Free practice quiz
AGACNP-BC Prep Course (AGACNP): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
A 29-year-old patient at 32 weeks’ gestation presents to an emergency department where the AGACNP is covering acute medical consults. Assessment: BP 178/112 mm Hg, severe headache, visual spots, right upper quadrant pain, and brisk reflexes. Oxygen saturation is 97% on room air; airway is patent. The charge nurse asks whether the patient should be admitted to the medical step-down unit under the AGACNP service. What is the safest next action?
A is correct: ABCs are stable, but severe hypertension with neurologic and right upper quadrant symptoms suggests an obstetric emergency outside AGACNP practice boundaries; stabilize and escalate/transfer. C delays specialty care in an inappropriate service. D ignores life-threatening preeclampsia features. B is unsafe delegation because the AGACNP must recognize instability and coordinate urgent escalation. Nursing priority is assess ABCs, implement immediate safety measures, delegate only supportive tasks, and notify/transfer urgently.
- Question 2 of 10
An AGACNP evaluates a 78-year-old in a step-down unit 6 hours after admission for pneumonia. Assessment shows T 39.1°C, HR 128/min, RR 32/min, BP 82/48 mm Hg after 1 L crystalloid, SpO2 88% on 6 L nasal cannula, new confusion, urine output 15 mL/hr, and lactate 4.2 mmol/L. What is the safest next action based on acuity and setting?
A is correct: ABCs and circulation drive priority; hypoxemia, hypotension, oliguria, confusion, and high lactate indicate shock exceeding step-down capability. C: cultures and lactate are appropriate but should not delay stabilization or escalation. B: monitoring after antipyretic therapy is unsafe because the patient is unstable now. D: transition planning is valid later, but physiologic instability takes priority. Assess airway, breathing, circulation, and perfusion first; intervene with oxygenation and sepsis resuscitation; delegate routine data gathering only; escalate immediately for persistent hypotension, hypoxemia, altered mentation, or lactate elevation.
- Question 3 of 10
An AGACNP is called to a step-down unit for a 72-year-old with pneumonia who was placed on BiPAP 15 minutes ago. The patient is restless, using accessory muscles, and speaks in one-word phrases. SpO2 is 84%, respiratory rate 34/min, heart rate 126/min, and blood pressure 92/58 mm Hg. Breath sounds are diminished bilaterally. Which action is the priority?
A is correct: ABCs and instability come first; worsening hypoxemia, hypotension, and increased work of breathing require immediate bedside reassessment and escalation. B is a useful diagnostic step, but delaying airway and breathing stabilization is the wrong priority. C may identify contributors and optimize therapy, but medication review does not address current respiratory failure. D may be appropriate later, especially if deterioration continues, but documentation and family discussion do not replace urgent stabilization. Nursing-process priority is assess/intervene first, then diagnostics, planning, and documentation.
- Question 4 of 10
A 72-year-old patient arrives with sudden right facial droop, aphasia, and right arm weakness. Blood pressure is 184/96 mm Hg, glucose is 108 mg/dL, and oxygen saturation is 96% on room air. Family is anxious and says, “She was fine earlier.” To guide immediate stroke-team decisions, which targeted history should the AGACNP obtain first?
D is correct. Using ABCs and the nursing process, time last known well and anticoagulant exposure are priority data because they affect urgent stroke imaging and reperfusion eligibility. C is useful for baseline function and discharge planning but does not drive immediate stabilization. A supports medication safety, but allergy review follows the time-sensitive stroke history unless an ordered intervention requires it immediately. B may identify mimics or infection, but it is lower priority than onset time and bleeding-risk medication history. Assess neurologic change and onset time; intervene by activating the stroke pathway per protocol; delegate vital signs/glucose collection as appropriate; escalate immediately for worsening airway, breathing, circulation, or neurologic status.
- Question 5 of 10
A 72-year-old patient on a step-down unit is 12 hours post bowel resection. Over 2 hours, vital signs trend from HR 92 to 122/min, BP 138/78 to 106/60 mm Hg, RR 18 to 28/min, and SpO2 96% to 92% on 2 L nasal cannula. Urine output is 20 mL/hr, and the patient is cool, anxious, and mildly confused. As the AGACNP, which action is the priority?
Using ABCs and circulation priority, the trend suggests compensated shock before frank hypotension. A is tempting because orthostatics assess volume status, but standing an unstable postoperative patient delays stabilization. A recognizes that trends matter, but persistent tachycardia, narrowing perfusion signs, oliguria, and confusion require action now. D is correct: reassess perfusion, support oxygenation and access, and escalate for rapid treatment. B is a real intervention if pain contributes to tachycardia, but treating pain first ignores worsening perfusion and mental status. Review Vital Sign Trend Meaning — focus on circulation, compensated shock, and escalation.
