___________________________________________________________________
Adult-Gerontology Acute Care Nurse
Practitioner Certification Exam
(AGACNP-BC) 2026–2027 | 100-
Question Advanced Practice Exam |
Questions & Answers with Detailed
Rationales | Complete Study Guide
1. A 72-year-old patient with septic shock remains hypotensive after receiving
an appropriate initial crystalloid bolus. Which intervention is most
appropriate?
A. Start dopamine as first-line therapy
B. Administer norepinephrine
C. Administer dobutamine alone
D. Give additional maintenance crystalloid indefinitely
,Answer: B. Administer norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for septic shock
when hypotension persists despite adequate initial fluid resuscitation. It
increases vascular tone with comparatively limited tachycardia.
2. A patient with acute decompensated heart failure has severe pulmonary
edema, blood pressure 198/110 mm Hg, and significant respiratory distress.
Which treatment is most appropriate initially?
A. Rapid intravenous fluid administration
B. Noninvasive positive-pressure ventilation and intravenous vasodilator therapy
C. Immediate beta-blocker escalation
D. Oral diuretic therapy only
Answer: B. Noninvasive positive-pressure ventilation and intravenous
vasodilator therapy
Rationale: Hypertensive acute pulmonary edema is characterized by markedly
elevated afterload and pulmonary congestion. Noninvasive ventilation improves
oxygenation and reduces work of breathing, while intravenous vasodilators
rapidly reduce preload and afterload.
3. A 68-year-old patient develops sudden aphasia and right-sided weakness 45
minutes before arrival. CT shows no intracranial hemorrhage. Which factor
is most important when determining eligibility for intravenous
thrombolysis?
A. Serum cholesterol level
B. Time from symptom onset or last known well
C. Previous history of hypertension alone
D. Hemoglobin A1c
Answer: B. Time from symptom onset or last known well
,Rationale: The treatment window and clinical eligibility criteria are central to
acute ischemic stroke thrombolysis decisions. Precise determination of the last-
known-well time is therefore critical.
4. A patient with severe COPD exacerbation has increasing somnolence, pH
7.24, and PaCO₂ 78 mm Hg despite initial therapy. What does this finding
most strongly indicate?
A. Pure metabolic alkalosis
B. Acute-on-chronic hypercapnic respiratory failure
C. Isolated hypoxemic respiratory failure
D. Respiratory alkalosis
Answer: B. Acute-on-chronic hypercapnic respiratory failure
Rationale: Marked hypercapnia accompanied by acidemia indicates inadequate
alveolar ventilation. In a patient with COPD, this may represent acute-on-
chronic hypercapnic respiratory failure and requires urgent ventilatory support
assessment.
5. A patient with diabetic ketoacidosis has glucose 480 mg/dL, pH 7.12, and
potassium 2.8 mEq/L. What should occur before starting intravenous
insulin?
A. Administer potassium replacement
B. Administer sodium bicarbonate routinely
C. Give a long-acting insulin dose
D. Restrict fluids
Answer: A. Administer potassium replacement
Rationale: Insulin drives potassium intracellularly and can cause life-threatening
hypokalemia. When serum potassium is significantly low, potassium must be
replaced before insulin is initiated.
, 6. A patient receiving unfractionated heparin develops a platelet count
decrease of more than 50% with new thrombosis 7 days after treatment
began. What is the priority intervention?
A. Continue heparin and monitor platelets
B. Stop all heparin exposure and initiate an appropriate non-heparin
anticoagulant
C. Administer platelet transfusion routinely
D. Start warfarin monotherapy immediately
Answer: B. Stop all heparin exposure and initiate an appropriate non-heparin
anticoagulant
Rationale: The timing, magnitude of thrombocytopenia, and thrombosis
strongly suggest heparin-induced thrombocytopenia. All heparin products
should be discontinued and an alternative anticoagulant initiated when
clinically appropriate.
7. A 79-year-old patient with atrial fibrillation presents with hypotension,
altered mental status, and ventricular rate of 180/min. What is the
preferred immediate treatment?
A. Oral metoprolol
B. Intravenous digoxin
C. Synchronized cardioversion
D. Observation
Answer: C. Synchronized cardioversion
Rationale: Hemodynamic instability caused by tachyarrhythmia is an indication
for immediate synchronized cardioversion rather than delayed pharmacologic
rate control.
8. A patient with suspected massive pulmonary embolism develops
hypotension and obstructive shock. Which finding most strongly supports
the diagnosis?
