ANCC Adult-Gerontology Acute Care Nurse Practitioner
(AGACNP-BC) Exam
Latest 2025–2026 Edition | Complete Questions & 100%
Verified Answers
,1. A 72-year-old man with a history of COPD presents with increased shortness of breath and productive
cough. ABG: pH 7.30, PaCO₂ 58 mmHg, PaO₂ 64 mmHg.
What is the most appropriate initial management?
A. Start IV corticosteroids and antibiotics
B. Administer oxygen to maintain SpO₂ > 96%
C. Begin noninvasive positive pressure ventilation (NPPV)
D. Intubate immediately
✅ Correct Answer: C
Rationale: NPPV is first-line therapy for acute COPD exacerbation with hypercapnic respiratory failure
(pH <7.35, PaCO₂ >45). It reduces intubation and mortality rates.
2. A 68-year-old female with heart failure presents with worsening dyspnea and bilateral crackles. BNP is
820 pg/mL.
Which medication should be administered first?
A. Furosemide IV
B. Carvedilol PO
C. Lisinopril PO
D. Spironolactone PO
✅ Correct Answer: A
Rationale: IV loop diuretics are the first-line treatment in acute decompensated heart failure to reduce
preload and relieve pulmonary congestion.
3. During central line insertion, a patient suddenly develops shortness of breath and hypotension.
What is the most likely complication?
A. Air embolism
B. Pneumonia
C. Cardiac tamponade
D. Catheter occlusion
✅ Correct Answer: A
Rationale: Air embolism may occur during central line placement/removal; symptoms include sudden
respiratory distress and hypotension. Place patient in Trendelenburg on left side.
4. A 79-year-old male postoperative patient becomes acutely confused. Labs: Na⁺ 129 mEq/L, glucose 88
mg/dL.
Most likely cause?
A. Hypoglycemia
B. Hyponatremia
C. Hypocalcemia
D. Uremia
✅ Correct Answer: B
,Rationale: Acute hyponatremia in elderly postoperative patients can lead to delirium and altered mental
status.
5. Which of the following findings indicates sepsis-induced organ dysfunction?
A. Platelets 180,000/mm³
B. MAP 75 mmHg
C. Lactate 5 mmol/L
D. HR 90 bpm
✅ Correct Answer: C
Rationale: Lactate >2 mmol/L indicates tissue hypoperfusion; >4 mmol/L reflects severe sepsis or septic
shock.
6. A patient with atrial fibrillation is started on warfarin. Which lab test monitors therapeutic effect?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
✅ Correct Answer: A
Rationale: Warfarin therapy is monitored via INR; therapeutic range 2.0–3.0 for atrial fibrillation
7. An elderly patient is admitted with urosepsis. Initial BP 82/50 mmHg, HR 120 bpm, lactate 4.8
mmol/L.
What is the first step in management?
A. Administer broad-spectrum antibiotics
B. Obtain blood cultures
C. Begin IV fluid resuscitation
D. Start norepinephrine infusion
✅ Correct Answer: C
Rationale: Fluid resuscitation with crystalloids (30 mL/kg) is first-line for hypotension in sepsis before
vasopressors or antibiotics.
8. Which diagnostic test confirms a pulmonary embolism?
A. Chest X-ray
B. CT pulmonary angiography
C. ECG
D. D-dimer
✅ Correct Answer: B
Rationale: CT pulmonary angiography is the gold standard for PE confirmation.
, 9. A 74-year-old diabetic presents with fever and flank pain. Urinalysis shows WBC casts.
Most likely diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Urethritis
✅ Correct Answer: B
Rationale: WBC casts are pathognomonic for pyelonephritis due to infection of renal parenchyma.
10. What is the primary action of ACE inhibitors in heart failure?
A. Increase preload
B. Decrease afterload
C. Increase myocardial contractility
D. Cause vasoconstriction
✅ Correct Answer: B
Rationale: ACE inhibitors reduce afterload and prevent remodeling, improving survival in heart failure.
11. Which ECG change is characteristic of hyperkalemia?
A. U waves
B. Prolonged QT interval
C. Peaked T waves
D. Flattened T waves
✅ Correct Answer: C
Rationale: Tall, peaked T waves are the earliest ECG sign of hyperkalemia due to delayed repolarization.
12. The most reliable indicator of adequate tissue perfusion in a critically ill patient is:
A. Blood pressure
B. Capillary refill time
C. Serum lactate
D. Urine output
✅ Correct Answer: D
Rationale: Urine output ≥0.5 mL/kg/hr is the most sensitive indicator of renal and systemic perfusion.
13. A 69-year-old male with atrial fibrillation develops sudden left leg pain and pallor.
Most likely diagnosis?
