Download Adult-Gerontology Acute
Care NP Exam: 100 Practice Questions
with Answers and Rationales ALREADY
GRADED A +
Below are 100 practice questions designed to reflect the content domains of the AGACNP certification exams from both the
American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN). The questions cover
the core domains: Clinical Judgment (80%) and Professional Caring and Ethical Practice (20%). Answers and detailed rationales
are provided for each.
Domain 1: Cardiovascular Disorders
1. A 68-year-old male with a history of hypertension and diabetes presents with chest pain
radiating to the jaw, diaphoresis, and nausea. An ECG shows ST-segment elevation in leads V1-
V4. Which intervention is a priority?
• A) Administer sublingual nitroglycerin
• B) Prepare the patient for immediate percutaneous coronary intervention (PCI)
• C) Begin alteplase (tPA) infusion
• D) Schedule a stress test
Answer: B) Prepare the patient for immediate percutaneous coronary intervention (PCI)
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior STEMI. The priority is to
rapidly restore coronary perfusion, with PCI being the preferred method if available within 90
minutes of arrival.
2. A 72-year-old patient with heart failure presents with acute pulmonary edema and a blood
pressure of 160/90 mmHg. Which medication is most appropriate for rapid symptom relief?
• A) Furosemide (Lasix) IV
, • B) Metoprolol (Lopressor) PO
• C) Digoxin PO
• D) Hydralazine IV
Answer: A) Furosemide (Lasix) IV
Rationale: In acute pulmonary edema, IV loop diuretics rapidly reduce preload and alleviate
pulmonary congestion, making them the first-line treatment.
3. A 65-year-old patient presents with sudden, severe "tearing" chest pain radiating to the
back, with a blood pressure of 210/110 mmHg. Which diagnosis should the AGACNP suspect?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe tearing chest pain radiating
to the back, often with severe hypertension. This is a surgical emergency.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which therapy is most
appropriate for stroke prevention?
• A) Aspirin 81 mg daily
• B) Warfarin or a direct oral anticoagulant (DOAC)
• C) Clopidogrel 75 mg daily
• D) No anticoagulation needed
Answer: B) Warfarin or a direct oral anticoagulant (DOAC)
Rationale: A CHA₂DS₂-VASc score of 4 indicates a high stroke risk, and oral anticoagulation with
warfarin or a DOAC is indicated for stroke prevention.
5. Which ECG finding is most consistent with pericarditis?
• A) ST-segment depression
• B) ST-segment elevation in multiple leads
• C) Diffuse, concave ST-segment elevation
, • D) Q waves in leads II, III, aVF
Answer: C) Diffuse, concave ST-segment elevation
Rationale: Pericarditis is characterized by diffuse, concave (scooped) ST-segment elevation,
often with PR-segment depression.
6. A patient presents with severe hypertension, headache, confusion, and retinal
hemorrhages. This presentation is most consistent with:
• A) Hypertensive urgency
• B) Hypertensive emergency
• C) Intracranial hemorrhage
• D) Stroke
Answer: B) Hypertensive emergency
Rationale: Hypertensive emergency is diagnosed when severe hypertension is accompanied by
end-organ damage, as indicated by confusion, retinal hemorrhages, and other neurological
symptoms.
7. A patient with hypertension is on an ACE inhibitor. Which lab value requires the most
immediate attention?
• A) Sodium 138 mEq/L
• B) Potassium 5.9 mEq/L
• C) Glucose 100 mg/dL
• D) Hemoglobin 13 g/dL
Answer: B) Potassium 5.9 mEq/L
Rationale: ACE inhibitors can cause hyperkalemia by reducing aldosterone secretion. A
potassium level of 5.9 mEq/L is concerning and requires provider notification.
8. A patient presents with unilateral leg swelling, pain, and warmth. The AGACNP should
order which diagnostic test first?
• A) Venous duplex ultrasound
• B) D-dimer
• C) CT angiography
• D) MRI
, Answer: A) Venous duplex ultrasound
Rationale: Venous duplex ultrasound is the gold standard non-invasive test for diagnosing deep
vein thrombosis (DVT).
9. A patient on warfarin therapy has an INR of 4.2. The target INR is 2.0-3.0. What is the most
appropriate action?
• A) Continue current dose
• B) Notify the provider for dose adjustment
• C) Administer vitamin K immediately
• D) Advise the patient to take an extra dose
Answer: B) Notify the provider for dose adjustment
Rationale: An INR above the therapeutic range increases bleeding risk. The provider should be
notified for dose adjustment and the patient assessed for signs of bleeding.
10. In cardiac arrest, which rhythm is considered "shockable"?
• A) Asystole
• B) Pulseless electrical activity (PEA)
• C) Ventricular fibrillation (VF)
• D) Sinus bradycardia
Answer: C) Ventricular fibrillation (VF)
Rationale: VF and pulseless ventricular tachycardia are the two shockable rhythms.
Defibrillation is indicated immediately.
Domain 2: Pulmonary Disorders
11. A 60-year-old COPD patient presents with increased sputum production, fever, and
hypoxia. A chest X-ray shows new infiltrates. What is the most appropriate initial treatment?
