AGACNP-BC Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Ventricular septal rupture: Incorrect. Septal rupture produces a harsh holosystolic murmur at the left lower sternal border, often with a palpable thrill and a left-to-right shunt.

Papillary muscle rupture: Correct. Inferior MI can rupture the posteromedial papillary muscle (single blood supply), causing acute severe mitral regurgitation: apical holosystolic murmur radiating to the axilla with flash pulmonary edema.

Acute fibrinous pericarditis: Incorrect. Pericarditis causes a scratchy, multi-component friction rub and positional chest pain, not a holosystolic murmur with pulmonary edema.

Left ventricular free-wall rupture: Incorrect. Free-wall rupture typically causes sudden tamponade and pulseless electrical activity, not a new regurgitant murmur.

Mechanical complications 3–5 days post-MI: papillary muscle rupture (apical murmur → axilla, pulmonary edema), VSR (LLSB murmur + thrill), free-wall rupture (tamponade). Confirm with urgent echo; both ruptures need surgery.

Answer: B

Neuroleptic malignant syndrome: Incorrect. NMS follows dopamine antagonists, develops over days, and causes lead-pipe rigidity with hyporeflexia rather than clonus.

Serotonin syndrome: Correct. Linezolid is a weak MAO inhibitor; combined with an SSRI it can cause serotonin syndrome, marked by clonus, hyperreflexia, hyperthermia and agitation.

Malignant hyperthermia: Incorrect. Malignant hyperthermia is triggered by volatile anesthetics or succinylcholine and presents with rigidity and rising end-tidal CO₂ in the operating room.

Anticholinergic toxicity: Incorrect. Anticholinergic toxicity causes dry, flushed skin and normal reflexes; diaphoresis and clonus point to serotonin excess.

Hunter criteria: serotonergic drug + clonus (spontaneous, inducible or ocular), hyperreflexia, agitation, diaphoresis, hyperthermia. Stop the agents, give supportive care and benzodiazepines, and consider cyproheptadine.

Answer: D

IV diltiazem bolus followed by a continuous infusion: Incorrect. Nondihydropyridine calcium channel blockers are negatively inotropic and should be avoided in HFrEF, especially with decompensation.

IV metoprolol 5 mg every 5 minutes for 3 doses: Incorrect. Beta-blockers are long-term therapy in HFrEF, but rapid IV loading during acute decompensation with borderline BP can worsen heart failure and cause hypotension.

IV adenosine 6 mg rapid push, repeated if needed: Incorrect. Adenosine briefly blocks the AV node but does not control the rate or convert atrial fibrillation.

IV amiodarone loading dose followed by an infusion: Correct. In decompensated HFrEF with AF, IV amiodarone (or digoxin) can control rate with less negative inotropy; synchronized cardioversion is used if he becomes unstable.

AF rate control: preserved EF → beta-blocker or non-DHP CCB; HFrEF/decompensated → avoid non-DHP CCB, use amiodarone or digoxin acutely, and cardiovert if unstable. Address anticoagulation (CHA₂DS₂-VASc).

Answer: C

Order CT pulmonary angiography, because the D-dimer exceeds the 500 cutoff: Incorrect. Using the fixed cutoff in older adults causes many false positives and unnecessary CT scans with radiation and contrast exposure.

Order a ventilation-perfusion scan instead of CT to avoid contrast: Incorrect. Any imaging is unnecessary here, because the age-adjusted D-dimer is negative in a PE-unlikely patient.

Consider PE excluded, because 650 is below her age-adjusted cutoff of 720: Correct. For patients over 50, the age-adjusted cutoff is age × 10 ng/mL (72 × 10 = 720). A D-dimer below this in a PE-unlikely patient safely excludes PE.

Start empiric anticoagulation while awaiting lower-extremity duplex: Incorrect. Empiric anticoagulation is for high clinical probability while awaiting imaging, not for a PE-unlikely patient with a negative age-adjusted D-dimer.

Age-adjusted D-dimer (age × 10 ng/mL FEU for patients >50) in PE-unlikely patients reduces imaging without missing clinically important PE (ADJUST-PE).

Answer: C

4: Incorrect. This uses the absolute difference in percentage points (4) as if it were the NNT; NNT is the reciprocal of the absolute risk reduction.

8: Incorrect. This uses the event rate in the treatment group rather than the difference between groups.

25: Correct. Absolute risk reduction = 12% − 8% = 4% = 0.04; NNT = 1 ÷ 0.04 = 25.

33: Incorrect. This corresponds to a relative risk reduction of about 33% (4 ÷ 12), which is not the NNT.

ARR = control event rate − treatment event rate; NNT = 1/ARR; RRR = ARR/control rate. NNT conveys clinical impact better than RRR.

Answer: B

The care setting, because acute care NPs may practice only in inpatient hospital units: Incorrect. The Consensus Model specifies that scope is not defined by setting; acute care NPs may work in clinics when caring for appropriate patients.

The patients' care needs, since acute care scope is based on acuity, not location: Correct. Acute care versus primary care NP scope is determined by patient needs (physiologic instability, complex acute illness), not by the practice setting.

The supervising physician's preference, documented in a delegation agreement: Incorrect. Physician preference does not define APRN scope; scope comes from education, certification, licensure and state law.

The number of hours the AGACNP previously worked as a bedside RN: Incorrect. Prior RN experience does not determine APRN role or population-focus scope.

Consensus Model (LACE): licensure, accreditation, certification, education. Population focus (adult-gerontology) plus role (acute vs primary care) is defined by patient needs, not setting.