ACNPC-AG EXAM QUESTIONS WITH 100% CORRECT
ANSWERS
Question 1
A 68-year-old male presents with chest pain, diaphoresis, and shortness of
breath. His ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely affected?
• A) Left anterior descending
• B) Right coronary artery
• C) Left circumflex
• D) Left main coronary artery
Answer: B) Right coronary artery Rationale: ST elevation in leads II, III, and
aVF is consistent with an inferior wall MI, which is typically caused by
occlusion of the right coronary artery.
Question 2
A 72-year-old female has a new onset of atrial fibrillation with a ventricular rate
of 145 bpm. Her blood pressure is 92/58 mmHg, respiratory rate 28/min, and
she complains of dizziness and chest discomfort. What is the most appropriate
immediate management?
• A) Oral metoprolol
• B) Synchronized cardioversion
• C) IV diltiazem
• D) Amiodarone drip
Answer: B) Synchronized cardioversion Rationale: The patient is
hemodynamically unstable with hypotension and symptoms related to the rapid
ventricular rate. Immediate synchronized cardioversion is indicated for patients
with hemodynamic instability.
,Question 3
Which of the following findings is most specific for diagnosing acute
decompensated heart failure?
• A) S3 gallop
• B) Elevated BNP
• C) Bilateral crackles
• D) Peripheral edema
Answer: A) S3 gallop Rationale: While elevated BNP, bilateral crackles, and
peripheral edema can be present in heart failure, the S3 gallop (ventricular
filling sound) is the most specific finding for acute decompensated heart failure.
Question 4
A 60-year-old male with known coronary artery disease presents with
cardiogenic shock following an extensive anterior wall MI. His BP is 75/40
mmHg, HR 120 bpm, with cool extremities and altered mental status. Initial
management should include:
• A) Immediate CABG
• B) Intra-aortic balloon pump and vasopressors
• C) Thrombolytics and anticoagulation
• D) Fluid bolus and observation
Answer: B) Intra-aortic balloon pump and vasopressors Rationale:
Cardiogenic shock requires immediate hemodynamic support with mechanical
devices such as an intra-aortic balloon pump and vasopressor medications to
maintain adequate perfusion.
Question 5
A 55-year-old female with hypertension and diabetes presents with severe chest
pain radiating to her back. CT angiography reveals an intimal flap in the
descending aorta. What is the most appropriate initial management?
• A) Immediate surgical repair
• B) Blood pressure control with IV beta-blockers
• C) Anticoagulation with heparin
• D) Thrombolytics
,Answer: B) Blood pressure control with IV beta-blockers Rationale: The
patient has a Type B aortic dissection (descending aorta). Initial management
focuses on blood pressure control with beta-blockers to reduce shear forces on
the aortic wall. Surgery is typically reserved for complications.
Question 6
A 70-year-old male presents with new-onset chest pain that worsens with
inspiration. ECG shows diffuse ST-segment elevation and PR-segment
depression. What is the most likely diagnosis?
• A) Anterior STEMI
• B) Acute pericarditis
• C) Pulmonary embolism
• D) Aortic dissection
Answer: B) Acute pericarditis Rationale: The combination of chest pain that
worsens with inspiration, diffuse ST-segment elevation, and PR-segment
depression is characteristic of acute pericarditis.
Question 7
Which finding is most consistent with cardiac tamponade?
• A) Widened pulse pressure
• B) Pulsus paradoxus
• C) Kussmaul's sign
• D) Narrow QRS complex
Answer: B) Pulsus paradoxus Rationale: Pulsus paradoxus (an exaggerated
decrease in systolic blood pressure during inspiration of >10 mmHg) is a
classic finding in cardiac tamponade.
Question 8
A 65-year-old female presents with syncope. ECG shows a PR interval of 0.24
seconds with intermittent non-conducted P waves. What is the most appropriate
management?
• A) Observation only
• B) Atropine
• C) Temporary pacemaker
, • D) Cardioversion
Answer: C) Temporary pacemaker Rationale: The ECG findings indicate
Mobitz type II second-degree AV block, which can progress to complete heart
block. Temporary pacing is indicated, particularly if the patient is symptomatic
with syncope.
Question 9
A 58-year-old male with a history of congestive heart failure presents with
increasing dyspnea. Vital signs are BP 110/70 mmHg, HR 105 bpm, RR
24/min, O2 saturation 92% on 2L NC. Physical exam reveals bilateral crackles,
S3 gallop, and JVD. Laboratory studies show BNP 1200 pg/mL. What is the
most appropriate initial pharmacological management?
• A) IV furosemide
• B) Dobutamine infusion
• C) Morphine sulfate
• D) Milrinone
Answer: A) IV furosemide Rationale: The patient has signs and symptoms of
acute heart failure with volume overload. IV furosemide is the first-line diuretic
therapy to reduce preload and relieve pulmonary congestion.
Question 10
A 48-year-old female with hypertension presents with a BP of 230/130 mmHg,
headache, and blurred vision. What is the most appropriate initial
antihypertensive agent?
• A) Hydralazine
• B) Labetalol
• C) Nitroglycerin
• D) Enalaprilat
Answer: B) Labetalol Rationale: The patient has hypertensive emergency
(severely elevated BP with end-organ damage). Labetalol is an appropriate
first-line agent because it has both alpha and beta-blocking effects, provides
rapid onset of action, and can be titrated easily.
