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AGACNP Certification Exam 2026/2027
Actual Exam | Correctly Answered Questions
| Up-To-Date Already Graded A+ | Pass
Guaranteed - A+ Graded
Domain 1: Assessment of Health Status
Q1: A 72-year-old patient is admitted to the ICU with septic shock secondary to pneumonia.
Which of the following hemodynamic parameters is MOST consistent with distributive shock?
A. Low cardiac output, high systemic vascular resistance (SVR)
B. High cardiac output, low systemic vascular resistance (SVR) [CORRECT]
C. Low cardiac output, low systemic vascular resistance (SVR)
D. High cardiac output, high systemic vascular resistance (SVR)
Correct Answer: B
Rationale: Distributive shock (septic, anaphylactic, neurogenic) is characterized by profound
vasodilation leading to low SVR. The body compensates by increasing cardiac output (high CO)
to maintain perfusion. Option A describes cardiogenic shock. Option C describes late septic
shock or hypovolemic shock. Option D is not a standard shock pattern.
Q2: A 65-year-old patient with a history of COPD presents with acute shortness of breath. ABG
results on room air: pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg, HCO3 26 mEq/L. What is the
interpretation of these ABG results?
A. Acute respiratory acidosis with hypoxemia [CORRECT]
B. Chronic respiratory acidosis with metabolic compensation
C. Acute metabolic acidosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: A
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Rationale: The pH is low (acidosis). The PaCO2 is elevated (respiratory acidosis). In acute
respiratory acidosis, the HCO3 increases by 1 mEq/L for every 10 mmHg rise in PaCO2. Here,
65 is 25 above normal (40), so HCO3 should rise by ~2.5, resulting in ~26-27. The actual HCO3
is 26, indicating no renal compensation yet, making it acute. PaO2 55 indicates hypoxemia.
Q3: A 78-year-old patient presents with chest pain, diaphoresis, and nausea. ECG reveals ST-
segment elevation in leads V1-V4. Which of the following laboratory findings is MOST specific
for myocardial necrosis?
A. Elevated CK-MB
B. Elevated troponin I [CORRECT]
C. Elevated myoglobin
D. Elevated LDH
Correct Answer: B
Rationale: Troponin I is the gold standard biomarker for myocardial necrosis due to its high
specificity for cardiac muscle. CK-MB is less specific. Myoglobin is early but non-specific. LDH
is obsolete for this purpose.
Q4: A 68-year-old patient with altered mental status has the following vital signs: HR 48 bpm,
BP 82/50 mmHg, RR 14, O2 sat 94% on room air. ECG shows complete heart block with a
junctional escape rhythm at 48 bpm. Which of the following is the MOST appropriate initial
intervention?
A. Administer atropine 0.5 mg IV
B. Prepare for transcutaneous pacing [CORRECT]
C. Administer epinephrine infusion
D. Place transvenous pacemaker
Correct Answer: B
Rationale: Symptomatic bradycardia with hypotension and altered mental status requires
immediate intervention. Atropine is often ineffective for infranodal blocks (like complete heart
,3
block). Transcutaneous pacing is the most immediate way to stabilize the patient while preparing
for transvenous pacing.
Q5: A 70-year-old patient with a history of stable angina presents with chest pain lasting 30
minutes. ECG shows ST depression in leads V5-V6. Which diagnostic test best differentiates
between NSTEMI and unstable angina?
A. Troponin I level [CORRECT]
B. CK-MB level
C. Echocardiogram
D. Chest X-ray
Correct Answer: A
Rationale: The distinction between NSTEMI and unstable angina relies on the presence of
myocardial necrosis. Elevated cardiac troponin indicates necrosis (NSTEMI), whereas normal
troponin with clinical symptoms indicates unstable angina.
