AGACNP-BC BOARD EXAM PREPARATION
2026 Original Practice Questions, Answers
& Rationales Adult-Gerontology Acute Care
Nurse Practitioner Review
SECTION I — CORE COMPETENCIES
Question 1 — Hemodynamics
A 78-year-old patient with several days of vomiting and diarrhea presents with
tachycardia, hypotension, dry mucous membranes, and oliguria. Which
mechanism best explains the hypotension?
A. Increased intravascular volume
B. Reduced effective circulating volume
C. Increased plasma oncotic pressure
D. Increased systemic vascular resistance
Answer: B
Rationale: Gastrointestinal fluid losses reduce intravascular volume, decreasing
venous return and cardiac output and contributing to hypotension.
Difficulty: Easy | Topic: Cardiovascular physiology
Question 2 — Acid-Base
A patient has a pH of 7.25, PaCO₂ of 30 mm Hg, and HCO₃⁻ of 13 mEq/L. Which
primary disorder is present?
,A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: C
Rationale: The pH is acidemic and bicarbonate is decreased, indicating primary
metabolic acidosis. The reduced PaCO₂ represents respiratory compensation.
Difficulty: Easy | Topic: Acid-base interpretation
Question 3 — Electrolytes
A patient with a serum sodium of 118 mEq/L develops a generalized seizure.
Which complication is most concerning?
A. Cerebral edema and neurologic dysfunction
B. Increased bone mineralization
C. Hypercoagulability
D. Increased erythropoiesis
Answer: A
Rationale: Severe symptomatic hyponatremia can cause cerebral edema and
neurologic manifestations, including seizures.
Difficulty: Moderate | Topic: Electrolytes
Question 4 — Respiratory Physiology
A patient with chronic hypercapnia has a PaCO₂ of 60 mm Hg and an elevated
bicarbonate level. What does the elevated bicarbonate most likely represent?
A. Renal compensation
B. Acute respiratory alkalosis
,C. Primary metabolic acidosis
D. Laboratory error
Answer: A
Rationale: In chronic respiratory acidosis, the kidneys retain bicarbonate and
increase acid excretion to partially compensate for elevated PaCO₂.
Difficulty: Moderate | Topic: Acid-base physiology
Question 5 — Older Adult
Which finding most strongly distinguishes delirium from dementia?
A. Gradual memory loss over several years
B. Acute onset with fluctuating attention
C. Long-standing impaired executive function
D. Stable cognitive impairment
Answer: B
Rationale: Delirium is characterized by an acute change in attention and cognition
with a fluctuating course.
Difficulty: Easy | Topic: Geriatric assessment
Question 6 — Oxygen Delivery
A patient with severe anemia develops fatigue and exertional dyspnea. Which
physiologic change contributes most directly?
A. Increased hemoglobin concentration
B. Reduced arterial oxygen content
C. Increased pulmonary diffusion capacity
D. Increased plasma sodium
Answer: B
, Rationale: Hemoglobin carries most of the oxygen in arterial blood. Severe
anemia therefore reduces arterial oxygen content and tissue oxygen delivery.
Difficulty: Easy | Topic: Hematology
Question 7 — Fluid Balance
A patient with decompensated heart failure develops bilateral lower-extremity
edema. Which mechanism contributes to the edema?
A. Increased capillary hydrostatic pressure
B. Decreased venous pressure
C. Increased plasma oncotic pressure
D. Reduced interstitial fluid
Answer: A
Rationale: Increased venous and capillary hydrostatic pressures promote
movement of fluid into the interstitial space.
Difficulty: Easy | Topic: Cardiovascular physiology
Question 8 — Pharmacology
An older adult taking multiple medications develops dizziness and recurrent falls.
Which intervention should be prioritized?
A. Add another medication
B. Perform medication reconciliation
C. Stop all medications immediately
D. Assume symptoms are due to aging
Answer: B
Rationale: Medication reconciliation can identify duplications, interactions,
inappropriate medications, and adverse effects contributing to falls.
