ANCC AGACNP COMPREHENSIVE PRACTICE
EXAM
Based on Maria T. Codina Leik's Adult-Gerontology Acute Care Nurse
Practitioner (AGACNP) Review / Frances Guide Framework
High-Yield Clinical Vignettes, Advanced Physiology, Pharmacology,
and Diagnostic Reasoning for Board Certification Success
Question 1 [Cardiovascular System]
A 68-year-old male is admitted to the Intensive Care Unit (ICU) with
acute decompensated heart failure (ADHF) characterized by severe
dyspnea, orthopnea, and a blood pressure of 185/110 mmHg. Physical
examination reveals bibasilar crackles, an S3 gallop, and 2+ pitting
edema to the knees. Laboratory results show a BNP of 1,200 pg/mL and
serum creatinine of 1.4 mg/dL. Which of the following is the most
appropriate initial pharmacological intervention?
A. Continuous infusion of Dobutamine at 2.5 mcg/kg/min
B. Intravenous administration of Furosemide and Nitroglycerin
infusion
C. Immediate administration of Metoprolol tartrate 25 mg orally
twice daily
D. Fluid bolus of 500 mL Normal Saline to optimize preload
Correct Answer: B. Intravenous administration of Furosemide
and Nitroglycerin infusion
Rationale: This patient presents with hypertensive acute
decompensated heart failure (flash pulmonary edema with high
systemic vascular resistance and elevated filling pressures). The
primary goals of acute management are reduction of preload (via loop
diuretics like furosemide) and afterload reduction (via vasodilators
, like nitroglycerin or nitroprusside) to decrease myocardial oxygen
demand and relieve pulmonary congestion. Dobutamine (Choice A) is
an inotrope reserved for patients with cardiogenic shock or severe
pump failure with hypotension, not hypertension. Beta-blockers
(Choice C) should be withheld or initiated at very low doses only after
acute decompensated volume overload is stabilized, as they can
worsen acute heart failure. A fluid bolus (Choice D) would precipitate
acute respiratory failure by worsening pulmonary edema.
Question 2 [Pulmonary / Critical Care]
A 56-year-old female post-coronary artery bypass graft (CABG) surgery
develops sudden-onset tachypnea, tachycardia, and hypoxemia on
postoperative day 2. Arterial blood gas (ABG) on 40% FiO2 reveals: pH
7.48, PaCO2 32 mmHg, PaO2 62 mmHg, HCO3 24 mEq/L. A stat
portable chest X-ray shows diffuse bilateral infiltrates not fully
explained by cardiac failure or fluid overload. Pulmonary artery
catheterization demonstrates a pulmonary artery wedge pressure
(PAWP) of 12 mmHg. Which of the following is the definitive
diagnosis?
A. Acute Respiratory Distress Syndrome (ARDS)
B. Cardiogenic Pulmonary Edema
C. Pulmonary Embolism
D. Atelectasis
Correct Answer: A. Acute Respiratory Distress Syndrome
(ARDS)
Rationale: The Berlin definition of ARDS includes: (1) acute onset
within 1 week of a known clinical insult; (2) bilateral opacities on
EXAM
Based on Maria T. Codina Leik's Adult-Gerontology Acute Care Nurse
Practitioner (AGACNP) Review / Frances Guide Framework
High-Yield Clinical Vignettes, Advanced Physiology, Pharmacology,
and Diagnostic Reasoning for Board Certification Success
Question 1 [Cardiovascular System]
A 68-year-old male is admitted to the Intensive Care Unit (ICU) with
acute decompensated heart failure (ADHF) characterized by severe
dyspnea, orthopnea, and a blood pressure of 185/110 mmHg. Physical
examination reveals bibasilar crackles, an S3 gallop, and 2+ pitting
edema to the knees. Laboratory results show a BNP of 1,200 pg/mL and
serum creatinine of 1.4 mg/dL. Which of the following is the most
appropriate initial pharmacological intervention?
A. Continuous infusion of Dobutamine at 2.5 mcg/kg/min
B. Intravenous administration of Furosemide and Nitroglycerin
infusion
C. Immediate administration of Metoprolol tartrate 25 mg orally
twice daily
D. Fluid bolus of 500 mL Normal Saline to optimize preload
Correct Answer: B. Intravenous administration of Furosemide
and Nitroglycerin infusion
Rationale: This patient presents with hypertensive acute
decompensated heart failure (flash pulmonary edema with high
systemic vascular resistance and elevated filling pressures). The
primary goals of acute management are reduction of preload (via loop
diuretics like furosemide) and afterload reduction (via vasodilators
, like nitroglycerin or nitroprusside) to decrease myocardial oxygen
demand and relieve pulmonary congestion. Dobutamine (Choice A) is
an inotrope reserved for patients with cardiogenic shock or severe
pump failure with hypotension, not hypertension. Beta-blockers
(Choice C) should be withheld or initiated at very low doses only after
acute decompensated volume overload is stabilized, as they can
worsen acute heart failure. A fluid bolus (Choice D) would precipitate
acute respiratory failure by worsening pulmonary edema.
Question 2 [Pulmonary / Critical Care]
A 56-year-old female post-coronary artery bypass graft (CABG) surgery
develops sudden-onset tachypnea, tachycardia, and hypoxemia on
postoperative day 2. Arterial blood gas (ABG) on 40% FiO2 reveals: pH
7.48, PaCO2 32 mmHg, PaO2 62 mmHg, HCO3 24 mEq/L. A stat
portable chest X-ray shows diffuse bilateral infiltrates not fully
explained by cardiac failure or fluid overload. Pulmonary artery
catheterization demonstrates a pulmonary artery wedge pressure
(PAWP) of 12 mmHg. Which of the following is the definitive
diagnosis?
A. Acute Respiratory Distress Syndrome (ARDS)
B. Cardiogenic Pulmonary Edema
C. Pulmonary Embolism
D. Atelectasis
Correct Answer: A. Acute Respiratory Distress Syndrome
(ARDS)
Rationale: The Berlin definition of ARDS includes: (1) acute onset
within 1 week of a known clinical insult; (2) bilateral opacities on
