ANP-654 – ADULT-GERONTOLOGY ACUTE CARE NURSE PRACTITIONER |
COMPLETE EXAM 2026/2027 | QUESTIONS AND 100% VERIFIED ANSWERS
| PASS GUARANTEE
ANP-654: Adult-Gerontology Acute Care NP
Q1. What is the first-line treatment for ST-elevation myocardial infarction
(STEMI)?
ANSWER Primary percutaneous coronary intervention (PCI) within 90 minutes
of first medical contact, or thrombolytics if PCI is unavailable within 120
minutes.
Q2. A 72-year-old presents with chest pain, ST elevations in leads II, III, and
aVF. Which coronary artery is likely occluded?
ANSWER Right coronary artery (RCA) — inferior wall MI.
Q3. What is the priority intervention for a patient with suspected aortic
dissection?
ANSWER Immediate IV beta-blockade (esmolol or labetalol) to reduce shear
stress, followed by emergent surgical or endovascular repair.
Q4. What are the classic symptoms of cardiac tamponade (Beck's Triad)?
ANSWER Hypotension, jugular venous distension (JVD), and muffled heart
sounds.
Q5. A patient with acute decompensated heart failure has a blood pressure of
85/50 mmHg. Which medication should be AVOIDED?
ANSWER ACE inhibitors and beta-blockers — they can worsen hypotension.
Use inotropes (dobutamine, milrinone) instead.
Q6. What is the first-line vasopressor for cardiogenic shock?
ANSWER Norepinephrine (Levophed).
,Q7. What ECG finding differentiates pericarditis from STEMI?
ANSWER Pericarditis shows diffuse ST elevation (not localized to one vascular
territory) and PR segment depression.
Q8. A patient with atrial fibrillation has a rapid ventricular rate of 160 bpm and
is hemodynamically unstable. What is the priority intervention?
ANSWER Synchronized cardioversion (50–100 J biphasic).
Q9. What is the CHA₂DS₂-VASc score threshold for initiating anticoagulation in
atrial fibrillation?
ANSWER Score ≥2 in men or ≥3 in women indicates need for anticoagulation.
Q10. Which anticoagulant is preferred for stroke prevention in non-valvular
atrial fibrillation?
ANSWER Direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban,
dabigatran, or edoxaban.
Q11. A patient with hypertrophic cardiomyopathy presents with syncope.
What is the most dangerous arrhythmia to monitor for?
ANSWER Ventricular tachycardia/fibrillation — leading cause of sudden
cardiac death.
Q12. What is the target MAP (mean arterial pressure) in septic shock?
ANSWER ≥65 mmHg.
Q13. A patient with endocarditis has a new-onset neurologic deficit. What
complication should be suspected?
ANSWER Septic emboli causing stroke or mycotic aneurysm.
Q14. What is the Duke criteria for definitive infective endocarditis?
ANSWER 2 major criteria, or 1 major + 3 minor criteria, or 5 minor criteria.
Q15. What is the most common cause of acute mitral regurgitation?
ANSWER Papillary muscle rupture, typically post-MI.
Q16. What physical finding is characteristic of severe aortic stenosis?
ANSWER Pulsus parvus et tardus (weak and delayed carotid upstroke), harsh
systolic ejection murmur radiating to carotids.
Q17. A patient presents with tearing chest pain radiating to the back, with BP
differential between arms >20 mmHg. What is the diagnosis?
ANSWER Aortic dissection.
, Q18. What imaging is the gold standard for diagnosing aortic dissection?
ANSWER CT angiography (CTA) of the chest/abdomen/pelvis.
Q19. What is the target blood pressure for a patient with acute aortic
dissection?
ANSWER Systolic <120 mmHg and heart rate <60 bpm.
Q20. A patient with acute pulmonary edema has crackles bilaterally and is
dyspneic. What is the immediate pharmacologic intervention?
ANSWER IV loop diuretics (furosemide) + nitrates (if SBP >100 mmHg) +
supplemental O₂.
Q21. What is the most common cause of right-sided heart failure?
ANSWER Left-sided heart failure (pulmonary hypertension from backward
failure).
Q22. A patient with a pacemaker presents with cannon A waves on exam.
What arrhythmia is present?
ANSWER AV dissociation/complete heart block with competing pacemaker
and intrinsic rhythm.
Q23. What is the treatment for torsades de pointes?
ANSWER IV magnesium sulfate 2g, correct electrolytes, overdrive pacing, or
isoproterenol.
Q24. Which electrolyte abnormality is most commonly associated with
torsades de pointes?
ANSWER Hypomagnesemia and hypokalemia.
Q25. A patient with WPW syndrome develops atrial fibrillation. Which
medication is CONTRAINDICATED?
ANSWER AV nodal blockers (digoxin, verapamil, diltiazem, adenosine) — can
accelerate conduction through accessory pathway causing ventricular
fibrillation.
Q26. What is the definitive treatment for WPW with recurrent
tachyarrhythmias?
ANSWER Catheter ablation of the accessory pathway.
Q27. A patient presents with chest pain, pericardial friction rub, and diffuse ST
elevation. What is the treatment?
ANSWER NSAIDs (ibuprofen or indomethacin) + colchicine; avoid
anticoagulation if pericardial effusion present.
