AGACNP-BC Practice Exam Questions
and Answers with Rationales Latest
Versions
1. A 72-year-old patient with a history of hypertension presents with
acute dyspnea, orthopnea, and bilateral crackles. BP is 188/104 mmHg,
HR 112/min, and oxygen saturation is 86% on room air. Chest
radiograph demonstrates pulmonary vascular congestion. Which
intervention should the AGACNP prioritize?
A. Administer a rapid 1-L normal saline bolus
B. Initiate noninvasive positive-pressure ventilation
C. Place the patient in the Trendelenburg position
D. Administer IV maintenance fluids
Answer: B. Initiate noninvasive positive-pressure ventilation
Rationale: Acute cardiogenic pulmonary edema with hypoxemia and
severe hypertension requires rapid reduction of respiratory distress and
improvement in oxygenation. Noninvasive positive-pressure ventilation,
such as CPAP or BiPAP, can improve alveolar recruitment and reduce
preload/afterload. IV vasodilator therapy may also be indicated when
blood pressure is markedly elevated. Fluid boluses would worsen
pulmonary edema.
2. A 68-year-old patient with atrial fibrillation develops sudden right-
sided weakness and expressive aphasia. Symptoms began 45 minutes
ago. CT of the head shows no intracranial hemorrhage. Which
intervention is most appropriate if there are no contraindications?
,A. Begin aspirin only
B. Administer IV thrombolytic therapy
C. Administer warfarin immediately
D. Delay treatment until MRI confirms infarction
Answer: B. Administer IV thrombolytic therapy
Rationale: This presentation is consistent with acute ischemic stroke. A
patient presenting within the appropriate treatment window who meets
eligibility criteria and has no hemorrhage on CT may receive IV
thrombolytic therapy. Treatment should not be unnecessarily delayed for
MRI when the initial CT excludes hemorrhage.
3. A 79-year-old hospitalized patient becomes acutely confused,
inattentive, and disoriented over several hours. Which finding most
strongly supports delirium rather than dementia?
A. Gradual memory decline over several years
B. Stable cognitive impairment
C. Acute fluctuating attention and awareness
D. Difficulty recalling remote events
Answer: C. Acute fluctuating attention and awareness
Rationale: Delirium is characterized by an acute change in attention and
awareness with a fluctuating course. Dementia generally develops
gradually and primarily involves persistent cognitive decline. In
hospitalized older adults, potential causes of delirium include infection,
medications, metabolic disturbances, hypoxia, pain, and urinary
retention.
,4. A patient with septic shock remains hypotensive after receiving an
appropriate initial crystalloid resuscitation. Which medication is
generally the preferred first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Phenylephrine
Answer: B. Norepinephrine
Rationale: Norepinephrine is generally the first-line vasopressor for
septic shock when hypotension persists despite adequate fluid
resuscitation. It primarily produces α-adrenergic vasoconstriction with
some β-adrenergic activity. Dobutamine is primarily an inotrope and
may be considered when cardiac dysfunction and inadequate perfusion
persist despite appropriate blood pressure support.
5. A 64-year-old patient presents with crushing substernal chest pain and
diaphoresis. ECG demonstrates ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most commonly associated with this
pattern?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery only
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior STEMI is classically associated with occlusion of
the right coronary artery, although the left circumflex artery can also
cause an inferior infarction. Leads II, III, and aVF represent the inferior
wall. Because inferior STEMI can involve the right ventricle, right-sided
, ECG leads should be considered, particularly when hypotension
accompanies the presentation.
6. A patient with severe COPD exacerbation has a pH of 7.25, PaCO₂ of
68 mmHg, and increasing work of breathing. The patient is awake and
able to protect the airway. Which intervention is most appropriate?
A. Immediate discharge with oral antibiotics
B. Noninvasive positive-pressure ventilation
C. High-dose IV fluids
D. Routine administration of bicarbonate
Answer: B. Noninvasive positive-pressure ventilation
Rationale: Acute hypercapnic respiratory failure with respiratory
acidosis in COPD can often be treated effectively with noninvasive
ventilation when the patient is awake and able to protect the airway. NIV
decreases work of breathing and improves alveolar ventilation.
Intubation is indicated if the patient deteriorates or cannot protect the
airway.
7. A 75-year-old patient taking warfarin presents with life-threatening
gastrointestinal bleeding. The INR is markedly elevated. Which reversal
strategy is most appropriate?
