ANCC AGACNP Certification-Style
Exam PRACTICE QUESTIONS
|ORIGINAL QUESTIONS & ANSWERS
|DETAILED RATIONALES |HINTED
COMPLETE EXAM PREP GRADED
A+*INSTANT DOWNLOAD PDF
1. A 68-year-old patient with septic shock remains hypotensive
after receiving an appropriate crystalloid bolus. Which medication
is the preferred first-line vasopressor?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Answer: C. Norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for
septic shock because it reliably increases vascular tone and mean
arterial pressure with less tachyarrhythmia than dopamine.
2. A patient with acute decompensated heart failure has severe
dyspnea, pulmonary edema, and a blood pressure of 190/105
mmHg. Which intervention is most appropriate initially?
A. Rapid IV fluid administration
B. Noninvasive positive-pressure ventilation
,C. Large-dose beta-blocker administration
D. Immediate administration of a vasopressor
Answer: B. Noninvasive positive-pressure ventilation
Rationale: Noninvasive positive-pressure ventilation improves
oxygenation, decreases preload and afterload, and reduces the work
of breathing in acute cardiogenic pulmonary edema.
3. A patient with COPD exacerbation has a pH of 7.25 and PaCO₂ of
72 mmHg despite supplemental oxygen. Which intervention is most
appropriate?
A. High-flow oxygen targeting 100% saturation
B. Noninvasive positive-pressure ventilation
C. Immediate chest tube placement
D. IV sodium bicarbonate
Answer: B. Noninvasive positive-pressure ventilation
Rationale: Hypercapnic respiratory acidosis with respiratory distress
in COPD is a major indication for noninvasive ventilation when there
is no contraindication.
4. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST elevation in contiguous leads
Answer: B. Peaked T waves
Rationale: Early hyperkalemia commonly produces tall, narrow,
peaked T waves. Progressive toxicity can cause PR prolongation, QRS
widening, and eventually a sine-wave pattern.
,5. A patient with potassium of 7.0 mEq/L has a widened QRS
complex. Which medication should be administered immediately to
stabilize the cardiac membrane?
A. Regular insulin
B. Sodium zirconium cyclosilicate
C. IV calcium gluconate
D. Furosemide
Answer: C. IV calcium gluconate
Rationale: IV calcium stabilizes the myocardial membrane and is
indicated when hyperkalemia causes ECG abnormalities. It does not
directly lower serum potassium.
6. A 72-year-old patient presents with new-onset atrial fibrillation,
hypotension, chest pain, and altered mental status. What is the
immediate treatment?
A. Oral beta blocker
B. IV amiodarone over several hours
C. Synchronized cardioversion
D. Observation
Answer: C. Synchronized cardioversion
Rationale: Hemodynamically unstable atrial fibrillation requires
immediate synchronized cardioversion.
7. A patient develops sudden aphasia and right-sided weakness 45
minutes before arrival. What is the priority diagnostic study?
A. MRI of the spine
B. Noncontrast CT of the head
, C. Carotid ultrasound
D. EEG
Answer: B. Noncontrast CT of the head
Rationale: Rapid noncontrast head CT is used initially to distinguish
ischemic stroke from intracranial hemorrhage and determine
eligibility for reperfusion therapy.
8. Which finding is most concerning for increased intracranial
pressure?
A. Mild headache
B. Bradycardia with hypertension and irregular respirations
C. Bilateral conjunctival injection
D. Increased bowel sounds
Answer: B. Bradycardia with hypertension and irregular
respirations
Rationale: The combination of hypertension, bradycardia, and
abnormal respirations is the Cushing response and indicates
potentially severe intracranial hypertension.
9. A patient with suspected bacterial meningitis is hypotensive and
febrile. Which action should occur promptly after appropriate
cultures are obtained, without delaying treatment?
