ANCC AGACNP Certification Exam 2026-2027 |
Complete Practice Questions with Verified Correct
Answers and Detailed Rationales || Latest Update
Question 1
The Advanced Practice Registered Nurse (APRN) is caring for a patient admitted with
chest pain. Which electrocardiogram (ECG) finding is most indicative of an acute ST-
elevation myocardial infarction (STEMI)?
A. ST-segment depression in leads V1-V3
B. New-onset left bundle branch block
C. ST-segment elevation in two contiguous leads
D. T-wave inversion in lead III
Correct Answer: C. ST-segment elevation in two contiguous leads
Rationale: ST-segment elevation in two or more contiguous leads is the hallmark ECG
finding for STEMI. New-onset LBBB is a STEMI equivalent but is not the most
indicative finding. ST depression suggests ischemia or NSTEMI. T-wave inversion is
non-specific and can be normal or indicate strain.
Question 2
A patient on mechanical ventilation suddenly develops high-pressure alarms. The ACNP
notes absent breath sounds on the left side and a shift of the trachea to the right. The
patient is now diaphoretic and hypoxic. What is the most likely cause?
A. Right mainstem intubation
B. Tension pneumothorax
C. Pulmonary embolism
D. Mucus plug
Correct Answer: B. Tension pneumothorax
Rationale: Tension pneumothorax presents with sudden hypoxia, hypotension
(diaphoresis indicates hemodynamic instability), absent breath sounds on the affected
side, and tracheal deviation to the opposite side. This is a medical emergency requiring
immediate needle decompression or chest tube insertion.
pg. 1
,Question 3
A patient is readmitted due to a suspected pulmonary embolus. Home medications
include metformin (Glucophage). Which diagnostic method would be indicated?
A. V/Q scan
B. Spiral CT
C. Pulmonary angiogram
D. Venous doppler study
Correct Answer: A. V/Q scan
Rationale: Spiral CT requires IV contrast, which is relatively contraindicated in
patients on metformin due to the risk of metformin-induced lactic acidosis and acute
kidney injury. A V/Q scan is a viable alternative that does not require IV contrast in this
high-risk patient.
Question 4
A 75-year-old COPD patient is being weaned from mechanical ventilation. The ACNP
should consider that elderly patients:
A. Have greater respiratory reserve than younger patients
B. Have equivalent PaO2/FiO2 ratios compared to younger patients
C. Tend to breathe faster and shallower than younger patients
D. Tend to have a lower A-a gradient compared to younger patients
Correct Answer: C. Tend to breathe faster and shallower than younger patients
Rationale: Due to age-related changes in lung mechanics (decreased chest wall
compliance, increased residual volume), elderly patients often adopt a rapid, shallow
breathing pattern. They have decreased respiratory reserve, and their A-a gradient
typically increases with age.
Question 5
Following a 10-foot fall, a patient has a dilated, unresponsive left pupil and rapidly
deteriorating consciousness after a lucid interval. The ACNP should FIRST suspect:
A. Basilar skull fracture
B. Subdural hematoma
C. Epidural hematoma
D. Cerebellar herniation
Correct Answer: C. Epidural hematoma
pg. 2
,Rationale: Epidural hematomas often present with a classic "lucid interval" followed
by rapid neurological decline. The blown pupil indicates uncal herniation. Subdural
hematomas usually have a more gradual decline.
Question 6
During discharge following knee replacement surgery, a patient experiences chest pain
lasting 10 minutes. Cardiac biomarkers and ECG are unremarkable. The patient is pain-
free and anxious to go home. The ACNP should:
A. Discharge the patient with PCP follow-up
B. Hold discharge and repeat cardiac biomarkers in 8 hours
C. Discharge with cardiology follow-up appointment
D. Hold discharge and schedule emergent cardiac catheterization
Correct Answer: B. Hold discharge and repeat cardiac biomarkers in 8 hours
Rationale: New chest pain post-operatively requires a thorough rule-out for ACS.
Biomarkers can take several hours to rise. Patient anxiety or a normal initial ECG does
not rule out ACS.
