ANCC AGACNP Frances Guide Review (2026) – 500+ Practice Questions & Answers for Acute Care NP Board
Exam Preparation
Questions 1–259
1. A 68-year-old male with a history of hypertension and smoking presents with acute onset
substernal chest pressure radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1–V4. Which is the MOST appropriate initial management?
A) Administer sublingual nitroglycerin and obtain cardiac biomarkers
B) Immediate transfer for percutaneous coronary intervention (PCI)
C) Administer morphine, oxygen, and aspirin
D) Obtain a chest X-ray and start heparin
Answer B: Immediate transfer for percutaneous coronary intervention (PCI)
Rationale: STEMI requires immediate reperfusion; PCI is preferred if available within 120 minutes of first
medical contact .
2. A 72-year-old patient with heart failure presents with worsening dyspnea, orthopnea, and
peripheral edema. JVD is noted at 12 cm H2O, and crackles are auscultated halfway up the lung fields.
Which diagnostic finding confirms the diagnosis?
A) Decreased BUN/Cr ratio
B) Elevated B-type natriuretic peptide (BNP)
C) Elevated troponin
D) Increased serum albumin
Answer B: Elevated B-type natriuretic peptide (BNP)
Rationale: BNP >100 pg/mL is released from ventricular myocytes in response to volume overload,
confirming HF .
3. A 65-year-old patient with sepsis has a serum lactate of 4.5 mmol/L and requires vasopressors to
maintain MAP >65 mmHg. Which of the following criteria defines this condition?
A) Serum lactate 1.2 mmol/L
B) Serum lactate >2 mmol/L with persistent hypotension requiring vasopressors
,C) White blood cell count 6,000/mm³
D) Procalcitonin 0.1 ng/mL
Answer B: Serum lactate >2 mmol/L with persistent hypotension requiring vasopressors
Rationale: Septic shock is defined as sepsis with vasopressor requirement AND lactate >2 mmol/L despite
fluid resuscitation .
4. A 58-year-old patient with a history of COPD is admitted with shortness of breath and fever. ABG
shows pH 7.29, PaCO2 58, PaO2 62, HCO3 26. What is the MOST appropriate interpretation?
A) Acute respiratory alkalosis
B) Acute respiratory acidosis
C) Chronic respiratory acidosis with acute exacerbation
D) Metabolic acidosis
Answer C: Chronic respiratory acidosis with acute exacerbation
Rationale: Low pH with elevated PaCO2 and normal HCO3 in a COPD patient indicates acute-on-chronic
respiratory acidosis .
5. A patient is started on amiodarone for atrial fibrillation. Which baseline test is MOST important to
obtain?
A) Liver function tests
B) Thyroid function tests
C) Pulmonary function tests
D) Renal function tests
Answer B: Thyroid function tests
Rationale: Amiodarone contains iodine and can cause both hypothyroidism and hyperthyroidism; baseline
thyroid testing is essential .
6. The LACE Consensus Model for APRN regulation includes which of the following components?
A) Licensure, Accreditation, Certification, and Education
B) Licensure, Assessment, Certification, and Examination
C) Leadership, Advocacy, Certification, and Education
D) Licensure, Accreditation, Collaboration, and Evaluation
Answer A: Licensure, Accreditation, Certification, and Education
, Rationale: LACE stands for Licensure, Accreditation, Certification, and Education—the four pillars of APRN
regulation .
7. A 60-year-old patient with a CHA₂DS₂-VASc score of 4 is being discharged on anticoagulation for
atrial fibrillation. Which anticoagulant is contraindicated in a patient with a mechanical mitral valve?
A) Apixaban
B) Warfarin
C) Heparin
D) Enoxaparin
Answer A: Apixaban
Rationale: Direct oral anticoagulants (DOACs) including apixaban are contraindicated in patients with
mechanical heart valves; warfarin is required .
8. A 70-year-old patient with coronary artery disease presents with "crushing" chest pain unrelieved
by nitroglycerin. ECG shows ST depression in leads V4–V6. Troponin is elevated. The MOST likely
diagnosis is:
A) Unstable angina
B) NSTEMI
C) STEMI
D) Pericarditis
Answer B: NSTEMI
Rationale: Elevated troponin with ischemic ECG changes (ST depression, no ST elevation) defines NSTEMI .
9. What is the best way for the AGACNP to become involved in policy making?
A) Join a hospital committee
B) Write your local congressman
C) Review literature and give more in-services
D) Attend legislative days at the state capitol
Answer A: Join a hospital committee
Rationale: Hospital committees provide direct opportunities to influence policy and demonstrate leadership
at the institutional level .