A. DVT
B. Arterial embolism
C. Cellulitis
D. Peripheral neuropathy
(AGACNP-BC) Exam
Latest 2025–2026 Edition | Complete Questions & 100%
Verified Answers
,1. A 72-year-old man with a history of COPD presents with increased shortness of breath and productive
cough. ABG: pH 7.30, PaCO₂ 58 mmHg, PaO₂ 64 mmHg.
What is the most appropriate initial management?
A. Start IV corticosteroids and antibiotics
B. Administer oxygen to maintain SpO₂ > 96%
C. Begin noninvasive positive pressure ventilation (NPPV)
D. Intubate immediately
✅ Correct Answer: C
Rationale: NPPV is first-line therapy for acute COPD exacerbation with hypercapnic respiratory failure
(pH <7.35, PaCO₂ >45). It reduces intubation and mortality rates.
2. A 68-year-old female with heart failure presents with worsening dyspnea and bilateral crackles. BNP is
820 pg/mL.
Which medication should be administered first?
A. Furosemide IV
B. Carvedilol PO
C. Lisinopril PO
D. Spironolactone PO
✅ Correct Answer: A
Rationale: IV loop diuretics are the first-line treatment in acute decompensated heart failure to reduce
preload and relieve pulmonary congestion.
3. During central line insertion, a patient suddenly develops shortness of breath and hypotension.
What is the most likely complication?
A. Air embolism
B. Pneumonia
C. Cardiac tamponade
D. Catheter occlusion
✅ Correct Answer: A
Rationale: Air embolism may occur during central line placement/removal; symptoms include sudden
respiratory distress and hypotension. Place patient in Trendelenburg on left side.
4. A 79-year-old male postoperative patient becomes acutely confused. Labs: Na⁺ 129 mEq/L, glucose 88
mg/dL.
Most likely cause?
A. Hypoglycemia
B. Hyponatremia
C. Hypocalcemia
D. Uremia
✅ Correct Answer: B
,Rationale: Acute hyponatremia in elderly postoperative patients can lead to delirium and altered mental
status.
5. Which of the following findings indicates sepsis-induced organ dysfunction?
A. Platelets 180,000/mm³
B. MAP 75 mmHg
C. Lactate 5 mmol/L
D. HR 90 bpm
✅ Correct Answer: C
Rationale: Lactate >2 mmol/L indicates tissue hypoperfusion; >4 mmol/L reflects severe sepsis or septic
shock.
6. A patient with atrial fibrillation is started on warfarin. Which lab test monitors therapeutic effect?
A. PT/INR
B. aPTT
C. Platelet count
D. D-dimer
✅ Correct Answer: A
Rationale: Warfarin therapy is monitored via INR; therapeutic range 2.0–3.0 for atrial fibrillation
7. An elderly patient is admitted with urosepsis. Initial BP 82/50 mmHg, HR 120 bpm, lactate 4.8
mmol/L.
What is the first step in management?
A. Administer broad-spectrum antibiotics
B. Obtain blood cultures
C. Begin IV fluid resuscitation
D. Start norepinephrine infusion
✅ Correct Answer: C
Rationale: Fluid resuscitation with crystalloids (30 mL/kg) is first-line for hypotension in sepsis before
vasopressors or antibiotics.
8. Which diagnostic test confirms a pulmonary embolism?
A. Chest X-ray
B. CT pulmonary angiography
C. ECG
D. D-dimer
✅ Correct Answer: B
Rationale: CT pulmonary angiography is the gold standard for PE confirmation.
, 9. A 74-year-old diabetic presents with fever and flank pain. Urinalysis shows WBC casts.
Most likely diagnosis?
A. Cystitis
B. Pyelonephritis
C. Glomerulonephritis
D. Urethritis
✅ Correct Answer: B
Rationale: WBC casts are pathognomonic for pyelonephritis due to infection of renal parenchyma.
10. What is the primary action of ACE inhibitors in heart failure?
A. Increase preload
B. Decrease afterload
C. Increase myocardial contractility
D. Cause vasoconstriction
✅ Correct Answer: B
Rationale: ACE inhibitors reduce afterload and prevent remodeling, improving survival in heart failure.
11. Which ECG change is characteristic of hyperkalemia?
A. U waves
B. Prolonged QT interval
C. Peaked T waves
D. Flattened T waves
✅ Correct Answer: C
Rationale: Tall, peaked T waves are the earliest ECG sign of hyperkalemia due to delayed repolarization.
12. The most reliable indicator of adequate tissue perfusion in a critically ill patient is:
A. Blood pressure
B. Capillary refill time
C. Serum lactate
D. Urine output
✅ Correct Answer: D
Rationale: Urine output ≥0.5 mL/kg/hr is the most sensitive indicator of renal and systemic perfusion.
13. A 69-year-old male with atrial fibrillation develops sudden left leg pain and pallor.
Most likely diagnosis?
A. DVT
B. Arterial embolism
C. Cellulitis
D. Peripheral neuropathy
