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

Answer: C

Hypovolemic hyponatremia from poor fluid intake: Hypovolemia usually gives a low urine sodium (under 20 to 30 mEq/L) and clinical volume depletion; she is euvolemic with a high urine sodium.

Primary polydipsia with excessive water intake: With primary polydipsia the kidneys excrete very dilute urine (osmolality under 100 mOsm/kg), not concentrated urine.

SIADH associated with the SSRI antidepressant: Correct. Low serum osmolality with inappropriately concentrated urine and high urine sodium in a euvolemic patient, with thyroid and adrenal causes excluded, fits SIADH. Older adults on SSRIs are at particular risk.

Pseudohyponatremia from high lipids or protein: Pseudohyponatremia has a normal measured serum osmolality; hers is low, so the hyponatremia is real (hypotonic).

Hypotonic, euvolemic hyponatremia with urine osm >100 and urine Na >30, after excluding hypothyroidism and adrenal insufficiency = SIADH; SSRIs are a common cause in older adults.

Answer: B

Memory loss for recent events and names: Short-term memory loss is typical of Alzheimer disease and does not distinguish delirium.

Acute onset with inattention and fluctuation: Correct. The Confusion Assessment Method requires acute onset with a fluctuating course plus inattention, along with disorganized thinking or altered consciousness. These features mark delirium on top of dementia.

Trouble finding the right words in speech: Word-finding difficulty is an expected cognitive feature of Alzheimer disease.

Gradual decline over months in independent self-care: A slow decline in function over months to years describes dementia; delirium develops over hours to days.

Delirium = acute onset, fluctuating course, inattention (CAM features 1 and 2) plus disorganized thinking or altered level of consciousness; dementia is gradual with intact attention early.

Answer: C

Deep nasotracheal suctioning every hour to keep the airway clear: Deep suctioning is uncomfortable, stimulates more secretions and is not recommended for terminal secretions.

A large IV fluid bolus to thin the secretions so they clear easily: Extra fluids at the end of life can increase secretions and edema; they do not help this symptom.

Side-lying positioning, an anticholinergic, and support for family: Correct. Repositioning, gentle oral care and an anticholinergic such as glycopyrrolate (best given early) reduce secretions; explaining that the sound is usually not distressing to the patient supports the family.

Supplemental oxygen by face mask at high flow to ease her breathing: The noise is from pooled secretions, not hypoxemia; high-flow oxygen does not reduce it and the mask may add discomfort.

Terminal secretions: reposition, gentle oral care, anticholinergic early, avoid deep suctioning and excess fluids, and educate the family.

Answer: B

Add a stool softener and schedule the patient for a cognitive screening: This adds another drug to the cascade and treats a downstream effect instead of the cause.

Lower the amlodipine dose or switch agents, then stop the drugs added later: Correct. This is a prescribing cascade: CCB edema → loop diuretic → urgency → anticholinergic → constipation and confusion. Fixing the first drug lets the later ones be deprescribed.

Change oxybutynin to an extended-release form to limit its side effects: Extended-release oxybutynin is still anticholinergic and keeps the cascade going.

Raise the furosemide dose so his ankle edema will resolve more quickly: CCB edema comes from capillary pressure, not volume overload, and responds poorly to diuretics; more furosemide would worsen urgency.

Prescribing cascade: an adverse drug effect is mistaken for a new condition and treated with another drug. Find the first drug and deprescribe from the top down.

Answer: C

Root cause analysis (RCA): RCA is retrospective; it analyzes an event that has already occurred.

Pareto analysis of incident types: A Pareto chart ranks existing problem categories by frequency; it does not predict failure modes of a new process.

Failure mode and effects analysis: Correct. FMEA is a proactive method that maps a process, lists potential failure modes, and scores severity, occurrence and detection to prioritize prevention.

Statistical process control charts: Control charts monitor variation in an ongoing process over time; they do not anticipate failures before a rollout.

FMEA = proactive (before failure); RCA = reactive (after an event). The Joint Commission expects proactive risk assessment for high-risk processes.

Answer: C

The ANCC board certification, which grants prescriptive authority in all states: Certification is one requirement for APRN licensure but does not itself grant prescriptive authority.

The scope set by her employer's job description and credentialing committee: Employers can restrict privileges within the law but cannot grant authority beyond state law.

The state's nurse practice act and board of nursing rules for CNS licensure: Correct. APRN scope, including CNS prescriptive authority, is set by state law and board of nursing regulation, and it varies widely by state.

The federal Consensus Model, which gives all APRNs full practice authority: The APRN Consensus Model is a recommended framework, not federal law; states adopt it to different degrees.

APRN scope of practice, including whether a CNS may prescribe, is defined by each state's nurse practice act and board of nursing, not by certification or employer.