Exam Preparation
Questions 1–259
1. A 68-year-old male with a history of hypertension and smoking presents with acute onset
substernal chest pressure radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1–V4. Which is the MOST appropriate initial management?
A) Administer sublingual nitroglycerin and obtain cardiac biomarkers
B) Immediate transfer for percutaneous coronary intervention (PCI)
C) Administer morphine, oxygen, and aspirin
D) Obtain a chest X-ray and start heparin
Answer B: Immediate transfer for percutaneous coronary intervention (PCI)
Rationale: STEMI requires immediate reperfusion; PCI is preferred if available within 120 minutes of first
medical contact .
2. A 72-year-old patient with heart failure presents with worsening dyspnea, orthopnea, and
peripheral edema. JVD is noted at 12 cm H2O, and crackles are auscultated halfway up the lung fields.
Which diagnostic finding confirms the diagnosis?
A) Decreased BUN/Cr ratio
B) Elevated B-type natriuretic peptide (BNP)
C) Elevated troponin
D) Increased serum albumin
Answer B: Elevated B-type natriuretic peptide (BNP)
Rationale: BNP >100 pg/mL is released from ventricular myocytes in response to volume overload,
confirming HF .
3. A 65-year-old patient with sepsis has a serum lactate of 4.5 mmol/L and requires vasopressors to
maintain MAP >65 mmHg. Which of the following criteria defines this condition?
A) Serum lactate 1.2 mmol/L
B) Serum lactate >2 mmol/L with persistent hypotension requiring vasopressors
,C) White blood cell count 6,000/mm³
D) Procalcitonin 0.1 ng/mL
Answer B: Serum lactate >2 mmol/L with persistent hypotension requiring vasopressors
Rationale: Septic shock is defined as sepsis with vasopressor requirement AND lactate >2 mmol/L despite
fluid resuscitation .
4. A 58-year-old patient with a history of COPD is admitted with shortness of breath and fever. ABG
shows pH 7.29, PaCO2 58, PaO2 62, HCO3 26. What is the MOST appropriate interpretation?
A) Acute respiratory alkalosis
B) Acute respiratory acidosis
C) Chronic respiratory acidosis with acute exacerbation
D) Metabolic acidosis
Answer C: Chronic respiratory acidosis with acute exacerbation
Rationale: Low pH with elevated PaCO2 and normal HCO3 in a COPD patient indicates acute-on-chronic
respiratory acidosis .
5. A patient is started on amiodarone for atrial fibrillation. Which baseline test is MOST important to
obtain?
A) Liver function tests
B) Thyroid function tests
C) Pulmonary function tests
D) Renal function tests
Answer B: Thyroid function tests
Rationale: Amiodarone contains iodine and can cause both hypothyroidism and hyperthyroidism; baseline
thyroid testing is essential .
6. The LACE Consensus Model for APRN regulation includes which of the following components?
A) Licensure, Accreditation, Certification, and Education
B) Licensure, Assessment, Certification, and Examination
C) Leadership, Advocacy, Certification, and Education
D) Licensure, Accreditation, Collaboration, and Evaluation
Answer A: Licensure, Accreditation, Certification, and Education
, Rationale: LACE stands for Licensure, Accreditation, Certification, and Education—the four pillars of APRN
regulation .
7. A 60-year-old patient with a CHA₂DS₂-VASc score of 4 is being discharged on anticoagulation for
atrial fibrillation. Which anticoagulant is contraindicated in a patient with a mechanical mitral valve?
A) Apixaban
B) Warfarin
C) Heparin
D) Enoxaparin
Answer A: Apixaban
Rationale: Direct oral anticoagulants (DOACs) including apixaban are contraindicated in patients with
mechanical heart valves; warfarin is required .
8. A 70-year-old patient with coronary artery disease presents with "crushing" chest pain unrelieved
by nitroglycerin. ECG shows ST depression in leads V4–V6. Troponin is elevated. The MOST likely
diagnosis is:
A) Unstable angina
B) NSTEMI
C) STEMI
D) Pericarditis
Answer B: NSTEMI
Rationale: Elevated troponin with ischemic ECG changes (ST depression, no ST elevation) defines NSTEMI .
9. What is the best way for the AGACNP to become involved in policy making?
A) Join a hospital committee
B) Write your local congressman
C) Review literature and give more in-services
D) Attend legislative days at the state capitol
Answer A: Join a hospital committee
Rationale: Hospital committees provide direct opportunities to influence policy and demonstrate leadership
at the institutional level .
