ANCC Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC) practice test exam
1. A 68-year-old male presents with acute onset of severe tearing chest pain radiating to the back. Blood
pressure is 180/100. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Tearing chest pain radiating to the back with severe hypertension is classic for aortic
dissection.
2. A patient with STEMI presents 3 hours after symptom onset. Timely PCI is not available. Which
fibrinolytic is most appropriate?
A. Argatroban
B. Eptifibatide
C. Bivalirudin
D. Reteplase
Answer: D
Rationale: Reteplase is a fibrinolytic agent indicated for STEMI when primary PCI is not available.
3. A patient with atrial fibrillation on warfarin has INR 5.2 and no bleeding. Most appropriate
management?
A. Administer vitamin K 10 mg orally
B. Administer fresh frozen plasma
,C. Hold warfarin and recheck INR in 24-48 hours
D. Administer prothrombin complex concentrate
Answer: C
Rationale: For asymptomatic patients with INR greater than 5.0 but less than 9.0, guidelines recommend
holding warfarin.
4. A 65-year-old woman with HFrEF (LVEF 30%) has a history of GI bleeding. Which anticoagulant is
preferred if she develops atrial fibrillation?
A. Warfarin
B. Rivaroxaban
C. Apixaban
D. Aspirin
Answer: C
Rationale: Apixaban has lower risk of major bleeding, including GI bleeding, compared to warfarin.
5. A patient on digoxin develops toxicity. Which electrolyte abnormality is most likely to precipitate this?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: Hypokalemia increases the risk of digitalis toxicity.
6. A patient with acute decompensated heart failure has persistent hypotension. Which finding indicates
cardiogenic shock?
,A. Cardiac index less than 2.2 L/min/m2 and PCWP greater than 18 mmHg
B. Cardiac index greater than 4.0 L/min/m2 and PCWP less than 12 mmHg
C. Central venous pressure less than 4 mmHg
D. Mixed venous oxygen saturation greater than 75%
Answer: A
Rationale: Cardiogenic shock is defined by cardiac index less than 2.2 L/min/m2 and PCWP greater than
18 mmHg.
7. Which ECG finding is the earliest sign of severe hyperkalemia?
A. Widened QRS
B. Peaked T waves
C. Sine wave pattern
D. Prolonged PR interval
Answer: B
Rationale: Peaked T waves are the earliest ECG sign of hyperkalemia.
8. A patient with severe hyperkalemia (K+ greater than 6.5 mEq/L) has ECG changes. What is the
immediate treatment to stabilize the cardiac membrane?
A. Insulin and glucose
B. IV calcium gluconate
C. Albuterol nebulizer
D. Emergent hemodialysis
Answer: B
, Rationale: IV calcium gluconate stabilizes the cardiac membrane immediately.
9. A patient with suspected acute aortic dissection presents with tearing chest pain radiating to the
back. What is the initial management priority?
A. Initiate thrombolytics
B. Control heart rate and blood pressure
C. Administer aspirin
D. Obtain echocardiogram before treatment
Answer: B
Rationale: For suspected aortic dissection, immediate heart rate and blood pressure control is critical.
10. A patient with heart failure on furosemide 40 mg IV BID has urine output 800 mL in 24 hours. Which
intervention is most appropriate?
A. Increase furosemide to 80 mg IV BID
B. Add metolazone
C. Switch to bumetanide
D. Add spironolactone
Answer: B
Rationale: In diuretic-resistant heart failure, addition of a thiazide diuretic such as metolazone creates a
synergistic effect.
11. A patient with severe aortic stenosis presents with exertional syncope. What is the
pathophysiological mechanism?
A. Left ventricle is pressure-overloaded and hypertrophied with fixed stroke volume
B. Right ventricle is volume-overloaded
1. A 68-year-old male presents with acute onset of severe tearing chest pain radiating to the back. Blood
pressure is 180/100. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Tearing chest pain radiating to the back with severe hypertension is classic for aortic
dissection.
2. A patient with STEMI presents 3 hours after symptom onset. Timely PCI is not available. Which
fibrinolytic is most appropriate?
A. Argatroban
B. Eptifibatide
C. Bivalirudin
D. Reteplase
Answer: D
Rationale: Reteplase is a fibrinolytic agent indicated for STEMI when primary PCI is not available.
3. A patient with atrial fibrillation on warfarin has INR 5.2 and no bleeding. Most appropriate
management?
A. Administer vitamin K 10 mg orally
B. Administer fresh frozen plasma
,C. Hold warfarin and recheck INR in 24-48 hours
D. Administer prothrombin complex concentrate
Answer: C
Rationale: For asymptomatic patients with INR greater than 5.0 but less than 9.0, guidelines recommend
holding warfarin.
4. A 65-year-old woman with HFrEF (LVEF 30%) has a history of GI bleeding. Which anticoagulant is
preferred if she develops atrial fibrillation?
A. Warfarin
B. Rivaroxaban
C. Apixaban
D. Aspirin
Answer: C
Rationale: Apixaban has lower risk of major bleeding, including GI bleeding, compared to warfarin.
5. A patient on digoxin develops toxicity. Which electrolyte abnormality is most likely to precipitate this?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: Hypokalemia increases the risk of digitalis toxicity.
6. A patient with acute decompensated heart failure has persistent hypotension. Which finding indicates
cardiogenic shock?
,A. Cardiac index less than 2.2 L/min/m2 and PCWP greater than 18 mmHg
B. Cardiac index greater than 4.0 L/min/m2 and PCWP less than 12 mmHg
C. Central venous pressure less than 4 mmHg
D. Mixed venous oxygen saturation greater than 75%
Answer: A
Rationale: Cardiogenic shock is defined by cardiac index less than 2.2 L/min/m2 and PCWP greater than
18 mmHg.
7. Which ECG finding is the earliest sign of severe hyperkalemia?
A. Widened QRS
B. Peaked T waves
C. Sine wave pattern
D. Prolonged PR interval
Answer: B
Rationale: Peaked T waves are the earliest ECG sign of hyperkalemia.
8. A patient with severe hyperkalemia (K+ greater than 6.5 mEq/L) has ECG changes. What is the
immediate treatment to stabilize the cardiac membrane?
A. Insulin and glucose
B. IV calcium gluconate
C. Albuterol nebulizer
D. Emergent hemodialysis
Answer: B
, Rationale: IV calcium gluconate stabilizes the cardiac membrane immediately.
9. A patient with suspected acute aortic dissection presents with tearing chest pain radiating to the
back. What is the initial management priority?
A. Initiate thrombolytics
B. Control heart rate and blood pressure
C. Administer aspirin
D. Obtain echocardiogram before treatment
Answer: B
Rationale: For suspected aortic dissection, immediate heart rate and blood pressure control is critical.
10. A patient with heart failure on furosemide 40 mg IV BID has urine output 800 mL in 24 hours. Which
intervention is most appropriate?
A. Increase furosemide to 80 mg IV BID
B. Add metolazone
C. Switch to bumetanide
D. Add spironolactone
Answer: B
Rationale: In diuretic-resistant heart failure, addition of a thiazide diuretic such as metolazone creates a
synergistic effect.
11. A patient with severe aortic stenosis presents with exertional syncope. What is the
pathophysiological mechanism?
A. Left ventricle is pressure-overloaded and hypertrophied with fixed stroke volume
B. Right ventricle is volume-overloaded
