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Exam Review

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

$275

AACN Member Fee

AACN

$385

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 or via Live Remote Proctoring. Exam fees are $275 for AACN members and $385 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-accredited and is distinct from ANCC's AGACNP-BC.

Sample AACN ACNPC-AG Practice Questions

Try these sample questions to review concepts for the AACN ACNPC-AG exam. 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.

Exam sponsor: AACN Certification Corporation. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

175 questions

Time Limit

3.5 hours

Passing Score

101 of 150 scored items (effective January 10, 2022)

Exam / Certification Fees

$275 AACN member / $385 non-member

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

~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.

Preparing for the AACN ACNPC-AG Exam

What You Need to Know

  • Passing score: 101 of 150 scored items (effective January 10, 2022)
  • Exam length: 175 questions
  • Time limit: 3.5 hours
  • Exam / certification fees: $275 AACN member / $385 non-member Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

AACN ACNPC-AG: Suggested Study Strategy

1Apply current sepsis guidance: prompt antibiotics according to infection likelihood and shock, cultures without treatment delay, reassessed fluids for hypoperfusion, and vasopressors guided by perfusion and MAP
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
5Review TBI cerebral perfusion targets and distinguish blood pressure management before IV thrombolysis from treatment of spontaneous intracerebral hemorrhage.
6Practice DKA/HHS care: reassessed fluids, potassium assessment before insulin, crisis-specific insulin/dextrose, and DKA transition after ketone/acidosis resolution with basal-insulin overlap
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 $275 for AACN members and $385 for non-members. The fee includes the application; retests follow AACN's discounted retest fee schedule.

What is the passing score for ACNPC-AG?

AACN currently lists a passing cut score of 101 of 150 scored items, effective January 10, 2022, established using the modified Angoff method. The 25 pretest items do not count toward the score.

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. Certification is one component of state APRN licensure; applicants must also meet their board of nursing's requirements.

Who is eligible to take ACNPC-AG?

Candidates need current, unencumbered U.S. RN or APRN licensure and a qualifying adult-gerontology acute care graduate program with advanced pathophysiology, pharmacology and assessment. The program must include at least 500 supervised clinical hours in direct acute adult-gerontology care completed in the U.S.; submit the program-director eligibility form and official final transcripts.

How do I prepare for the ACNPC-AG exam?

Use the AACN handbook to plan study across organ-system management, ECG, ventilation, hemodynamics and prescribing. Review practice-question explanations and pace a full simulation at 175 questions in 3.5 hours.