2026 Original Practice Questions, Answers
& Rationales Adult-Gerontology Acute Care
Nurse Practitioner Review
SECTION I — CORE COMPETENCIES
Question 1 — Hemodynamics
A 78-year-old patient with several days of vomiting and diarrhea presents with
tachycardia, hypotension, dry mucous membranes, and oliguria. Which
mechanism best explains the hypotension?
A. Increased intravascular volume
B. Reduced effective circulating volume
C. Increased plasma oncotic pressure
D. Increased systemic vascular resistance
Answer: B
Rationale: Gastrointestinal fluid losses reduce intravascular volume, decreasing
venous return and cardiac output and contributing to hypotension.
Difficulty: Easy | Topic: Cardiovascular physiology
Question 2 — Acid-Base
A patient has a pH of 7.25, PaCO₂ of 30 mm Hg, and HCO₃⁻ of 13 mEq/L. Which
primary disorder is present?
,A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: C
Rationale: The pH is acidemic and bicarbonate is decreased, indicating primary
metabolic acidosis. The reduced PaCO₂ represents respiratory compensation.
Difficulty: Easy | Topic: Acid-base interpretation
Question 3 — Electrolytes
A patient with a serum sodium of 118 mEq/L develops a generalized seizure.
Which complication is most concerning?
A. Cerebral edema and neurologic dysfunction
B. Increased bone mineralization
C. Hypercoagulability
D. Increased erythropoiesis
Answer: A
Rationale: Severe symptomatic hyponatremia can cause cerebral edema and
neurologic manifestations, including seizures.
Difficulty: Moderate | Topic: Electrolytes
Question 4 — Respiratory Physiology
A patient with chronic hypercapnia has a PaCO₂ of 60 mm Hg and an elevated
bicarbonate level. What does the elevated bicarbonate most likely represent?
A. Renal compensation
B. Acute respiratory alkalosis
,C. Primary metabolic acidosis
D. Laboratory error
Answer: A
Rationale: In chronic respiratory acidosis, the kidneys retain bicarbonate and
increase acid excretion to partially compensate for elevated PaCO₂.
Difficulty: Moderate | Topic: Acid-base physiology
Question 5 — Older Adult
Which finding most strongly distinguishes delirium from dementia?
A. Gradual memory loss over several years
B. Acute onset with fluctuating attention
C. Long-standing impaired executive function
D. Stable cognitive impairment
Answer: B
Rationale: Delirium is characterized by an acute change in attention and cognition
with a fluctuating course.
Difficulty: Easy | Topic: Geriatric assessment
Question 6 — Oxygen Delivery
A patient with severe anemia develops fatigue and exertional dyspnea. Which
physiologic change contributes most directly?
A. Increased hemoglobin concentration
B. Reduced arterial oxygen content
C. Increased pulmonary diffusion capacity
D. Increased plasma sodium
Answer: B
, Rationale: Hemoglobin carries most of the oxygen in arterial blood. Severe
anemia therefore reduces arterial oxygen content and tissue oxygen delivery.
Difficulty: Easy | Topic: Hematology
Question 7 — Fluid Balance
A patient with decompensated heart failure develops bilateral lower-extremity
edema. Which mechanism contributes to the edema?
A. Increased capillary hydrostatic pressure
B. Decreased venous pressure
C. Increased plasma oncotic pressure
D. Reduced interstitial fluid
Answer: A
Rationale: Increased venous and capillary hydrostatic pressures promote
movement of fluid into the interstitial space.
Difficulty: Easy | Topic: Cardiovascular physiology
Question 8 — Pharmacology
An older adult taking multiple medications develops dizziness and recurrent falls.
Which intervention should be prioritized?
A. Add another medication
B. Perform medication reconciliation
C. Stop all medications immediately
D. Assume symptoms are due to aging
Answer: B
Rationale: Medication reconciliation can identify duplications, interactions,
inappropriate medications, and adverse effects contributing to falls.