Question 11
ANSWERS
Question 1
A 68-year-old male presents with chest pain, diaphoresis, and shortness of
breath. His ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely affected?
• A) Left anterior descending
• B) Right coronary artery
• C) Left circumflex
• D) Left main coronary artery
Answer: B) Right coronary artery Rationale: ST elevation in leads II, III, and
aVF is consistent with an inferior wall MI, which is typically caused by
occlusion of the right coronary artery.
Question 2
A 72-year-old female has a new onset of atrial fibrillation with a ventricular rate
of 145 bpm. Her blood pressure is 92/58 mmHg, respiratory rate 28/min, and
she complains of dizziness and chest discomfort. What is the most appropriate
immediate management?
• A) Oral metoprolol
• B) Synchronized cardioversion
• C) IV diltiazem
• D) Amiodarone drip
Answer: B) Synchronized cardioversion Rationale: The patient is
hemodynamically unstable with hypotension and symptoms related to the rapid
ventricular rate. Immediate synchronized cardioversion is indicated for patients
with hemodynamic instability.
,Question 3
Which of the following findings is most specific for diagnosing acute
decompensated heart failure?
• A) S3 gallop
• B) Elevated BNP
• C) Bilateral crackles
• D) Peripheral edema
Answer: A) S3 gallop Rationale: While elevated BNP, bilateral crackles, and
peripheral edema can be present in heart failure, the S3 gallop (ventricular
filling sound) is the most specific finding for acute decompensated heart failure.
Question 4
A 60-year-old male with known coronary artery disease presents with
cardiogenic shock following an extensive anterior wall MI. His BP is 75/40
mmHg, HR 120 bpm, with cool extremities and altered mental status. Initial
management should include:
• A) Immediate CABG
• B) Intra-aortic balloon pump and vasopressors
• C) Thrombolytics and anticoagulation
• D) Fluid bolus and observation
Answer: B) Intra-aortic balloon pump and vasopressors Rationale:
Cardiogenic shock requires immediate hemodynamic support with mechanical
devices such as an intra-aortic balloon pump and vasopressor medications to
maintain adequate perfusion.
Question 5
A 55-year-old female with hypertension and diabetes presents with severe chest
pain radiating to her back. CT angiography reveals an intimal flap in the
descending aorta. What is the most appropriate initial management?
• A) Immediate surgical repair
• B) Blood pressure control with IV beta-blockers
• C) Anticoagulation with heparin
• D) Thrombolytics
,Answer: B) Blood pressure control with IV beta-blockers Rationale: The
patient has a Type B aortic dissection (descending aorta). Initial management
focuses on blood pressure control with beta-blockers to reduce shear forces on
the aortic wall. Surgery is typically reserved for complications.
Question 6
A 70-year-old male presents with new-onset chest pain that worsens with
inspiration. ECG shows diffuse ST-segment elevation and PR-segment
depression. What is the most likely diagnosis?
• A) Anterior STEMI
• B) Acute pericarditis
• C) Pulmonary embolism
• D) Aortic dissection
Answer: B) Acute pericarditis Rationale: The combination of chest pain that
worsens with inspiration, diffuse ST-segment elevation, and PR-segment
depression is characteristic of acute pericarditis.
Question 7
Which finding is most consistent with cardiac tamponade?
• A) Widened pulse pressure
• B) Pulsus paradoxus
• C) Kussmaul's sign
• D) Narrow QRS complex
Answer: B) Pulsus paradoxus Rationale: Pulsus paradoxus (an exaggerated
decrease in systolic blood pressure during inspiration of >10 mmHg) is a
classic finding in cardiac tamponade.
Question 8
A 65-year-old female presents with syncope. ECG shows a PR interval of 0.24
seconds with intermittent non-conducted P waves. What is the most appropriate
management?
• A) Observation only
• B) Atropine
• C) Temporary pacemaker
, • D) Cardioversion
Answer: C) Temporary pacemaker Rationale: The ECG findings indicate
Mobitz type II second-degree AV block, which can progress to complete heart
block. Temporary pacing is indicated, particularly if the patient is symptomatic
with syncope.
Question 9
A 58-year-old male with a history of congestive heart failure presents with
increasing dyspnea. Vital signs are BP 110/70 mmHg, HR 105 bpm, RR
24/min, O2 saturation 92% on 2L NC. Physical exam reveals bilateral crackles,
S3 gallop, and JVD. Laboratory studies show BNP 1200 pg/mL. What is the
most appropriate initial pharmacological management?
• A) IV furosemide
• B) Dobutamine infusion
• C) Morphine sulfate
• D) Milrinone
Answer: A) IV furosemide Rationale: The patient has signs and symptoms of
acute heart failure with volume overload. IV furosemide is the first-line diuretic
therapy to reduce preload and relieve pulmonary congestion.
Question 10
A 48-year-old female with hypertension presents with a BP of 230/130 mmHg,
headache, and blurred vision. What is the most appropriate initial
antihypertensive agent?
• A) Hydralazine
• B) Labetalol
• C) Nitroglycerin
• D) Enalaprilat
Answer: B) Labetalol Rationale: The patient has hypertensive emergency
(severely elevated BP with end-organ damage). Labetalol is an appropriate
first-line agent because it has both alpha and beta-blocking effects, provides
rapid onset of action, and can be titrated easily.
Question 11
