Adult-Gerontology Acute Care Nurse Practitioner
Certification Examination (AGACNP-C) 2026–2027 |
Comprehensive Question Practice Test with Answers &
Rationales| Free Pdf Access
1. A 68-year-old client presents to the emergency department with crushing substernal chest
pain, diaphoresis, and nausea. What is the priority action?
A. Obtain a 12-lead ECG immediately
B. Schedule outpatient cardiology follow-up
C. Encourage oral fluids
D. Obtain a dietary history
Correct Answer: A
Rationale: Acute coronary syndrome (ACS) must be rapidly identified to prevent irreversible
myocardial damage. A 12-lead ECG should be obtained within 10 minutes of presentation to
evaluate for ST-segment elevation myocardial infarction (STEMI), which requires immediate
reperfusion therapy. Scheduling outpatient follow-up (B) is unsafe for an acute presentation.
Encouraging oral fluids (C) is contraindicated if the patient might need emergent surgery or if
they have heart failure. Obtaining a dietary history (D) is not a priority during an acute
emergency.
2. Which assessment finding in a critically ill client requires immediate intervention?
A. Oxygen saturation of 82%
B. Blood pressure of 132/78 mm Hg
C. Temperature of 99.1°F (37.3°C)
D. Heart rate of 88/min
Correct Answer: A
Rationale: Severe hypoxemia (SpO2 < 90%) threatens tissue oxygenation and requires urgent
intervention, such as supplemental oxygen, mechanical ventilation, or airway management. A
blood pressure of 132/78 mm Hg (B), a temperature of 99.1°F (C), and a heart rate of 88/min (D)
are all within normal physiological limits and do not require immediate emergency intervention.
,3. A client with septic shock is receiving vasopressor therapy. Which assessment parameter is
most important to monitor?
A. Mean arterial pressure (MAP)
B. Hair distribution
C. Visual acuity
D. Skin pigmentation
Correct Answer: A
Rationale: Vasopressors (e.g., norepinephrine, vasopressin) are titrated to maintain adequate
tissue perfusion, which is commonly assessed by maintaining a Mean Arterial Pressure (MAP) of
at least 65 mm Hg. Hair distribution (B), visual acuity (C), and skin pigmentation (D) are not
relevant parameters for titrating vasopressors in shock states.
4. A client develops sudden unilateral weakness, facial droop, and aphasia. What should the
nurse practitioner suspect?
A. Acute ischemic stroke
B. Migraine
C. Bell's palsy
D. Sinusitis
Correct Answer: A
Rationale: These findings are classic signs of acute stroke (cerebrovascular accident) and require
emergency evaluation. Sudden focal neurological deficits indicate an interruption of cerebral
blood flow. A migraine (B) can cause visual disturbances and headache but rarely presents with
sudden focal weakness and aphasia. Bell's palsy (C) affects the entire half of the face (including
the forehead) and does not typically cause unilateral extremity weakness or aphasia. Sinusitis
(D) presents with facial pain and congestion, not acute focal neurological deficits.
5. Which laboratory value is most concerning in a critically ill client?
A. Potassium 6.7 mEq/L
B. Sodium 140 mEq/L
C. Glucose 102 mg/dL
D. Hemoglobin 13.5 g/dL
Correct Answer: A
,Rationale: Severe hyperkalemia (potassium > 6.5 mEq/L) can rapidly lead to life-threatening
cardiac dysrhythmias, such as ventricular fibrillation or asystole. It requires immediate
treatment (e.g., calcium gluconate, insulin/glucose, kayexalate). A sodium level of 140 mEq/L
(B), a glucose level of 102 mg/dL (C), and a hemoglobin of 13.5 g/dL (D) are all within normal
reference ranges.
6. A client with acute respiratory distress syndrome (ARDS) is most likely to exhibit:
A. Severe hypoxemia refractory to oxygen therapy
B. Bradycardia only
C. Hyperactivity
D. Hypertension without respiratory symptoms
Correct Answer: A
Rationale: ARDS is characterized by severe hypoxemia and impaired gas exchange due to diffuse
alveolar damage and pulmonary edema. The hypoxemia is often refractory to conventional
oxygen therapy, requiring mechanical ventilation with PEEP. Bradycardia (B), hyperactivity (C),
and isolated hypertension without respiratory symptoms (D) do not describe the classic
presentation of ARDS.