Q6: A 45-year-old patient is admitted with DKA. ABG results: pH 7.20, PaCO2 28 mmHg, PaO2
90 mmHg, HCO3 12 mEq/L. This ABG is consistent with:
A. Uncompensated metabolic acidosis
B. Partially compensated metabolic acidosis [CORRECT]
C. Fully compensated metabolic acidosis
D. Respiratory acidosis
Correct Answer: B
Rationale: The pH is low (acidosis). The HCO3 is low (metabolic acidosis). The PaCO2 is low
(respiratory compensation via Kussmaul respirations). Because the pH has not returned to the
normal range (7.35-7.45), compensation is partial.
Q7: The AGACNP is assessing a patient with acute liver failure. Which of the following
laboratory findings indicates synthetic liver dysfunction?
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A. Elevated AST and ALT
B. Elevated bilirubin
C. Prolonged prothrombin time (PT/INR) [CORRECT]
D. Low albumin
Correct Answer: C
Rationale: While all are markers of liver issues, the PT/INR measures the liver's ability to
synthesize clotting factors (II, V, VII, IX, X). An elevated PT/INR indicates significant synthetic
dysfunction and is a marker of prognosis in acute liver failure.
Q8: A 60-year-old patient presents with acute dyspnea. ABG on room air: pH 7.48, PaCO2 32
mmHg, PaO2 62 mmHg, HCO3 24 mEq/L. Alveolar-arterial (A-a) gradient calculation reveals
an elevated gradient. Which condition is MOST likely?
A. Anxiety-induced hyperventilation
B. COPD exacerbation
C. Pulmonary embolism [CORRECT]
D. Metabolic acidosis
Correct Answer: C
Rationale: The patient has respiratory alkalosis with hypoxemia. Anxiety-induced
hyperventilation would have a normal A-a gradient. An elevated A-a gradient in the setting of
acute hyperventilation and hypoxemia suggests a V/Q mismatch, such as pulmonary embolism
or pneumonia.
Q9: A geriatric patient is being evaluated for delirium. Which of the following is the MOST
sensitive bedside screening tool for cognitive impairment in the acute care setting?
A. Mini-Mental State Examination (MMSE)
B. Confusion Assessment Method (CAM) [CORRECT]
C. Glasgow Coma Scale (GCS)
D. Clock Drawing Test
AGACNP Certification Exam 2026/2027
Actual Exam | Correctly Answered Questions
| Up-To-Date Already Graded A+ | Pass
Guaranteed - A+ Graded
Domain 1: Assessment of Health Status
Q1: A 72-year-old patient is admitted to the ICU with septic shock secondary to pneumonia.
Which of the following hemodynamic parameters is MOST consistent with distributive shock?
A. Low cardiac output, high systemic vascular resistance (SVR)
B. High cardiac output, low systemic vascular resistance (SVR) [CORRECT]
C. Low cardiac output, low systemic vascular resistance (SVR)
D. High cardiac output, high systemic vascular resistance (SVR)
Correct Answer: B
Rationale: Distributive shock (septic, anaphylactic, neurogenic) is characterized by profound
vasodilation leading to low SVR. The body compensates by increasing cardiac output (high CO)
to maintain perfusion. Option A describes cardiogenic shock. Option C describes late septic
shock or hypovolemic shock. Option D is not a standard shock pattern.
Q2: A 65-year-old patient with a history of COPD presents with acute shortness of breath. ABG
results on room air: pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg, HCO3 26 mEq/L. What is the
interpretation of these ABG results?
A. Acute respiratory acidosis with hypoxemia [CORRECT]
B. Chronic respiratory acidosis with metabolic compensation
C. Acute metabolic acidosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: A
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Rationale: The pH is low (acidosis). The PaCO2 is elevated (respiratory acidosis). In acute
respiratory acidosis, the HCO3 increases by 1 mEq/L for every 10 mmHg rise in PaCO2. Here,
65 is 25 above normal (40), so HCO3 should rise by ~2.5, resulting in ~26-27. The actual HCO3
is 26, indicating no renal compensation yet, making it acute. PaO2 55 indicates hypoxemia.
Q3: A 78-year-old patient presents with chest pain, diaphoresis, and nausea. ECG reveals ST-
segment elevation in leads V1-V4. Which of the following laboratory findings is MOST specific
for myocardial necrosis?
