AACN AGACNP CRITICAL CARE REVIEW: 100 NCLEX-STYLE PRACTICE QUESTIONS
WITH DETAILED RATIONALES FOR ACUTE CARE NURSE PRACTITIONER
CERTIFICATION SUCCESS (2026 EDITION)
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) NCLEX-Style Questions with
Detailed Rationales
Question 1
A 72-year-old patient presents with sudden onset chest pain radiating to the left arm,
diaphoresis, and nausea. Which diagnostic test should the AGACNP prioritize first?
A. Chest X-ray
B. Troponin level
C. Electrocardiogram (ECG)
D. Echocardiogram
Correct Answer:
C. Electrocardiogram (ECG)
Rationale:
An ECG should be obtained immediately in any patient suspected of having acute coronary
syndrome because it can rapidly identify ST-segment elevation myocardial infarction (STEMI)
or other life-threatening cardiac abnormalities. Early identification allows timely interventions
such as reperfusion therapy.
Troponin testing is important but may take time to elevate. Chest X-ray and echocardiography
are supportive tests but are not the immediate priority in suspected myocardial infarction.
Question 2
,A patient with septic shock remains hypotensive despite aggressive IV fluid resuscitation.
Which medication is considered first-line vasopressor therapy?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Correct Answer:
C. Norepinephrine
Rationale:
Norepinephrine is the recommended first-line vasopressor in septic shock because it
effectively increases systemic vascular resistance and improves blood pressure with fewer
arrhythmias compared to dopamine.
Vasopressin may be added later as adjunct therapy. Epinephrine is usually reserved for
refractory cases.
Question 3
A patient receiving mechanical ventilation suddenly develops hypotension, absent breath
sounds on one side, and tracheal deviation. Which condition should the AGACNP suspect?
A. Pulmonary edema
B. Cardiac tamponade
C. Tension pneumothorax
D. Pleural effusion
Correct Answer:
C. Tension pneumothorax
Rationale:
Tension pneumothorax occurs when trapped air in the pleural space compresses the lungs
and mediastinal structures. Signs include hypotension, unilateral absent breath sounds,
tracheal deviation, and respiratory distress.
Immediate decompression is required because the condition can rapidly become fatal.
,Question 4
A patient with diabetic ketoacidosis (DKA) is receiving insulin infusion therapy. Which
electrolyte requires the closest monitoring?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
Correct Answer:
C. Potassium
Rationale:
Insulin drives potassium into cells, potentially causing life-threatening hypokalemia during
DKA treatment. Frequent potassium monitoring is essential to prevent dysrhythmias and
muscle weakness.
Question 5
Which finding is most concerning in a patient with increased intracranial pressure?
A. Headache
B. Glasgow Coma Scale decline from 14 to 10
C. Mild nausea
D. Temperature 37.2°C
Correct Answer:
B. Glasgow Coma Scale decline from 14 to 10
Rationale:
A declining neurological status is a major indicator of worsening intracranial pressure and
possible cerebral herniation. Immediate intervention is necessary.
Question 6
An AGACNP is evaluating a patient with acute respiratory distress syndrome (ARDS). Which
hallmark finding is expected?
, A. Severe hypoxemia refractory to oxygen therapy
B. Bradycardia with hypertension
C. Elevated hemoglobin levels
D. Hyperglycemia only
Correct Answer:
A. Severe hypoxemia refractory to oxygen therapy
Rationale:
ARDS causes diffuse alveolar damage leading to severe oxygenation impairment that often
does not improve significantly with standard oxygen therapy alone.
Question 7
A patient develops sudden unilateral weakness and facial drooping. What is the AGACNP’s
priority action?
A. Administer oral fluids
B. Activate stroke protocol
C. Reassess in one hour
D. Obtain dietary history
Correct Answer:
B. Activate stroke protocol
Rationale:
Stroke symptoms require rapid assessment and intervention to preserve brain tissue and
improve outcomes.
Question 8
A patient with hyperkalemia is most likely to exhibit which ECG finding?
