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ADULT-GERONTOLOGY ACUTE CARE NURSE
PRACTITIONER CERTIFICATION (AGACNP-
BC®) 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
|RATED A+ |HIGHLY RECOMMENDED BY
EXPERTS |NEW AND REVISED|INSTANT
DOWNLOAD
1. A 72-year-old male with a history of hypertension and type 2
diabetes mellitus presents to the emergency department with acute
onset of severe, tearing chest pain that radiates to his back. His
blood pressure is 180/110 mmHg in the right arm and 140/90 mmHg
in the left arm. Which of the following is the most appropriate initial
diagnostic study?
A. Transthoracic echocardiogram
B. Computed tomography angiography (CTA) of the chest
C. 12-lead electrocardiogram
D. Chest X-ray
Rationale: The presentation of acute, severe tearing chest pain
radiating to the back with a significant blood pressure differential
between arms is classic for acute aortic dissection. CTA of the chest is
the gold standard for rapid diagnosis and should be obtained
emergently. While an ECG and CXR are important, they are not
diagnostic for dissection. A TTE may be useful but is less sensitive
than CTA in this context.
2. A 65-year-old female with a history of chronic obstructive
pulmonary disease (COPD) is admitted with pneumonia. Her
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arterial blood gas (ABG) on room air reveals pH 7.31, PaCO₂ 65
mmHg, PaO₂ 55 mmHg, and HCO₃ 31 mEq/L. What is the
interpretation of this ABG?
A. Acute respiratory acidosis with metabolic alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Acute respiratory acidosis without compensation
Rationale: The pH is low (7.31) indicating acidosis. The PaCO₂ is
elevated (65 mmHg) indicating a respiratory etiology. The HCO₃ is
elevated (31 mEq/L) above normal, suggesting metabolic
compensation. Since the pH remains abnormal, this is a partially
compensated respiratory acidosis, not fully compensated (where pH
would return to normal). Acute respiratory acidosis without
compensation would show a normal HCO₃.
3. A 58-year-old man with end-stage renal disease (ESRD) on
hemodialysis presents with confusion, muscle twitching, and nausea.
His serum potassium is 6.8 mEq/L. Which of the following is the
most immediate intervention?
A. Oral sodium polystyrene sulfonate (Kayexalate)
B. Intravenous insulin with dextrose
C. Intravenous calcium gluconate
D. Emergent hemodialysis
Rationale: While all options are treatments for hyperkalemia, the
priority in a patient with ESRD and severe hyperkalemia (K > 6.5
mEq/L) with neurological symptoms is emergent hemodialysis to
rapidly remove potassium. Calcium gluconate stabilizes the
myocardium, insulin drives potassium into cells, and Kayexalate is
slower. However, definitive treatment is dialysis. In the acute setting,
calcium gluconate would be given first to protect the heart, followed by
insulin and then dialysis. The question asks for the "most immediate
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intervention" to lower potassium, which is hemodialysis in this
context.
4. A 70-year-old patient is post-operative day 2 following a coronary
artery bypass graft (CABG). He develops acute shortness of breath,
tachycardia, and hypotension. A bedside echocardiogram reveals a
large pericardial effusion with signs of cardiac tamponade. What is
the priority nursing and medical intervention?
A. Administer intravenous fluids
B. Prepare for emergent pericardiocentesis
C. Administer dobutamine
D. Increase the rate of the dopamine infusion
Rationale: Cardiac tamponade is a life-threatening condition where
fluid accumulation in the pericardial sac compresses the heart,
impairing filling and causing obstructive shock. The definitive
treatment is emergent pericardiocentesis to drain the fluid. While
fluids and inotropes may be temporizing measures, they do not address
the underlying mechanical obstruction.
5. Which of the following findings is most indicative of a systemic
inflammatory response syndrome (SIRS) in a patient without an
identified infection?
