AGACNP Practice Test 2026: 250+ Board-
Style Questions & Answers for Acute
Care NP Certification (AANP/ANCC) |
Graded A+ | Guaranteed Pass!!
Comprehensive AGACNP Practice Questions Cardiovascular
1. A 78-year-old male with a history of hypertension and chronic kidney disease presents with
a new onset of a "beefy red" tongue, significant fatigue, and paresthesia in his hands and
feet. His laboratory results show a Mean Corpuscular Volume (MCV) of 108 fL. Which of the
following is the most likely diagnosis?
A) Iron Deficiency Anemia
B) Folate Deficiency Anemia
C) Pernicious Anemia
D) Anemia of Chronic Disease
Answer: C
Rationale: Pernicious anemia is a macrocytic anemia (MCV > 100) caused by a lack of intrinsic
factor, leading to Vitamin B12 deficiency. Classic signs include a beefy red tongue and
neurological symptoms like paresthesia, which distinguish it from folate deficiency.
2. A patient with atrial fibrillation on warfarin has INR 5.2 and no signs of bleeding. What is
the most appropriate management?
A) Administer vitamin K 10 mg orally
B) Administer fresh frozen plasma
C) Hold warfarin and recheck INR in 24-48 hours
D) Administer prothrombin complex concentrate
Answer: C
Rationale: For asymptomatic patients with INR >5.0 but <9.0, guidelines recommend holding
warfarin and monitoring INR. Vitamin K is generally reserved for INR >10 or when bleeding risk
is high.
,3. A 52-year-old female patient was involved in a motor vehicle collision and sustained blunt
trauma to her chest. She was unresponsive and intubated at the scene. Upon presentation in
the ED, the patient is coughing, and pink frothy secretions are noted in the endotracheal
tube. Her blood pressure is 60/30, heart rate 134. She has markedly elevated JVD. An
echocardiogram revealed a flail mitral valve and torrential regurgitation, consistent with
mitral valve rupture. Which intervention is most important in this client's plan of care?
A) Urgent left heart catheterization
B) Immediate cardiac surgery for repair
C) STAT intravenous diuretic dose
D) Initiation of intravenous inotrope therapy
Answer: B
Rationale: Traumatic mitral valve rupture with cardiogenic shock requires immediate surgical
repair. Delaying surgery for diagnostic studies or medical management alone is not sufficient for
this mechanical cause of shock.
4. Which ECG finding is most specific for acute myocardial infarction?
A) Sinus tachycardia
B) ST-segment elevation in contiguous leads
C) First-degree AV block
D) Premature atrial contractions
Answer: B
Rationale: ST-segment elevation in contiguous leads is the hallmark ECG finding of acute ST-
elevation myocardial infarction (STEMI), indicating acute coronary occlusion.
5. Which finding is most specific for cardiac tamponade?
A) Hypertension and bradycardia
B) Beck's triad (hypotension, JVD, muffled heart sounds)
C) Wide pulse pressure
D) Pulsus paradoxus <10 mmHg
Answer: B
Rationale: Beck's triad is the classic sign of cardiac tamponade. Pulsus paradoxus (>10 mmHg) is
also suggestive but not as specific as the triad.
6. A patient presents with new onset ST segment elevation and T wave inversion in leads II,
III, and aVF. The most appropriate diagnosis is:
A) Anterior myocardial infarction
,B) Inferior myocardial infarction
C) Lateral myocardial infarction
D) Septal myocardial infarction
Answer: B
Rationale: Leads II, III, and aVF represent the inferior wall of the heart. ST elevation in these
leads indicates an inferior myocardial infarction, typically involving the right coronary artery.
7. Which medication is contraindicated in acute decompensated heart failure with
hypotension?
A) Furosemide
B) Nitroglycerin
C) Dobutamine
D) Metoprolol
Answer: D
Rationale: Beta-blockers such as metoprolol are negative inotropes and can worsen hypotension
and cardiogenic shock in acute decompensated heart failure; they are typically held until the
patient is stabilized.
8. A patient with STEMI presents 3 hours after symptom onset and timely PCI is not available.
Which is most appropriate?
A) Argatroban
B) Eptifibatide
C) Bivalirudin
D) Reteplase
Answer: D
Rationale: When timely PCI is not available for STEMI, fibrinolytic therapy (e.g., reteplase,
tenecteplase, alteplase) is indicated within 12 hours of symptom onset in patients without
contraindications.
