ANCC AGACNP Frances Guide Review – 500+ Practice Questions & Answers (2026).

ANCC AGACNP Frances Guide Review – 500+ Practice Questions & Answers (2026)



Practice Questions 1–250
Questions 1–50: Critical Care Hemodynamics & Shock


1. A 72-year-old patient with septic shock is started on norepinephrine. What is the primary desired
effect of this medication?
A) Increased cardiac contractility
B) Vasoconstriction and increased mean arterial pressure (MAP)
C) Bronchodilation
D) Diuresis
Answer B: Vasoconstriction and increased mean arterial pressure (MAP)
Rationale: Norepinephrine is a potent alpha-1 agonist causing vasoconstriction, which increases systemic
vascular resistance and MAP. ---




2. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m² and a pulmonary artery wedge
pressure (PAWP) of 22 mmHg. Which medication is most appropriate?
A) Norepinephrine
B) Dobutamine
C) Phenylephrine
D) Vasopressin
Answer B: Dobutamine
Rationale: Dobutamine is a positive inotrope that increases cardiac contractility and cardiac index in
cardiogenic shock with elevated filling pressures. ---




3. Which hemodynamic parameter is most indicative of adequate tissue perfusion in a patient with
septic shock?
A) Central venous pressure (CVP) 12 mmHg
B) Central venous oxygen saturation (ScvO₂) ≥ 70%
C) Heart rate 110 bpm

,D) Mean arterial pressure (MAP) 60 mmHg
Answer B: Central venous oxygen saturation (ScvO₂) ≥ 70%
Rationale: ScvO₂ reflects the balance between oxygen delivery and consumption; ≥70% indicates adequate
tissue perfusion. ---




4. A patient with distributive shock has a systemic vascular resistance (SVR) of 400 dynes·sec/cm⁵.
Which vasopressor is first-line?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Answer B: Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock to increase SVR and MAP. ---




5. Which of the following findings is consistent with obstructive shock?
A) Low cardiac output, low SVR
B) Low cardiac output, high CVP, and evidence of mechanical obstruction
C) High cardiac output, low SVR
D) Normal cardiac output, normal SVR
Answer B: Low cardiac output, high CVP, and evidence of mechanical obstruction
Rationale: Obstructive shock (e.g., PE, cardiac tamponade) presents with low cardiac output and elevated
CVP due to impaired filling. ---




6. A patient with septic shock has a serum lactate of 4.5 mmol/L. What is the recommended initial
fluid resuscitation strategy?
A) 500 mL of 0.9% normal saline bolus
B) 30 mL/kg crystalloid bolus
C) 1 L of lactated Ringer's over 4 hours
D) 250 mL of albumin
Answer B: 30 mL/kg crystalloid bolus
Rationale: Surviving Sepsis Campaign recommends 30 mL/kg crystalloid for sepsis-induced hypoperfusion.
---

,7. Which vasopressor is preferred in a patient with septic shock and severe tachycardia?
A) Norepinephrine
B) Vasopressin
C) Dobutamine
D) Epinephrine
Answer B: Vasopressin
Rationale: Vasopressin is a non-adrenergic vasopressor that does not cause tachycardia, making it useful
when heart rate is already elevated. ---




8. A patient in hypovolemic shock has not responded to 2 L of crystalloid. What is the next best step?
A) Start norepinephrine
B) Transfuse packed red blood cells if hemoglobin is low
C) Administer albumin
D) Start dobutamine
Answer B: Transfuse packed red blood cells if hemoglobin is low
Rationale: Persistent hypovolemic shock after crystalloid resuscitation may indicate ongoing blood loss
requiring transfusion. ---




9. Which of the following is a contraindication to the use of an intra-aortic balloon pump (IABP)?
A) Cardiogenic shock
B) Severe aortic regurgitation
C) Unstable angina
D) Acute myocardial infarction with complications
Answer B: Severe aortic regurgitation
Rationale: IABP is contraindicated in severe aortic regurgitation because balloon inflation during diastole
worsens regurgitation. ---




10. A patient with septic shock on norepinephrine has a MAP of 55 mmHg despite maximum doses.
Which agent should be added?
A) Dobutamine
B) Vasopressin
C) Phenylephrine

, D) Milrinone
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Answer B: Vasopressin j j




Rationale: Vasopressin is often added as a second-line vasopressor in refractory septic shock. ---
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11. Which of the following is a sign of adequate volume resuscitation in a patient with shock?
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A) Heart rate 120 bpm
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B) Urine output ≥ 0.5 mL/kg/hr
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C) Central venous pressure 4 mmHg
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D) Mean arterial pressure 55 mmHg
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Answer B: Urine output ≥ 0.5 mL/kg/hr
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Rationale: Urine output ≥ 0.5 mL/kg/hr indicates adequate renal perfusion and volume status. ---
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12. A patient with anaphylactic shock should receive which medication first?
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A) Methylprednisolone IV
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B) Diphenhydramine IV
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C) Epinephrine IM
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D) Albuterol nebulizer
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Answer C: Epinephrine IM j j j




Rationale: Epinephrine IM is the first-line treatment for anaphylaxis. ---
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13. Which of the following is a characteristic finding in early septic shock?
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A) Cold, clammy skin
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B) Warm, flushed skin with bounding pulses
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C) Bradycardia
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D) Oliguria
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Answer B: Warm, flushed skin with bounding pulses
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Rationale: Early septic shock (hyperdynamic phase) presents with warm, flushed skin due to vasodilation. ---
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14. A patient with cardiogenic shock has a cardiac output of 2.5 L/min. Which medication should be
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A) Norepinephrine
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B) Dobutamine or milrinone
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