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# ANCC AGACNP BOARD EXAM MASTERY
## ADULT-GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER (AGACNP-BC®)
### 2026-2027 EDITION | 250+ QUESTIONS
WITH DETAILED RATIONALES
# Table Of Contents
| Section | Domain/Content Area | Questions | Page |
|---------|---------------------|-----------|------|
| **Domain 1** | **Core Competencies** | 1-30 | 1 |
| **Domain 2** | **Clinical Practice** | 31-100 | 8 |
| **Domain 3** | **Professional Role** | 101-130 | 19 |
| **Domain 4** | **Cardiovascular** | 131-160 | 24 |
| **Domain 5** | **Pulmonary & Critical Care** | 161-190 | 29 |
| **Domain 6** | **Renal/Genitourinary & Endocrine** | 191-215 | 34 |
| **Domain 7** | **Neurology & Multisystem** | 216-240 | 38 |
| **Domain 8** | **Psychosocial/Behavioral & Professional Issues** | 241-250 |
42 |
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# DOMAIN 1: CORE COMPETENCIES
### Question 1
An AGACNP is evaluating a 72-year-old patient with new-onset confusion, fever,
and tachycardia. The patient's family reports the patient has been "just not acting
right" for 2 days. What is the MOST appropriate initial action?
A) Order a stat head CT to rule out stroke
B) Perform a comprehensive history and physical examination focusing on
infectious and metabolic causes
C) Consult psychiatry for possible acute psychosis
D) Start empiric broad-spectrum antibiotics immediately
**Correct Answer: B**
**Rationale:** In an older adult with acute confusion, the AGACNP must
prioritize a systematic evaluation for underlying causes. The most common cause
of acute confusion in older adults is delirium, often triggered by infection,
metabolic derangement, or medication effects. A comprehensive history and
physical examination should guide diagnostic testing and treatment decisions.
**Incorrect Answers:**
- **A. Order a stat head CT** – While stroke must be considered, a CT is not the
initial step without specific neurologic deficits. The history of fever suggests an
infectious etiology.
- **C. Consult psychiatry** – Psychiatry consultation may be needed, but the
underlying medical cause must be evaluated first.
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- **D. Start empiric broad-spectrum antibiotics** – Empiric antibiotics without a
thorough evaluation are inappropriate. The source of infection must be identified
first.
---
### Question 2
According to the AACN ACNPC-AG test plan, which of the following domains
represents the highest percentage of exam questions?
A) Professional Caring and Ethical Practice
B) Clinical Judgment
C) Core Competencies
D) Health Promotion and Disease Prevention
**Correct Answer: B**
**Rationale:** Clinical Judgment accounts for **80%** of the AACN ACNPC-
AG exam content. This includes assessment, diagnosis, planning, implementation,
and evaluation of care for adult-gerontology patients with acute, critical, and
complex chronic conditions. Professional Caring and Ethical Practice accounts for
the remaining 20%.
**Incorrect Answers:**
- **A. Professional Caring and Ethical Practice** – This is 20%, not the highest
percentage.
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- **C. Core Competencies** – This is an ANCC domain, accounting for 24% of
that exam.
- **D. Health Promotion and Disease Prevention** – This is included within
Clinical Judgment but is not a separate domain with the highest percentage.
---
### Question 3
An AGACNP is managing a 68-year-old patient with sepsis. Which laboratory
finding is MOST consistent with septic shock?
A) Serum lactate 1.2 mmol/L
B) Serum lactate 4.5 mmol/L
C) White blood cell count 6,000/mm³
D) Procalcitonin 0.1 ng/mL
**Correct Answer: B**
**Rationale:** An elevated serum lactate (>2 mmol/L) in the setting of sepsis
indicates tissue hypoperfusion and is a key criterion for septic shock. Septic shock
is defined as sepsis with persistent hypotension requiring vasopressors AND a
serum lactate >2 mmol/L despite adequate fluid resuscitation.
**Incorrect Answers:**
- **A. Serum lactate 1.2 mmol/L** – This is a normal lactate level and does not
indicate septic shock.
