100+ Free AACN ACNPC-AG Practice Questions

Pass your AACN Acute Care Adult-Gerontology Nurse Practitioner Certification (ACNPC-AG) exam on the first try — instant access, no signup required.

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An ACNP is evaluating a 64-year-old man in the ED with substernal chest pressure that began 90 minutes ago. The 12-lead ECG shows 2 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. Vital signs: BP 92/58, HR 48, RR 18, SpO2 96% on room air. Which additional ECG lead set is most important to obtain before administering nitroglycerin?

Right-sided precordial leads (V3R-V6R)

Posterior leads (V7-V9)

Lewis lead configuration

Modified chest lead 1 (MCL1)

to track

2026 Statistics

Key Facts: AACN ACNPC-AG Exam

175

Total Questions

AACN ACNPC-AG handbook

150

Scored Questions

AACN ACNPC-AG handbook

3.5h

Exam Time

AACN ACNPC-AG handbook

$270

AACN Member Fee

AACN

$380

Non-Member Fee

AACN

5 yr

Certification Validity

AACN renewal page

AACN ACNPC-AG is a 175-item exam (150 scored + 25 pretest) administered over 3.5 hours at PSI test centers. Exam fees are $270 for AACN members and $380 for non-members. Content emphasizes clinical judgment for acute and critical adult-gerontology care plus professional caring/ethical practice grounded in the Synergy Model. ACNPC-AG is ABSNC- and NCCA-accredited and is distinct from ANCC's AGACNP-BC.

Sample AACN ACNPC-AG Practice Questions

Try these sample questions to test your AACN ACNPC-AG exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1An ACNP is evaluating a 64-year-old man in the ED with substernal chest pressure that began 90 minutes ago. The 12-lead ECG shows 2 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. Vital signs: BP 92/58, HR 48, RR 18, SpO2 96% on room air. Which additional ECG lead set is most important to obtain before administering nitroglycerin?

A.Right-sided precordial leads (V3R-V6R)

B.Posterior leads (V7-V9)

C.Lewis lead configuration

D.Modified chest lead 1 (MCL1)

Explanation: The patient has an inferior STEMI with hypotension and bradycardia, raising concern for right ventricular (RV) infarction. Right-sided leads (V4R most sensitive; ST elevation ≥1 mm) confirm RV involvement. RV infarcts are preload-dependent: nitroglycerin and other preload reducers can cause profound hypotension. Confirming RV involvement first changes management to IV fluid resuscitation and avoidance of nitrates, morphine, and diuretics.

2A 58-year-old patient with ARDS is on volume-control ventilation. Weight is 80 kg, height 178 cm (predicted body weight 73 kg). The current tidal volume is 600 mL with plateau pressure 34 cmH2O, PEEP 12, FiO2 0.7, PaO2 62. Per ARDSnet protocol, what is the most appropriate next adjustment?

A.Decrease tidal volume to 440 mL and recheck plateau pressure

B.Increase tidal volume to 700 mL to improve oxygenation

C.Increase respiratory rate but maintain current tidal volume

D.Switch to pressure-control ventilation at the same settings

Explanation: ARDSnet specifies tidal volume of 6 mL/kg of predicted body weight (PBW) with a plateau pressure goal of ≤30 cmH2O. PBW is 73 kg, so target Vt = 73 × 6 = 438 mL (≈440 mL). The current 600 mL (~8.2 mL/kg PBW) and Pplat 34 both exceed targets. Reducing Vt is the priority lung-protective intervention; if pH falls, RR can be increased up to 35.

3A 72-year-old septic patient remains hypotensive (MAP 58) after 30 mL/kg of balanced crystalloid. Lactate is 4.2 mmol/L. Per the Surviving Sepsis 1-hour bundle, which intervention should be initiated next?

A.Norepinephrine titrated to MAP ≥65 mmHg

B.Vasopressin 0.04 units/min as first-line vasopressor

C.Hydrocortisone 200 mg IV daily

D.Albumin 5% 500 mL bolus

Explanation: The Surviving Sepsis Campaign 1-hour bundle recommends initiation of vasopressors during or after fluid resuscitation when MAP remains <65 mmHg. Norepinephrine is the first-line vasopressor. Vasopressin is added (not first) when norepinephrine doses exceed 0.25-0.5 mcg/kg/min. Stress-dose steroids are reserved for refractory shock on vasopressors. Albumin is a reasonable adjunct but not the priority bundle action.

4An ACNP is interpreting an ABG on a patient with COPD exacerbation: pH 7.28, PaCO2 72, PaO2 58, HCO3 33, on 2 L NC. The patient is somnolent but arousable, with accessory muscle use. What is the most appropriate intervention?

