Adult-Gerontology Acute Care Nurse Practitioner Certification
(AGACNP-BC®) Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hemodynamic Management | Q1 – Q10
Section 2 | Pulmonary & Ventilatory Management | Q11 – Q20
Section 3 | Neurologic & Multisystem Disorders | Q21 – Q30
Section 4 | Renal, Endocrine & Metabolic Disorders | Q31 – Q40
Section 5 | Professional Issues & Procedures in Acute Care | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMODYNAMIC MANAGEMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old client is admitted to the coronary care unit 12 hours after an anterior
STEMI. The client is diaphoretic, confused, and has a blood pressure of 78/52 mmHg,
heart rate of 110 beats/min, and jugular venous distention. The lung fields are clear
bilaterally, and the extremities are cool and mottled. The AGACNP should recognize this
presentation as most consistent with:
A. Septic shock from a hospital-acquired infection
B. Cardiogenic shock from left ventricular pump failure ✓ CORRECT
C. Hypovolemic shock secondary to aggressive diuresis
D. Anaphylactic shock from contrast dye exposure
Correct Answer: B
Rationale: Jugular venous distention with clear lungs and cool extremities is the classic
triad for cardiogenic shock, indicating elevated right-sided pressures and peripheral
,vasoconstriction from pump failure. Septic shock typically presents with warm, flushed
skin and bounding pulses, while hypovolemic shock would show flat neck veins rather
than JVD.
Question 2 of 50
A 72-year-old client presents to the emergency department with new-onset atrial
fibrillation and a rapid ventricular response at 156 beats/min. The blood pressure is
92/58 mmHg, and the client is mildly confused. The AGACNP should prioritize which
intervention?
A. Administer a 500 mL bolus of normal saline and start a diltiazem infusion
B. Administer IV amiodarone to achieve pharmacologic cardioversion
C. Perform immediate synchronized cardioversion at 100 to 200 joules ✓ CORRECT
D. Administer IV digoxin to slow the ventricular response
Correct Answer: C
Rationale: Atrial fibrillation with rapid ventricular response accompanied by hypotension
and altered mental status meets criteria for hemodynamic instability, which requires
immediate synchronized cardioversion rather than rate-controlling agents. Diltiazem,
amiodarone, and digoxin are appropriate for stable patients but can worsen hypotension
in unstable presentations.
Question 3 of 50
A 55-year-old client with a known thoracic aortic aneurysm presents with sudden
tearing chest pain radiating to the back. The blood pressure is 190/110 mmHg, and the
AGACNP notes a 20 mmHg systolic pressure difference between the right and left
arms. Before initiating any other antihypertensive therapy, the AGACNP should first
administer:
A. IV nitroprusside to rapidly lower the mean arterial pressure
, B. IV hydralazine to reduce afterload and shear stress
C. IV nicardipine for controlled blood pressure reduction
D. IV esmolol or labetalol to reduce dP/dt and aortic wall stress ✓ CORRECT
Correct Answer: D
Rationale: In acute aortic dissection, beta-blockade must precede vasodilator therapy
because reducing blood pressure without first lowering heart rate and contractility can
increase dP/dt and propagate the dissection. Nitroprusside, hydralazine, and nicardipine
are appropriate adjuncts only after beta-blockade is established.
Question 4 of 50
An 82-year-old client with severe symptomatic aortic stenosis is being prepped for
urgent transcatheter aortic valve replacement. The client experiences a syncopal
episode, and the monitor shows a heart rate of 42 beats/min with complete
atrioventricular dissociation. The blood pressure is 110/70 mmHg. The AGACNP
should:
A. Administer atropine 0.5 mg IV and reassess in 5 minutes
B. Apply transcutaneous pacing pads and observe for response
C. Start a dopamine infusion at 5 mcg/kg/min to increase heart rate
D. Arrange for temporary transvenous pacing before the procedure ✓ CORRECT
Correct Answer: D
Rationale: Symptomatic complete heart block in a patient with severe aortic stenosis
requires temporary pacing to maintain cardiac output and prevent further syncope or
ischemia. Atropine is often ineffective in infranodal blocks, and transcutaneous pacing
is uncomfortable and less reliable as a bridge in this setting.
