AGACNP 2026 MIRROR EXAM – ADULT
GERONTOLOGY ACUTE CARE NP PRACTICE
TEST EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
LATEST UPDATE ALREADY GRADED A+
Section 1: Cardiovascular Disorders (Questions 1–30)
1. A 58-year-old male presents with crushing substernal chest pain, diaphoresis,
and ST-segment elevation in leads II, III, and aVF. Which coronary artery is most
commonly involved?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main
Correct Answer: B
Rationale: ST elevations in leads II, III, and aVF indicate an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA) in approximately 80% of cases. The RCA supplies the
inferior wall of the left ventricle.
2. A patient with acute decompensated heart failure has severe pulmonary
congestion and a blood pressure of 168/94 mm Hg. Which agent is most
appropriate for initial management?
A. Nitroglycerin infusion
B. Dopamine infusion
C. Phenylephrine infusion
D. Normal saline bolus
Correct Answer: A
Rationale: Nitroglycerin is a vasodilator that reduces preload and afterload, making
it ideal for hypertensive acute decompensated heart failure with pulmonary
,congestion. Dopamine and phenylephrine would worsen afterload. Fluid boluses
would exacerbate congestion.
3. A 68-year-old male with a history of heart failure presents with increasing
dyspnea and an S3 gallop. The BNP is 850 pg/mL. Which finding is most
consistent with acute decompensated heart failure?
A. S3 gallop
B. S4 gallop
C. Pleural friction rub
D. Systolic murmur
Correct Answer: A
Rationale: An S3 gallop is a classic finding of volume overload and acute
decompensated heart failure. It is caused by rapid ventricular filling into a dilated
ventricle and correlates with elevated filling pressures.
4. A patient presents with sudden-onset tearing chest pain radiating to the back, a
20 mm Hg difference in blood pressure between arms, and a widened mediastinum
on chest radiograph. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: The triad of tearing chest pain radiating to the back, interarm blood
pressure differential, and widened mediastinum is classic for acute aortic
dissection. Immediate CT angiography is indicated.
5. A patient with heart failure has a BNP of 150 pg/mL. Which interpretation is
most accurate?
A. Normal BNP
B. Mildly elevated BNP, may indicate heart failure
C. Severely elevated BNP, definitive heart failure
D. BNP is not useful for heart failure diagnosis
Correct Answer: B
Rationale: BNP levels above 100 pg/mL are considered elevated. A level of 150
pg/mL is mildly elevated and may indicate heart failure, though levels above 400
pg/mL are more strongly associated with heart failure.
,6. A patient with atrial fibrillation is started on a beta-blocker for rate control.
Which mechanism explains the therapeutic benefit?
A. Beta-1 receptor antagonism reducing heart rate and myocardial oxygen demand
B. Alpha-1 receptor antagonism reducing blood pressure
C. Calcium channel blockade reducing contractility
D. Sodium channel blockade slowing conduction
Correct Answer: A
Rationale: Beta-1 receptor antagonism reduces heart rate and myocardial oxygen
demand, which is the primary therapeutic mechanism for rate control in atrial
fibrillation.
7. A 72-year-old male with hypertension and diabetes presents with acute onset of
substernal chest pressure radiating to the jaw. Troponin is elevated. What is the
most appropriate initial action?
A. Schedule outpatient stress testing
B. Activate an urgent reperfusion pathway
C. Administer oral antacids
D. Obtain a chest radiograph first
Correct Answer: B
Rationale: Elevated troponin with characteristic chest pain indicates acute coronary
syndrome. Urgent reperfusion (PCI or thrombolysis) is indicated within 90 minutes
of presentation for STEMI.
8. A patient with cardiac tamponade presents with hypotension, distended neck
veins, and muffled heart sounds. This triad is known as:
A. Cushing's triad
B. Beck's triad
C. Charcot's triad
D. Virchow's triad
Correct Answer: B
Rationale: Beck's triad consists of hypotension, distended neck veins (jugular
venous distension), and muffled heart sounds. It is the classic presentation of
cardiac tamponade.
9. A patient with pericarditis is most likely to report which characteristic of pain?
A. Pain that worsens with inspiration and improves when leaning forward
, B. Pain that radiates to the back
C. Pain that is relieved by lying flat
D. Pain that is constant and unrelated to position
Correct Answer: A
Rationale: Pericarditis pain is pleuritic (worsens with inspiration) and positional
(improves when leaning forward), which distinguishes it from ischemic cardiac
pain.
10. A patient with chronic heart failure is prescribed spironolactone. Which
monitoring parameter is most important?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Serum potassium and renal function should be monitored closely.
11. A patient with a mechanical aortic valve develops a platelet count drop from
280,000 to 95,000/mcL on postoperative day 5 with new deep vein thrombosis.
What is the most definitive management?
A. Discontinue heparin and initiate enoxaparin
B. Stop all heparin products and initiate argatroban
C. Transfuse four units of platelets
D. Switch to subcutaneous heparin every 8 hours
Correct Answer: B
Rationale: This presentation is classic for heparin-induced thrombocytopenia
(HIT). All heparin products must be stopped immediately, and a non-heparin
anticoagulant such as argatroban should be initiated. Enoxaparin is contraindicated
due to cross-reactivity.
12. A patient with acute decompensated heart failure is receiving furosemide.
Which assessment finding indicates adequate diuresis?