Adult-Gerontology Acute Care Nurse
Practitioner Certification Exam
(AGACNP-BC) 2026–2027 | 100-
Question Advanced Practice Exam |
Questions & Answers with Detailed
Rationales | Complete Study Guide
1. A 72-year-old patient with septic shock remains hypotensive after receiving
an appropriate initial crystalloid bolus. Which intervention is most
appropriate?
A. Start dopamine as first-line therapy
B. Administer norepinephrine
C. Administer dobutamine alone
D. Give additional maintenance crystalloid indefinitely
,Answer: B. Administer norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for septic shock
when hypotension persists despite adequate initial fluid resuscitation. It
increases vascular tone with comparatively limited tachycardia.
2. A patient with acute decompensated heart failure has severe pulmonary
edema, blood pressure 198/110 mm Hg, and significant respiratory distress.
Which treatment is most appropriate initially?
A. Rapid intravenous fluid administration
B. Noninvasive positive-pressure ventilation and intravenous vasodilator therapy
C. Immediate beta-blocker escalation
D. Oral diuretic therapy only
Answer: B. Noninvasive positive-pressure ventilation and intravenous
vasodilator therapy
Rationale: Hypertensive acute pulmonary edema is characterized by markedly
elevated afterload and pulmonary congestion. Noninvasive ventilation improves
oxygenation and reduces work of breathing, while intravenous vasodilators
rapidly reduce preload and afterload.
3. A 68-year-old patient develops sudden aphasia and right-sided weakness 45
minutes before arrival. CT shows no intracranial hemorrhage. Which factor
is most important when determining eligibility for intravenous
thrombolysis?
A. Serum cholesterol level
B. Time from symptom onset or last known well
C. Previous history of hypertension alone
D. Hemoglobin A1c
Answer: B. Time from symptom onset or last known well
,Rationale: The treatment window and clinical eligibility criteria are central to
acute ischemic stroke thrombolysis decisions. Precise determination of the last-
known-well time is therefore critical.
4. A patient with severe COPD exacerbation has increasing somnolence, pH
7.24, and PaCO₂ 78 mm Hg despite initial therapy. What does this finding
most strongly indicate?
A. Pure metabolic alkalosis
B. Acute-on-chronic hypercapnic respiratory failure
C. Isolated hypoxemic respiratory failure
D. Respiratory alkalosis
Answer: B. Acute-on-chronic hypercapnic respiratory failure
Rationale: Marked hypercapnia accompanied by acidemia indicates inadequate
alveolar ventilation. In a patient with COPD, this may represent acute-on-
chronic hypercapnic respiratory failure and requires urgent ventilatory support
assessment.
5. A patient with diabetic ketoacidosis has glucose 480 mg/dL, pH 7.12, and
potassium 2.8 mEq/L. What should occur before starting intravenous
insulin?
A. Administer potassium replacement
B. Administer sodium bicarbonate routinely
C. Give a long-acting insulin dose
D. Restrict fluids
Answer: A. Administer potassium replacement
Rationale: Insulin drives potassium intracellularly and can cause life-threatening
hypokalemia. When serum potassium is significantly low, potassium must be
replaced before insulin is initiated.
, 6. A patient receiving unfractionated heparin develops a platelet count
decrease of more than 50% with new thrombosis 7 days after treatment
began. What is the priority intervention?
A. Continue heparin and monitor platelets
B. Stop all heparin exposure and initiate an appropriate non-heparin
anticoagulant
C. Administer platelet transfusion routinely
D. Start warfarin monotherapy immediately
Answer: B. Stop all heparin exposure and initiate an appropriate non-heparin
anticoagulant
Rationale: The timing, magnitude of thrombocytopenia, and thrombosis
strongly suggest heparin-induced thrombocytopenia. All heparin products
should be discontinued and an alternative anticoagulant initiated when
clinically appropriate.
7. A 79-year-old patient with atrial fibrillation presents with hypotension,
altered mental status, and ventricular rate of 180/min. What is the
preferred immediate treatment?
A. Oral metoprolol
B. Intravenous digoxin
C. Synchronized cardioversion
D. Observation
Answer: C. Synchronized cardioversion
Rationale: Hemodynamic instability caused by tachyarrhythmia is an indication
for immediate synchronized cardioversion rather than delayed pharmacologic
rate control.
8. A patient with suspected massive pulmonary embolism develops
hypotension and obstructive shock. Which finding most strongly supports
the diagnosis?