# ANCC AGACNP BOARD EXAM MASTERY
## ADULT-GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER (AGACNP-BC®)
### 2026-2027 EDITION | 250+ QUESTIONS
WITH DETAILED RATIONALES
# Table Of Contents
| Section | Domain/Content Area | Questions | Page |
|---------|---------------------|-----------|------|
| **Domain 1** | **Core Competencies** | 1-30 | 1 |
| **Domain 2** | **Clinical Practice** | 31-100 | 8 |
| **Domain 3** | **Professional Role** | 101-130 | 19 |
| **Domain 4** | **Cardiovascular** | 131-160 | 24 |
| **Domain 5** | **Pulmonary & Critical Care** | 161-190 | 29 |
| **Domain 6** | **Renal/Genitourinary & Endocrine** | 191-215 | 34 |
| **Domain 7** | **Neurology & Multisystem** | 216-240 | 38 |
| **Domain 8** | **Psychosocial/Behavioral & Professional Issues** | 241-250 |
42 |
,2|Page
# DOMAIN 1: CORE COMPETENCIES
### Question 1
An AGACNP is evaluating a 72-year-old patient with new-onset confusion, fever,
and tachycardia. The patient's family reports the patient has been "just not acting
right" for 2 days. What is the MOST appropriate initial action?
A) Order a stat head CT to rule out stroke
B) Perform a comprehensive history and physical examination focusing on
infectious and metabolic causes
C) Consult psychiatry for possible acute psychosis
D) Start empiric broad-spectrum antibiotics immediately
**Correct Answer: B**
**Rationale:** In an older adult with acute confusion, the AGACNP must
prioritize a systematic evaluation for underlying causes. The most common cause
of acute confusion in older adults is delirium, often triggered by infection,
metabolic derangement, or medication effects. A comprehensive history and
physical examination should guide diagnostic testing and treatment decisions.
**Incorrect Answers:**
- **A. Order a stat head CT** – While stroke must be considered, a CT is not the
initial step without specific neurologic deficits. The history of fever suggests an
infectious etiology.
- **C. Consult psychiatry** – Psychiatry consultation may be needed, but the
underlying medical cause must be evaluated first.
,3|Page
- **D. Start empiric broad-spectrum antibiotics** – Empiric antibiotics without a
thorough evaluation are inappropriate. The source of infection must be identified
first.
---
### Question 2
According to the AACN ACNPC-AG test plan, which of the following domains
represents the highest percentage of exam questions?
A) Professional Caring and Ethical Practice
B) Clinical Judgment
C) Core Competencies
D) Health Promotion and Disease Prevention
**Correct Answer: B**
**Rationale:** Clinical Judgment accounts for **80%** of the AACN ACNPC-
AG exam content. This includes assessment, diagnosis, planning, implementation,
and evaluation of care for adult-gerontology patients with acute, critical, and
complex chronic conditions. Professional Caring and Ethical Practice accounts for
the remaining 20%.
**Incorrect Answers:**
- **A. Professional Caring and Ethical Practice** – This is 20%, not the highest
percentage.
, 4|Page
- **C. Core Competencies** – This is an ANCC domain, accounting for 24% of
that exam.
- **D. Health Promotion and Disease Prevention** – This is included within
Clinical Judgment but is not a separate domain with the highest percentage.
---
### Question 3
An AGACNP is managing a 68-year-old patient with sepsis. Which laboratory
finding is MOST consistent with septic shock?
A) Serum lactate 1.2 mmol/L
B) Serum lactate 4.5 mmol/L
C) White blood cell count 6,000/mm³
D) Procalcitonin 0.1 ng/mL
**Correct Answer: B**
**Rationale:** An elevated serum lactate (>2 mmol/L) in the setting of sepsis
indicates tissue hypoperfusion and is a key criterion for septic shock. Septic shock
is defined as sepsis with persistent hypotension requiring vasopressors AND a
serum lactate >2 mmol/L despite adequate fluid resuscitation.
**Incorrect Answers:**
- **A. Serum lactate 1.2 mmol/L** – This is a normal lactate level and does not
indicate septic shock.