Question 7
Concerns are raised about increasing blood product utilization. The ACNP is asked to
participate in an inter-professional team. Upon agreeing to participate, the ACNP
should first:
A. Verify the meeting schedule aligns with availability
B. Ensure suggestions will be adopted
C. Identify the goals assigned to the team
D. Find out who else will be participating
Correct Answer: C. Identify the goals assigned to the team
Rationale: Before effective participation, the ACNP must first understand the charge
of the team and its specific goals. This allows for focused contribution and alignment of
efforts with the project's objectives.
Question 8
A patient with ESRD on hemodialysis is admitted with fever and altered mental status.
Blood pressure is 88/54 mmHg. What is the priority intervention?
pg. 3
, A. Obtain blood cultures
B. Administer broad-spectrum antibiotics
C. Administer a fluid bolus
D. Start vasopressors
Correct Answer: C. Administer a fluid bolus
Rationale: This patient is in septic shock. Sepsis guidelines prioritize fluid
resuscitation BEFORE or simultaneously with antibiotics in hypotension. Administering
30 mL/kg of crystalloids is first-line.
Question 9
An elderly patient with COPD and pneumonia develops worsening respiratory distress,
becomes confused, and cannot protect the airway. The most appropriate next step is:
A. Initiate BiPAP
B. Administer high-flow nasal cannula
C. Perform endotracheal intubation
D. Increase oxygen delivery rate
Correct Answer: C. Perform endotracheal intubation
Rationale: Endotracheal intubation is indicated when a patient cannot protect their
airway (confusion, deteriorating mental status) or when ventilatory failure is imminent.
Non-invasive ventilation (BiPAP) is not appropriate if the patient cannot protect their
airway.
Question 10
Which of the following is a valid competency of the Adult-Gerontology Acute Care Nurse
Practitioner?
A. Provides primary care to pediatric patients
B. Manages complex acute, critical, and chronically ill adult patients
C. Practices independently only in outpatient settings
D. Performs surgical procedures independently
Correct Answer: B. Manages complex acute, critical, and chronically ill adult patients
Rationale: The AGACNP manages complex acute, critical, and chronically ill adult and
older adult patients at risk for urgent and emergent conditions, using both
physiologically and technologically derived data. AGACNPs do not care for pediatric
patients.
pg. 4
Complete Practice Questions with Verified Correct
Answers and Detailed Rationales || Latest Update
Question 1
The Advanced Practice Registered Nurse (APRN) is caring for a patient admitted with
chest pain. Which electrocardiogram (ECG) finding is most indicative of an acute ST-
elevation myocardial infarction (STEMI)?
A. ST-segment depression in leads V1-V3
B. New-onset left bundle branch block
C. ST-segment elevation in two contiguous leads
D. T-wave inversion in lead III
Correct Answer: C. ST-segment elevation in two contiguous leads
Rationale: ST-segment elevation in two or more contiguous leads is the hallmark ECG
finding for STEMI. New-onset LBBB is a STEMI equivalent but is not the most
indicative finding. ST depression suggests ischemia or NSTEMI. T-wave inversion is
non-specific and can be normal or indicate strain.
Question 2
A patient on mechanical ventilation suddenly develops high-pressure alarms. The ACNP
notes absent breath sounds on the left side and a shift of the trachea to the right. The
patient is now diaphoretic and hypoxic. What is the most likely cause?
A. Right mainstem intubation
B. Tension pneumothorax
C. Pulmonary embolism
D. Mucus plug
Correct Answer: B. Tension pneumothorax
Rationale: Tension pneumothorax presents with sudden hypoxia, hypotension
(diaphoresis indicates hemodynamic instability), absent breath sounds on the affected
side, and tracheal deviation to the opposite side. This is a medical emergency requiring
immediate needle decompression or chest tube insertion.
pg. 1
,Question 3
A patient is readmitted due to a suspected pulmonary embolus. Home medications
include metformin (Glucophage). Which diagnostic method would be indicated?
A. V/Q scan
B. Spiral CT
C. Pulmonary angiogram
D. Venous doppler study
Correct Answer: A. V/Q scan
Rationale: Spiral CT requires IV contrast, which is relatively contraindicated in
patients on metformin due to the risk of metformin-induced lactic acidosis and acute
kidney injury. A V/Q scan is a viable alternative that does not require IV contrast in this
high-risk patient.