A. Weight loss of 1 kg per day
B. Increased jugular venous pressure
C. Decreased urine output
D. New S3 gallop
GERONTOLOGY ACUTE CARE NP PRACTICE
TEST EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
LATEST UPDATE ALREADY GRADED A+
Section 1: Cardiovascular Disorders (Questions 1–30)
1. A 58-year-old male presents with crushing substernal chest pain, diaphoresis,
and ST-segment elevation in leads II, III, and aVF. Which coronary artery is most
commonly involved?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Left main
Correct Answer: B
Rationale: ST elevations in leads II, III, and aVF indicate an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery (RCA) in approximately 80% of cases. The RCA supplies the
inferior wall of the left ventricle.
2. A patient with acute decompensated heart failure has severe pulmonary
congestion and a blood pressure of 168/94 mm Hg. Which agent is most
appropriate for initial management?
A. Nitroglycerin infusion
B. Dopamine infusion
C. Phenylephrine infusion
D. Normal saline bolus
Correct Answer: A
Rationale: Nitroglycerin is a vasodilator that reduces preload and afterload, making
it ideal for hypertensive acute decompensated heart failure with pulmonary
,congestion. Dopamine and phenylephrine would worsen afterload. Fluid boluses
would exacerbate congestion.
3. A 68-year-old male with a history of heart failure presents with increasing
dyspnea and an S3 gallop. The BNP is 850 pg/mL. Which finding is most
consistent with acute decompensated heart failure?
A. S3 gallop
B. S4 gallop
C. Pleural friction rub
D. Systolic murmur
Correct Answer: A
Rationale: An S3 gallop is a classic finding of volume overload and acute
decompensated heart failure. It is caused by rapid ventricular filling into a dilated
ventricle and correlates with elevated filling pressures.
4. A patient presents with sudden-onset tearing chest pain radiating to the back, a
20 mm Hg difference in blood pressure between arms, and a widened mediastinum
on chest radiograph. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Acute aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: The triad of tearing chest pain radiating to the back, interarm blood
pressure differential, and widened mediastinum is classic for acute aortic
dissection. Immediate CT angiography is indicated.
5. A patient with heart failure has a BNP of 150 pg/mL. Which interpretation is
most accurate?
A. Normal BNP
B. Mildly elevated BNP, may indicate heart failure
C. Severely elevated BNP, definitive heart failure
D. BNP is not useful for heart failure diagnosis
Correct Answer: B
Rationale: BNP levels above 100 pg/mL are considered elevated. A level of 150
pg/mL is mildly elevated and may indicate heart failure, though levels above 400
pg/mL are more strongly associated with heart failure.
,6. A patient with atrial fibrillation is started on a beta-blocker for rate control.
Which mechanism explains the therapeutic benefit?
A. Beta-1 receptor antagonism reducing heart rate and myocardial oxygen demand
B. Alpha-1 receptor antagonism reducing blood pressure
C. Calcium channel blockade reducing contractility
D. Sodium channel blockade slowing conduction
Correct Answer: A
Rationale: Beta-1 receptor antagonism reduces heart rate and myocardial oxygen
demand, which is the primary therapeutic mechanism for rate control in atrial
fibrillation.
7. A 72-year-old male with hypertension and diabetes presents with acute onset of
substernal chest pressure radiating to the jaw. Troponin is elevated. What is the
most appropriate initial action?
A. Schedule outpatient stress testing
B. Activate an urgent reperfusion pathway
C. Administer oral antacids
D. Obtain a chest radiograph first
Correct Answer: B
Rationale: Elevated troponin with characteristic chest pain indicates acute coronary
syndrome. Urgent reperfusion (PCI or thrombolysis) is indicated within 90 minutes
of presentation for STEMI.
8. A patient with cardiac tamponade presents with hypotension, distended neck
veins, and muffled heart sounds. This triad is known as:
A. Cushing's triad
B. Beck's triad
C. Charcot's triad
D. Virchow's triad
Correct Answer: B
Rationale: Beck's triad consists of hypotension, distended neck veins (jugular
venous distension), and muffled heart sounds. It is the classic presentation of
cardiac tamponade.
9. A patient with pericarditis is most likely to report which characteristic of pain?
A. Pain that worsens with inspiration and improves when leaning forward
, B. Pain that radiates to the back
C. Pain that is relieved by lying flat
D. Pain that is constant and unrelated to position
Correct Answer: A
Rationale: Pericarditis pain is pleuritic (worsens with inspiration) and positional
(improves when leaning forward), which distinguishes it from ischemic cardiac
pain.
10. A patient with chronic heart failure is prescribed spironolactone. Which
monitoring parameter is most important?
A. Serum potassium
B. Serum sodium
C. Serum calcium
D. Serum magnesium
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause
hyperkalemia. Serum potassium and renal function should be monitored closely.
11. A patient with a mechanical aortic valve develops a platelet count drop from
280,000 to 95,000/mcL on postoperative day 5 with new deep vein thrombosis.
What is the most definitive management?
A. Discontinue heparin and initiate enoxaparin
B. Stop all heparin products and initiate argatroban
C. Transfuse four units of platelets
D. Switch to subcutaneous heparin every 8 hours
Correct Answer: B
Rationale: This presentation is classic for heparin-induced thrombocytopenia
(HIT). All heparin products must be stopped immediately, and a non-heparin
anticoagulant such as argatroban should be initiated. Enoxaparin is contraindicated
due to cross-reactivity.
12. A patient with acute decompensated heart failure is receiving furosemide.
Which assessment finding indicates adequate diuresis?
A. Weight loss of 1 kg per day
B. Increased jugular venous pressure
C. Decreased urine output
D. New S3 gallop