7. Which assessment finding suggests cardiogenic shock?
A. Hypotension with cool, clammy skin
B. Warm, dry skin
C. Bradycardia with hypertension
D. Fever with flushed skin
Correct Answer: A
Rationale: Cardiogenic shock results from the heart's inability to pump effectively, leading to
decreased cardiac output. Compensatory mechanisms cause peripheral vasoconstriction,
resulting in cool, clammy skin and hypotension (systolic BP < 90 mm Hg). Warm, dry skin (B) is
characteristic of distributive shock (e.g., early septic shock). Bradycardia with hypertension (C) is
not typical. Fever with flushed skin (D) suggests an infectious or inflammatory process, not
cardiogenic shock.
, 8. A 55-year-old client is admitted with a diagnosis of DKA. Which of the following is the
priority nursing intervention?
A. Administer intravenous regular insulin as ordered
B. Administer subcutaneous insulin glargine
C. Restrict fluid intake
D. Administer oral hypoglycemic agents
Correct Answer: A
Rationale: In DKA, the priority is to correct fluid depletion and hyperglycemia. Intravenous
regular insulin is the standard of care to lower blood glucose and stop ketone production.
Subcutaneous insulin (B) has a slower onset and is not appropriate for acute DKA management.
Restricting fluids (C) is contraindicated, as these patients are severely volume-depleted. Oral
hypoglycemics (D) are ineffective in managing DKA.
9. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg. Which
intervention should the NP implement first?
A. Elevate the head of the bed to 30 degrees
B. Administer a bolus of hypotonic intravenous fluids
C. Perform aggressive endotracheal suctioning
D. Place the patient in a flat, supine position
Correct Answer: A
Rationale: Normal ICP is 0-15 mm Hg. An ICP of 22 mm Hg indicates intracranial hypertension.
The first-line intervention is to elevate the head of the bed to 30 degrees to promote venous
drainage from the head, thereby reducing ICP. Administering hypotonic fluids (B) can worsen
cerebral edema. Aggressive suctioning (C) can increase ICP. Placing the patient flat (D) impedes
venous drainage and increases ICP.
10. Which clinical manifestation is most indicative of thyroid storm?
A. Hyperthermia, tachycardia, and altered mental status
B. Bradycardia, hypothermia, and lethargy
C. Weight gain, constipation, and dry skin
D. Hypotension, bradycardia, and hyperreflexia
Correct Answer: A
Certification Examination (AGACNP-C) 2026–2027 |
Comprehensive Question Practice Test with Answers &
Rationales| Free Pdf Access
1. A 68-year-old client presents to the emergency department with crushing substernal chest
pain, diaphoresis, and nausea. What is the priority action?
A. Obtain a 12-lead ECG immediately
B. Schedule outpatient cardiology follow-up
C. Encourage oral fluids
D. Obtain a dietary history
Correct Answer: A
Rationale: Acute coronary syndrome (ACS) must be rapidly identified to prevent irreversible
myocardial damage. A 12-lead ECG should be obtained within 10 minutes of presentation to
evaluate for ST-segment elevation myocardial infarction (STEMI), which requires immediate
reperfusion therapy. Scheduling outpatient follow-up (B) is unsafe for an acute presentation.
Encouraging oral fluids (C) is contraindicated if the patient might need emergent surgery or if
they have heart failure. Obtaining a dietary history (D) is not a priority during an acute
emergency.
2. Which assessment finding in a critically ill client requires immediate intervention?
A. Oxygen saturation of 82%
B. Blood pressure of 132/78 mm Hg
C. Temperature of 99.1°F (37.3°C)
D. Heart rate of 88/min
Correct Answer: A
Rationale: Severe hypoxemia (SpO2 < 90%) threatens tissue oxygenation and requires urgent
intervention, such as supplemental oxygen, mechanical ventilation, or airway management. A
blood pressure of 132/78 mm Hg (B), a temperature of 99.1°F (C), and a heart rate of 88/min (D)
are all within normal physiological limits and do not require immediate emergency intervention.
,3. A client with septic shock is receiving vasopressor therapy. Which assessment parameter is
most important to monitor?
A. Mean arterial pressure (MAP)
B. Hair distribution
C. Visual acuity
D. Skin pigmentation
Correct Answer: A
Rationale: Vasopressors (e.g., norepinephrine, vasopressin) are titrated to maintain adequate
tissue perfusion, which is commonly assessed by maintaining a Mean Arterial Pressure (MAP) of
at least 65 mm Hg. Hair distribution (B), visual acuity (C), and skin pigmentation (D) are not
relevant parameters for titrating vasopressors in shock states.