A.Initiate noninvasive positive pressure ventilation (BiPAP)

B.Increase oxygen to 6 L NC and recheck ABG in 30 minutes

C.Intubate immediately for airway protection

D.Administer IV bicarbonate to correct acidemia

Explanation: Acute-on-chronic respiratory acidosis with pH <7.35, PaCO2 elevated, accessory muscle use, and hypercapnia is a class I indication for NIV (BiPAP) in COPD. NIV reduces intubation rates by ~50%, mortality, and hospital length of stay. The patient is arousable and able to protect the airway, so intubation is not yet required. Increasing FiO2 alone risks worsening hypercapnia via Haldane effect and V/Q mismatch.

5A 45-year-old presents with sudden severe headache ("worst of my life"). Non-contrast head CT performed 4 hours after onset is read as normal. What is the most appropriate next step?

A.Lumbar puncture to evaluate for xanthochromia and RBCs

B.Discharge home with outpatient migraine follow-up

C.MRI brain with gadolinium

D.CT angiography of the head and neck

Explanation: Thunderclap headache requires aggressive workup for subarachnoid hemorrhage (SAH). Non-contrast CT sensitivity is ~98% within 6 hours but drops thereafter. When CT is performed beyond 6 hours and is negative, lumbar puncture is required: xanthochromia (yellow CSF supernatant) appears 6-12 hours after bleeding and is the most specific finding. RBC count comparing tubes 1 and 4 is also assessed. CTA is appropriate as part of the workup if SAH is confirmed.

6A patient in cardiogenic shock from acute decompensated heart failure has BP 78/50, HR 118, lactate 5.1, cool extremities, and mottling. PAC shows CI 1.6 L/min/m2, SVR 1900 dynes·s·cm-5, PCWP 28. Which initial inotrope/vasoactive strategy is most appropriate?

A.Dobutamine 2.5-5 mcg/kg/min

B.Norepinephrine 0.1 mcg/kg/min monotherapy

C.Phenylephrine 0.5 mcg/kg/min

D.Esmolol 50 mcg/kg/min

Explanation: The hemodynamic profile is classic cold-and-wet cardiogenic shock: low CI, elevated SVR, elevated PCWP. Dobutamine (β1 inotrope with mild β2 vasodilation) augments contractility and lowers SVR/PCWP. Norepinephrine alone increases afterload and may worsen CI. Phenylephrine is a pure α-agonist that further raises SVR. Beta-blockade is contraindicated in acute cardiogenic shock. In severe hypotension (SBP <70), norepinephrine may be added with dobutamine.

7A 28-year-old presents with DKA: glucose 612, pH 7.10, HCO3 8, anion gap 28, K+ 5.8, Na+ 132. The patient is alert. What is the most appropriate initial fluid management?

A.Normal saline 15-20 mL/kg over the first hour

B.D5W with 40 mEq KCl at 250 mL/hr

C.Lactated Ringers 2 L bolus then dextrose-containing fluid

D.Sodium bicarbonate 100 mEq IV bolus

Explanation: ADA DKA protocol: initial isotonic crystalloid (NS or balanced) at 15-20 mL/kg (~1-1.5 L) over the first hour to restore intravascular volume. Switch to 0.45% NS at 250-500 mL/hr based on corrected Na+ once euvolemic. Add dextrose when glucose reaches ~200-250. Insulin is started after K+ is confirmed >3.3. Bicarbonate is reserved for pH <6.9. Although K+ is 5.8 here, total body potassium is depleted; replacement begins when K+ <5.2.

8An ACNP is preparing to perform an internal jugular central venous catheter insertion. According to the CDC and SHEA guidelines for prevention of CLABSI, which step has the strongest evidence for reducing infection risk?

A.Use of full barrier precautions and a sterile catheter cart checklist

B.Routine catheter exchange every 7 days

C.Antibiotic prophylaxis prior to insertion

D.Femoral site selection in obese patients to reduce pneumothorax risk

Explanation: CDC/SHEA bundle for CLABSI prevention: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal site selection (subclavian preferred over IJ; avoid femoral when possible), and daily review of line necessity. Bundled checklists with full barriers (cap, mask, sterile gown, sterile gloves, full body drape) have the strongest evidence. Routine line exchange does not reduce CLABSI and increases mechanical complications. Prophylactic antibiotics are not recommended.

9A 70-year-old post-CABG patient develops new-onset atrial fibrillation with RVR (HR 145), BP 110/70, and is asymptomatic. Which initial rate-control strategy is most appropriate?

A.IV amiodarone 150 mg over 10 minutes then 1 mg/min infusion

B.IV diltiazem 0.25 mg/kg bolus then 5-15 mg/hr infusion

C.IV digoxin 0.5 mg load then 0.25 mg q6h

D.Synchronized DC cardioversion at 120 J

Explanation: Post-cardiac-surgery AF affects ~30% of patients. Amiodarone is preferred for rate and rhythm control in postoperative cardiac surgery patients because of negative inotropy concerns with diltiazem in patients with reduced LV function. AHA/ACC/HRS post-op AF guidelines recommend amiodarone or beta-blockers. Diltiazem is acceptable in preserved EF without HF. Digoxin is slow-acting and ineffective in high-adrenergic states. Cardioversion is reserved for hemodynamic instability.