Pulmonary & Critical Care
9. A patient with ARDS is receiving mechanical ventilation. Arterial blood gas results: pH 7.28,
PaCO2 57 mm Hg, PaO2 56 mm Hg, HCO3 18 mEq/L, SaO2 84%. Ventilator settings: FIO2 70%,
Rate 15 breaths/minute, Tidal volume 600 mL, PEEP 5 cm H2O. Which of the following
adjustments should the ACNP make to optimize oxygenation?
A) Increase tidal volume
B) Decrease FiO2
, C) Increase PEEP
D) Decrease respiratory rate
Answer: C
*Rationale: ARDS is characterized by non-cardiogenic pulmonary edema and decreased lung
compliance. Increasing PEEP helps recruit collapsed alveoli, improves oxygenation, and allows
for reduction in FiO2, thereby decreasing oxygen toxicity risk.*
10. Which intervention is lung-protective for a patient with ARDS?
A) Tidal volume 10-12 mL/kg IBW
B) Tidal volume 4-8 mL/kg IBW and plateau pressure <30 cm H2O
C) High PEEP only
D) Permissive hypercapnia only
Answer: B
*Rationale: Lung-protective ventilation for ARDS includes low tidal volumes (4-8 mL/kg ideal
body weight) and limiting plateau pressure to <30 cm H2O to prevent ventilator-induced lung
injury.*
11. Which finding suggests neurogenic shock?
A) Hypertension and bradycardia
B) Hypotension and bradycardia
C) Hypotension and tachycardia
D) Hypertension and tachycardia
Answer: B
Rationale: Neurogenic shock (from spinal cord injury) causes hypotension due to loss of
sympathetic tone and bradycardia due to unopposed vagal tone.
12. A patient with COPD exacerbation has arterial blood gas: pH 7.28, PaCO2 65 mm Hg, PaO2
55 mm Hg, HCO3 26 mEq/L. The patient is awake but tired. What is the most appropriate next
step?
A) Intubate and initiate mechanical ventilation
B) Initiate noninvasive positive pressure ventilation (NPPV)
C) Increase supplemental oxygen to 100%
D) Adminute sodium bicarbonate
Answer: B
*Rationale: Acute hypercapnic respiratory failure with pH <7.30 indicates need for ventilatory
Style Questions & Answers for Acute
Care NP Certification (AANP/ANCC) |
Graded A+ | Guaranteed Pass!!
Comprehensive AGACNP Practice Questions Cardiovascular
1. A 78-year-old male with a history of hypertension and chronic kidney disease presents with
a new onset of a "beefy red" tongue, significant fatigue, and paresthesia in his hands and
feet. His laboratory results show a Mean Corpuscular Volume (MCV) of 108 fL. Which of the
following is the most likely diagnosis?
A) Iron Deficiency Anemia
B) Folate Deficiency Anemia
C) Pernicious Anemia
D) Anemia of Chronic Disease
Answer: C
Rationale: Pernicious anemia is a macrocytic anemia (MCV > 100) caused by a lack of intrinsic
factor, leading to Vitamin B12 deficiency. Classic signs include a beefy red tongue and
neurological symptoms like paresthesia, which distinguish it from folate deficiency.
2. A patient with atrial fibrillation on warfarin has INR 5.2 and no signs of bleeding. What is
the most appropriate management?
A) Administer vitamin K 10 mg orally
B) Administer fresh frozen plasma
C) Hold warfarin and recheck INR in 24-48 hours
D) Administer prothrombin complex concentrate
Answer: C
Rationale: For asymptomatic patients with INR >5.0 but <9.0, guidelines recommend holding
warfarin and monitoring INR. Vitamin K is generally reserved for INR >10 or when bleeding risk
is high.
,3. A 52-year-old female patient was involved in a motor vehicle collision and sustained blunt
trauma to her chest. She was unresponsive and intubated at the scene. Upon presentation in
the ED, the patient is coughing, and pink frothy secretions are noted in the endotracheal
tube. Her blood pressure is 60/30, heart rate 134. She has markedly elevated JVD. An
echocardiogram revealed a flail mitral valve and torrential regurgitation, consistent with
mitral valve rupture. Which intervention is most important in this client's plan of care?
A) Urgent left heart catheterization
B) Immediate cardiac surgery for repair
C) STAT intravenous diuretic dose
D) Initiation of intravenous inotrope therapy
Answer: B
Rationale: Traumatic mitral valve rupture with cardiogenic shock requires immediate surgical
repair. Delaying surgery for diagnostic studies or medical management alone is not sufficient for
this mechanical cause of shock.
