8/15/26, 3:02 AM ANCC AGACNP Frances Guide Review · 2026
ANCC AGACNP FRANCES GUIDE REVIEW EXAM QUESTIONS &
RATIONALES
2025–2026 Updated Version | Complete Study Guide
1. A 68-year-old male with septic shock and acute kidney injury is started on
norepinephrine. Which hemodynamic parameter best guides titration?
A. Central venous pressure (CVP)
B. Mean arterial pressure (MAP)
C. Cardiac index (CI)
D. Pulmonary artery occlusion pressure (PAOP)
Correct Answer: B. Mean arterial pressure (MAP)
Rationale: Norepinephrine is a vasopressor titrated to achieve a MAP ≥65 mmHg in septic
shock. CVP and PAOP are volume status indicators, not primary targets for vasopressor
titration.
2. A 74-year-old female with COPD exacerbation is on BiPAP. Which setting adjustment
would most likely reduce her work of breathing?
A. Increase IPAP
B. Increase EPAP
C. Decrease backup rate
D. Decrease FiO₂
Correct Answer: A. Increase IPAP
Rationale: Increasing inspiratory positive airway pressure (IPAP) augments tidal volume and
unloads respiratory muscles. EPAP is mainly for oxygenation and PEEP.
3. A 62-year-old post-cardiac arrest patient has a GCS of 6. Targeted temperature
management (TTM) is initiated. What core temperature range is recommended for the
first 24 hours?
A. 32–34°C
B. 34–36°C
C. 36–37°C
D. 37–38°C
Correct Answer: B. 34–36°C
Rationale: Current guidelines recommend TTM at 32–36°C, but many institutions use 34–
36°C as a practical range. Option A is the older 32–34°C range.
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, 8/15/26, 3:02 AM ANCC AGACNP Frances Guide Review · 2026
4. A 71-year-old with atrial fibrillation and rapid ventricular rate (HR 148) is
hemodynamically stable. Which medication is preferred for acute rate control?
A. Amiodarone IV
B. Metoprolol IV
C. Diltiazem IV
D. Digoxin IV
Correct Answer: C. Diltiazem IV
Rationale: IV diltiazem (calcium channel blocker) is first-line for acute rate control in stable
atrial fibrillation. Metoprolol is also used, but diltiazem is often preferred in the acute setting
with preserved ejection fraction.
5. A 66-year-old male with new-onset confusion, fever, and flank pain. Urinalysis shows
WBC casts. Most likely diagnosis?
A. Acute cystitis
B. Acute pyelonephritis
C. Urosepsis
D. Renal abscess
Correct Answer: B. Acute pyelonephritis
Rationale: WBC casts are pathognomonic for acute pyelonephritis (upper UTI). Cystitis does
not produce casts; urosepsis is a complication but not the primary diagnosis.
6. A 78-year-old with COPD and chronic hypoxemia presents with worsening dyspnea.
ABG: pH 7.29, PaCO₂ 68, PaO₂ 55, HCO₃ 28. Which intervention is most appropriate?
A. Increase O₂ to 4 L/min via NC
B. Initiate BiPAP
C. Intubate and mechanical ventilation
D. IV methylprednisolone
Correct Answer: B. Initiate BiPAP
Rationale: pH 7.29 with hypercapnia indicates acute respiratory acidosis. BiPAP is first-line
for hypercapnic respiratory failure in COPD if hemodynamically stable. Intubation is reserved
for failure or instability.
7. A 55-year-old female with sudden onset right-sided weakness, aphasia. Last known
well 3 hours ago. CT head negative. Which treatment is recommended?
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ANCC AGACNP FRANCES GUIDE REVIEW EXAM QUESTIONS &
RATIONALES
2025–2026 Updated Version | Complete Study Guide
1. A 68-year-old male with septic shock and acute kidney injury is started on
norepinephrine. Which hemodynamic parameter best guides titration?
A. Central venous pressure (CVP)
B. Mean arterial pressure (MAP)
C. Cardiac index (CI)
D. Pulmonary artery occlusion pressure (PAOP)
Correct Answer: B. Mean arterial pressure (MAP)
Rationale: Norepinephrine is a vasopressor titrated to achieve a MAP ≥65 mmHg in septic
shock. CVP and PAOP are volume status indicators, not primary targets for vasopressor
titration.
2. A 74-year-old female with COPD exacerbation is on BiPAP. Which setting adjustment
would most likely reduce her work of breathing?
A. Increase IPAP
B. Increase EPAP
C. Decrease backup rate
D. Decrease FiO₂
Correct Answer: A. Increase IPAP
Rationale: Increasing inspiratory positive airway pressure (IPAP) augments tidal volume and
unloads respiratory muscles. EPAP is mainly for oxygenation and PEEP.
3. A 62-year-old post-cardiac arrest patient has a GCS of 6. Targeted temperature
management (TTM) is initiated. What core temperature range is recommended for the
first 24 hours?
A. 32–34°C
B. 34–36°C
C. 36–37°C
D. 37–38°C
Correct Answer: B. 34–36°C
Rationale: Current guidelines recommend TTM at 32–36°C, but many institutions use 34–
36°C as a practical range. Option A is the older 32–34°C range.
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, 8/15/26, 3:02 AM ANCC AGACNP Frances Guide Review · 2026
4. A 71-year-old with atrial fibrillation and rapid ventricular rate (HR 148) is
hemodynamically stable. Which medication is preferred for acute rate control?
A. Amiodarone IV
B. Metoprolol IV
C. Diltiazem IV
D. Digoxin IV
Correct Answer: C. Diltiazem IV
Rationale: IV diltiazem (calcium channel blocker) is first-line for acute rate control in stable
atrial fibrillation. Metoprolol is also used, but diltiazem is often preferred in the acute setting
with preserved ejection fraction.
5. A 66-year-old male with new-onset confusion, fever, and flank pain. Urinalysis shows
WBC casts. Most likely diagnosis?
A. Acute cystitis
B. Acute pyelonephritis
C. Urosepsis
D. Renal abscess
Correct Answer: B. Acute pyelonephritis
Rationale: WBC casts are pathognomonic for acute pyelonephritis (upper UTI). Cystitis does
not produce casts; urosepsis is a complication but not the primary diagnosis.
6. A 78-year-old with COPD and chronic hypoxemia presents with worsening dyspnea.
ABG: pH 7.29, PaCO₂ 68, PaO₂ 55, HCO₃ 28. Which intervention is most appropriate?
A. Increase O₂ to 4 L/min via NC
B. Initiate BiPAP
C. Intubate and mechanical ventilation
D. IV methylprednisolone
Correct Answer: B. Initiate BiPAP
Rationale: pH 7.29 with hypercapnia indicates acute respiratory acidosis. BiPAP is first-line
for hypercapnic respiratory failure in COPD if hemodynamically stable. Intubation is reserved
for failure or instability.
7. A 55-year-old female with sudden onset right-sided weakness, aphasia. Last known
well 3 hours ago. CT head negative. Which treatment is recommended?
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