ANCC AGACNP Certification ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Question 1
A 72-year-old male with a history of hypertension and diabetes presents with crushing
substernal chest pain radiating to the left arm. His ECG shows ST-segment elevation in leads II,
III, and aVF. Which coronary artery is most likely occluded?
• A. Left anterior descending artery
• B. Left circumflex artery
• C. Right coronary artery
• D. Posterior descending artery
Answer: C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction. The right coronary artery (RCA) supplies the inferior portion of the myocardium in
most individuals and is therefore the vessel most commonly involved. The left anterior
descending artery supplies the anterior wall and septum, producing ST elevation in V1-V4. The
left circumflex artery may cause lateral infarctions involving leads I, aVL, V5, and V6. Recognition
of ECG patterns and associated coronary anatomy is essential for early reperfusion therapy.
Question 2
A patient presents with hypotension, jugular venous distention, and muffled heart sounds.
What condition is suspected?
• A. Myocardial infarction
• B. Cardiac tamponade
• C. Pulmonary edema
• D. Pneumonia
,Answer: B. Cardiac tamponade
Rationale: Beck's triad (hypotension, jugular venous distention, and muffled heart sounds)
indicates cardiac tamponade, where fluid in the pericardial sac compresses the heart and
reduces cardiac output. Immediate intervention with pericardiocentesis may be required.
Myocardial infarction typically presents with chest pain and ECG changes. Pulmonary edema
presents with crackles and respiratory distress.
Question 3
A patient with acute decompensated heart failure presents with dyspnea, orthopnea, and
peripheral edema. Which medication is most appropriate for initial afterload reduction?
• A. Digoxin
• B. Nitroglycerin
• C. Sodium nitroprusside
• D. Dobutamine
Answer: C. Sodium nitroprusside
Rationale: Sodium nitroprusside is a potent arterial and venous vasodilator that reduces
afterload and preload, making it ideal for acute decompensated heart failure with severe
hypertension. Nitroglycerin primarily reduces preload. Digoxin provides inotropic support but is
not first-line for afterload reduction. Dobutamine is an inotrope used for cardiogenic shock.
Question 4
Which ECG finding is most characteristic of pericarditis?
• A. ST-segment elevation in all leads with reciprocal depression
• B. Diffuse ST-segment elevation with PR depression
• C. Deep Q waves in leads II, III, and aVF
• D. Prolonged QT interval
Answer: B. Diffuse ST-segment elevation with PR depression
Rationale: Pericarditis typically presents with diffuse ST-segment elevation and PR depression
across most leads, without reciprocal changes. This distinguishes it from myocardial infarction,
which shows ST elevation with reciprocal changes in opposite leads.
,Question 5
A 72-year-old female with atrial fibrillation is admitted with rapid ventricular response and
acute decompensated heart failure. She is hypotensive and dyspneic. Which agent is
contraindicated?
• A. IV diltiazem
• B. IV digoxin
• C. IV amiodarone
• D. IV furosemide
Answer: A. IV diltiazem
Rationale: Calcium channel blockers such as diltiazem are contraindicated in hypotensive
patients with acute decompensated heart failure due to negative inotropic effects. Digoxin may
help control rate, amiodarone is safe for rate/rhythm control, and furosemide treats volume
overload.
Question 6
A patient with acute inferior wall MI develops bradycardia and hypotension. Which medication
should be administered first?
• A. Atropine
• B. Epinephrine
• C. Dopamine
• D. Norepinephrine
Answer: A. Atropine
Rationale: Inferior wall MIs often involve the right coronary artery, which supplies the SA and
AV nodes, leading to bradycardia and heart block. Atropine is the first-line treatment for
symptomatic bradycardia. Epinephrine, dopamine, and norepinephrine are vasopressors used
for hypotension but do not specifically address bradyarrhythmias.
Question 7
Which finding on physical examination is most consistent with mitral stenosis?
, • A. Systolic ejection murmur at the left sternal border
• B. Diastolic rumble murmur at the apex
• C. Hologystolic murmur at the apex radiating to the axilla
• D. Continuous murmur at the left upper sternal border
Answer: B. Diastolic rumble murmur at the apex
Rationale: Mitral stenosis produces a low-pitched diastolic rumble murmur best heard at the
apex with the patient in the left lateral decubitus position. A systolic ejection murmur suggests
aortic stenosis. A hologystolic murmur radiating to the axilla suggests mitral regurgitation. A
continuous murmur suggests patent ductus arteriosus.
Question 8
A patient presents with sudden chest pain radiating to the back with unequal arm blood
pressures. Which emergency should the AGACNP suspect?
• A. Pulmonary embolism
• B. Aortic dissection
• C. Myocardial infarction
• D. Pericarditis
Answer: B. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe chest pain radiating to the
back, along with pulse or blood pressure differentials between arms. This is a life-threatening
emergency requiring immediate surgical consultation and blood pressure control.
Question 9
Which medication is used to control ventricular rate in atrial fibrillation?
