ANCC AGACNP Practice Exam – Most Recent exam COMPLETE (2026)
EXAM Questions and Answers (Verified Answers) (Latest Update 2026)
Graded A+
Q1: A 68-year-old man in the ICU has acute decompensated heart failure. He is hypotensive,
with pulmonary crackles and low urine output. Which pharmacologic agent is most appropriate
to diurese him while maintaining perfusion?
A) Furosemide bolus
B) Dopamine infusion
C) Low-dose loop diuretic plus vasodilator
D) Norepinephrine
Rationale: Low-dose loop diuretics combined with vasodilators can improve fluid removal
while supporting perfusion. High-dose diuretics or vasopressors alone may worsen hypotension
or renal perfusion.
Q2: Which physiologic change is most likely in an older adult with acute respiratory distress?
A) Increased chest wall compliance
B) Decreased elastic recoil
C) Increased vital capacity
D) Increased respiratory drive
Rationale: Aging reduces elastic recoil, decreases gas exchange efficiency, and increases risk of
hypoxemia in acute respiratory illness.
Q3: A hemodynamically stable patient with suspected pulmonary embolism requires next-step
diagnostic testing.
A) V/Q scan
B) CT pulmonary angiogram
C) Pulmonary function test
D) Echocardiogram
Rationale: CT pulmonary angiography is the gold standard in stable patients; V/Q scan is
reserved for contrast allergies or instability.
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,Q4: Which intravenous analgesic is preferred for acute pain in a patient with renal failure?
A) Morphine
B) Meperidine
C) Fentanyl
D) Hydromorphone
Rationale: Fentanyl is metabolized hepatically, avoiding accumulation in renal impairment.
Morphine and meperidine metabolites can accumulate, increasing toxicity.
Q5: In acute liver failure, which lab value best reflects synthetic function?
A) ALT
B) AST
C) INR
D) Bilirubin
Rationale: INR indicates hepatic production of clotting factors, reflecting synthetic function.
ALT/AST indicate hepatocellular injury but not functional capacity.
Q6: A patient on high-dose norepinephrine develops oliguria. Next step?
A) Increase norepinephrine
B) Perform fluid challenge while monitoring hemodynamics
C) Add second vasopressor immediately
D) Begin dialysis
Rationale: Evaluate for hypovolemia and perfusion deficits before escalating vasopressors;
aggressive fluid resuscitation may restore renal perfusion.
Q7: Role of AGACNP in evidence-based practice?
A) Administering medications only
B) Participating in QI and applying research to clinical decision-making
C) Only direct patient care
D) Laboratory testing
Rationale: AGACNPs integrate evidence into practice, lead QI initiatives, and make patient-
centered clinical decisions.
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, Q8: A 75-year-old post-stroke patient requires BP management. Key consideration?
A) Use very high doses aggressively
B) Avoid rapid BP lowering to preserve cerebral perfusion
C) Prefer beta-blockers exclusively
D) Stop all BP meds
Rationale: Abrupt BP reduction can worsen ischemia; gradual titration preserves cerebral
perfusion.
Q9: Preventing ventilator-associated pneumonia (VAP) in ICU:
A) Suctioning every hour
B) Elevate head of bed 30–45 degrees
C) Daily broad-spectrum antibiotics
D) Mouth swabbing with sterile water
Rationale: Head-of-bed elevation reduces aspiration risk. Routine suctioning or antibiotics are
not recommended for prevention.
Q10: Recommended glucose target for critically ill patients?
A) 50–70 mg/dL
B) 140–180 mg/dL
C) 180–240 mg/dL
D) >200 mg/dL
Rationale: Moderately tight glycemic control avoids hypoglycemia while reducing
hyperglycemia complications.
Q11: ICU patient with hypotension and GI bleeding – most urgent action?
A) Administer IV PPI
B) Activate massive transfusion protocol
C) Order endoscopy
D) Give platelets
Rationale: Immediate resuscitation with blood products is life-saving; procedural interventions
follow stabilization.