COMPLETE EXAM 2026/2027 | QUESTIONS AND 100% VERIFIED ANSWERS
| PASS GUARANTEE
ANP-654: Adult-Gerontology Acute Care NP
Q1. What is the first-line treatment for ST-elevation myocardial infarction
(STEMI)?
ANSWER Primary percutaneous coronary intervention (PCI) within 90 minutes
of first medical contact, or thrombolytics if PCI is unavailable within 120
minutes.
Q2. A 72-year-old presents with chest pain, ST elevations in leads II, III, and
aVF. Which coronary artery is likely occluded?
ANSWER Right coronary artery (RCA) — inferior wall MI.
Q3. What is the priority intervention for a patient with suspected aortic
dissection?
ANSWER Immediate IV beta-blockade (esmolol or labetalol) to reduce shear
stress, followed by emergent surgical or endovascular repair.
Q4. What are the classic symptoms of cardiac tamponade (Beck's Triad)?
ANSWER Hypotension, jugular venous distension (JVD), and muffled heart
sounds.
Q5. A patient with acute decompensated heart failure has a blood pressure of
85/50 mmHg. Which medication should be AVOIDED?
ANSWER ACE inhibitors and beta-blockers — they can worsen hypotension.
Use inotropes (dobutamine, milrinone) instead.
Q6. What is the first-line vasopressor for cardiogenic shock?
ANSWER Norepinephrine (Levophed).
,Q7. What ECG finding differentiates pericarditis from STEMI?
ANSWER Pericarditis shows diffuse ST elevation (not localized to one vascular
territory) and PR segment depression.
Q8. A patient with atrial fibrillation has a rapid ventricular rate of 160 bpm and
is hemodynamically unstable. What is the priority intervention?
ANSWER Synchronized cardioversion (50–100 J biphasic).
Q9. What is the CHA₂DS₂-VASc score threshold for initiating anticoagulation in
atrial fibrillation?
ANSWER Score ≥2 in men or ≥3 in women indicates need for anticoagulation.
Q10. Which anticoagulant is preferred for stroke prevention in non-valvular
atrial fibrillation?
ANSWER Direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban,
dabigatran, or edoxaban.
Q11. A patient with hypertrophic cardiomyopathy presents with syncope.
What is the most dangerous arrhythmia to monitor for?
ANSWER Ventricular tachycardia/fibrillation — leading cause of sudden
cardiac death.
Q12. What is the target MAP (mean arterial pressure) in septic shock?
ANSWER ≥65 mmHg.
Q13. A patient with endocarditis has a new-onset neurologic deficit. What
complication should be suspected?
ANSWER Septic emboli causing stroke or mycotic aneurysm.
Q14. What is the Duke criteria for definitive infective endocarditis?
ANSWER 2 major criteria, or 1 major + 3 minor criteria, or 5 minor criteria.
Q15. What is the most common cause of acute mitral regurgitation?
ANSWER Papillary muscle rupture, typically post-MI.
Q16. What physical finding is characteristic of severe aortic stenosis?
ANSWER Pulsus parvus et tardus (weak and delayed carotid upstroke), harsh
systolic ejection murmur radiating to carotids.
Q17. A patient presents with tearing chest pain radiating to the back, with BP
differential between arms >20 mmHg. What is the diagnosis?
ANSWER Aortic dissection.
, Q18. What imaging is the gold standard for diagnosing aortic dissection?
ANSWER CT angiography (CTA) of the chest/abdomen/pelvis.
Q19. What is the target blood pressure for a patient with acute aortic
dissection?
ANSWER Systolic <120 mmHg and heart rate <60 bpm.
Q20. A patient with acute pulmonary edema has crackles bilaterally and is
dyspneic. What is the immediate pharmacologic intervention?
ANSWER IV loop diuretics (furosemide) + nitrates (if SBP >100 mmHg) +
supplemental O₂.
Q21. What is the most common cause of right-sided heart failure?
ANSWER Left-sided heart failure (pulmonary hypertension from backward
failure).
Q22. A patient with a pacemaker presents with cannon A waves on exam.
What arrhythmia is present?
ANSWER AV dissociation/complete heart block with competing pacemaker
and intrinsic rhythm.
Q23. What is the treatment for torsades de pointes?
ANSWER IV magnesium sulfate 2g, correct electrolytes, overdrive pacing, or
isoproterenol.
Q24. Which electrolyte abnormality is most commonly associated with
torsades de pointes?
ANSWER Hypomagnesemia and hypokalemia.
Q25. A patient with WPW syndrome develops atrial fibrillation. Which
medication is CONTRAINDICATED?
ANSWER AV nodal blockers (digoxin, verapamil, diltiazem, adenosine) — can
accelerate conduction through accessory pathway causing ventricular
fibrillation.
Q26. What is the definitive treatment for WPW with recurrent
tachyarrhythmias?
ANSWER Catheter ablation of the accessory pathway.
Q27. A patient presents with chest pain, pericardial friction rub, and diffuse ST
elevation. What is the treatment?
ANSWER NSAIDs (ibuprofen or indomethacin) + colchicine; avoid
anticoagulation if pericardial effusion present.
