2026 ANCC AGACNP FRANCES GUIDE REVIEW 300
PRACTICE QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES LATEST UPDATES OF THIS YEAR.ASSURED
PASS
CORE COMPETENCIES (Advanced Pathophysiology, Pharmacology, Physical
Assessment)
Question 1
A 68yearold male with a history of hypertension presents with a blood pressure of
210/115 mmHg, severe headache, confusion, and visual disturbances. Which of
the following is the most appropriate initial management?
A) Administer oral labetalol and discharge with followup
B) Initiate IV antihypertensive therapy with close monitoring
C) Administer sublingual nifedipine
D) Observe for 24 hours with serial blood pressure checks
Correct Answer: B
Rationale: This patient is presenting with hypertensive emergency—severe
hypertension with acute target organ damage (headache, confusion, visual
disturbances). IV antihypertensive therapy (e.g., labetalol, nicardipine, sodium
nitroprusside) should be initiated with close monitoring in an intensive care
,setting. Oral agents and observation are inappropriate for hypertensive
emergency .
Question 2
A 72yearold male with a history of hypertension presents with substernal chest
pain that occurs with exertion and is relieved by rest. He takes sublingual
nitroglycerin with relief within 2 minutes. This is most consistent with:
A) Unstable angina
B) Stable angina
C) Acute myocardial infarction
D) Prinzmetal's angina
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain with exertion
that is relieved by rest or nitroglycerin within minutes. Unstable angina occurs at
rest or with minimal exertion, AMI presents with persistent pain and elevated
cardiac biomarkers, and Prinzmetal's angina is vasospastic and often occurs at rest
.
Question 3
,A 75yearold male presents with sudden, painless vision loss in the right eye
described as a "curtain coming down." Fundoscopic examination reveals a pale
retina with a cherryred spot. What is the most likely diagnosis?
A) Central retinal artery occlusion
B) Central retinal vein occlusion
C) Acute angleclosure glaucoma
D) Retinal detachment
Correct Answer: A
Rationale: Central retinal artery occlusion (CRAO) presents with sudden, painless,
profound vision loss with a cherryred spot on fundoscopic exam. This is an ocular
emergency requiring immediate ophthalmology consultation. Central retinal vein
occlusion presents with retinal hemorrhages, acute angleclosure glaucoma
presents with painful red eye and halos, and retinal detachment presents with
flashes and floaters .
Question 4
Telemetry monitoring reveals episodes of complete heart block with ventricular
escape rhythm at 30 beats per minute in a 70yearold male who experienced
syncope. What is the most appropriate intervention?
A) Initiate atropine 0.5 mg IV push
B) Start a dopamine infusion
C) Place a temporary transcutaneous pacemaker
D) Schedule an outpatient electrophysiology study
, Correct Answer: C
Rationale: Complete heart block with symptomatic bradycardia (syncope) and a
ventricular escape rhythm is a medical emergency requiring immediate pacing. A
temporary transcutaneous pacemaker should be placed while preparing for
permanent pacemaker implantation. Atropine is generally ineffective for complete
heart block .
Question 5
A 62yearold male with a history of atrial fibrillation on warfarin presents with
sudden onset of severe headache, nausea, and vomiting. Neurological
examination reveals leftsided weakness and aphasia. INR is 4.5. What is the most
likely diagnosis?
A) Ischemic stroke
B) Intracranial hemorrhage
C) Subarachnoid hemorrhage
D) Migraine with aura
Correct Answer: B
Rationale: A patient on warfarin with a supratherapeutic INR (4.5) presenting with
sudden severe headache and focal neurologic deficits is at high risk for intracranial
hemorrhage. This requires immediate CT imaging of the head and reversal of
anticoagulation with vitamin K and fresh frozen plasma or prothrombin complex
concentrate .
PRACTICE QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES LATEST UPDATES OF THIS YEAR.ASSURED
PASS
CORE COMPETENCIES (Advanced Pathophysiology, Pharmacology, Physical
Assessment)
Question 1
A 68yearold male with a history of hypertension presents with a blood pressure of
210/115 mmHg, severe headache, confusion, and visual disturbances. Which of
the following is the most appropriate initial management?
A) Administer oral labetalol and discharge with followup
B) Initiate IV antihypertensive therapy with close monitoring
C) Administer sublingual nifedipine
D) Observe for 24 hours with serial blood pressure checks
Correct Answer: B
Rationale: This patient is presenting with hypertensive emergency—severe
hypertension with acute target organ damage (headache, confusion, visual
disturbances). IV antihypertensive therapy (e.g., labetalol, nicardipine, sodium
nitroprusside) should be initiated with close monitoring in an intensive care
,setting. Oral agents and observation are inappropriate for hypertensive
emergency .
Question 2
A 72yearold male with a history of hypertension presents with substernal chest
pain that occurs with exertion and is relieved by rest. He takes sublingual
nitroglycerin with relief within 2 minutes. This is most consistent with:
A) Unstable angina
B) Stable angina
C) Acute myocardial infarction
D) Prinzmetal's angina
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain with exertion
that is relieved by rest or nitroglycerin within minutes. Unstable angina occurs at
rest or with minimal exertion, AMI presents with persistent pain and elevated
cardiac biomarkers, and Prinzmetal's angina is vasospastic and often occurs at rest
.
Question 3
,A 75yearold male presents with sudden, painless vision loss in the right eye
described as a "curtain coming down." Fundoscopic examination reveals a pale
retina with a cherryred spot. What is the most likely diagnosis?
A) Central retinal artery occlusion
B) Central retinal vein occlusion
C) Acute angleclosure glaucoma
D) Retinal detachment
Correct Answer: A
Rationale: Central retinal artery occlusion (CRAO) presents with sudden, painless,
profound vision loss with a cherryred spot on fundoscopic exam. This is an ocular
emergency requiring immediate ophthalmology consultation. Central retinal vein
occlusion presents with retinal hemorrhages, acute angleclosure glaucoma
presents with painful red eye and halos, and retinal detachment presents with
flashes and floaters .
Question 4
Telemetry monitoring reveals episodes of complete heart block with ventricular
escape rhythm at 30 beats per minute in a 70yearold male who experienced
syncope. What is the most appropriate intervention?
A) Initiate atropine 0.5 mg IV push
B) Start a dopamine infusion
C) Place a temporary transcutaneous pacemaker
D) Schedule an outpatient electrophysiology study
, Correct Answer: C
Rationale: Complete heart block with symptomatic bradycardia (syncope) and a
ventricular escape rhythm is a medical emergency requiring immediate pacing. A
temporary transcutaneous pacemaker should be placed while preparing for
permanent pacemaker implantation. Atropine is generally ineffective for complete
heart block .
Question 5
A 62yearold male with a history of atrial fibrillation on warfarin presents with
sudden onset of severe headache, nausea, and vomiting. Neurological
examination reveals leftsided weakness and aphasia. INR is 4.5. What is the most
likely diagnosis?
A) Ischemic stroke
B) Intracranial hemorrhage
C) Subarachnoid hemorrhage
D) Migraine with aura
Correct Answer: B
Rationale: A patient on warfarin with a supratherapeutic INR (4.5) presenting with
sudden severe headache and focal neurologic deficits is at high risk for intracranial
hemorrhage. This requires immediate CT imaging of the head and reversal of
anticoagulation with vitamin K and fresh frozen plasma or prothrombin complex
concentrate .
