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ANCC AGACNP BOARD EXAM COMPLETE Original Questions with
Answers & Rationales
SECTION 1: CARDIOVASCULAR
1. A 68-year-old patient presents with crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea. ECG
shows ST-segment elevation in leads II, III, and aVF. The
AGACNP recognizes this as:
A) Anterior wall MI
B) Inferior wall MI
C) Lateral wall MI
D) Posterior wall MI
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction (right coronary artery
distribution). Anterior MI = V1–V4; Lateral MI = I, aVL, V5–V6.
2. The first-line reperfusion strategy for STEMI within 90
minutes of first medical contact is:
A) Thrombolytics
B) Percutaneous coronary intervention (PCI)
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C) Coronary artery bypass grafting
D) Observation only
Answer: B
Rationale: Primary PCI is preferred when it can be performed
within 90 minutes. Thrombolytics are used if PCI is unavailable
within that window.
3. A patient with acute decompensated heart failure presents
with dyspnea, crackles bilaterally, and SpO₂ 85%. The priority
intervention is:
A) Administer IV furosemide
B) Apply oxygen and consider non-invasive positive pressure
ventilation (BiPAP/CPAP)
C) Order a chest X-ray
D) Start a beta blocker only
Answer: B
Rationale: Oxygenation and ventilatory support are priorities in
acute pulmonary edema. NIPPV reduces work of breathing and
improves oxygenation.
4. Which medication is CONTRAINDICATED in acute
decompensated heart failure with hypotension?
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A) IV nitroglycerin
B) IV furosemide
C) IV metoprolol
D) IV morphine only
Answer: C
Rationale: Beta blockers have negative inotropic effects and
worsen acute HF with hypotension. They are for chronic HF, not
acute decompensation with low BP.
5. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of
5 requires:
A) Aspirin only
B) Oral anticoagulation (DOAC or warfarin)
C) No anticoagulation
D) Clopidogrel only
Answer: B
Rationale: CHA₂DS₂-VASc ≥ 2 (men) or ≥ 3 (women) indicates
significant stroke risk warranting anticoagulation.
6. The most common cause of cardiogenic shock is:
A) Sepsis
B) Massive myocardial infarction
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C) Pulmonary embolism
D) Cardiac tamponade only
Answer: B
Rationale: Massive MI causing pump failure is the most
common cause of cardiogenic shock.
7. Beck's triad for cardiac tamponade includes:
A) Hypertension, tachycardia, fever
B) Hypotension, distended neck veins, muffled heart sounds
C) Chest pain, cough, hemoptysis
D) Tachycardia, hypertension, dyspnea only
Answer: B
Rationale: Beck's triad: hypotension, JVD, muffled heart
sounds—classic for tamponade.
8. The treatment for cardiac tamponade is:
A) Observation
B) Pericardiocentesis
C) Antibiotics
D) Beta blockers only
Answer: B
ANCC AGACNP BOARD EXAM COMPLETE Original Questions with
Answers & Rationales
SECTION 1: CARDIOVASCULAR
1. A 68-year-old patient presents with crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea. ECG
shows ST-segment elevation in leads II, III, and aVF. The
AGACNP recognizes this as:
A) Anterior wall MI
B) Inferior wall MI
C) Lateral wall MI
D) Posterior wall MI
Answer: B
Rationale: ST elevation in leads II, III, and aVF indicates an
inferior wall myocardial infarction (right coronary artery
distribution). Anterior MI = V1–V4; Lateral MI = I, aVL, V5–V6.
2. The first-line reperfusion strategy for STEMI within 90
minutes of first medical contact is:
A) Thrombolytics
B) Percutaneous coronary intervention (PCI)
, Page |2
C) Coronary artery bypass grafting
D) Observation only
Answer: B
Rationale: Primary PCI is preferred when it can be performed
within 90 minutes. Thrombolytics are used if PCI is unavailable
within that window.
3. A patient with acute decompensated heart failure presents
with dyspnea, crackles bilaterally, and SpO₂ 85%. The priority
intervention is:
A) Administer IV furosemide
B) Apply oxygen and consider non-invasive positive pressure
ventilation (BiPAP/CPAP)
C) Order a chest X-ray
D) Start a beta blocker only
Answer: B
Rationale: Oxygenation and ventilatory support are priorities in
acute pulmonary edema. NIPPV reduces work of breathing and
improves oxygenation.
4. Which medication is CONTRAINDICATED in acute
decompensated heart failure with hypotension?
, Page |3
A) IV nitroglycerin
B) IV furosemide
C) IV metoprolol
D) IV morphine only
Answer: C
Rationale: Beta blockers have negative inotropic effects and
worsen acute HF with hypotension. They are for chronic HF, not
acute decompensation with low BP.
5. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of
5 requires:
A) Aspirin only
B) Oral anticoagulation (DOAC or warfarin)
C) No anticoagulation
D) Clopidogrel only
Answer: B
Rationale: CHA₂DS₂-VASc ≥ 2 (men) or ≥ 3 (women) indicates
significant stroke risk warranting anticoagulation.
6. The most common cause of cardiogenic shock is:
A) Sepsis
B) Massive myocardial infarction
, Page |4
C) Pulmonary embolism
D) Cardiac tamponade only
Answer: B
Rationale: Massive MI causing pump failure is the most
common cause of cardiogenic shock.
7. Beck's triad for cardiac tamponade includes:
A) Hypertension, tachycardia, fever
B) Hypotension, distended neck veins, muffled heart sounds
C) Chest pain, cough, hemoptysis
D) Tachycardia, hypertension, dyspnea only
Answer: B
Rationale: Beck's triad: hypotension, JVD, muffled heart
sounds—classic for tamponade.
8. The treatment for cardiac tamponade is:
A) Observation
B) Pericardiocentesis
C) Antibiotics
D) Beta blockers only
Answer: B