10A 55-year-old with severe sepsis from pneumonia has an indwelling arterial line for hemodynamic monitoring. Which waveform abnormality most strongly suggests an underdamped (whip) tracing requiring correction?

A.Sharp peak with multiple oscillations after the dicrotic notch

B.Slurred upstroke with loss of the dicrotic notch

C.Square-wave test that returns to baseline after 1 oscillation

D.Diminished waveform amplitude across the respiratory cycle

Explanation: An underdamped arterial waveform shows a narrow sharp peak with multiple oscillations after the dicrotic notch and a square-wave (fast-flush) test returning with >2 oscillations. This causes systolic overestimation and diastolic underestimation. Causes include excess tubing, air bubbles, or kinks. An overdamped waveform shows a slurred upstroke and loss of the dicrotic notch. Pulse pressure variation across respiration is a fluid responsiveness indicator, not a damping issue.

About the AACN ACNPC-AG Exam

The AACN ACNPC-AG validates entry-level acute care adult-gerontology NP competency in clinical judgment and professional caring/ethical practice across acute, critical, and complex chronic illness. The exam emphasizes diagnostic reasoning, ordering and interpreting diagnostics, prescriptive practice, ventilator and hemodynamic management, and the AACN Synergy Model.

Questions

175 scored questions

Time Limit

3.5 hours

Passing Score

Criterion-referenced (Angoff)

Exam Fee

$270 AACN member / $380 non-member (AACN Certification Corporation)

AACN ACNPC-AG Exam Content Outline

~80%

Clinical Judgment

Diagnostic reasoning and management across pulmonary, cardiovascular, neurologic, renal, GI, endocrine, heme/onc, infectious disease, and trauma for acute, critical, and complex chronic adult-gerontology patients.

~20%

Professional Caring & Ethical Practice

Advocacy, ethics, scope of practice, prescriptive authority, collaboration, clinical inquiry, and AACN Synergy Model application.

How to Pass the AACN ACNPC-AG Exam

What You Need to Know

Passing score: Criterion-referenced (Angoff)
Exam length: 175 questions
Time limit: 3.5 hours
Exam fee: $270 AACN member / $380 non-member

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

AACN ACNPC-AG Study Tips from Top Performers

1Memorize the Surviving Sepsis 1-hour bundle: lactate, cultures, broad-spectrum antibiotics, fluid 30 mL/kg, vasopressors for MAP <65

2Master ARDSnet: 6 mL/kg PBW tidal volume and plateau ≤30; know prone positioning indications (P/F <150)

3Drill ECG: STEMI criteria, Sgarbossa for LBBB, Wellens, posterior MI, and arrhythmias

4Review vasopressor dose ranges and indications: norepinephrine, vasopressin, epinephrine, dobutamine, milrinone

5Know ICP/CPP targets in TBI (CPP 60-70) and stroke BP rules (alteplase <185/110, ICH SBP 130-150)

6Practice DKA/HHS protocols: fluid first, K+ before insulin, transition to subcutaneous when anion gap closes

7Memorize Beers Criteria red-flag medications and delirium prevention bundle (CAM, ABCDEF)

8Run at least one 175-question, 3.5-hour timed simulation to build endurance

Frequently Asked Questions

How many questions are on the ACNPC-AG exam?

AACN lists 175 total questions: 150 scored items and 25 unscored pretest items. Total testing time is 3 hours and 30 minutes.

How much does the ACNPC-AG exam cost?

AACN charges $270 for AACN members and $380 for non-members. The fee includes the application; retests follow AACN's retake fee schedule.

What is the passing score for ACNPC-AG?

AACN uses a criterion-referenced (Angoff) cut score determined per form. Candidates are notified pass/fail and receive subscores by content area.

What is the difference between AACN ACNPC-AG and ANCC AGACNP-BC?

Both certify adult-gerontology acute care NPs and are ABSNC-accredited. AACN's ACNPC-AG is administered through PSI and emphasizes the Synergy Model. ANCC's AGACNP-BC is administered through Prometric. Either credential meets state licensure for AG-ACNP practice.

Who is eligible to take ACNPC-AG?

Candidates must hold an active unencumbered RN license and have completed an accredited adult-gerontology acute care NP master's, post-graduate certificate, or DNP program with the three APRN core courses (advanced patho, pharm, and assessment).

How do I prepare for the ACNPC-AG exam?

Study the AACN handbook test plan, organ-system pathophysiology and management, ECG, vent settings, hemodynamics, and acute care prescribing. Drill 100+ practice questions per blueprint domain and run a full timed 175-question simulation before scheduling.