• A. Adenosine
• B. Diltiazem
• C. Atropine
• D. Lidocaine
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Question 1
A 72-year-old male with a history of hypertension and diabetes presents with crushing
substernal chest pain radiating to the left arm. His ECG shows ST-segment elevation in leads II,
III, and aVF. Which coronary artery is most likely occluded?
• A. Left anterior descending artery
• B. Left circumflex artery
• C. Right coronary artery
• D. Posterior descending artery
Answer: C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction. The right coronary artery (RCA) supplies the inferior portion of the myocardium in
most individuals and is therefore the vessel most commonly involved. The left anterior
descending artery supplies the anterior wall and septum, producing ST elevation in V1-V4. The
left circumflex artery may cause lateral infarctions involving leads I, aVL, V5, and V6. Recognition
of ECG patterns and associated coronary anatomy is essential for early reperfusion therapy.
Question 2
A patient presents with hypotension, jugular venous distention, and muffled heart sounds.
What condition is suspected?
• A. Myocardial infarction
• B. Cardiac tamponade
• C. Pulmonary edema
• D. Pneumonia
,Answer: B. Cardiac tamponade
Rationale: Beck's triad (hypotension, jugular venous distention, and muffled heart sounds)
indicates cardiac tamponade, where fluid in the pericardial sac compresses the heart and
reduces cardiac output. Immediate intervention with pericardiocentesis may be required.
Myocardial infarction typically presents with chest pain and ECG changes. Pulmonary edema
presents with crackles and respiratory distress.
Question 3
A patient with acute decompensated heart failure presents with dyspnea, orthopnea, and
peripheral edema. Which medication is most appropriate for initial afterload reduction?
• A. Digoxin
• B. Nitroglycerin
• C. Sodium nitroprusside
• D. Dobutamine
Answer: C. Sodium nitroprusside
Rationale: Sodium nitroprusside is a potent arterial and venous vasodilator that reduces
afterload and preload, making it ideal for acute decompensated heart failure with severe
hypertension. Nitroglycerin primarily reduces preload. Digoxin provides inotropic support but is
not first-line for afterload reduction. Dobutamine is an inotrope used for cardiogenic shock.
Question 4
Which ECG finding is most characteristic of pericarditis?
• A. ST-segment elevation in all leads with reciprocal depression
• B. Diffuse ST-segment elevation with PR depression
• C. Deep Q waves in leads II, III, and aVF
• D. Prolonged QT interval
Answer: B. Diffuse ST-segment elevation with PR depression
Rationale: Pericarditis typically presents with diffuse ST-segment elevation and PR depression
across most leads, without reciprocal changes. This distinguishes it from myocardial infarction,
which shows ST elevation with reciprocal changes in opposite leads.
,Question 5
A 72-year-old female with atrial fibrillation is admitted with rapid ventricular response and
acute decompensated heart failure. She is hypotensive and dyspneic. Which agent is
contraindicated?
• A. IV diltiazem
• B. IV digoxin
• C. IV amiodarone
• D. IV furosemide
Answer: A. IV diltiazem
Rationale: Calcium channel blockers such as diltiazem are contraindicated in hypotensive
patients with acute decompensated heart failure due to negative inotropic effects. Digoxin may
help control rate, amiodarone is safe for rate/rhythm control, and furosemide treats volume
overload.
Question 6
A patient with acute inferior wall MI develops bradycardia and hypotension. Which medication
should be administered first?
• A. Atropine
• B. Epinephrine
• C. Dopamine
• D. Norepinephrine
Answer: A. Atropine
Rationale: Inferior wall MIs often involve the right coronary artery, which supplies the SA and
AV nodes, leading to bradycardia and heart block. Atropine is the first-line treatment for
symptomatic bradycardia. Epinephrine, dopamine, and norepinephrine are vasopressors used
for hypotension but do not specifically address bradyarrhythmias.
Question 7
Which finding on physical examination is most consistent with mitral stenosis?
, • A. Systolic ejection murmur at the left sternal border
• B. Diastolic rumble murmur at the apex
• C. Hologystolic murmur at the apex radiating to the axilla
• D. Continuous murmur at the left upper sternal border
Answer: B. Diastolic rumble murmur at the apex
Rationale: Mitral stenosis produces a low-pitched diastolic rumble murmur best heard at the
apex with the patient in the left lateral decubitus position. A systolic ejection murmur suggests
aortic stenosis. A hologystolic murmur radiating to the axilla suggests mitral regurgitation. A
continuous murmur suggests patent ductus arteriosus.
Question 8
A patient presents with sudden chest pain radiating to the back with unequal arm blood
pressures. Which emergency should the AGACNP suspect?
• A. Pulmonary embolism
• B. Aortic dissection
• C. Myocardial infarction
• D. Pericarditis
Answer: B. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe chest pain radiating to the
back, along with pulse or blood pressure differentials between arms. This is a life-threatening
emergency requiring immediate surgical consultation and blood pressure control.
Question 9
Which medication is used to control ventricular rate in atrial fibrillation?
• A. Adenosine
• B. Diltiazem
• C. Atropine
• D. Lidocaine