• A) Oral steroids
• B) Antibiotics
• C) Bronchodilators
• D) Antiviral therapy
Care NP Exam: 100 Practice Questions
with Answers and Rationales ALREADY
GRADED A +
Below are 100 practice questions designed to reflect the content domains of the AGACNP certification exams from both the
American Nurses Credentialing Center (ANCC) and the American Association of Critical-Care Nurses (AACN). The questions cover
the core domains: Clinical Judgment (80%) and Professional Caring and Ethical Practice (20%). Answers and detailed rationales
are provided for each.
Domain 1: Cardiovascular Disorders
1. A 68-year-old male with a history of hypertension and diabetes presents with chest pain
radiating to the jaw, diaphoresis, and nausea. An ECG shows ST-segment elevation in leads V1-
V4. Which intervention is a priority?
• A) Administer sublingual nitroglycerin
• B) Prepare the patient for immediate percutaneous coronary intervention (PCI)
• C) Begin alteplase (tPA) infusion
• D) Schedule a stress test
Answer: B) Prepare the patient for immediate percutaneous coronary intervention (PCI)
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior STEMI. The priority is to
rapidly restore coronary perfusion, with PCI being the preferred method if available within 90
minutes of arrival.
2. A 72-year-old patient with heart failure presents with acute pulmonary edema and a blood
pressure of 160/90 mmHg. Which medication is most appropriate for rapid symptom relief?
• A) Furosemide (Lasix) IV
, • B) Metoprolol (Lopressor) PO
• C) Digoxin PO
• D) Hydralazine IV
Answer: A) Furosemide (Lasix) IV
Rationale: In acute pulmonary edema, IV loop diuretics rapidly reduce preload and alleviate
pulmonary congestion, making them the first-line treatment.
3. A 65-year-old patient presents with sudden, severe "tearing" chest pain radiating to the
back, with a blood pressure of 210/110 mmHg. Which diagnosis should the AGACNP suspect?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe tearing chest pain radiating
to the back, often with severe hypertension. This is a surgical emergency.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which therapy is most
appropriate for stroke prevention?
• A) Aspirin 81 mg daily
• B) Warfarin or a direct oral anticoagulant (DOAC)
• C) Clopidogrel 75 mg daily
• D) No anticoagulation needed
Answer: B) Warfarin or a direct oral anticoagulant (DOAC)
Rationale: A CHA₂DS₂-VASc score of 4 indicates a high stroke risk, and oral anticoagulation with
warfarin or a DOAC is indicated for stroke prevention.
5. Which ECG finding is most consistent with pericarditis?
• A) ST-segment depression
• B) ST-segment elevation in multiple leads
• C) Diffuse, concave ST-segment elevation
, • D) Q waves in leads II, III, aVF
Answer: C) Diffuse, concave ST-segment elevation
Rationale: Pericarditis is characterized by diffuse, concave (scooped) ST-segment elevation,
often with PR-segment depression.
6. A patient presents with severe hypertension, headache, confusion, and retinal
hemorrhages. This presentation is most consistent with:
• A) Hypertensive urgency
• B) Hypertensive emergency
• C) Intracranial hemorrhage
• D) Stroke
Answer: B) Hypertensive emergency
Rationale: Hypertensive emergency is diagnosed when severe hypertension is accompanied by
end-organ damage, as indicated by confusion, retinal hemorrhages, and other neurological
symptoms.
7. A patient with hypertension is on an ACE inhibitor. Which lab value requires the most
immediate attention?
• A) Sodium 138 mEq/L
• B) Potassium 5.9 mEq/L
• C) Glucose 100 mg/dL
• D) Hemoglobin 13 g/dL
Answer: B) Potassium 5.9 mEq/L
Rationale: ACE inhibitors can cause hyperkalemia by reducing aldosterone secretion. A
potassium level of 5.9 mEq/L is concerning and requires provider notification.
8. A patient presents with unilateral leg swelling, pain, and warmth. The AGACNP should
order which diagnostic test first?
• A) Venous duplex ultrasound
• B) D-dimer
• C) CT angiography
• D) MRI
, Answer: A) Venous duplex ultrasound
Rationale: Venous duplex ultrasound is the gold standard non-invasive test for diagnosing deep
vein thrombosis (DVT).
9. A patient on warfarin therapy has an INR of 4.2. The target INR is 2.0-3.0. What is the most
appropriate action?
• A) Continue current dose
• B) Notify the provider for dose adjustment
• C) Administer vitamin K immediately
• D) Advise the patient to take an extra dose
Answer: B) Notify the provider for dose adjustment
Rationale: An INR above the therapeutic range increases bleeding risk. The provider should be
notified for dose adjustment and the patient assessed for signs of bleeding.
10. In cardiac arrest, which rhythm is considered "shockable"?
• A) Asystole
• B) Pulseless electrical activity (PEA)
• C) Ventricular fibrillation (VF)
• D) Sinus bradycardia
Answer: C) Ventricular fibrillation (VF)
Rationale: VF and pulseless ventricular tachycardia are the two shockable rhythms.
Defibrillation is indicated immediately.
Domain 2: Pulmonary Disorders
11. A 60-year-old COPD patient presents with increased sputum production, fever, and
hypoxia. A chest X-ray shows new infiltrates. What is the most appropriate initial treatment?
• A) Oral steroids
• B) Antibiotics
• C) Bronchodilators
• D) Antiviral therapy
