ANCC AGACNP-BC Practice Exam – 260 Questions
with Rationales | Adult-Gerontology Acute Care Nurse
Practitioner Certification | Updated 2026
TABLE OF CONTENTS
Domain 1: Assessment and Diagnosis Questions 1 to 65
Domain 2: Planning and Implementation Questions 66 to 130
Domain 3: Evaluation Questions 131 to 195
Domain 4: Professional Role and Leadership Questions 196 to 260
DOMAIN 1: ASSESSMENT AND DIAGNOSIS QUESTIONS 1 TO 65
Question 1
A 72-year-old male patient is admitted with acute onset of severe, tearing
chest pain radiating to the back. His blood pressure is 190/100 in the right
arm and 110/70 in the left arm. Which of the following is the most likely
diagnosis?
A. Acute aortic dissection
B. Myocardial infarction
C. Pulmonary embolism
D. Pericarditis
,Correct Answer: A
Rationale: Acute aortic dissection presents with severe, tearing chest pain
radiating to the back and a pulse deficit with different blood pressures
between arms. Myocardial infarction typically presents with pressure or
heaviness in the chest. Pulmonary embolism presents with pleuritic chest
pain and dyspnea. Pericarditis presents with sharp chest pain that improves
when leaning forward.
Question 2
A 68-year-old female patient presents with acute confusion, fever, and flank
pain. Her urinalysis shows white blood cell casts. Which of the following is
the most likely diagnosis?
A. Pyelonephritis
B. Cystitis
C. Urethritis
D. Prostatitis
Correct Answer: A
Rationale: Pyelonephritis is characterized by fever, flank pain, and white
blood cell casts in the urine. Cystitis presents with suprapubic pain and
dysuria. Urethritis presents with urethral discharge. Prostatitis presents with
perineal pain and fever.
Question 3
,A 75-year-old male patient is admitted with shortness of breath and leg
swelling. On exam, you note jugular venous distension, crackles in both
lung bases, and 3 plus pitting edema in both legs. Which of the following is
the most likely diagnosis?
A. Heart failure
B. Chronic obstructive pulmonary disease
C. Pneumonia
D. Pulmonary embolism
Correct Answer: A
Rationale: Heart failure presents with dyspnea, crackles on lung
auscultation, peripheral edema, and jugular venous distension. Chronic
obstructive pulmonary disease presents with chronic cough and wheezing.
Pneumonia presents with fever and productive cough. Pulmonary embolism
presents with acute dyspnea and pleuritic chest pain.
Question 4
A 62-year-old male patient presents with epigastric pain radiating to his
back. His serum amylase and lipase are elevated. Which of the following is
the most likely diagnosis?
A. Acute pancreatitis
B. Cholecystitis
C. Peptic ulcer disease
D. Gastroenteritis
, Correct Answer: A
Rationale: Acute pancreatitis presents with epigastric pain radiating to the
back, nausea, and vomiting with elevated serum amylase and lipase.
Cholecystitis presents with right upper quadrant pain. Peptic ulcer disease
presents with burning epigastric pain. Gastroenteritis presents with diarrhea
and vomiting.
Question 5
A 65-year-old female patient presents with a painful, red, swollen left calf.
She recently returned from a long flight. Which of the following is the most
likely diagnosis?
A. Deep vein thrombosis
B. Cellulitis
C. Venous insufficiency
D. Lymphedema
Correct Answer: A
Rationale: Deep vein thrombosis presents with unilateral leg pain, swelling,
redness, and warmth. Recent prolonged immobilization from a long flight is
a significant risk factor. Cellulitis presents with erythema and warmth.
Venous insufficiency presents with bilateral swelling. Lymphedema presents
with chronic painless swelling.
Question 6
with Rationales | Adult-Gerontology Acute Care Nurse
Practitioner Certification | Updated 2026
TABLE OF CONTENTS
Domain 1: Assessment and Diagnosis Questions 1 to 65
Domain 2: Planning and Implementation Questions 66 to 130
Domain 3: Evaluation Questions 131 to 195
Domain 4: Professional Role and Leadership Questions 196 to 260
DOMAIN 1: ASSESSMENT AND DIAGNOSIS QUESTIONS 1 TO 65
Question 1
A 72-year-old male patient is admitted with acute onset of severe, tearing
chest pain radiating to the back. His blood pressure is 190/100 in the right
arm and 110/70 in the left arm. Which of the following is the most likely
diagnosis?
A. Acute aortic dissection
B. Myocardial infarction
C. Pulmonary embolism
D. Pericarditis
,Correct Answer: A
Rationale: Acute aortic dissection presents with severe, tearing chest pain
radiating to the back and a pulse deficit with different blood pressures
between arms. Myocardial infarction typically presents with pressure or
heaviness in the chest. Pulmonary embolism presents with pleuritic chest
pain and dyspnea. Pericarditis presents with sharp chest pain that improves
when leaning forward.
Question 2
A 68-year-old female patient presents with acute confusion, fever, and flank
pain. Her urinalysis shows white blood cell casts. Which of the following is
the most likely diagnosis?
A. Pyelonephritis
B. Cystitis
C. Urethritis
D. Prostatitis
Correct Answer: A
Rationale: Pyelonephritis is characterized by fever, flank pain, and white
blood cell casts in the urine. Cystitis presents with suprapubic pain and
dysuria. Urethritis presents with urethral discharge. Prostatitis presents with
perineal pain and fever.
Question 3
,A 75-year-old male patient is admitted with shortness of breath and leg
swelling. On exam, you note jugular venous distension, crackles in both
lung bases, and 3 plus pitting edema in both legs. Which of the following is
the most likely diagnosis?
A. Heart failure
B. Chronic obstructive pulmonary disease
C. Pneumonia
D. Pulmonary embolism
Correct Answer: A
Rationale: Heart failure presents with dyspnea, crackles on lung
auscultation, peripheral edema, and jugular venous distension. Chronic
obstructive pulmonary disease presents with chronic cough and wheezing.
Pneumonia presents with fever and productive cough. Pulmonary embolism
presents with acute dyspnea and pleuritic chest pain.
Question 4
A 62-year-old male patient presents with epigastric pain radiating to his
back. His serum amylase and lipase are elevated. Which of the following is
the most likely diagnosis?
A. Acute pancreatitis
B. Cholecystitis
C. Peptic ulcer disease
D. Gastroenteritis
, Correct Answer: A
Rationale: Acute pancreatitis presents with epigastric pain radiating to the
back, nausea, and vomiting with elevated serum amylase and lipase.
Cholecystitis presents with right upper quadrant pain. Peptic ulcer disease
presents with burning epigastric pain. Gastroenteritis presents with diarrhea
and vomiting.
Question 5
A 65-year-old female patient presents with a painful, red, swollen left calf.
She recently returned from a long flight. Which of the following is the most
likely diagnosis?
A. Deep vein thrombosis
B. Cellulitis
C. Venous insufficiency
D. Lymphedema
Correct Answer: A
Rationale: Deep vein thrombosis presents with unilateral leg pain, swelling,
redness, and warmth. Recent prolonged immobilization from a long flight is
a significant risk factor. Cellulitis presents with erythema and warmth.
Venous insufficiency presents with bilateral swelling. Lymphedema presents
with chronic painless swelling.
Question 6