4. Which ECG finding is most specific for acute myocardial infarction?
A) Sinus tachycardia
B) ST-segment elevation in contiguous leads
C) First-degree AV block
D) Premature atrial contractions
Answer: B
Rationale: ST-segment elevation in contiguous leads is the hallmark ECG finding of acute ST-
elevation myocardial infarction (STEMI), indicating acute coronary occlusion.
5. Which finding is most specific for cardiac tamponade?
A) Hypertension and bradycardia
B) Beck's triad (hypotension, JVD, muffled heart sounds)
C) Wide pulse pressure
D) Pulsus paradoxus <10 mmHg
Answer: B
Rationale: Beck's triad is the classic sign of cardiac tamponade. Pulsus paradoxus (>10 mmHg) is
also suggestive but not as specific as the triad.
6. A patient presents with new onset ST segment elevation and T wave inversion in leads II,
III, and aVF. The most appropriate diagnosis is:
A) Anterior myocardial infarction
,B) Inferior myocardial infarction
C) Lateral myocardial infarction
D) Septal myocardial infarction
Answer: B
Rationale: Leads II, III, and aVF represent the inferior wall of the heart. ST elevation in these
leads indicates an inferior myocardial infarction, typically involving the right coronary artery.
7. Which medication is contraindicated in acute decompensated heart failure with
hypotension?
A) Furosemide
B) Nitroglycerin
C) Dobutamine
D) Metoprolol
Answer: D
Rationale: Beta-blockers such as metoprolol are negative inotropes and can worsen hypotension
and cardiogenic shock in acute decompensated heart failure; they are typically held until the
patient is stabilized.
8. A patient with STEMI presents 3 hours after symptom onset and timely PCI is not available.
Which is most appropriate?
A) Argatroban
B) Eptifibatide
C) Bivalirudin
D) Reteplase
Answer: D
Rationale: When timely PCI is not available for STEMI, fibrinolytic therapy (e.g., reteplase,
tenecteplase, alteplase) is indicated within 12 hours of symptom onset in patients without
contraindications.
Pulmonary & Critical Care
9. A patient with ARDS is receiving mechanical ventilation. Arterial blood gas results: pH 7.28,
PaCO2 57 mm Hg, PaO2 56 mm Hg, HCO3 18 mEq/L, SaO2 84%. Ventilator settings: FIO2 70%,
Rate 15 breaths/minute, Tidal volume 600 mL, PEEP 5 cm H2O. Which of the following
adjustments should the ACNP make to optimize oxygenation?
A) Increase tidal volume
B) Decrease FiO2
, C) Increase PEEP
D) Decrease respiratory rate
Answer: C
*Rationale: ARDS is characterized by non-cardiogenic pulmonary edema and decreased lung
compliance. Increasing PEEP helps recruit collapsed alveoli, improves oxygenation, and allows
for reduction in FiO2, thereby decreasing oxygen toxicity risk.*
10. Which intervention is lung-protective for a patient with ARDS?
A) Tidal volume 10-12 mL/kg IBW
B) Tidal volume 4-8 mL/kg IBW and plateau pressure <30 cm H2O
C) High PEEP only
D) Permissive hypercapnia only
Answer: B
*Rationale: Lung-protective ventilation for ARDS includes low tidal volumes (4-8 mL/kg ideal
body weight) and limiting plateau pressure to <30 cm H2O to prevent ventilator-induced lung
injury.*
11. Which finding suggests neurogenic shock?
A) Hypertension and bradycardia
B) Hypotension and bradycardia
C) Hypotension and tachycardia
D) Hypertension and tachycardia
Answer: B
Rationale: Neurogenic shock (from spinal cord injury) causes hypotension due to loss of
sympathetic tone and bradycardia due to unopposed vagal tone.
12. A patient with COPD exacerbation has arterial blood gas: pH 7.28, PaCO2 65 mm Hg, PaO2
55 mm Hg, HCO3 26 mEq/L. The patient is awake but tired. What is the most appropriate next
step?
A) Intubate and initiate mechanical ventilation
B) Initiate noninvasive positive pressure ventilation (NPPV)
C) Increase supplemental oxygen to 100%
D) Adminute sodium bicarbonate
Answer: B
*Rationale: Acute hypercapnic respiratory failure with pH <7.30 indicates need for ventilatory