- Question 6 of 10
A 72-year-old admitted with NSTEMI triggers a telemetry alarm. Assessment: HR 34/min, BP 82/48 mm Hg, cool clammy skin, new confusion, SpO2 93% on 2 L nasal cannula. The strip shows regular P waves with no consistent PR relationship to wide QRS complexes. As the AGACNP at the bedside, which immediate action has the highest priority?
D is correct. ABCs/circulation are threatened: symptomatic complete heart block with hypotension and altered mentation requires immediate escalation and pacing readiness. A is appropriate assessment but delays stabilization. B addresses a reversible cause, but medication review is secondary to perfusion support. C is unsafe because instability is present; observation alone risks cardiac arrest. Nursing-process priority is assess instability, intervene to support circulation, delegate tasks such as ECG/labs to team members, and escalate immediately to emergency/cardiology support.
- Question 7 of 10
A 74-year-old patient with chronic kidney disease is hospitalized for pneumonia. New assessment findings include weakness, nausea, BP 96/58 mm Hg, HR 112/min, RR 24/min, and oxygen saturation 92% on room air. Yesterday: K 4.8 mEq/L, creatinine 1.6 mg/dL, WBC 14,000/mm3. Today: K 6.7 mEq/L, CO2 18 mEq/L, creatinine 2.9 mg/dL, WBC 19,000/mm3. Telemetry shows peaked T waves. Which action should the AGACNP take first?
D is correct. Circulation is the priority: severe hyperkalemia with ECG changes can cause lethal dysrhythmias and requires immediate stabilization and escalation. A is tempting because hemolysis can falsely elevate potassium, but ECG changes make waiting unsafe. C is appropriate for infection management, but leukocytosis is lower priority than an immediately life-threatening electrolyte abnormality. B may support perfusion and kidney injury, but fluids do not rapidly protect the myocardium from hyperkalemia.
- Question 8 of 10
A 68-year-old patient with severe COPD is admitted to the step-down unit for increasing somnolence and dyspnea. Respirations are 10/min and shallow, SpO2 is 88% on 4 L nasal cannula, and wheezes are diminished bilaterally. ABG shows pH 7.28, PaCO2 62 mm Hg, and HCO3 27 mEq/L. Which interpretation best guides the priority acute care nursing action?
D is correct: Low pH with elevated PaCO2 and near-normal HCO3 indicates primary respiratory acidosis from hypoventilation; ABC priority is ventilation support and escalation. A is tempting because acidosis is present, but HCO3 is not low. B is incorrect because PaCO2 is high, not low. C is incorrect because pH is acidemic, not alkalemic. Assess airway/breathing first; intervene to improve ventilation; delegate routine vitals only if stable; escalate for somnolence, hypoxemia, or worsening ABGs.
- Question 9 of 10
A 76-year-old patient in the step-down unit develops sudden dyspnea and pleuritic right chest pain after central venous catheter placement. SpO2 is 88% on 2 L nasal cannula, respiratory rate 30/min, heart rate 118/min, and right breath sounds are markedly decreased. Portable chest radiograph shows a visible right pleural line with no peripheral vascular markings. What is the priority action?
B: Comparing prior films is useful, but ABCs take priority when acute hypoxemia and a pneumothorax pattern are present. C: Diuresis is appropriate for pulmonary edema, but this film shows a pleural line without distal markings, not vascular congestion. D: Correct. Breathing is the priority: support oxygenation, monitor for tension physiology, and escalate urgently for decompression/chest tube per privileges and policy. A: Ultrasound-guided thoracentesis is appropriate for effusion, but this imaging pattern and sudden symptoms indicate pneumothorax rather than fluid.
- Question 10 of 10
A 78-year-old patient in the step-down unit reports new indigestion, mild shortness of breath, and diaphoresis 2 hours after dinner. History includes diabetes, chronic kidney disease, and hypertension. Vital signs are BP 156/88 mm Hg, HR 104/min, RR 22/min, SpO2 93% on room air. The patient denies crushing chest pain. As the AGACNP, what is the priority action?
D is correct: ABCs and circulation priority require rapid evaluation for ACS; older adults and patients with diabetes may have dyspnea, diaphoresis, or indigestion without classic pain. ECG timing and serial troponins guide urgent escalation. B is tempting for indigestion, but treating presumed reflux before cardiac assessment delays care. C is an appropriate analysis step later, not before ruling out immediately dangerous causes. A provides comfort and reassessment, but safety priority requires objective cardiac assessment first because symptoms and risk factors suggest possible ACS.
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