A. Oral vitamin K alone
B. Four-factor prothrombin complex concentrate plus IV vitamin K
C. Protamine sulfate
D. Idarucizumab
Answer: B. Four-factor prothrombin complex concentrate plus IV
vitamin K
and Answers with Rationales Latest
Versions
1. A 72-year-old patient with a history of hypertension presents with
acute dyspnea, orthopnea, and bilateral crackles. BP is 188/104 mmHg,
HR 112/min, and oxygen saturation is 86% on room air. Chest
radiograph demonstrates pulmonary vascular congestion. Which
intervention should the AGACNP prioritize?
A. Administer a rapid 1-L normal saline bolus
B. Initiate noninvasive positive-pressure ventilation
C. Place the patient in the Trendelenburg position
D. Administer IV maintenance fluids
Answer: B. Initiate noninvasive positive-pressure ventilation
Rationale: Acute cardiogenic pulmonary edema with hypoxemia and
severe hypertension requires rapid reduction of respiratory distress and
improvement in oxygenation. Noninvasive positive-pressure ventilation,
such as CPAP or BiPAP, can improve alveolar recruitment and reduce
preload/afterload. IV vasodilator therapy may also be indicated when
blood pressure is markedly elevated. Fluid boluses would worsen
pulmonary edema.
2. A 68-year-old patient with atrial fibrillation develops sudden right-
sided weakness and expressive aphasia. Symptoms began 45 minutes
ago. CT of the head shows no intracranial hemorrhage. Which
intervention is most appropriate if there are no contraindications?
,A. Begin aspirin only
B. Administer IV thrombolytic therapy
C. Administer warfarin immediately
D. Delay treatment until MRI confirms infarction
Answer: B. Administer IV thrombolytic therapy
Rationale: This presentation is consistent with acute ischemic stroke. A
patient presenting within the appropriate treatment window who meets
eligibility criteria and has no hemorrhage on CT may receive IV
thrombolytic therapy. Treatment should not be unnecessarily delayed for
MRI when the initial CT excludes hemorrhage.
3. A 79-year-old hospitalized patient becomes acutely confused,
inattentive, and disoriented over several hours. Which finding most
strongly supports delirium rather than dementia?
A. Gradual memory decline over several years
B. Stable cognitive impairment
C. Acute fluctuating attention and awareness
D. Difficulty recalling remote events
Answer: C. Acute fluctuating attention and awareness
Rationale: Delirium is characterized by an acute change in attention and
awareness with a fluctuating course. Dementia generally develops
gradually and primarily involves persistent cognitive decline. In
hospitalized older adults, potential causes of delirium include infection,
medications, metabolic disturbances, hypoxia, pain, and urinary
retention.
,4. A patient with septic shock remains hypotensive after receiving an
appropriate initial crystalloid resuscitation. Which medication is
generally the preferred first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Phenylephrine
Answer: B. Norepinephrine
Rationale: Norepinephrine is generally the first-line vasopressor for
septic shock when hypotension persists despite adequate fluid
resuscitation. It primarily produces α-adrenergic vasoconstriction with
some β-adrenergic activity. Dobutamine is primarily an inotrope and
may be considered when cardiac dysfunction and inadequate perfusion
persist despite appropriate blood pressure support.
5. A 64-year-old patient presents with crushing substernal chest pain and
diaphoresis. ECG demonstrates ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most commonly associated with this
pattern?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery only
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior STEMI is classically associated with occlusion of
the right coronary artery, although the left circumflex artery can also
cause an inferior infarction. Leads II, III, and aVF represent the inferior
wall. Because inferior STEMI can involve the right ventricle, right-sided
, ECG leads should be considered, particularly when hypotension
accompanies the presentation.
6. A patient with severe COPD exacerbation has a pH of 7.25, PaCO₂ of
68 mmHg, and increasing work of breathing. The patient is awake and
able to protect the airway. Which intervention is most appropriate?
A. Immediate discharge with oral antibiotics
B. Noninvasive positive-pressure ventilation
C. High-dose IV fluids
D. Routine administration of bicarbonate
Answer: B. Noninvasive positive-pressure ventilation
Rationale: Acute hypercapnic respiratory failure with respiratory
acidosis in COPD can often be treated effectively with noninvasive
ventilation when the patient is awake and able to protect the airway. NIV
decreases work of breathing and improves alveolar ventilation.
Intubation is indicated if the patient deteriorates or cannot protect the
airway.
7. A 75-year-old patient taking warfarin presents with life-threatening
gastrointestinal bleeding. The INR is markedly elevated. Which reversal
strategy is most appropriate?
A. Oral vitamin K alone
B. Four-factor prothrombin complex concentrate plus IV vitamin K
C. Protamine sulfate
D. Idarucizumab
Answer: B. Four-factor prothrombin complex concentrate plus IV
vitamin K
