ANCC AGACNP FRANCES GUIDE REVIEW – 500+ PRACTICE
QUESTIONS AND ANSWERS FOR 2026 ACUTE CARE NP
BOARD EXAM PREPARATION STUDY PDF
ANCC AGACNP Frances Guide Review 2026/2027
200+ Original Practice Questions & Detailed Rationales
Adult-Gerontology Acute Care Nurse Practitioner Board Exam Preparation
Academic Year: 2026/2027
Important Academic Notice
This document is an original exam-preparation resource for Adult-Gerontology Acute Care
Nurse Practitioner (AGACNP) students. It is designed around the publicly available ANCC
AGACNP examination framework and broad acute-care NP competencies.
Table of Contents
1. Introduction — Questions 1–40
2. Core Concepts — Questions 41–80
3. Applied Scenarios — Questions 81–120
4. Critical Thinking — Questions 121–160
5. Review Questions — Questions 161–200
6. Answer & Rationale Format
7. SEO Resource Metadata
SECTION I — INTRODUCTION
Questions 1–40
Question 1
Which finding most strongly suggests acute hypoxemic respiratory failure?
,A. SpO₂ 96% on room air
B. PaO₂ 58 mmHg despite supplemental oxygen
C. Respiratory rate 18/min
D. PaCO₂ 40 mmHg
Correct Answer: B
Rationale: A markedly reduced arterial oxygen tension despite supplemental oxygen indicates
significant impairment of oxygenation. Respiratory rate and PaCO₂ can remain normal early in
respiratory failure, so they do not exclude clinically important hypoxemia.
Question 2
A patient with suspected septic shock has persistent hypotension after appropriate initial
crystalloid administration. Which medication is generally used as the first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Phenylephrine
Correct Answer: B
Rationale: Norepinephrine is generally the preferred initial vasopressor for septic shock because
it increases vascular tone and mean arterial pressure with less tachyarrhythmia than dopamine.
Dobutamine is primarily an inotropic agent and is considered when cardiac dysfunction and
inadequate perfusion persist despite appropriate pressure support.
Question 3
Which ECG finding is most characteristic of hyperkalemia?
A. U waves
B. Peaked T waves
C. Prolonged QT interval
D. ST elevation in contiguous leads
Correct Answer: B
Rationale: Hyperkalemia classically causes tall, narrow, peaked T waves early in its ECG
progression. More severe hyperkalemia may produce PR prolongation, QRS widening,
conduction abnormalities, and eventually a sine-wave pattern.
,Question 4
A patient with acute pulmonary edema is severely hypertensive and dyspneic. Which
intervention directly reduces preload and afterload while rapidly improving pulmonary
congestion?
A. Large-volume crystalloid administration
B. Intravenous nitrate therapy
C. Oral potassium replacement
D. Intramuscular glucagon
Correct Answer: B
Rationale: Nitroglycerin produces venodilation at lower doses and additional arterial dilation at
higher doses, reducing preload and afterload. In appropriately selected hypertensive acute heart
failure, this can rapidly improve pulmonary edema.
Question 5
Which physical finding is most consistent with left-sided heart failure?
A. Jugular venous distention only
B. Pulmonary crackles
C. Isolated hepatomegaly
D. Dependent edema without respiratory findings
Correct Answer: B
Rationale: Left ventricular failure increases pulmonary venous pressure, producing interstitial
and alveolar fluid accumulation. Crackles, orthopnea, and pulmonary edema therefore commonly
accompany acute left-sided heart failure.
Question 6
Which acid-base disorder is suggested by pH 7.25, PaCO₂ 60 mmHg, and HCO₃⁻ 26 mEq/L?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
, Rationale: The pH is acidemic and the PaCO₂ is elevated, identifying respiratory acidosis as the
primary disorder. The relatively normal bicarbonate suggests limited or absent metabolic
compensation, consistent with an acute process.
Question 7
Which clinical finding is most concerning for an acute ischemic stroke involving the dominant
cerebral hemisphere?
A. Unilateral facial droop and aphasia
B. Bilateral ankle edema
C. Isolated urinary retention
D. Chronic low back pain
Correct Answer: A
Rationale: Aphasia indicates dysfunction of language-dominant cortical regions, while facial
weakness may reflect corticobulbar pathway involvement. Sudden focal neurologic deficits
require immediate stroke evaluation.
Question 8
What is the principal purpose of a noncontrast head CT in the initial evaluation of suspected
acute ischemic stroke?
A. Confirm every ischemic infarction
B. Exclude intracranial hemorrhage and other major mimics
C. Measure cerebral perfusion directly
D. Determine long-term rehabilitation needs
Correct Answer: B
Rationale: Early noncontrast CT may be normal in ischemic stroke, particularly shortly after
symptom onset. Its critical initial role is to identify hemorrhage and other structural
abnormalities that would change acute management.
Question 9
Which laboratory abnormality is most characteristic of diabetic ketoacidosis?
