# 2026 ANCC AGACNP Frances Guide Review – 400+ Practice Questions & Answers for Adult-Gerontology
Acute Care NP Board Exam Prep
Welcome to this comprehensive ANCC Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) board
exam review. This resource contains 400+ actual-style practice questions covering the full scope of AGACNP
practice as outlined in the Frances Guide and ANCC test blueprint. Each question includes the correct answer
(in italics) and a short rationale (≤3 lines). Use this exam to strengthen your clinical reasoning and prepare
for the AGACNP certification exam.
Key Topics Covered
• Cardiovascular – Acute coronary syndromes, heart failure, arrhythmias, hypertension, shock, valvular
disease, vascular emergencies
• Pulmonary – Respiratory failure, ARDS, COPD, asthma, pneumonia, pulmonary embolism, mechanical
ventilation
• Neurological – Stroke, seizures, head trauma, delirium, increased ICP, meningitis, encephalopathy
• Renal & Electrolytes – Acute kidney injury, chronic kidney disease, fluid/electrolyte imbalances, acid-
base disorders
• Endocrine – DKA, HHS, adrenal insufficiency, thyroid storm, SIADH, diabetes insipidus
• Gastrointestinal – GI bleeding, pancreatitis, liver failure, bowel obstruction, peritonitis
• Infectious Disease – Sepsis, pneumonia, UTIs, skin/soft tissue infections, antibiotic stewardship,
immunocompromised host
• Hematology/Oncology – Anemia, coagulopathies, thrombocytopenia, neutropenic fever, transfusion
reactions
• Critical Care Procedures & Monitoring – Hemodynamic monitoring, central lines, arterial lines,
intubation, ventilation, sedation, analgesia
• Pharmacology – Vasopressors, antiarrhythmics, antibiotics, anticoagulants, sedatives, analgesics,
paralytics
,• Ethical/Legal & End-of-Life – Advance directives, surrogate decision-making, withdrawal of care, futility,
informed consent
• Geriatric Considerations – Polypharmacy, falls, frailty, dementia, delirium, atypical presentations
• Professional Practice – Scope of practice, interprofessional collaboration, quality improvement, evidence-
based practice
Questions 1–400
1. A 72-year-old male presents with acute onset substernal chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4. What is the priority
intervention?
A) Administer morphine 4 mg IV
B) Activate the STEMI protocol and prepare for emergent PCI
C) Obtain a chest X-ray
D) Administer nitroglycerin 0.4 mg SL
Answer B: Activate the STEMI protocol and prepare for emergent PCI
Rationale: ST-elevation MI requires immediate reperfusion; PCI within 90 minutes is the gold standard.
2. A 68-year-old female with CHF is admitted with worsening dyspnea, JVD, and crackles bilaterally.
BNP is 1200 pg/mL. Which intervention is most appropriate initially?
A) Fluid bolus 500 mL NS
B) IV furosemide and oxygen supplementation
C) Dobutamine infusion
D) IV amiodarone
Answer B: IV furosemide and oxygen supplementation
Rationale: Acute decompensated heart failure with volume overload requires diuresis and oxygenation.
3. A 65-year-old male with COPD presents with worsening dyspnea, fever, and purulent sputum. ABG:
pH 7.28, PaCO2 62 mmHg, PaO2 52 mmHg, HCO3 28 mEq/L. What is the most appropriate next step?
A) BiPAP ventilation
B) Intubate and initiate mechanical ventilation
C) Nebulized albuterol and ipratropium
D) IV methylprednisolone
Answer B: Intubate and initiate mechanical ventilation
,Rationale: Acute respiratory acidosis with pH <7.30 and altered mental status indicates need for intubation.
4. A 78-year-old female with a history of hypertension presents with sudden severe headache,
nausea, and vomiting. CT head shows subarachnoid hemorrhage. Which medication should be given
immediately?
A) Aspirin 325 mg PO
B) Nimodipine 60 mg PO every 4 hours
C) Heparin 5000 units SC
D) Mannitol 1 g/kg IV
Answer B: Nimodipine 60 mg PO every 4 hours
Rationale: Nimodipine improves outcomes by preventing vasospasm in subarachnoid hemorrhage.
5. A 55-year-old male with cirrhosis is admitted with hematemesis and melena. Vital signs: BP 90/60,
HR 120, RR 22. Which intervention is the priority?
A) IV proton pump inhibitor
B) IV fluids, blood products, and emergent endoscopy
C) Oral lactulose
D) IV octreotide
Answer B: IV fluids, blood products, and emergent endoscopy
Rationale: Upper GI bleeding with hemodynamic instability requires resuscitation and urgent EGD.