Question 4
A 75-year-old COPD patient is being weaned from mechanical ventilation. The ACNP
should consider that elderly patients:
A. Have greater respiratory reserve than younger patients
B. Have equivalent PaO2/FiO2 ratios compared to younger patients
C. Tend to breathe faster and shallower than younger patients
D. Tend to have a lower A-a gradient compared to younger patients
Correct Answer: C. Tend to breathe faster and shallower than younger patients
Rationale: Due to age-related changes in lung mechanics (decreased chest wall
compliance, increased residual volume), elderly patients often adopt a rapid, shallow
breathing pattern. They have decreased respiratory reserve, and their A-a gradient
typically increases with age.
Question 5
Following a 10-foot fall, a patient has a dilated, unresponsive left pupil and rapidly
deteriorating consciousness after a lucid interval. The ACNP should FIRST suspect:
A. Basilar skull fracture
B. Subdural hematoma
C. Epidural hematoma
D. Cerebellar herniation
Correct Answer: C. Epidural hematoma
pg. 2
,Rationale: Epidural hematomas often present with a classic "lucid interval" followed
by rapid neurological decline. The blown pupil indicates uncal herniation. Subdural
hematomas usually have a more gradual decline.
Question 6
During discharge following knee replacement surgery, a patient experiences chest pain
lasting 10 minutes. Cardiac biomarkers and ECG are unremarkable. The patient is pain-
free and anxious to go home. The ACNP should:
A. Discharge the patient with PCP follow-up
B. Hold discharge and repeat cardiac biomarkers in 8 hours
C. Discharge with cardiology follow-up appointment
D. Hold discharge and schedule emergent cardiac catheterization
Correct Answer: B. Hold discharge and repeat cardiac biomarkers in 8 hours
Rationale: New chest pain post-operatively requires a thorough rule-out for ACS.
Biomarkers can take several hours to rise. Patient anxiety or a normal initial ECG does
not rule out ACS.
Question 7
Concerns are raised about increasing blood product utilization. The ACNP is asked to
participate in an inter-professional team. Upon agreeing to participate, the ACNP
should first:
A. Verify the meeting schedule aligns with availability
B. Ensure suggestions will be adopted
C. Identify the goals assigned to the team
D. Find out who else will be participating
Correct Answer: C. Identify the goals assigned to the team
Rationale: Before effective participation, the ACNP must first understand the charge
of the team and its specific goals. This allows for focused contribution and alignment of
efforts with the project's objectives.
Question 8
A patient with ESRD on hemodialysis is admitted with fever and altered mental status.
Blood pressure is 88/54 mmHg. What is the priority intervention?
pg. 3
, A. Obtain blood cultures
B. Administer broad-spectrum antibiotics
C. Administer a fluid bolus
D. Start vasopressors
Correct Answer: C. Administer a fluid bolus
Rationale: This patient is in septic shock. Sepsis guidelines prioritize fluid
resuscitation BEFORE or simultaneously with antibiotics in hypotension. Administering
30 mL/kg of crystalloids is first-line.
Question 9
An elderly patient with COPD and pneumonia develops worsening respiratory distress,
becomes confused, and cannot protect the airway. The most appropriate next step is:
A. Initiate BiPAP
B. Administer high-flow nasal cannula
C. Perform endotracheal intubation
D. Increase oxygen delivery rate
Correct Answer: C. Perform endotracheal intubation
Rationale: Endotracheal intubation is indicated when a patient cannot protect their
airway (confusion, deteriorating mental status) or when ventilatory failure is imminent.
Non-invasive ventilation (BiPAP) is not appropriate if the patient cannot protect their
airway.
Question 10
Which of the following is a valid competency of the Adult-Gerontology Acute Care Nurse
Practitioner?
A. Provides primary care to pediatric patients
B. Manages complex acute, critical, and chronically ill adult patients
C. Practices independently only in outpatient settings
D. Performs surgical procedures independently
Correct Answer: B. Manages complex acute, critical, and chronically ill adult patients
Rationale: The AGACNP manages complex acute, critical, and chronically ill adult and
older adult patients at risk for urgent and emergent conditions, using both
physiologically and technologically derived data. AGACNPs do not care for pediatric
patients.
pg. 4