4. A client develops sudden unilateral weakness, facial droop, and aphasia. What should the
nurse practitioner suspect?
A. Acute ischemic stroke
B. Migraine
C. Bell's palsy
D. Sinusitis
Correct Answer: A
Rationale: These findings are classic signs of acute stroke (cerebrovascular accident) and require
emergency evaluation. Sudden focal neurological deficits indicate an interruption of cerebral
blood flow. A migraine (B) can cause visual disturbances and headache but rarely presents with
sudden focal weakness and aphasia. Bell's palsy (C) affects the entire half of the face (including
the forehead) and does not typically cause unilateral extremity weakness or aphasia. Sinusitis
(D) presents with facial pain and congestion, not acute focal neurological deficits.
5. Which laboratory value is most concerning in a critically ill client?
A. Potassium 6.7 mEq/L
B. Sodium 140 mEq/L
C. Glucose 102 mg/dL
D. Hemoglobin 13.5 g/dL
Correct Answer: A
,Rationale: Severe hyperkalemia (potassium > 6.5 mEq/L) can rapidly lead to life-threatening
cardiac dysrhythmias, such as ventricular fibrillation or asystole. It requires immediate
treatment (e.g., calcium gluconate, insulin/glucose, kayexalate). A sodium level of 140 mEq/L
(B), a glucose level of 102 mg/dL (C), and a hemoglobin of 13.5 g/dL (D) are all within normal
reference ranges.
6. A client with acute respiratory distress syndrome (ARDS) is most likely to exhibit:
A. Severe hypoxemia refractory to oxygen therapy
B. Bradycardia only
C. Hyperactivity
D. Hypertension without respiratory symptoms
Correct Answer: A
Rationale: ARDS is characterized by severe hypoxemia and impaired gas exchange due to diffuse
alveolar damage and pulmonary edema. The hypoxemia is often refractory to conventional
oxygen therapy, requiring mechanical ventilation with PEEP. Bradycardia (B), hyperactivity (C),
and isolated hypertension without respiratory symptoms (D) do not describe the classic
presentation of ARDS.
7. Which assessment finding suggests cardiogenic shock?
A. Hypotension with cool, clammy skin
B. Warm, dry skin
C. Bradycardia with hypertension
D. Fever with flushed skin
Correct Answer: A
Rationale: Cardiogenic shock results from the heart's inability to pump effectively, leading to
decreased cardiac output. Compensatory mechanisms cause peripheral vasoconstriction,
resulting in cool, clammy skin and hypotension (systolic BP < 90 mm Hg). Warm, dry skin (B) is
characteristic of distributive shock (e.g., early septic shock). Bradycardia with hypertension (C) is
not typical. Fever with flushed skin (D) suggests an infectious or inflammatory process, not
cardiogenic shock.
, 8. A 55-year-old client is admitted with a diagnosis of DKA. Which of the following is the
priority nursing intervention?
A. Administer intravenous regular insulin as ordered
B. Administer subcutaneous insulin glargine
C. Restrict fluid intake
D. Administer oral hypoglycemic agents
Correct Answer: A
Rationale: In DKA, the priority is to correct fluid depletion and hyperglycemia. Intravenous
regular insulin is the standard of care to lower blood glucose and stop ketone production.
Subcutaneous insulin (B) has a slower onset and is not appropriate for acute DKA management.
Restricting fluids (C) is contraindicated, as these patients are severely volume-depleted. Oral
hypoglycemics (D) are ineffective in managing DKA.
9. A client with a traumatic brain injury has an intracranial pressure (ICP) of 22 mm Hg. Which
intervention should the NP implement first?
A. Elevate the head of the bed to 30 degrees
B. Administer a bolus of hypotonic intravenous fluids
C. Perform aggressive endotracheal suctioning
D. Place the patient in a flat, supine position
Correct Answer: A
Rationale: Normal ICP is 0-15 mm Hg. An ICP of 22 mm Hg indicates intracranial hypertension.
The first-line intervention is to elevate the head of the bed to 30 degrees to promote venous
drainage from the head, thereby reducing ICP. Administering hypotonic fluids (B) can worsen
cerebral edema. Aggressive suctioning (C) can increase ICP. Placing the patient flat (D) impedes
venous drainage and increases ICP.
10. Which clinical manifestation is most indicative of thyroid storm?
A. Hyperthermia, tachycardia, and altered mental status
B. Bradycardia, hypothermia, and lethargy
C. Weight gain, constipation, and dry skin
D. Hypotension, bradycardia, and hyperreflexia
Correct Answer: A