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EXAMPREPMASTER
EXAM Questions and Answers (Verified Answers) (Latest Update 2026)
Graded A+
Q1: A 68-year-old man in the ICU has acute decompensated heart failure. He is hypotensive,
with pulmonary crackles and low urine output. Which pharmacologic agent is most appropriate
to diurese him while maintaining perfusion?
A) Furosemide bolus
B) Dopamine infusion
C) Low-dose loop diuretic plus vasodilator
D) Norepinephrine
Rationale: Low-dose loop diuretics combined with vasodilators can improve fluid removal
while supporting perfusion. High-dose diuretics or vasopressors alone may worsen hypotension
or renal perfusion.
Q2: Which physiologic change is most likely in an older adult with acute respiratory distress?
A) Increased chest wall compliance
B) Decreased elastic recoil
C) Increased vital capacity
D) Increased respiratory drive
Rationale: Aging reduces elastic recoil, decreases gas exchange efficiency, and increases risk of
hypoxemia in acute respiratory illness.
Q3: A hemodynamically stable patient with suspected pulmonary embolism requires next-step
diagnostic testing.
A) V/Q scan
B) CT pulmonary angiogram
C) Pulmonary function test
D) Echocardiogram
Rationale: CT pulmonary angiography is the gold standard in stable patients; V/Q scan is
reserved for contrast allergies or instability.
1
Page
EXAMPREPMASTER
,Q4: Which intravenous analgesic is preferred for acute pain in a patient with renal failure?
A) Morphine
B) Meperidine
C) Fentanyl
D) Hydromorphone
Rationale: Fentanyl is metabolized hepatically, avoiding accumulation in renal impairment.
Morphine and meperidine metabolites can accumulate, increasing toxicity.
Q5: In acute liver failure, which lab value best reflects synthetic function?
A) ALT
B) AST
C) INR
D) Bilirubin
Rationale: INR indicates hepatic production of clotting factors, reflecting synthetic function.
ALT/AST indicate hepatocellular injury but not functional capacity.
Q6: A patient on high-dose norepinephrine develops oliguria. Next step?
A) Increase norepinephrine
B) Perform fluid challenge while monitoring hemodynamics
C) Add second vasopressor immediately
D) Begin dialysis
Rationale: Evaluate for hypovolemia and perfusion deficits before escalating vasopressors;
aggressive fluid resuscitation may restore renal perfusion.
Q7: Role of AGACNP in evidence-based practice?
A) Administering medications only
B) Participating in QI and applying research to clinical decision-making
C) Only direct patient care
D) Laboratory testing
Rationale: AGACNPs integrate evidence into practice, lead QI initiatives, and make patient-
centered clinical decisions.
2
Page
EXAMPREPMASTER
, Q8: A 75-year-old post-stroke patient requires BP management. Key consideration?
A) Use very high doses aggressively
B) Avoid rapid BP lowering to preserve cerebral perfusion
C) Prefer beta-blockers exclusively
D) Stop all BP meds
Rationale: Abrupt BP reduction can worsen ischemia; gradual titration preserves cerebral
perfusion.
Q9: Preventing ventilator-associated pneumonia (VAP) in ICU:
A) Suctioning every hour
B) Elevate head of bed 30–45 degrees
C) Daily broad-spectrum antibiotics
D) Mouth swabbing with sterile water
Rationale: Head-of-bed elevation reduces aspiration risk. Routine suctioning or antibiotics are
not recommended for prevention.
Q10: Recommended glucose target for critically ill patients?
A) 50–70 mg/dL
B) 140–180 mg/dL
C) 180–240 mg/dL
D) >200 mg/dL
Rationale: Moderately tight glycemic control avoids hypoglycemia while reducing
hyperglycemia complications.
Q11: ICU patient with hypotension and GI bleeding – most urgent action?
A) Administer IV PPI
B) Activate massive transfusion protocol
C) Order endoscopy
D) Give platelets
Rationale: Immediate resuscitation with blood products is life-saving; procedural interventions
follow stabilization.
3
Page
EXAMPREPMASTER
