ANCC AGACNP Certification Exam – 2026/2027 Edition
Practice Questions with Answers and Detailed Rationales |
Graded A+
EXAM OVERVIEW
The ANCC Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) board
certification exam is an entry-level competency evaluation for APRNs seeking
AGACNP-BC credentialing . The exam consists of 175 questions (150 scored, 25
pretest) with a 3.5-hour time limit . The content is distributed across three
domains :
Domain Weigh
Core Competencies (Advanced Health Assessment, Pathophysiology,
24%
Pharmacology)
Clinical Practice (Diagnostic Reasoning, Acute Disease Management) 43%
Professional Role (Ethics, Healthcare Policy, Billing, Quality Improvement) 33%
A passing score requires a scaled score of 350 . The exam integrates current
guidelines including ACC/AHA, ADA, GINA, and GOLD standards .
,SECTION 1: CORE COMPETENCIES – PATHOPHYSIOLOGY & PHARMACOLOGY
Questions 1-50
Q1. A 72-year-old patient presents with acute confusion, fever, and tachycardia.
The family reports the patient has been increasingly confused over the past 24
hours. Which of the following is the priority assessment?
A) Complete neurological examination
B) Urinalysis and urine culture
C) Head CT scan
D) Serum glucose level
Answer: B) Urinalysis and urine culture
Rationale: In older adults, acute confusion (delirium) is often the primary
manifestation of a urinary tract infection, particularly in the absence of classic
urinary symptoms. Fever and tachycardia support an infectious etiology.
Urinalysis and culture should be obtained promptly. Immunosenescence blunts
classic febrile responses in the elderly, making non-specific symptoms like
confusion the primary clue to infection. Head CT (C) is not the first step unless
there is a focal neurological deficit or history of trauma.
Q2. A 65-year-old patient with COPD requires initial pharmacotherapy for Group
E (high exacerbation risk). According to the 2025 GOLD guidelines, which
regimen is most appropriate?
A) SABA monotherapy
B) LAMA monotherapy
C) LABA + ICS
D) LABA + LAMA
Answer: D) LABA + LAMA
Rationale: The 2025 GOLD guidelines recommend LABA + LAMA as the initial
therapy for Group E COPD (high exacerbation risk). Dual long-acting
bronchodilation maximizes exacerbation prevention. ICS is reserved for patients
,with eosinophil counts >300 cells/µL to avoid pneumonia risk. SABA monotherapy
(A) is for reliever use, not maintenance. LAMA monotherapy (B) is inadequate for
high-risk patients. LABA + ICS (C) is no longer encouraged unless eosinophils are
markedly elevated.
Q3. A patient with asthma is being evaluated for initial therapy. Which of the
following represents the current GINA 2026 standard for pharmacological
management?
A) SABA as the sole reliever medication
B) ICS-formoterol as the reliever therapy
C) LTRA monotherapy
D) LAMA as first-line therapy
Answer: B) ICS-formoterol as the reliever therapy
Rationale: GINA 2026 abolishes SABA-only therapy for asthma. All reliever
medications must contain an anti-inflammatory component. ICS-formoterol is the
recommended reliever therapy. SABA monotherapy is considered dangerous due
to increased mortality risk. ICS-containing medication is the absolute minimum
pharmacological requirement for any patient diagnosed with asthma. LTRA (C) is
clinically inferior to ICS therapy for baseline inflammation.
Q4. A patient is receiving IV antibiotics for septic shock. Which finding indicates
the need for additional fluid resuscitation?
A) Mean arterial pressure (MAP) 72 mmHg
B) Central venous pressure 10 mmHg
C) Urine output 25 mL/hr over 2 hours
D) Heart rate 88 bpm
Answer: C) Urine output 25 mL/hr over 2 hours
Rationale: Urine output <30 mL/hr indicates inadequate renal perfusion and is a
key indicator of the need for additional fluid resuscitation in septic shock. MAP
<65 mmHg (A) would also require intervention, but 72 mmHg is adequate. CVP (B)
, and heart rate (D) are less specific indicators. The Sepsis Hour-1 Bundle mandates
immediate fluid resuscitation and broad-spectrum antibiotics.
Q5. A 70-year-old patient has a serum sodium of 125 mEq/L and an elevated
urine sodium (>20 mEq/L). Which condition is the most likely cause?
A) Heart failure
B) Cirrhosis
C) Diuretic use
D) SIADH
Answer: C) Diuretic use
Rationale: Hypovolemic hyponatremia with urine Na >20 mEq/L is caused by
diuretics, ACE inhibitors, or mineralocorticoid deficiency. Heart failure (A) and
cirrhosis (B) cause hypervolemic hyponatremia (urine Na <20). SIADH (D) causes
euvolemic hyponatremia.
Q6. A patient presents with a sharp, pleuritic chest pain that improves with
sitting forward. ECG shows widespread ST-segment elevation. Which diagnosis
is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Pericarditis
D) Aortic dissection
Answer: C) Pericarditis
Rationale: Pericarditis is characterized by sharp, pleuritic chest pain that improves
with leaning forward or sitting upright. ECG findings include widespread ST-
segment elevation and PR depression. A pericardial friction rub may also be
present. Acute MI (A) typically shows localized ST elevation with reciprocal
changes. Pulmonary embolism (B) presents with tachycardia, hypoxia, and
pleuritic pain.