A. Elevated CK-MB
B. Elevated troponin I [CORRECT]
C. Elevated myoglobin
D. Elevated LDH
Correct Answer: B
Rationale: Troponin I is the gold standard biomarker for myocardial necrosis due to its high
specificity for cardiac muscle. CK-MB is less specific. Myoglobin is early but non-specific. LDH
is obsolete for this purpose.
Q4: A 68-year-old patient with altered mental status has the following vital signs: HR 48 bpm,
BP 82/50 mmHg, RR 14, O2 sat 94% on room air. ECG shows complete heart block with a
junctional escape rhythm at 48 bpm. Which of the following is the MOST appropriate initial
intervention?
A. Administer atropine 0.5 mg IV
B. Prepare for transcutaneous pacing [CORRECT]
C. Administer epinephrine infusion
D. Place transvenous pacemaker
Correct Answer: B
Rationale: Symptomatic bradycardia with hypotension and altered mental status requires
immediate intervention. Atropine is often ineffective for infranodal blocks (like complete heart
,3
block). Transcutaneous pacing is the most immediate way to stabilize the patient while preparing
for transvenous pacing.
Q5: A 70-year-old patient with a history of stable angina presents with chest pain lasting 30
minutes. ECG shows ST depression in leads V5-V6. Which diagnostic test best differentiates
between NSTEMI and unstable angina?
A. Troponin I level [CORRECT]
B. CK-MB level
C. Echocardiogram
D. Chest X-ray
Correct Answer: A
Rationale: The distinction between NSTEMI and unstable angina relies on the presence of
myocardial necrosis. Elevated cardiac troponin indicates necrosis (NSTEMI), whereas normal
troponin with clinical symptoms indicates unstable angina.
Q6: A 45-year-old patient is admitted with DKA. ABG results: pH 7.20, PaCO2 28 mmHg, PaO2
90 mmHg, HCO3 12 mEq/L. This ABG is consistent with:
A. Uncompensated metabolic acidosis
B. Partially compensated metabolic acidosis [CORRECT]
C. Fully compensated metabolic acidosis
D. Respiratory acidosis
Correct Answer: B
Rationale: The pH is low (acidosis). The HCO3 is low (metabolic acidosis). The PaCO2 is low
(respiratory compensation via Kussmaul respirations). Because the pH has not returned to the
normal range (7.35-7.45), compensation is partial.
Q7: The AGACNP is assessing a patient with acute liver failure. Which of the following
laboratory findings indicates synthetic liver dysfunction?
, 4
A. Elevated AST and ALT
B. Elevated bilirubin
C. Prolonged prothrombin time (PT/INR) [CORRECT]
D. Low albumin
Correct Answer: C
Rationale: While all are markers of liver issues, the PT/INR measures the liver's ability to
synthesize clotting factors (II, V, VII, IX, X). An elevated PT/INR indicates significant synthetic
dysfunction and is a marker of prognosis in acute liver failure.
Q8: A 60-year-old patient presents with acute dyspnea. ABG on room air: pH 7.48, PaCO2 32
mmHg, PaO2 62 mmHg, HCO3 24 mEq/L. Alveolar-arterial (A-a) gradient calculation reveals
an elevated gradient. Which condition is MOST likely?
A. Anxiety-induced hyperventilation
B. COPD exacerbation
C. Pulmonary embolism [CORRECT]
D. Metabolic acidosis
Correct Answer: C
Rationale: The patient has respiratory alkalosis with hypoxemia. Anxiety-induced
hyperventilation would have a normal A-a gradient. An elevated A-a gradient in the setting of
acute hyperventilation and hypoxemia suggests a V/Q mismatch, such as pulmonary embolism
or pneumonia.
Q9: A geriatric patient is being evaluated for delirium. Which of the following is the MOST
sensitive bedside screening tool for cognitive impairment in the acute care setting?
A. Mini-Mental State Examination (MMSE)
B. Confusion Assessment Method (CAM) [CORRECT]
C. Glasgow Coma Scale (GCS)
D. Clock Drawing Test
