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
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