Practice Questions with Answers and Detailed Rationales |
Graded A+
EXAM OVERVIEW
The ANCC Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) board
certification exam is an entry-level competency evaluation for APRNs seeking
AGACNP-BC credentialing . The exam consists of 175 questions (150 scored, 25
pretest) with a 3.5-hour time limit . The content is distributed across three
domains :
Domain Weigh
Core Competencies (Advanced Health Assessment, Pathophysiology,
24%
Pharmacology)
Clinical Practice (Diagnostic Reasoning, Acute Disease Management) 43%
Professional Role (Ethics, Healthcare Policy, Billing, Quality Improvement) 33%
A passing score requires a scaled score of 350 . The exam integrates current
guidelines including ACC/AHA, ADA, GINA, and GOLD standards .
,SECTION 1: CORE COMPETENCIES – PATHOPHYSIOLOGY & PHARMACOLOGY
Questions 1-50
Q1. A 72-year-old patient presents with acute confusion, fever, and tachycardia.
The family reports the patient has been increasingly confused over the past 24
hours. Which of the following is the priority assessment?
A) Complete neurological examination
B) Urinalysis and urine culture
C) Head CT scan
D) Serum glucose level
Answer: B) Urinalysis and urine culture
Rationale: In older adults, acute confusion (delirium) is often the primary
manifestation of a urinary tract infection, particularly in the absence of classic
urinary symptoms. Fever and tachycardia support an infectious etiology.
Urinalysis and culture should be obtained promptly. Immunosenescence blunts
classic febrile responses in the elderly, making non-specific symptoms like
confusion the primary clue to infection. Head CT (C) is not the first step unless
there is a focal neurological deficit or history of trauma.
Q2. A 65-year-old patient with COPD requires initial pharmacotherapy for Group
E (high exacerbation risk). According to the 2025 GOLD guidelines, which
regimen is most appropriate?
A) SABA monotherapy
B) LAMA monotherapy
C) LABA + ICS
D) LABA + LAMA
Answer: D) LABA + LAMA
Rationale: The 2025 GOLD guidelines recommend LABA + LAMA as the initial
therapy for Group E COPD (high exacerbation risk). Dual long-acting
bronchodilation maximizes exacerbation prevention. ICS is reserved for patients
,with eosinophil counts >300 cells/µL to avoid pneumonia risk. SABA monotherapy
(A) is for reliever use, not maintenance. LAMA monotherapy (B) is inadequate for
high-risk patients. LABA + ICS (C) is no longer encouraged unless eosinophils are
markedly elevated.
Q3. A patient with asthma is being evaluated for initial therapy. Which of the
following represents the current GINA 2026 standard for pharmacological
management?
A) SABA as the sole reliever medication
B) ICS-formoterol as the reliever therapy
C) LTRA monotherapy
D) LAMA as first-line therapy
Answer: B) ICS-formoterol as the reliever therapy
Rationale: GINA 2026 abolishes SABA-only therapy for asthma. All reliever
medications must contain an anti-inflammatory component. ICS-formoterol is the
recommended reliever therapy. SABA monotherapy is considered dangerous due
to increased mortality risk. ICS-containing medication is the absolute minimum
pharmacological requirement for any patient diagnosed with asthma. LTRA (C) is
clinically inferior to ICS therapy for baseline inflammation.
Q4. A patient is receiving IV antibiotics for septic shock. Which finding indicates
the need for additional fluid resuscitation?
A) Mean arterial pressure (MAP) 72 mmHg
B) Central venous pressure 10 mmHg
C) Urine output 25 mL/hr over 2 hours
D) Heart rate 88 bpm
Answer: C) Urine output 25 mL/hr over 2 hours
Rationale: Urine output <30 mL/hr indicates inadequate renal perfusion and is a
key indicator of the need for additional fluid resuscitation in septic shock. MAP
<65 mmHg (A) would also require intervention, but 72 mmHg is adequate. CVP (B)
, and heart rate (D) are less specific indicators. The Sepsis Hour-1 Bundle mandates
immediate fluid resuscitation and broad-spectrum antibiotics.
Q5. A 70-year-old patient has a serum sodium of 125 mEq/L and an elevated
urine sodium (>20 mEq/L). Which condition is the most likely cause?
A) Heart failure
B) Cirrhosis
C) Diuretic use
D) SIADH
Answer: C) Diuretic use
Rationale: Hypovolemic hyponatremia with urine Na >20 mEq/L is caused by
diuretics, ACE inhibitors, or mineralocorticoid deficiency. Heart failure (A) and
cirrhosis (B) cause hypervolemic hyponatremia (urine Na <20). SIADH (D) causes
euvolemic hyponatremia.
Q6. A patient presents with a sharp, pleuritic chest pain that improves with
sitting forward. ECG shows widespread ST-segment elevation. Which diagnosis
is most likely?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Pericarditis
D) Aortic dissection
Answer: C) Pericarditis
Rationale: Pericarditis is characterized by sharp, pleuritic chest pain that improves
with leaning forward or sitting upright. ECG findings include widespread ST-
segment elevation and PR depression. A pericardial friction rub may also be
present. Acute MI (A) typically shows localized ST elevation with reciprocal
changes. Pulmonary embolism (B) presents with tachycardia, hypoxia, and
pleuritic pain.