A. Heart rate 88 bpm
B. Respiratory rate 18 breaths/min
C. Temperature 38.5°C (101.3°F)
D. White blood cell count 8,000 cells/mm³
Rationale: SIRS is defined as two or more of the following:
temperature > 38°C or < 36°C, heart rate > 90 bpm, respiratory rate >
20 breaths/min or PaCO₂ < 32 mmHg, and WBC > 12,000 or < 4,000
cells/mm³ or > 10% bands. A temperature of 38.5°C meets one of the
criteria. The other values listed are within normal limits.
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6. A 78-year-old female with a history of atrial fibrillation on
warfarin presents with a sudden, severe headache and right-sided
weakness. Her INR is 4.5. A non-contrast head CT shows a large
left-sided intraparenchymal hemorrhage. Which of the following is
the most appropriate immediate management step?
A. Administer vitamin K 10 mg IV
B. Administer fresh frozen plasma (FFP)
C. Administer prothrombin complex concentrate (PCC)
D. Hold warfarin and monitor closely
Rationale: In a patient with a life-threatening intracranial
hemorrhage on warfarin, the most rapid and effective reversal agent is
prothrombin complex concentrate (PCC). FFP is a slower alternative.
Vitamin K takes hours to work and is not sufficient alone in an
emergency. Holding warfarin alone is inadequate.
7. A 62-year-old male with a history of liver cirrhosis is admitted
with altered mental status, asterixis, and fetor hepaticus. His
ammonia level is 120 µmol/L. What is the primary
pathophysiological mechanism contributing to his condition?
A. Accumulation of bilirubin in the brain
B. Impaired hepatic urea cycle leading to increased circulating
ammonia
C. Decreased renal excretion of glutamine
D. Increased production of ammonia by skeletal muscle
Rationale: Hepatic encephalopathy in cirrhosis is primarily due to the
liver's inability to convert ammonia to urea via the urea cycle. This
leads to increased circulating ammonia, which crosses the blood-brain
barrier and causes neurotoxicity, leading to altered mental status,
asterixis, and other neurological symptoms.
8. A 45-year-old female with a history of systemic lupus
erythematosus (SLE) presents with acute onset of pleuritic chest
ADULT-GERONTOLOGY ACUTE CARE NURSE
PRACTITIONER CERTIFICATION (AGACNP-
BC®) 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
|RATED A+ |HIGHLY RECOMMENDED BY
EXPERTS |NEW AND REVISED|INSTANT
DOWNLOAD
1. A 72-year-old male with a history of hypertension and type 2
diabetes mellitus presents to the emergency department with acute
onset of severe, tearing chest pain that radiates to his back. His
blood pressure is 180/110 mmHg in the right arm and 140/90 mmHg
in the left arm. Which of the following is the most appropriate initial
diagnostic study?
A. Transthoracic echocardiogram
B. Computed tomography angiography (CTA) of the chest
C. 12-lead electrocardiogram
D. Chest X-ray
Rationale: The presentation of acute, severe tearing chest pain
radiating to the back with a significant blood pressure differential
between arms is classic for acute aortic dissection. CTA of the chest is
the gold standard for rapid diagnosis and should be obtained
emergently. While an ECG and CXR are important, they are not
diagnostic for dissection. A TTE may be useful but is less sensitive
than CTA in this context.
2. A 65-year-old female with a history of chronic obstructive
pulmonary disease (COPD) is admitted with pneumonia. Her
,2|Page
arterial blood gas (ABG) on room air reveals pH 7.31, PaCO₂ 65
mmHg, PaO₂ 55 mmHg, and HCO₃ 31 mEq/L. What is the
interpretation of this ABG?
A. Acute respiratory acidosis with metabolic alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Acute respiratory acidosis without compensation
Rationale: The pH is low (7.31) indicating acidosis. The PaCO₂ is
elevated (65 mmHg) indicating a respiratory etiology. The HCO₃ is
elevated (31 mEq/L) above normal, suggesting metabolic
compensation. Since the pH remains abnormal, this is a partially
compensated respiratory acidosis, not fully compensated (where pH
would return to normal). Acute respiratory acidosis without
compensation would show a normal HCO₃.
