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ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
CERTIFICATION (AGACNP-BC®) — 100-QUESTION
COMPREHENSIVE EXAMINATION WITH RATIONALES
Advanced Pathophysiology / Pharmacology / Clinical Management
Exam coverage :
✓ Core Competencies (Questions 1–24): Advanced
pathophysiology, pharmacology, and physical assessment,
including shock, acid-base, and medication management.
✓ Clinical Practice (Questions 25–76): Acute care
management across cardiovascular, pulmonary, neurologic,
renal, endocrine, and gastrointestinal systems.
✓ Professional Role (Questions 77–100): Scope of practice,
ethics, quality improvement, evidence-based practice, and
patient education.
Question 1: A 72-year-old patient with a history of heart failure
with reduced ejection fraction (HFrEF) presents with worsening
dyspnea, orthopnea, and a 5-pound weight gain over three days.
Vital signs are BP 148/92 mmHg, HR 112 beats/min, RR 24
breaths/min, and SpO₂ 89% on room air. Which
pathophysiological mechanism best explains the patient's
acute decompensation?
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A. Increased systemic vascular resistance leading to reduced
cardiac output
B. Fluid overload resulting from neurohormonal activation and
sodium retention
C. Acute myocardial infarction causing papillary muscle rupture
D. Pulmonary embolism increasing right ventricular afterload
CORRECT ANSWER: B
RATIONALE: In HFrEF, reduced cardiac output triggers
compensatory neurohormonal activation (RAAS and
sympathetic nervous system), leading to sodium and water
retention, which causes fluid overload and pulmonary
congestion. Option A describes a mechanism more consistent
with hypertensive emergency without fluid overload. Option C is
incorrect because acute myocardial infarction with papillary
muscle rupture would present with acute mitral regurgitation
and flash pulmonary edema, not gradual weight gain. Option D
is incorrect because pulmonary embolism typically presents
with sudden dyspnea, pleuritic chest pain, and hypoxemia
without weight gain.
Question 2: A 68-year-old patient is admitted to the ICU with
septic shock. After 30 mL/kg of crystalloid fluid resuscitation,
the patient remains hypotensive with a MAP of 58 mmHg. Which
vasopressor is the first-line agent of choice?
A. Dopamine
B. Norepinephrine
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C. Vasopressin
D. Phenylephrine
CORRECT ANSWER: B
RATIONALE: Norepinephrine is the first-line vasopressor for
septic shock due to its balanced alpha- and beta-adrenergic
effects, which increase systemic vascular resistance and
cardiac output while maintaining mesenteric perfusion. Option
A is incorrect because dopamine is associated with higher
arrhythmia risk and is no longer first-line. Option C is incorrect
because vasopressin is typically added as a second-line agent
to reduce norepinephrine requirements. Option D is incorrect
because phenylephrine is a pure alpha agonist that can reduce
cardiac output and is not first-line.
Question 3: A 75-year-old patient with a history of atrial
fibrillation on warfarin presents with an INR of 8.5 and no active
bleeding. Which is the most appropriate management?
A. Administer vitamin K 10 mg IV and fresh frozen plasma
B. Hold warfarin and administer oral vitamin K 2.5–5 mg
C. Continue warfarin and recheck INR in 24 hours
D. Administer protamine sulfate
CORRECT ANSWER: B
RATIONALE: For an INR of 8.5 without bleeding, guidelines
recommend holding warfarin and administering low-dose oral
vitamin K (2.5–5 mg) to reverse the anticoagulant effect
gradually. Option A is incorrect because IV vitamin K and FFP
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are reserved for major bleeding or urgent reversal. Option C is
incorrect because continuing warfarin with such a high INR risks
bleeding. Option D is incorrect because protamine sulfate
reverses heparin, not warfarin.
Question 4: A 70-year-old patient is intubated for acute
respiratory distress syndrome (ARDS). Which ventilator strategy
is most appropriate?
A. High tidal volume (12 mL/kg predicted body weight) with low
PEEP
B. Low tidal volume (6 mL/kg predicted body weight) with
appropriate PEEP
C. High tidal volume with high respiratory rate
D. Low PEEP and high tidal volume to maximize oxygenation
CORRECT ANSWER: B
RATIONALE: Lung-protective ventilation with low tidal volume
(6 mL/kg predicted body weight) and adequate PEEP reduces
mortality in ARDS by minimizing ventilator-induced lung injury.
Option A is incorrect because high tidal volumes cause
volutrauma. Option C is incorrect because high tidal volumes
are harmful regardless of respiratory rate. Option D is incorrect
because low PEEP can lead to atelectrauma.
ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER
CERTIFICATION (AGACNP-BC®) — 100-QUESTION
COMPREHENSIVE EXAMINATION WITH RATIONALES
Advanced Pathophysiology / Pharmacology / Clinical Management
Exam coverage :
✓ Core Competencies (Questions 1–24): Advanced
pathophysiology, pharmacology, and physical assessment,
including shock, acid-base, and medication management.
✓ Clinical Practice (Questions 25–76): Acute care
management across cardiovascular, pulmonary, neurologic,
renal, endocrine, and gastrointestinal systems.
✓ Professional Role (Questions 77–100): Scope of practice,
ethics, quality improvement, evidence-based practice, and
patient education.
Question 1: A 72-year-old patient with a history of heart failure
with reduced ejection fraction (HFrEF) presents with worsening
dyspnea, orthopnea, and a 5-pound weight gain over three days.
Vital signs are BP 148/92 mmHg, HR 112 beats/min, RR 24
breaths/min, and SpO₂ 89% on room air. Which
pathophysiological mechanism best explains the patient's
acute decompensation?
, Page 2 of 63
A. Increased systemic vascular resistance leading to reduced
cardiac output
B. Fluid overload resulting from neurohormonal activation and
sodium retention
C. Acute myocardial infarction causing papillary muscle rupture
D. Pulmonary embolism increasing right ventricular afterload
CORRECT ANSWER: B
RATIONALE: In HFrEF, reduced cardiac output triggers
compensatory neurohormonal activation (RAAS and
sympathetic nervous system), leading to sodium and water
retention, which causes fluid overload and pulmonary
congestion. Option A describes a mechanism more consistent
with hypertensive emergency without fluid overload. Option C is
incorrect because acute myocardial infarction with papillary
muscle rupture would present with acute mitral regurgitation
and flash pulmonary edema, not gradual weight gain. Option D
is incorrect because pulmonary embolism typically presents
with sudden dyspnea, pleuritic chest pain, and hypoxemia
without weight gain.
Question 2: A 68-year-old patient is admitted to the ICU with
septic shock. After 30 mL/kg of crystalloid fluid resuscitation,
the patient remains hypotensive with a MAP of 58 mmHg. Which
vasopressor is the first-line agent of choice?
A. Dopamine
B. Norepinephrine
, Page 3 of 63
C. Vasopressin
D. Phenylephrine
CORRECT ANSWER: B
RATIONALE: Norepinephrine is the first-line vasopressor for
septic shock due to its balanced alpha- and beta-adrenergic
effects, which increase systemic vascular resistance and
cardiac output while maintaining mesenteric perfusion. Option
A is incorrect because dopamine is associated with higher
arrhythmia risk and is no longer first-line. Option C is incorrect
because vasopressin is typically added as a second-line agent
to reduce norepinephrine requirements. Option D is incorrect
because phenylephrine is a pure alpha agonist that can reduce
cardiac output and is not first-line.
Question 3: A 75-year-old patient with a history of atrial
fibrillation on warfarin presents with an INR of 8.5 and no active
bleeding. Which is the most appropriate management?
A. Administer vitamin K 10 mg IV and fresh frozen plasma
B. Hold warfarin and administer oral vitamin K 2.5–5 mg
C. Continue warfarin and recheck INR in 24 hours
D. Administer protamine sulfate
CORRECT ANSWER: B
RATIONALE: For an INR of 8.5 without bleeding, guidelines
recommend holding warfarin and administering low-dose oral
vitamin K (2.5–5 mg) to reverse the anticoagulant effect
gradually. Option A is incorrect because IV vitamin K and FFP
, Page 4 of 63
are reserved for major bleeding or urgent reversal. Option C is
incorrect because continuing warfarin with such a high INR risks
bleeding. Option D is incorrect because protamine sulfate
reverses heparin, not warfarin.
Question 4: A 70-year-old patient is intubated for acute
respiratory distress syndrome (ARDS). Which ventilator strategy
is most appropriate?
A. High tidal volume (12 mL/kg predicted body weight) with low
PEEP
B. Low tidal volume (6 mL/kg predicted body weight) with
appropriate PEEP
C. High tidal volume with high respiratory rate
D. Low PEEP and high tidal volume to maximize oxygenation
CORRECT ANSWER: B
RATIONALE: Lung-protective ventilation with low tidal volume
(6 mL/kg predicted body weight) and adequate PEEP reduces
mortality in ARDS by minimizing ventilator-induced lung injury.
Option A is incorrect because high tidal volumes cause
volutrauma. Option C is incorrect because high tidal volumes
are harmful regardless of respiratory rate. Option D is incorrect
because low PEEP can lead to atelectrauma.
