Adult-Gerontology Clinical Nurse Specialist
Certification (AGCNS-BC)EXAM NEWEST
COMPLETE QUESTIONS AND CORRECT
VERIFIED ANSWERS(DETAILED
ANSWERS)|ALREADY GRADED A+
Domain 1: Direct Care (Questions 1-40)
,1. A 72-year-old patient with a history of heart failure presents with increasing dyspnea, orthopnea, and bilateral
lower extremity edema. Which physical assessment finding is most consistent with a diagnosis of
decompensated heart failure?
a) Flat jugular veins
b) An S3 heart sound
c) A pleural friction rub
d) Hyperresonance on lung percussion
Answer: b) An S3 heart sound
Rationale: An S3 gallop is an early diastolic sound produced by rapid ventricular filling into a non-compliant,
volume-overloaded ventricle, a hallmark of decompensated heart failure. Flat jugular veins (a) suggest
hypovolemia. A pleural friction rub (c) is associated with pleuritis. Hyperresonance (d) suggests pneumothorax
or COPD.
2. The AG-CNS is developing a care plan for an 80-year-old patient with advanced dementia who is having
difficulty with oral intake. The family is struggling with the decision regarding a percutaneous endoscopic
gastrostomy (PEG) tube. What is the CNS's priority action?
a) Recommend the PEG tube to prevent aspiration.
b) Educate the family that PEG tubes in advanced dementia do not improve survival or prevent aspiration.
c) Defer the decision to the attending physician only.
,d) Start the patient on total parenteral nutrition (TPN).
Answer: b) Educate the family that PEG tubes in advanced dementia do not improve survival or prevent
aspiration.
Rationale: Evidence strongly indicates that PEG tube placement in advanced dementia does not reduce the risk
of aspiration pneumonia, improve functional status, or prolong life. The CNS's role is to provide evidence-based
information to guide shared decision-making. TPN (d) is not a long-term solution and carries significant risks.
3. An 85-year-old patient develops an acute confusional state post-operatively following a hip repair. The patient
is agitated and attempting to pull out their IV. What is the first-line nursing intervention?
a) Apply wrist restraints.
b) Administer IV haloperidol immediately.
c) Request a sitter and re-orient the patient frequently.
d) Insert a urinary catheter to prevent the need to get out of bed.
Answer: c) Request a sitter and re-orient the patient frequently.
Rationale: For delirium, non-pharmacological interventions are first-line. These include ensuring safety with a
sitter, frequent reorientation, maintaining a quiet environment, and mobilizing the patient as soon as possible.
Restraints (a) can increase agitation. Antipsychotics (b) are used only if the patient is a danger to self/others.
Unnecessary catheters (d) increase infection risk.
, 4. Which medication is most likely contributing to a functional decline characterized by falls, cognitive
impairment, and dry mouth in a 78-year-old?
a) Metformin
b) Diphenhydramine
c) Atorvastatin
d) Lisinopril
Answer: b) Diphenhydramine
Rationale: Diphenhydramine is a first-generation antihistamine with potent anticholinergic properties, which can
cause confusion, dry mouth, urinary retention, and increased fall risk in older adults. It is on the Beers Criteria list
of potentially inappropriate medications.
5. A patient with type 2 diabetes has an HbA1c of 7.8%. Based on the American Diabetes Association's goals for
many non-frail older adults, the AG-CNS should recommend which target?
a) <6.5%
b) <7.0%
c) <7.5%
d) <8.5%
Certification (AGCNS-BC)EXAM NEWEST
COMPLETE QUESTIONS AND CORRECT
VERIFIED ANSWERS(DETAILED
ANSWERS)|ALREADY GRADED A+
Domain 1: Direct Care (Questions 1-40)
,1. A 72-year-old patient with a history of heart failure presents with increasing dyspnea, orthopnea, and bilateral
lower extremity edema. Which physical assessment finding is most consistent with a diagnosis of
decompensated heart failure?
a) Flat jugular veins
b) An S3 heart sound
c) A pleural friction rub
d) Hyperresonance on lung percussion
Answer: b) An S3 heart sound
Rationale: An S3 gallop is an early diastolic sound produced by rapid ventricular filling into a non-compliant,
volume-overloaded ventricle, a hallmark of decompensated heart failure. Flat jugular veins (a) suggest
hypovolemia. A pleural friction rub (c) is associated with pleuritis. Hyperresonance (d) suggests pneumothorax
or COPD.
2. The AG-CNS is developing a care plan for an 80-year-old patient with advanced dementia who is having
difficulty with oral intake. The family is struggling with the decision regarding a percutaneous endoscopic
gastrostomy (PEG) tube. What is the CNS's priority action?
a) Recommend the PEG tube to prevent aspiration.
b) Educate the family that PEG tubes in advanced dementia do not improve survival or prevent aspiration.
c) Defer the decision to the attending physician only.
,d) Start the patient on total parenteral nutrition (TPN).
Answer: b) Educate the family that PEG tubes in advanced dementia do not improve survival or prevent
aspiration.
Rationale: Evidence strongly indicates that PEG tube placement in advanced dementia does not reduce the risk
of aspiration pneumonia, improve functional status, or prolong life. The CNS's role is to provide evidence-based
information to guide shared decision-making. TPN (d) is not a long-term solution and carries significant risks.
3. An 85-year-old patient develops an acute confusional state post-operatively following a hip repair. The patient
is agitated and attempting to pull out their IV. What is the first-line nursing intervention?
a) Apply wrist restraints.
b) Administer IV haloperidol immediately.
c) Request a sitter and re-orient the patient frequently.
d) Insert a urinary catheter to prevent the need to get out of bed.
Answer: c) Request a sitter and re-orient the patient frequently.
Rationale: For delirium, non-pharmacological interventions are first-line. These include ensuring safety with a
sitter, frequent reorientation, maintaining a quiet environment, and mobilizing the patient as soon as possible.
Restraints (a) can increase agitation. Antipsychotics (b) are used only if the patient is a danger to self/others.
Unnecessary catheters (d) increase infection risk.
, 4. Which medication is most likely contributing to a functional decline characterized by falls, cognitive
impairment, and dry mouth in a 78-year-old?
a) Metformin
b) Diphenhydramine
c) Atorvastatin
d) Lisinopril
Answer: b) Diphenhydramine
Rationale: Diphenhydramine is a first-generation antihistamine with potent anticholinergic properties, which can
cause confusion, dry mouth, urinary retention, and increased fall risk in older adults. It is on the Beers Criteria list
of potentially inappropriate medications.
5. A patient with type 2 diabetes has an HbA1c of 7.8%. Based on the American Diabetes Association's goals for
many non-frail older adults, the AG-CNS should recommend which target?
a) <6.5%
b) <7.0%
c) <7.5%
d) <8.5%