3. A 58-year-old man with end-stage renal disease (ESRD) on
hemodialysis presents with confusion, muscle twitching, and nausea.
His serum potassium is 6.8 mEq/L. Which of the following is the
most immediate intervention?
A. Oral sodium polystyrene sulfonate (Kayexalate)
B. Intravenous insulin with dextrose
C. Intravenous calcium gluconate
D. Emergent hemodialysis
Rationale: While all options are treatments for hyperkalemia, the
priority in a patient with ESRD and severe hyperkalemia (K > 6.5
mEq/L) with neurological symptoms is emergent hemodialysis to
rapidly remove potassium. Calcium gluconate stabilizes the
myocardium, insulin drives potassium into cells, and Kayexalate is
slower. However, definitive treatment is dialysis. In the acute setting,
calcium gluconate would be given first to protect the heart, followed by
insulin and then dialysis. The question asks for the "most immediate
,3|Page
intervention" to lower potassium, which is hemodialysis in this
context.
4. A 70-year-old patient is post-operative day 2 following a coronary
artery bypass graft (CABG). He develops acute shortness of breath,
tachycardia, and hypotension. A bedside echocardiogram reveals a
large pericardial effusion with signs of cardiac tamponade. What is
the priority nursing and medical intervention?
A. Administer intravenous fluids
B. Prepare for emergent pericardiocentesis
C. Administer dobutamine
D. Increase the rate of the dopamine infusion
Rationale: Cardiac tamponade is a life-threatening condition where
fluid accumulation in the pericardial sac compresses the heart,
impairing filling and causing obstructive shock. The definitive
treatment is emergent pericardiocentesis to drain the fluid. While
fluids and inotropes may be temporizing measures, they do not address
the underlying mechanical obstruction.
5. Which of the following findings is most indicative of a systemic
inflammatory response syndrome (SIRS) in a patient without an
identified infection?
A. Heart rate 88 bpm
B. Respiratory rate 18 breaths/min
C. Temperature 38.5°C (101.3°F)
D. White blood cell count 8,000 cells/mm³
Rationale: SIRS is defined as two or more of the following:
temperature > 38°C or < 36°C, heart rate > 90 bpm, respiratory rate >
20 breaths/min or PaCO₂ < 32 mmHg, and WBC > 12,000 or < 4,000
cells/mm³ or > 10% bands. A temperature of 38.5°C meets one of the
criteria. The other values listed are within normal limits.
, 4|Page
6. A 78-year-old female with a history of atrial fibrillation on
warfarin presents with a sudden, severe headache and right-sided
weakness. Her INR is 4.5. A non-contrast head CT shows a large
left-sided intraparenchymal hemorrhage. Which of the following is
the most appropriate immediate management step?
A. Administer vitamin K 10 mg IV
B. Administer fresh frozen plasma (FFP)
C. Administer prothrombin complex concentrate (PCC)
D. Hold warfarin and monitor closely
Rationale: In a patient with a life-threatening intracranial
hemorrhage on warfarin, the most rapid and effective reversal agent is
prothrombin complex concentrate (PCC). FFP is a slower alternative.
Vitamin K takes hours to work and is not sufficient alone in an
emergency. Holding warfarin alone is inadequate.
7. A 62-year-old male with a history of liver cirrhosis is admitted
with altered mental status, asterixis, and fetor hepaticus. His
ammonia level is 120 µmol/L. What is the primary
pathophysiological mechanism contributing to his condition?
A. Accumulation of bilirubin in the brain
B. Impaired hepatic urea cycle leading to increased circulating
ammonia
C. Decreased renal excretion of glutamine
D. Increased production of ammonia by skeletal muscle
Rationale: Hepatic encephalopathy in cirrhosis is primarily due to the
liver's inability to convert ammonia to urea via the urea cycle. This
leads to increased circulating ammonia, which crosses the blood-brain
barrier and causes neurotoxicity, leading to altered mental status,
asterixis, and other neurological symptoms.
8. A 45-year-old female with a history of systemic lupus
erythematosus (SLE) presents with acute onset of pleuritic chest
