Free Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) board certification examination Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) board certification examination practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1An older adult with hypertension has symptoms of heart failure despite a preserved left ventricular ejection fraction. Which mechanism best explains the impaired ventricular filling?

   1. A. A stiff left ventricle relaxes poorly between beats.
   2. B. A weak left ventricle ejects too little blood with each beat.
   3. C. A failing right ventricle sends too little blood to the lungs.
   4. D. A pulmonary artery clot blocks blood flow through the lungs.

   Answer: A

   Explanation: NHLBI states, "In heart failure with preserved ejection fraction (HFpEF), the left side of your heart is too stiff to fully relax between heartbeats." The patient's preserved ejection fraction and impaired filling point to this mechanism.

   Reference: Heart Failure - Causes and Risk Factors | NHLBI, NIH — What causes left-sided heart failure? / HFpEF paragraph

2. 2A previously normotensive adult has elevated blood pressure at a routine office visit. Before labeling the patient hypertensive and starting treatment, which confirmation approach reflects USPSTF guidance?

   1. A. Confirm with validated ambulatory or home blood pressure monitoring.
   2. B. Confirm with a second office reading obtained during the same visit.
   3. C. Confirm with an exercise blood pressure measurement at peak exertion.
   4. D. Confirm with repeated pulse pressure estimates from the office record.

   Answer: A

   Explanation: The USPSTF states, "Ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) with validated and accurate devices should be used outside of a clinical setting to confirm a diagnosis of hypertension before starting treatment." A single elevated office visit requires out-of-office confirmation.

   Reference: Recommendation: Hypertension in Adults: Screening | USPSTF — Practice Considerations / Screening Tests

3. 3A team is designing a new high-risk medication process and wants to identify how it might fail before rollout. Which quality tool is built for this prospective review?

   1. A. Failure Modes and Effects Analysis
   2. B. Root Cause Analysis
   3. C. Incident reporting review
   4. D. Retrospective mortality review

   Answer: A

   Explanation: IHI describes FMEA as "A systematic, proactive method for evaluating a process or product to identify where and how it might fail". The new process has not yet been implemented, so a prospective failure review fits.

   Reference: Failure Modes and Effects Analysis (FMEA) Tool | IHI — FMEA Tool / overview

4. 4An adult with longstanding left-sided heart failure develops worsening right ventricular failure. Which hemodynamic change links the two conditions?

   1. A. Raised pressure in vessels carrying blood from the heart to the lungs.
   2. B. Reduced pressure in vessels carrying blood from the heart to the lungs.
   3. C. Raised pressure in vessels carrying blood from the lungs to the left atrium.
   4. D. Reduced pressure in vessels carrying blood from the lungs to the left atrium.

   Answer: A

   Explanation: NHLBI explains, "The build-up of blood raises the pressure in the blood vessels that carry blood from your heart to your lungs." This pulmonary vascular pressure increase makes the right heart work harder in left-sided failure.

   Reference: Heart Failure - Causes and Risk Factors | NHLBI, NIH — What causes right-sided heart failure? / first paragraph

5. 5An adult aged 52 years without known hypertension asks how often routine blood pressure screening is suggested. Which interval matches USPSTF guidance for this age group?

   1. A. Every year
   2. B. Every 3 years
   3. C. Every 5 years
   4. D. Every 10 years

   Answer: A

   Explanation: The USPSTF states, "The USPSTF suggests annual screening for hypertension in adults 40 years or older". At age 52, annual screening is the suggested interval.

   Reference: Recommendation: Hypertension in Adults: Screening | USPSTF — Practice Considerations / Screening Intervals

6. 6A unit tracks adverse drug events per 1,000 administered doses to see whether a medication-safety project improves patients' results. What type of improvement measure is this?

   1. A. Outcome measure
   2. B. Process measure
   3. C. Balancing measure
   4. D. Structure measure

   Answer: A

   Explanation: IHI explains that "the outcome measure indicates how the system is working, specifically the impact on the customers/patients." Under Outcome Measures, it lists "For medication systems: Adverse drug events per 1,000 doses". The unit is measuring patient harm, so the event rate is an outcome measure.

   Reference: Model for Improvement: Establishing Measures | IHI — Three Types of Measures / Outcome Measures

7. 7An adult becomes hypoventilated after an opioid overdose and develops hypercapnia. Which physiologic disturbance most directly explains the carbon dioxide retention?

   1. A. The brain fails to respond adequately to elevated blood carbon dioxide.
   2. B. The alveoli fill with fluid and slow the movement of dissolved gases.
   3. C. The airways narrow and impede expiration of carbon dioxide-rich air.
   4. D. The breathing muscles lose force because of impaired nerve signaling.

   Answer: A

   Explanation: NHLBI states, "In opioid overdose, for example, the brain may not detect high levels of carbon dioxide in the blood." In this case, impaired central detection reduces the drive to deepen breathing and clear carbon dioxide.

   Reference: Respiratory Failure - Causes and Risk Factors | NHLBI, NIH — What causes respiratory failure? / Conditions that affect the brain's control over breathing

8. 8A patient repeatedly has high office blood pressure but normal readings outside the clinic. Which blood pressure pattern does this represent?

   1. A. White coat hypertension
   2. B. Masked hypertension
   3. C. Sustained hypertension
   4. D. Resistant hypertension

   Answer: A

   Explanation: The USPSTF describes "white coat" hypertension as "blood pressure measurements that are high when obtained in a clinical office setting but normal when obtained outside the office". The patient's pattern matches this definition.

   Reference: Recommendation: Hypertension in Adults: Screening | USPSTF — How Does Evidence Fit With Biological Understanding? / hypertension patterns

9. 9A unit tests a new discharge process, then compares the observed readmission trend with its prediction before deciding what to revise. Which PDSA stage is being performed?

   1. A. Plan
   2. B. Do
   3. C. Study
   4. D. Act

   Answer: C

   Explanation: The IHI model describes the cycle as "planning it, trying it, observing the results, and acting on what is learned." Comparing observed data with the prediction is the Study stage.

   Reference: Model for Improvement | IHI — Testing Changes / PDSA cycle

10. 10A patient with pneumonia has alveolar fluid and new hypoxemia despite adequate cardiac output and respiratory effort. Which pathophysiologic defect most directly lowers arterial oxygen in this setting?

    1. A. Reduced oxygen transfer across the fluid-filled alveolar interface.
    2. B. Reduced oxygen transport caused by low circulating hemoglobin.
    3. C. Reduced oxygen delivery caused by diminished cardiac output.
    4. D. Reduced oxygen intake caused by weakened inspiratory muscles.

    Answer: A

    Explanation: NHLBI states, "This makes it harder for oxygen to pass from the air sacs into your blood" about fluid in the lungs. The specified alveolar fluid impairs transfer into blood; the other mechanisms are genuine causes of impaired oxygen delivery or ventilation but are excluded by the stated findings.

    Reference: Respiratory Failure - Causes and Risk Factors | NHLBI, NIH — What causes respiratory failure? / Fluid in your lungs