,AGACNP CERTIFICATION EXAM PREP – COMPLETE 1,000-QUESTION TEST BANK
SECTION 1: CARDIOVASCULAR DISORDERS (150 Questions – 15% of Clinical Judgment)
1. A 68-year-old male presents to the ED with acute substernal chest pain radiating to his left arm that
began 45 minutes ago. ECG shows ST-segment elevation in leads V2-V5. Which is the most appropriate
initial management?
A) Aspirin 324 mg chewed, nitroglycerin sublingual, and cardiac biomarkers
B) Morphine 2 mg IV and immediate transfer to cath lab
C) Aspirin 81 mg PO and outpatient stress test
D) Oxygen 4 L/min and wait for troponin results
Answer: A
Rationale:
Correct: Aspirin (324 mg chewed), nitroglycerin, and cardiac biomarkers are the standard initial
management for suspected STEMI. Aspirin reduces mortality; nitroglycerin relieves ischemic pain.
B: Morphine is an option but not the priority; cath lab transfer occurs after stabilization.
C: Aspirin 81 mg is inadequate (324 mg is standard); stress testing is contraindicated in acute STEMI.
D: Oxygen is not routinely indicated unless SpO2 <90%; waiting for troponin delays definitive care.
Topic: Acute Coronary Syndrome (STEMI)
2. A 72-year-old female with hypertension and type 2 diabetes is hospitalized with acute
decompensated heart failure. BP 158/92, HR 102, RR 24, SpO2 91%. Crackles bilaterally. Which
medication should be administered FIRST?
A) Furosemide 40 mg IV push
B) Metoprolol succinate 25 mg PO
C) Lisinopril 10 mg PO
D) Aspirin 81 mg PO
Answer: A
Rationale:
Correct: Furosemide is first-line for acute decompensated heart failure with volume overload, reducing
preload and improving symptoms rapidly.
B: Beta-blockers are for chronic management, not acute decompensation.
C: ACE inhibitors are initiated after diuresis when hemodynamically stable.
,D: Aspirin has no role in acute heart failure management.
Topic: Acute Decompensated Heart Failure
3. A 65-year-old male with atrial fibrillation on apixaban presents with sudden severe headache, nausea,
and left-sided weakness. INR is 1.2. Which diagnostic test is MOST appropriate?
A) Non-contrast head CT
B) MRI brain
C) CT angiography head
D) Lumbar puncture
Answer: A
Rationale:
Correct: Non-contrast head CT is first-line imaging for acute stroke to rule out hemorrhage, especially in
patients on DOACs.
B: MRI is more sensitive but not readily available in all ED settings.
C: CTA may be needed for large vessel occlusion but non-contrast CT comes first.
D: LP is contraindicated if increased ICP is suspected.
Topic: Acute Stroke/Intracranial Hemorrhage
4. A 74-year-old male with hypertension is found to have BP 180/110 mmHg in clinic. He is
asymptomatic. Current medications include lisinopril 20 mg daily. What is the most appropriate
management?
A) Admit for IV antihypertensive therapy
B) Add amlodipine 5 mg daily and recheck in 1 week
C) Double lisinopril to 40 mg daily
D) Stat CT head to rule out stroke
Answer: B
Rationale:
Correct: Asymptomatic severe hypertension should be managed with gradual BP reduction over days to
weeks. Adding a second agent (CCB) is appropriate.
A: IV antihypertensives are only for hypertensive emergencies with end-organ damage.
C: Adding a second agent is preferred over doubling the dose.
D: CT head is not indicated without neurological symptoms.
Topic: Hypertension Management
, 5. A 70-year-old female with HFrEF (EF 25%) presents with worsening dyspnea and orthopnea. Which
medication regimen is MOST appropriate for long-term management?
A) Furosemide, lisinopril, carvedilol, spironolactone
B) Furosemide, digoxin, amlodipine, metoprolol succinate
C) Lisinopril, amlodipine, digoxin, furosemide
D) Carvedilol, lisinopril, amlodipine, furosemide
Answer: A
Rationale:
Correct: Guideline-directed medical therapy (GDMT) for HFrEF includes diuretic, ACE inhibitor/ARB,
beta-blocker (carvedilol), and aldosterone antagonist (spironolactone).
B, C, D: Amlodipine (CCB) is not recommended in HFrEF due to negative inotropic effects.
Topic: Heart Failure with Reduced Ejection Fraction (HFrEF)
6. A 62-year-old male with coronary artery disease presents with palpitations. ECG shows irregularly
irregular rhythm with no distinct P waves. What is the most appropriate initial rate control?
A) Amiodarone 150 mg IV push
B) Metoprolol 5 mg IV push
C) Digoxin 0.5 mg IV push
D) Diltiazem 20 mg IV push
Answer: B
Rationale:
Correct: Atrial fibrillation with RVR. Beta-blockers (metoprolol) are first-line for rate control in patients
with CAD.
A: Amiodarone is a rhythm control agent, not first-line for rate control.
C: Digoxin is second-line, particularly in HF patients.
D: Diltiazem can be used but beta-blockers are preferred in CAD patients.
Topic: Atrial Fibrillation Management
7. A 75-year-old male presents with syncope. ECG shows heart rate 38 bpm with wide QRS complex. He
reports dizziness and near-syncope. What is the most appropriate management?
