires
hemodynamic stabilization first.
Question 5
A 67-year-old man with COPD presents with worsening dyspnea, fever, and altered
mental status. Arterial blood gas on 2L NC shows pH 7.25, PaCO₂ 78 mmHg, PaO₂ 52
mmHg, HCO₃⁻ 34 mEq/L. The AGACNP's initial ventilator strategy for noninvasive
positive pressure ventilation (NIPPV) is:
A. CPAP 10 cmH₂O with FiO₂ 0.40
B. BiPAP with IPAP 12 cmH₂O, EPAP 5 cmH₂O, FiO₂ 0.40
C. BiPAP with IPAP 18 cmH₂O, EPAP 8 cmH₂O, FiO₂ 0.40
D. Immediate endotracheal intubation and volume-controlled ventilation
Correct Answer: C — BiPAP with IPAP 18 cmH₂O, EPAP 8 cmH₂O, FiO₂ 0.40
Rationale: This patient has acute-on-chronic hypercapnic respiratory failure with
acidemia. Effective NIPPV requires adequate pressure support (IPAP-EPAP difference of
10-12 cmH₂O) to augment tidal volume and reduce work of breathing. An IPAP of 18
with EPAP 8 provides pressure support of 10 cmH₂O, appropriate for severe COPD
exacerbation. Lower settings may be insufficient, while immediate intubation bypasses
a proven first-line therapy for COPD with acceptable mental status.
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Examination Information
Total Questions: 50
Time Allowed: 150 minutes
Question Type: Single-best-answer multiple choice (4 options)
Target Candidate: Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) preparing
for AACN ACNPC-AG certification; typically 500+ hours of direct acute care experience
required
Passing Standard (practice): 75% correct (38 of 50 questions)
──────────────────────────────
EXAM STRUCTURE
──────────────────────────────
Domain 1: Clinical Judgment (25% — 13 questions)
Question 1
A 72-year-old man is admitted with acute-onset dyspnea, tachycardia, and hypotension.
He recently underwent total knee arthroplasty 5 days ago. Physical examination reveals
unilateral leg swelling and a PaO₂ of 58 mmHg on room air. CT pulmonary angiography
confirms bilateral pulmonary emboli. The AGACNP's immediate priority is:
A. Initiate therapeutic anticoagulation with unfractionated heparin
B. Obtain emergent surgical embolectomy consultation
C. Administer systemic thrombolysis with alteplase
D. Place an inferior vena cava filter
Correct Answer: A — Initiate therapeutic anticoagulation with unfractionated heparin
,Rationale: Hemodynamically stable patients with acute pulmonary embolism require
immediate therapeutic anticoagulation. Unfractionated heparin allows rapid attainment
of therapeutic levels and is easily reversible if bleeding complications arise. Systemic
thrombolysis is reserved for massive PE with hemodynamic instability; surgical
embolectomy and IVC filters are secondary interventions for contraindications to
anticoagulation or recurrent emboli despite adequate therapy.
Question 2
A 68-year-old woman with a history of atrial fibrillation on apixaban presents with a
sudden severe headache, vomiting, and declining consciousness. CT reveals a large
intracerebral hemorrhage with midline shift. The AGACNP's immediate management
priority is:
A. Administer intravenous vitamin K and 4-factor prothrombin complex concentrate
B. Reverse anticoagulation with idarucizumab
C. Initiate antihypertensive therapy targeting systolic BP <140 mmHg
D. Prepare for emergent decompressive craniectomy
Correct Answer: A — Administer intravenous vitamin K and 4-factor prothrombin
complex concentrate
Rationale: Apixaban is a factor Xa inhibitor; 4-factor prothrombin complex concentrate
(PCC) provides rapid reversal of factor Xa activity, and vitamin K supports sustained
hemostasis. Idarucizumab reverses dabigatran only. While blood pressure management
and neurosurgical consultation are important, reversing life-threatening anticoagulation
is the immediate priority in a patient with declining consciousness and mass effect.
Question 3
,A 59-year-old man with decompensated cirrhosis presents with massive hematemesis.
Vital signs show BP 82/50 mmHg, HR 128 bpm, RR 24/min. Two large-bore IVs are
established. The AGACNP's next immediate intervention is:
A. Administer intravenous octreotide and initiate antibiotic prophylaxis
B. Perform emergent endotracheal intubation for airway protection
C. Insert a nasogastric tube for gastric lavage and assessment
D. Begin transfusion of packed red blood cells with a target Hgb >10 g/dL
Correct Answer: A — Administer intravenous octreotide and initiate antibiotic
prophylaxis
Rationale: Variceal hemorrhage is the most likely cause in decompensated cirrhosis.
Octreotide reduces splanchnic blood flow and portal pressure, while prophylactic
antibiotics (ceftriaxone or norfloxacin) reduce infection risk and improve survival.
Endotracheal intubation is indicated for altered mental status or aspiration risk, not as a
routine intervention. Transfusion targets should be conservative (Hgb 7-8 g/dL) to avoid
increasing portal pressure. Nasogastric tube insertion is contraindicated in suspected
variceal bleeding.
Question 4
A 74-year-old woman with acute myocardial infarction develops cardiogenic shock.
Despite inotropic support, her cardiac index remains 1.8 L/min/m² with a pulmonary
capillary wedge pressure of 24 mmHg. The AGACNP recognizes that the next
evidence-based intervention is:
A. Initiation of intra-aortic balloon pump (IABP) counterpulsation
B. Initiation of venoarterial extracorporeal membrane oxygenation (VA-ECMO)
C. Addition of milrinone to augment inotropy
D. Emergent coronary artery bypass grafting
, Correct Answer: B — Initiation of venoarterial extracorporeal membrane oxygenation
(VA-ECMO)
Rationale: Refractory cardiogenic shock despite maximal medical therapy is an
indication for mechanical circulatory support. VA-ECMO provides both cardiac and
respiratory support, maintaining end-organ perfusion while definitive revascularization
or recovery occurs. IABP has been shown to provide no mortality benefit in cardiogenic
shock (IABP-SHOCK II trial). Milrinone would further reduce systemic vascular
resistance without addressing the underlying pump failure. CABG requires
hemodynamic stabilization first.
Question 5
A 67-year-old man with COPD presents with worsening dyspnea, fever, and altered
mental status. Arterial blood gas on 2L NC shows pH 7.25, PaCO₂ 78 mmHg, PaO₂ 52
mmHg, HCO₃⁻ 34 mEq/L. The AGACNP's initial ventilator strategy for noninvasive
positive pressure ventilation (NIPPV) is:
A. CPAP 10 cmH₂O with FiO₂ 0.40
B. BiPAP with IPAP 12 cmH₂O, EPAP 5 cmH₂O, FiO₂ 0.40
C. BiPAP with IPAP 18 cmH₂O, EPAP 8 cmH₂O, FiO₂ 0.40
D. Immediate endotracheal intubation and volume-controlled ventilation
Correct Answer: C — BiPAP with IPAP 18 cmH₂O, EPAP 8 cmH₂O, FiO₂ 0.40
Rationale: This patient has acute-on-chronic hypercapnic respiratory failure with
acidemia. Effective NIPPV requires adequate pressure support (IPAP-EPAP difference of
10-12 cmH₂O) to augment tidal volume and reduce work of breathing. An IPAP of 18
with EPAP 8 provides pressure support of 10 cmH₂O, appropriate for severe COPD
exacerbation. Lower settings may be insufficient, while immediate intubation bypasses
a proven first-line therapy for COPD with acceptable mental status.