A. Administer empiric IV antibiotics
B. Wait for lumbar puncture results
C. Begin oral antibiotics
D. Obtain an outpatient MRI
Answer: A. Administer empiric IV antibiotics
Exam PRACTICE QUESTIONS
|ORIGINAL QUESTIONS & ANSWERS
|DETAILED RATIONALES |HINTED
COMPLETE EXAM PREP GRADED
A+*INSTANT DOWNLOAD PDF
1. A 68-year-old patient with septic shock remains hypotensive
after receiving an appropriate crystalloid bolus. Which medication
is the preferred first-line vasopressor?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Answer: C. Norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for
septic shock because it reliably increases vascular tone and mean
arterial pressure with less tachyarrhythmia than dopamine.
2. A patient with acute decompensated heart failure has severe
dyspnea, pulmonary edema, and a blood pressure of 190/105
mmHg. Which intervention is most appropriate initially?
A. Rapid IV fluid administration
B. Noninvasive positive-pressure ventilation
,C. Large-dose beta-blocker administration
D. Immediate administration of a vasopressor
Answer: B. Noninvasive positive-pressure ventilation
Rationale: Noninvasive positive-pressure ventilation improves
oxygenation, decreases preload and afterload, and reduces the work
of breathing in acute cardiogenic pulmonary edema.
3. A patient with COPD exacerbation has a pH of 7.25 and PaCO₂ of
72 mmHg despite supplemental oxygen. Which intervention is most
appropriate?
A. High-flow oxygen targeting 100% saturation
B. Noninvasive positive-pressure ventilation
C. Immediate chest tube placement
D. IV sodium bicarbonate
Answer: B. Noninvasive positive-pressure ventilation
Rationale: Hypercapnic respiratory acidosis with respiratory distress
in COPD is a major indication for noninvasive ventilation when there
is no contraindication.
4. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST elevation in contiguous leads
Answer: B. Peaked T waves
Rationale: Early hyperkalemia commonly produces tall, narrow,
peaked T waves. Progressive toxicity can cause PR prolongation, QRS
widening, and eventually a sine-wave pattern.
,5. A patient with potassium of 7.0 mEq/L has a widened QRS
complex. Which medication should be administered immediately to
stabilize the cardiac membrane?
A. Regular insulin
B. Sodium zirconium cyclosilicate
C. IV calcium gluconate
D. Furosemide
Answer: C. IV calcium gluconate
Rationale: IV calcium stabilizes the myocardial membrane and is
indicated when hyperkalemia causes ECG abnormalities. It does not
directly lower serum potassium.
6. A 72-year-old patient presents with new-onset atrial fibrillation,
hypotension, chest pain, and altered mental status. What is the
immediate treatment?
A. Oral beta blocker
B. IV amiodarone over several hours
C. Synchronized cardioversion
D. Observation
Answer: C. Synchronized cardioversion
Rationale: Hemodynamically unstable atrial fibrillation requires
immediate synchronized cardioversion.
7. A patient develops sudden aphasia and right-sided weakness 45
minutes before arrival. What is the priority diagnostic study?
A. MRI of the spine
B. Noncontrast CT of the head
, C. Carotid ultrasound
D. EEG
Answer: B. Noncontrast CT of the head
Rationale: Rapid noncontrast head CT is used initially to distinguish
ischemic stroke from intracranial hemorrhage and determine
eligibility for reperfusion therapy.
8. Which finding is most concerning for increased intracranial
pressure?
A. Mild headache
B. Bradycardia with hypertension and irregular respirations
C. Bilateral conjunctival injection
D. Increased bowel sounds
Answer: B. Bradycardia with hypertension and irregular
respirations
Rationale: The combination of hypertension, bradycardia, and
abnormal respirations is the Cushing response and indicates
potentially severe intracranial hypertension.
9. A patient with suspected bacterial meningitis is hypotensive and
febrile. Which action should occur promptly after appropriate
cultures are obtained, without delaying treatment?
A. Administer empiric IV antibiotics
B. Wait for lumbar puncture results
C. Begin oral antibiotics
D. Obtain an outpatient MRI
Answer: A. Administer empiric IV antibiotics