A. Metabolic alkalosis
B. Anion-gap metabolic acidosis
QUESTIONS AND ANSWERS FOR 2026 ACUTE CARE NP
BOARD EXAM PREPARATION STUDY PDF
ANCC AGACNP Frances Guide Review 2026/2027
200+ Original Practice Questions & Detailed Rationales
Adult-Gerontology Acute Care Nurse Practitioner Board Exam Preparation
Academic Year: 2026/2027
Important Academic Notice
This document is an original exam-preparation resource for Adult-Gerontology Acute Care
Nurse Practitioner (AGACNP) students. It is designed around the publicly available ANCC
AGACNP examination framework and broad acute-care NP competencies.
Table of Contents
1. Introduction — Questions 1–40
2. Core Concepts — Questions 41–80
3. Applied Scenarios — Questions 81–120
4. Critical Thinking — Questions 121–160
5. Review Questions — Questions 161–200
6. Answer & Rationale Format
7. SEO Resource Metadata
SECTION I — INTRODUCTION
Questions 1–40
Question 1
Which finding most strongly suggests acute hypoxemic respiratory failure?
,A. SpO₂ 96% on room air
B. PaO₂ 58 mmHg despite supplemental oxygen
C. Respiratory rate 18/min
D. PaCO₂ 40 mmHg
Correct Answer: B
Rationale: A markedly reduced arterial oxygen tension despite supplemental oxygen indicates
significant impairment of oxygenation. Respiratory rate and PaCO₂ can remain normal early in
respiratory failure, so they do not exclude clinically important hypoxemia.
Question 2
A patient with suspected septic shock has persistent hypotension after appropriate initial
crystalloid administration. Which medication is generally used as the first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Phenylephrine
Correct Answer: B
Rationale: Norepinephrine is generally the preferred initial vasopressor for septic shock because
it increases vascular tone and mean arterial pressure with less tachyarrhythmia than dopamine.
Dobutamine is primarily an inotropic agent and is considered when cardiac dysfunction and
inadequate perfusion persist despite appropriate pressure support.
Question 3
Which ECG finding is most characteristic of hyperkalemia?
A. U waves
B. Peaked T waves
C. Prolonged QT interval
D. ST elevation in contiguous leads
Correct Answer: B
Rationale: Hyperkalemia classically causes tall, narrow, peaked T waves early in its ECG
progression. More severe hyperkalemia may produce PR prolongation, QRS widening,
conduction abnormalities, and eventually a sine-wave pattern.
,Question 4
A patient with acute pulmonary edema is severely hypertensive and dyspneic. Which
intervention directly reduces preload and afterload while rapidly improving pulmonary
congestion?
A. Large-volume crystalloid administration
B. Intravenous nitrate therapy
C. Oral potassium replacement
D. Intramuscular glucagon
Correct Answer: B
Rationale: Nitroglycerin produces venodilation at lower doses and additional arterial dilation at
higher doses, reducing preload and afterload. In appropriately selected hypertensive acute heart
failure, this can rapidly improve pulmonary edema.
Question 5
Which physical finding is most consistent with left-sided heart failure?
A. Jugular venous distention only
B. Pulmonary crackles
C. Isolated hepatomegaly
D. Dependent edema without respiratory findings
Correct Answer: B
Rationale: Left ventricular failure increases pulmonary venous pressure, producing interstitial
and alveolar fluid accumulation. Crackles, orthopnea, and pulmonary edema therefore commonly
accompany acute left-sided heart failure.
Question 6
Which acid-base disorder is suggested by pH 7.25, PaCO₂ 60 mmHg, and HCO₃⁻ 26 mEq/L?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: A
, Rationale: The pH is acidemic and the PaCO₂ is elevated, identifying respiratory acidosis as the
primary disorder. The relatively normal bicarbonate suggests limited or absent metabolic
compensation, consistent with an acute process.
Question 7
Which clinical finding is most concerning for an acute ischemic stroke involving the dominant
cerebral hemisphere?
A. Unilateral facial droop and aphasia
B. Bilateral ankle edema
C. Isolated urinary retention
D. Chronic low back pain
Correct Answer: A
Rationale: Aphasia indicates dysfunction of language-dominant cortical regions, while facial
weakness may reflect corticobulbar pathway involvement. Sudden focal neurologic deficits
require immediate stroke evaluation.
Question 8
What is the principal purpose of a noncontrast head CT in the initial evaluation of suspected
acute ischemic stroke?
A. Confirm every ischemic infarction
B. Exclude intracranial hemorrhage and other major mimics
C. Measure cerebral perfusion directly
D. Determine long-term rehabilitation needs
Correct Answer: B
Rationale: Early noncontrast CT may be normal in ischemic stroke, particularly shortly after
symptom onset. Its critical initial role is to identify hemorrhage and other structural
abnormalities that would change acute management.
Question 9
Which laboratory abnormality is most characteristic of diabetic ketoacidosis?
A. Metabolic alkalosis
B. Anion-gap metabolic acidosis