Question 5 of 50
A 64-year-old client with a history of heart failure with preserved ejection fraction is
admitted with acute dyspnea and bilateral pulmonary crackles. The echocardiogram
(AGACNP-BC®) Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hemodynamic Management | Q1 – Q10
Section 2 | Pulmonary & Ventilatory Management | Q11 – Q20
Section 3 | Neurologic & Multisystem Disorders | Q21 – Q30
Section 4 | Renal, Endocrine & Metabolic Disorders | Q31 – Q40
Section 5 | Professional Issues & Procedures in Acute Care | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMODYNAMIC MANAGEMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old client is admitted to the coronary care unit 12 hours after an anterior
STEMI. The client is diaphoretic, confused, and has a blood pressure of 78/52 mmHg,
heart rate of 110 beats/min, and jugular venous distention. The lung fields are clear
bilaterally, and the extremities are cool and mottled. The AGACNP should recognize this
presentation as most consistent with:
A. Septic shock from a hospital-acquired infection
B. Cardiogenic shock from left ventricular pump failure ✓ CORRECT
C. Hypovolemic shock secondary to aggressive diuresis
D. Anaphylactic shock from contrast dye exposure
Correct Answer: B
Rationale: Jugular venous distention with clear lungs and cool extremities is the classic
triad for cardiogenic shock, indicating elevated right-sided pressures and peripheral
,vasoconstriction from pump failure. Septic shock typically presents with warm, flushed
skin and bounding pulses, while hypovolemic shock would show flat neck veins rather
than JVD.
Question 2 of 50
A 72-year-old client presents to the emergency department with new-onset atrial
fibrillation and a rapid ventricular response at 156 beats/min. The blood pressure is
92/58 mmHg, and the client is mildly confused. The AGACNP should prioritize which
intervention?
A. Administer a 500 mL bolus of normal saline and start a diltiazem infusion
B. Administer IV amiodarone to achieve pharmacologic cardioversion
C. Perform immediate synchronized cardioversion at 100 to 200 joules ✓ CORRECT
D. Administer IV digoxin to slow the ventricular response
Correct Answer: C
Rationale: Atrial fibrillation with rapid ventricular response accompanied by hypotension
and altered mental status meets criteria for hemodynamic instability, which requires
immediate synchronized cardioversion rather than rate-controlling agents. Diltiazem,
amiodarone, and digoxin are appropriate for stable patients but can worsen hypotension
in unstable presentations.
Question 3 of 50
A 55-year-old client with a known thoracic aortic aneurysm presents with sudden
tearing chest pain radiating to the back. The blood pressure is 190/110 mmHg, and the
AGACNP notes a 20 mmHg systolic pressure difference between the right and left
arms. Before initiating any other antihypertensive therapy, the AGACNP should first
administer:
A. IV nitroprusside to rapidly lower the mean arterial pressure
, B. IV hydralazine to reduce afterload and shear stress
C. IV nicardipine for controlled blood pressure reduction
D. IV esmolol or labetalol to reduce dP/dt and aortic wall stress ✓ CORRECT
Correct Answer: D
Rationale: In acute aortic dissection, beta-blockade must precede vasodilator therapy
because reducing blood pressure without first lowering heart rate and contractility can
increase dP/dt and propagate the dissection. Nitroprusside, hydralazine, and nicardipine
are appropriate adjuncts only after beta-blockade is established.
Question 4 of 50
An 82-year-old client with severe symptomatic aortic stenosis is being prepped for
urgent transcatheter aortic valve replacement. The client experiences a syncopal
episode, and the monitor shows a heart rate of 42 beats/min with complete
atrioventricular dissociation. The blood pressure is 110/70 mmHg. The AGACNP
should:
A. Administer atropine 0.5 mg IV and reassess in 5 minutes
B. Apply transcutaneous pacing pads and observe for response
C. Start a dopamine infusion at 5 mcg/kg/min to increase heart rate
D. Arrange for temporary transvenous pacing before the procedure ✓ CORRECT
Correct Answer: D
Rationale: Symptomatic complete heart block in a patient with severe aortic stenosis
requires temporary pacing to maintain cardiac output and prevent further syncope or
ischemia. Atropine is often ineffective in infranodal blocks, and transcutaneous pacing
is uncomfortable and less reliable as a bridge in this setting.
Question 5 of 50
A 64-year-old client with a history of heart failure with preserved ejection fraction is
admitted with acute dyspnea and bilateral pulmonary crackles. The echocardiogram