6. A 70-year-old male is 2 days post-op from abdominal surgery. He becomes acutely confused,
tachycardic, and febrile. WBC 18,000 with left shift. What is the most likely diagnosis?
A) Delirium tremens
B) Sepsis from intra-abdominal source
C) Pulmonary embolism
D) Medication side effect
Answer B: Sepsis from intra-abdominal source
Rationale: Post-operative fever, tachycardia, leukocytosis, and confusion suggest infection/sepsis.
7. A 62-year-old female with ESRD on hemodialysis presents with hypotension, nausea, and vomiting.
Serum potassium is 6.8 mEq/L. Which intervention is first?
, A) IV calcium gluconate
B) IV insulin with dextrose and albuterol nebulizer
C) IV sodium bicarbonate
D) IV furosemide
Answer B: IV insulin with dextrose and albuterol nebulizer
Rationale: Emergent potassium lowering: insulin shifts K+ intracellularly, albuterol also lowers K+.
8. A 75-year-old male with known AAA presents with sudden severe back pain and hypotension.
What is the priority diagnostic test?
A) CT angiography
B) Bedside ultrasound (FAST) if unstable; CT if stable
C) Abdominal X-ray
D) MRI
Answer B: Bedside ultrasound (FAST) if unstable; CT if stable
Rationale: Ruptured AAA is life-threatening; FAST can confirm free fluid, but CT is definitive if stable.
9. A 60-year-old female with diabetes presents with fever, chills, and right flank pain. Urinalysis
shows WBC casts. What is the most likely diagnosis?
A) Cystitis
B) Pyelonephritis
C) Renal stone
D) Glomerulonephritis
Answer B: Pyelonephritis
Rationale: Fever, flank pain, and WBC casts indicate upper urinary tract infection (pyelonephritis).
10. A 68-year-old male with a history of AFib on warfarin presents with sudden onset left-sided
weakness, facial droop, and dysarthria. Last known well was 2 hours ago. What is the most
appropriate next step?
A) CT head without contrast
B) CT head without contrast; if no bleed, consider IV tPA if no contraindications
C) MRI brain
D) Carotid ultrasound
Answer B: CT head without contrast; if no bleed, consider IV tPA if no contraindications
Acute Care NP Board Exam Prep
Welcome to this comprehensive ANCC Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) board
exam review. This resource contains 400+ actual-style practice questions covering the full scope of AGACNP
practice as outlined in the Frances Guide and ANCC test blueprint. Each question includes the correct answer
(in italics) and a short rationale (≤3 lines). Use this exam to strengthen your clinical reasoning and prepare
for the AGACNP certification exam.
Key Topics Covered
• Cardiovascular – Acute coronary syndromes, heart failure, arrhythmias, hypertension, shock, valvular
disease, vascular emergencies
• Pulmonary – Respiratory failure, ARDS, COPD, asthma, pneumonia, pulmonary embolism, mechanical
ventilation
• Neurological – Stroke, seizures, head trauma, delirium, increased ICP, meningitis, encephalopathy
• Renal & Electrolytes – Acute kidney injury, chronic kidney disease, fluid/electrolyte imbalances, acid-
base disorders
• Endocrine – DKA, HHS, adrenal insufficiency, thyroid storm, SIADH, diabetes insipidus
• Gastrointestinal – GI bleeding, pancreatitis, liver failure, bowel obstruction, peritonitis
• Infectious Disease – Sepsis, pneumonia, UTIs, skin/soft tissue infections, antibiotic stewardship,
immunocompromised host
• Hematology/Oncology – Anemia, coagulopathies, thrombocytopenia, neutropenic fever, transfusion
reactions
• Critical Care Procedures & Monitoring – Hemodynamic monitoring, central lines, arterial lines,
intubation, ventilation, sedation, analgesia
• Pharmacology – Vasopressors, antiarrhythmics, antibiotics, anticoagulants, sedatives, analgesics,
paralytics
,• Ethical/Legal & End-of-Life – Advance directives, surrogate decision-making, withdrawal of care, futility,
informed consent
• Geriatric Considerations – Polypharmacy, falls, frailty, dementia, delirium, atypical presentations
• Professional Practice – Scope of practice, interprofessional collaboration, quality improvement, evidence-
based practice
Questions 1–400
1. A 72-year-old male presents with acute onset substernal chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4. What is the priority
intervention?
A) Administer morphine 4 mg IV
B) Activate the STEMI protocol and prepare for emergent PCI
C) Obtain a chest X-ray
D) Administer nitroglycerin 0.4 mg SL
Answer B: Activate the STEMI protocol and prepare for emergent PCI
Rationale: ST-elevation MI requires immediate reperfusion; PCI within 90 minutes is the gold standard.
2. A 68-year-old female with CHF is admitted with worsening dyspnea, JVD, and crackles bilaterally.
BNP is 1200 pg/mL. Which intervention is most appropriate initially?
A) Fluid bolus 500 mL NS
B) IV furosemide and oxygen supplementation
C) Dobutamine infusion
D) IV amiodarone
Answer B: IV furosemide and oxygen supplementation
Rationale: Acute decompensated heart failure with volume overload requires diuresis and oxygenation.
3. A 65-year-old male with COPD presents with worsening dyspnea, fever, and purulent sputum. ABG:
pH 7.28, PaCO2 62 mmHg, PaO2 52 mmHg, HCO3 28 mEq/L. What is the most appropriate next step?
A) BiPAP ventilation
B) Intubate and initiate mechanical ventilation
C) Nebulized albuterol and ipratropium
D) IV methylprednisolone
Answer B: Intubate and initiate mechanical ventilation
,Rationale: Acute respiratory acidosis with pH <7.30 and altered mental status indicates need for intubation.
4. A 78-year-old female with a history of hypertension presents with sudden severe headache,
nausea, and vomiting. CT head shows subarachnoid hemorrhage. Which medication should be given
immediately?
A) Aspirin 325 mg PO
B) Nimodipine 60 mg PO every 4 hours
C) Heparin 5000 units SC
D) Mannitol 1 g/kg IV
Answer B: Nimodipine 60 mg PO every 4 hours
Rationale: Nimodipine improves outcomes by preventing vasospasm in subarachnoid hemorrhage.
5. A 55-year-old male with cirrhosis is admitted with hematemesis and melena. Vital signs: BP 90/60,
HR 120, RR 22. Which intervention is the priority?
A) IV proton pump inhibitor
B) IV fluids, blood products, and emergent endoscopy
C) Oral lactulose
D) IV octreotide
Answer B: IV fluids, blood products, and emergent endoscopy
Rationale: Upper GI bleeding with hemodynamic instability requires resuscitation and urgent EGD.
6. A 70-year-old male is 2 days post-op from abdominal surgery. He becomes acutely confused,
tachycardic, and febrile. WBC 18,000 with left shift. What is the most likely diagnosis?
A) Delirium tremens
B) Sepsis from intra-abdominal source
C) Pulmonary embolism
D) Medication side effect
Answer B: Sepsis from intra-abdominal source
Rationale: Post-operative fever, tachycardia, leukocytosis, and confusion suggest infection/sepsis.
7. A 62-year-old female with ESRD on hemodialysis presents with hypotension, nausea, and vomiting.
Serum potassium is 6.8 mEq/L. Which intervention is first?
, A) IV calcium gluconate
B) IV insulin with dextrose and albuterol nebulizer
C) IV sodium bicarbonate
D) IV furosemide
Answer B: IV insulin with dextrose and albuterol nebulizer
Rationale: Emergent potassium lowering: insulin shifts K+ intracellularly, albuterol also lowers K+.
8. A 75-year-old male with known AAA presents with sudden severe back pain and hypotension.
What is the priority diagnostic test?
A) CT angiography
B) Bedside ultrasound (FAST) if unstable; CT if stable
C) Abdominal X-ray
D) MRI
Answer B: Bedside ultrasound (FAST) if unstable; CT if stable
Rationale: Ruptured AAA is life-threatening; FAST can confirm free fluid, but CT is definitive if stable.
9. A 60-year-old female with diabetes presents with fever, chills, and right flank pain. Urinalysis
shows WBC casts. What is the most likely diagnosis?
A) Cystitis
B) Pyelonephritis
C) Renal stone
D) Glomerulonephritis
Answer B: Pyelonephritis
Rationale: Fever, flank pain, and WBC casts indicate upper urinary tract infection (pyelonephritis).
10. A 68-year-old male with a history of AFib on warfarin presents with sudden onset left-sided
weakness, facial droop, and dysarthria. Last known well was 2 hours ago. What is the most
appropriate next step?
A) CT head without contrast
B) CT head without contrast; if no bleed, consider IV tPA if no contraindications
C) MRI brain
D) Carotid ultrasound
Answer B: CT head without contrast; if no bleed, consider IV tPA if no contraindications