A. Flattened T waves
B. Peaked T waves
C. Shortened PR interval
D. ST depression only
Correct Answer:
WITH DETAILED RATIONALES FOR ACUTE CARE NURSE PRACTITIONER
CERTIFICATION SUCCESS (2026 EDITION)
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) NCLEX-Style Questions with
Detailed Rationales
Question 1
A 72-year-old patient presents with sudden onset chest pain radiating to the left arm,
diaphoresis, and nausea. Which diagnostic test should the AGACNP prioritize first?
A. Chest X-ray
B. Troponin level
C. Electrocardiogram (ECG)
D. Echocardiogram
Correct Answer:
C. Electrocardiogram (ECG)
Rationale:
An ECG should be obtained immediately in any patient suspected of having acute coronary
syndrome because it can rapidly identify ST-segment elevation myocardial infarction (STEMI)
or other life-threatening cardiac abnormalities. Early identification allows timely interventions
such as reperfusion therapy.
Troponin testing is important but may take time to elevate. Chest X-ray and echocardiography
are supportive tests but are not the immediate priority in suspected myocardial infarction.
Question 2
,A patient with septic shock remains hypotensive despite aggressive IV fluid resuscitation.
Which medication is considered first-line vasopressor therapy?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Correct Answer:
C. Norepinephrine
Rationale:
Norepinephrine is the recommended first-line vasopressor in septic shock because it
effectively increases systemic vascular resistance and improves blood pressure with fewer
arrhythmias compared to dopamine.
Vasopressin may be added later as adjunct therapy. Epinephrine is usually reserved for
refractory cases.
Question 3
A patient receiving mechanical ventilation suddenly develops hypotension, absent breath
sounds on one side, and tracheal deviation. Which condition should the AGACNP suspect?
A. Pulmonary edema
B. Cardiac tamponade
C. Tension pneumothorax
D. Pleural effusion
Correct Answer:
C. Tension pneumothorax
Rationale:
Tension pneumothorax occurs when trapped air in the pleural space compresses the lungs
and mediastinal structures. Signs include hypotension, unilateral absent breath sounds,
tracheal deviation, and respiratory distress.
Immediate decompression is required because the condition can rapidly become fatal.
,Question 4
A patient with diabetic ketoacidosis (DKA) is receiving insulin infusion therapy. Which
electrolyte requires the closest monitoring?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
Correct Answer:
C. Potassium
Rationale:
Insulin drives potassium into cells, potentially causing life-threatening hypokalemia during
DKA treatment. Frequent potassium monitoring is essential to prevent dysrhythmias and
muscle weakness.
Question 5
Which finding is most concerning in a patient with increased intracranial pressure?
A. Headache
B. Glasgow Coma Scale decline from 14 to 10
C. Mild nausea
D. Temperature 37.2°C
Correct Answer:
B. Glasgow Coma Scale decline from 14 to 10
Rationale:
A declining neurological status is a major indicator of worsening intracranial pressure and
possible cerebral herniation. Immediate intervention is necessary.
Question 6
An AGACNP is evaluating a patient with acute respiratory distress syndrome (ARDS). Which
hallmark finding is expected?
, A. Severe hypoxemia refractory to oxygen therapy
B. Bradycardia with hypertension
C. Elevated hemoglobin levels
D. Hyperglycemia only
Correct Answer:
A. Severe hypoxemia refractory to oxygen therapy
Rationale:
ARDS causes diffuse alveolar damage leading to severe oxygenation impairment that often
does not improve significantly with standard oxygen therapy alone.
Question 7
A patient develops sudden unilateral weakness and facial drooping. What is the AGACNP’s
priority action?
A. Administer oral fluids
B. Activate stroke protocol
C. Reassess in one hour
D. Obtain dietary history
Correct Answer:
B. Activate stroke protocol
Rationale:
Stroke symptoms require rapid assessment and intervention to preserve brain tissue and
improve outcomes.
Question 8
A patient with hyperkalemia is most likely to exhibit which ECG finding?
A. Flattened T waves
B. Peaked T waves
C. Shortened PR interval
D. ST depression only
Correct Answer:
