Page 1 of 169
Gerontology Acute Care Nurse Practitioner
(AGACNP-BC) Exam Latest 2025–2026
Edition | Complete Questions & 100%
Verified Answers
1. An 82-year-old male with a history of hypertension
presents to the ICU with acute onset of chest pain radiating to
the jaw, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1–V4. The most appropriate immediate
intervention is:
A) Administer sublingual nitroglycerin
B) Obtain a chest x-ray
C) Activate the catheterization lab for primary PCI
D) Administer tenecteplase
,Page 2 of 169
Correct Answer: C
Rationale: STEMI in an elderly patient requires rapid reperfusion.
Primary PCI is preferred if available within 120 minutes.
Fibrinolytics (tenecteplase) are an alternative if PCI is not
available, but they carry higher bleeding risk in older adults.
2. SCENARIO: A 75-year-old female with heart failure with
preserved ejection fraction (HFpEF) presents with worsening
dyspnea, elevated jugular venous pressure, and lower extremity
edema. Vital signs: BP 150/90, HR 88, RR 22, SpO₂ 92% on 2L.
Current medications include lisinopril, furosemide, and
metoprolol. Which medication should be added first?
A) Spironolactone
B) Digoxin
C) Hydralazine
D) Sacubitril/valsartan
,Page 3 of 169
Correct Answer: A
Rationale: In HFpEF, guideline-directed therapy includes diuretics
for volume overload and, in selected patients, mineralocorticoid
receptor antagonists (spironolactone) to reduce hospitalizations.
Sacubitril/valsartan is not approved for HFpEF. Digoxin is
second-line.
3. A 68-year-old male with atrial fibrillation (CHA₂DS₂-VASc
score of 4) is admitted with an acute ischemic stroke. He was
taking apixaban but missed the last 2 doses. The neurologist
recommends IV alteplase. The AGACNP should:
A) Administer alteplase immediately because the last apixaban
dose was >48 hours ago
B) Check an anti-Xa level; if < 0.5 ng/mL, give alteplase
C) Avoid alteplase due to high bleeding risk in elderly
D) Give half-dose alteplase
, Page 4 of 169
Correct Answer: B
Rationale: In patients on a direct oral anticoagulant (DOAC) with
last dose >48 hours or with normal renal function, an anti-Xa level
can guide thrombolytic decision. Apixaban has a half-life of ~12
hours; missing 2 doses (≈48 hours) generally results in low levels,
but checking anti-Xa provides safety.
4. SCENARIO: An 80-year-old with hypertension and CKD stage
3 has a BP of 180/100 mm Hg in the ICU. She is asymptomatic.
Her home lisinopril 10 mg daily was held due to AKI (creatinine
1.8 from baseline 1.2). The best next step is:
A) Restart lisinopril at 10 mg
B) Administer IV hydralazine 10 mg
C) Start amlodipine 5 mg daily
D) Observe without intervention
Gerontology Acute Care Nurse Practitioner
(AGACNP-BC) Exam Latest 2025–2026
Edition | Complete Questions & 100%
Verified Answers
1. An 82-year-old male with a history of hypertension
presents to the ICU with acute onset of chest pain radiating to
the jaw, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1–V4. The most appropriate immediate
intervention is:
A) Administer sublingual nitroglycerin
B) Obtain a chest x-ray
C) Activate the catheterization lab for primary PCI
D) Administer tenecteplase
,Page 2 of 169
Correct Answer: C
Rationale: STEMI in an elderly patient requires rapid reperfusion.
Primary PCI is preferred if available within 120 minutes.
Fibrinolytics (tenecteplase) are an alternative if PCI is not
available, but they carry higher bleeding risk in older adults.
2. SCENARIO: A 75-year-old female with heart failure with
preserved ejection fraction (HFpEF) presents with worsening
dyspnea, elevated jugular venous pressure, and lower extremity
edema. Vital signs: BP 150/90, HR 88, RR 22, SpO₂ 92% on 2L.
Current medications include lisinopril, furosemide, and
metoprolol. Which medication should be added first?
A) Spironolactone
B) Digoxin
C) Hydralazine
D) Sacubitril/valsartan
,Page 3 of 169
Correct Answer: A
Rationale: In HFpEF, guideline-directed therapy includes diuretics
for volume overload and, in selected patients, mineralocorticoid
receptor antagonists (spironolactone) to reduce hospitalizations.
Sacubitril/valsartan is not approved for HFpEF. Digoxin is
second-line.
3. A 68-year-old male with atrial fibrillation (CHA₂DS₂-VASc
score of 4) is admitted with an acute ischemic stroke. He was
taking apixaban but missed the last 2 doses. The neurologist
recommends IV alteplase. The AGACNP should:
A) Administer alteplase immediately because the last apixaban
dose was >48 hours ago
B) Check an anti-Xa level; if < 0.5 ng/mL, give alteplase
C) Avoid alteplase due to high bleeding risk in elderly
D) Give half-dose alteplase
, Page 4 of 169
Correct Answer: B
Rationale: In patients on a direct oral anticoagulant (DOAC) with
last dose >48 hours or with normal renal function, an anti-Xa level
can guide thrombolytic decision. Apixaban has a half-life of ~12
hours; missing 2 doses (≈48 hours) generally results in low levels,
but checking anti-Xa provides safety.
4. SCENARIO: An 80-year-old with hypertension and CKD stage
3 has a BP of 180/100 mm Hg in the ICU. She is asymptomatic.
Her home lisinopril 10 mg daily was held due to AKI (creatinine
1.8 from baseline 1.2). The best next step is:
A) Restart lisinopril at 10 mg
B) Administer IV hydralazine 10 mg
C) Start amlodipine 5 mg daily
D) Observe without intervention