A) Transcutaneous pacing
B) Atropine 0.5 mg IV
SECTION 1: CARDIOVASCULAR DISORDERS (150 Questions – 15% of Clinical Judgment)
1. A 68-year-old male presents to the ED with acute substernal chest pain radiating to his left arm that
began 45 minutes ago. ECG shows ST-segment elevation in leads V2-V5. Which is the most appropriate
initial management?
A) Aspirin 324 mg chewed, nitroglycerin sublingual, and cardiac biomarkers
B) Morphine 2 mg IV and immediate transfer to cath lab
C) Aspirin 81 mg PO and outpatient stress test
D) Oxygen 4 L/min and wait for troponin results
Answer: A
Rationale:
Correct: Aspirin (324 mg chewed), nitroglycerin, and cardiac biomarkers are the standard initial
management for suspected STEMI. Aspirin reduces mortality; nitroglycerin relieves ischemic pain.
B: Morphine is an option but not the priority; cath lab transfer occurs after stabilization.
C: Aspirin 81 mg is inadequate (324 mg is standard); stress testing is contraindicated in acute STEMI.
D: Oxygen is not routinely indicated unless SpO2 <90%; waiting for troponin delays definitive care.
Topic: Acute Coronary Syndrome (STEMI)
2. A 72-year-old female with hypertension and type 2 diabetes is hospitalized with acute
decompensated heart failure. BP 158/92, HR 102, RR 24, SpO2 91%. Crackles bilaterally. Which
medication should be administered FIRST?
A) Furosemide 40 mg IV push
B) Metoprolol succinate 25 mg PO
C) Lisinopril 10 mg PO
D) Aspirin 81 mg PO
Answer: A
Rationale:
Correct: Furosemide is first-line for acute decompensated heart failure with volume overload, reducing
preload and improving symptoms rapidly.
B: Beta-blockers are for chronic management, not acute decompensation.
C: ACE inhibitors are initiated after diuresis when hemodynamically stable.
,D: Aspirin has no role in acute heart failure management.
Topic: Acute Decompensated Heart Failure
3. A 65-year-old male with atrial fibrillation on apixaban presents with sudden severe headache, nausea,
and left-sided weakness. INR is 1.2. Which diagnostic test is MOST appropriate?
A) Non-contrast head CT
B) MRI brain
C) CT angiography head
D) Lumbar puncture
Answer: A
Rationale:
Correct: Non-contrast head CT is first-line imaging for acute stroke to rule out hemorrhage, especially in
patients on DOACs.
B: MRI is more sensitive but not readily available in all ED settings.
C: CTA may be needed for large vessel occlusion but non-contrast CT comes first.
D: LP is contraindicated if increased ICP is suspected.
Topic: Acute Stroke/Intracranial Hemorrhage
4. A 74-year-old male with hypertension is found to have BP 180/110 mmHg in clinic. He is
asymptomatic. Current medications include lisinopril 20 mg daily. What is the most appropriate
management?
A) Admit for IV antihypertensive therapy
B) Add amlodipine 5 mg daily and recheck in 1 week
C) Double lisinopril to 40 mg daily
D) Stat CT head to rule out stroke
Answer: B
Rationale:
Correct: Asymptomatic severe hypertension should be managed with gradual BP reduction over days to
weeks. Adding a second agent (CCB) is appropriate.
A: IV antihypertensives are only for hypertensive emergencies with end-organ damage.
C: Adding a second agent is preferred over doubling the dose.
D: CT head is not indicated without neurological symptoms.
Topic: Hypertension Management
, 5. A 70-year-old female with HFrEF (EF 25%) presents with worsening dyspnea and orthopnea. Which
medication regimen is MOST appropriate for long-term management?
A) Furosemide, lisinopril, carvedilol, spironolactone
B) Furosemide, digoxin, amlodipine, metoprolol succinate
C) Lisinopril, amlodipine, digoxin, furosemide
D) Carvedilol, lisinopril, amlodipine, furosemide
Answer: A
Rationale:
Correct: Guideline-directed medical therapy (GDMT) for HFrEF includes diuretic, ACE inhibitor/ARB,
beta-blocker (carvedilol), and aldosterone antagonist (spironolactone).
B, C, D: Amlodipine (CCB) is not recommended in HFrEF due to negative inotropic effects.
Topic: Heart Failure with Reduced Ejection Fraction (HFrEF)
6. A 62-year-old male with coronary artery disease presents with palpitations. ECG shows irregularly
irregular rhythm with no distinct P waves. What is the most appropriate initial rate control?
A) Amiodarone 150 mg IV push
B) Metoprolol 5 mg IV push
C) Digoxin 0.5 mg IV push
D) Diltiazem 20 mg IV push
Answer: B
Rationale:
Correct: Atrial fibrillation with RVR. Beta-blockers (metoprolol) are first-line for rate control in patients
with CAD.
A: Amiodarone is a rhythm control agent, not first-line for rate control.
C: Digoxin is second-line, particularly in HF patients.
D: Diltiazem can be used but beta-blockers are preferred in CAD patients.
Topic: Atrial Fibrillation Management
7. A 75-year-old male presents with syncope. ECG shows heart rate 38 bpm with wide QRS complex. He
reports dizziness and near-syncope. What is the most appropriate management?
A) Transcutaneous pacing
B) Atropine 0.5 mg IV
