ANCC AGACNP Certification
American Nurses Credentialing
Center (ANCC)
2026/2027 Academic Year
Practice Questions & Correct
Answers Plus Rationales
Latest 2026 PDF
THIS DOCUMENT CONTAINS:
✓ Practice Questions & Correct Answers 2026/27
✓ Verified Correct Answers & Rationales
✓ Instant Pdf Download
,1
Section I: Cardiovascular Disorders (Questions 1-20)
1. A 68-year-old male with a history of HTN and DM presents
to the ED with acute onset substernal chest pain radiating to
the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1-V4. Which initial intervention is MOST
appropriate?
a) Administer sublingual nitroglycerin and wait for cardiology
consult
b) Administer aspirin, obtain cardiac enzymes, and prepare for
emergent percutaneous coronary intervention (PCI)
c) Administer morphine, oxygen, and transfer to the telemetry
unit
d) Administer metoprolol and schedule a stress test
Correct Answer: b — The patient is experiencing an acute STEMI
(ST-elevation myocardial infarction) with elevation in anterior
leads (V1-V4), indicating anterior wall MI. Door-to-balloon time
for PCI should be ≤90 minutes. Aspirin is immediate, and
emergency PCI is the preferred reperfusion strategy.
2. A 72-year-old patient with heart failure with reduced
ejection fraction (HFrEF) is on optimal GDMT including
sacubitril/valsartan, metoprolol succinate, and
spironolactone. Which additional medication has
demonstrated mortality benefit in HFrEF?
a) Diltiazem
,2
b) Empagliflozin
c) Digoxin
d) Hydralazine
Correct Answer: b — SGLT2 inhibitors (empagliflozin,
dapagliflozin) have demonstrated mortality and hospitalization
benefits in HFrEF regardless of diabetes status.
Hydralazine/isosorbide dinitrate is specifically indicated for
Black patients or those intolerant to ACEi/ARBs.
3. A patient presents with new-onset atrial fibrillation with
rapid ventricular response (HR 140). The patient is
hemodynamically stable. What is the FIRST-line rate control
strategy?
a) Amiodarone IV
b) Beta-blocker (metoprolol) or calcium channel blocker
(diltiazem)
c) Digoxin IV
d) Immediate synchronized cardioversion
Correct Answer: b — Beta-blockers (metoprolol) or non-
dihydropyridine calcium channel blockers (diltiazem) are first-
line rate control agents in hemodynamically stable atrial
fibrillation.
4. A 55-year-old patient with hypertension is prescribed an
ACE inhibitor. One week later, the patient develops
angioedema with swelling of the lips and tongue. What is the
, 3
MOST appropriate next step?
a) Continue ACE inhibitor and add an antihistamine
b) Discontinue ACE inhibitor and prescribe an ARB
c) Discontinue ACE inhibitor and prescribe a beta-blocker
d) Continue ACE inhibitor and monitor closely
Correct Answer: b — Angioedema is a potentially life-threatening
adverse effect of ACE inhibitors. The medication should be
discontinued immediately. ARBs can be considered as an
alternative as they do not increase bradykinin levels to the same
degree.
5. A 70-year-old patient with a history of CAD is started on
atorvastatin 80 mg. The patient reports muscle aches and
weakness. Which laboratory test is MOST important to
evaluate?
a) Complete blood count
b) Liver function tests
c) Creatine kinase (CK)
d) Renal function
Correct Answer: c — Creatine kinase elevation >10x the upper
limit of normal warrants statin discontinuation due to
rhabdomyolysis risk. LFTs should also be monitored but are not
the most urgent test for muscle symptoms.
6. A patient with end-stage heart failure has a left ventricular
assist device (LVAD). Which finding requires the MOST
American Nurses Credentialing
Center (ANCC)
2026/2027 Academic Year
Practice Questions & Correct
Answers Plus Rationales
Latest 2026 PDF
THIS DOCUMENT CONTAINS:
✓ Practice Questions & Correct Answers 2026/27
✓ Verified Correct Answers & Rationales
✓ Instant Pdf Download
,1
Section I: Cardiovascular Disorders (Questions 1-20)
1. A 68-year-old male with a history of HTN and DM presents
to the ED with acute onset substernal chest pain radiating to
the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1-V4. Which initial intervention is MOST
appropriate?
a) Administer sublingual nitroglycerin and wait for cardiology
consult
b) Administer aspirin, obtain cardiac enzymes, and prepare for
emergent percutaneous coronary intervention (PCI)
c) Administer morphine, oxygen, and transfer to the telemetry
unit
d) Administer metoprolol and schedule a stress test
Correct Answer: b — The patient is experiencing an acute STEMI
(ST-elevation myocardial infarction) with elevation in anterior
leads (V1-V4), indicating anterior wall MI. Door-to-balloon time
for PCI should be ≤90 minutes. Aspirin is immediate, and
emergency PCI is the preferred reperfusion strategy.
2. A 72-year-old patient with heart failure with reduced
ejection fraction (HFrEF) is on optimal GDMT including
sacubitril/valsartan, metoprolol succinate, and
spironolactone. Which additional medication has
demonstrated mortality benefit in HFrEF?
a) Diltiazem
,2
b) Empagliflozin
c) Digoxin
d) Hydralazine
Correct Answer: b — SGLT2 inhibitors (empagliflozin,
dapagliflozin) have demonstrated mortality and hospitalization
benefits in HFrEF regardless of diabetes status.
Hydralazine/isosorbide dinitrate is specifically indicated for
Black patients or those intolerant to ACEi/ARBs.
3. A patient presents with new-onset atrial fibrillation with
rapid ventricular response (HR 140). The patient is
hemodynamically stable. What is the FIRST-line rate control
strategy?
a) Amiodarone IV
b) Beta-blocker (metoprolol) or calcium channel blocker
(diltiazem)
c) Digoxin IV
d) Immediate synchronized cardioversion
Correct Answer: b — Beta-blockers (metoprolol) or non-
dihydropyridine calcium channel blockers (diltiazem) are first-
line rate control agents in hemodynamically stable atrial
fibrillation.
4. A 55-year-old patient with hypertension is prescribed an
ACE inhibitor. One week later, the patient develops
angioedema with swelling of the lips and tongue. What is the
, 3
MOST appropriate next step?
a) Continue ACE inhibitor and add an antihistamine
b) Discontinue ACE inhibitor and prescribe an ARB
c) Discontinue ACE inhibitor and prescribe a beta-blocker
d) Continue ACE inhibitor and monitor closely
Correct Answer: b — Angioedema is a potentially life-threatening
adverse effect of ACE inhibitors. The medication should be
discontinued immediately. ARBs can be considered as an
alternative as they do not increase bradykinin levels to the same
degree.
5. A 70-year-old patient with a history of CAD is started on
atorvastatin 80 mg. The patient reports muscle aches and
weakness. Which laboratory test is MOST important to
evaluate?
a) Complete blood count
b) Liver function tests
c) Creatine kinase (CK)
d) Renal function
Correct Answer: c — Creatine kinase elevation >10x the upper
limit of normal warrants statin discontinuation due to
rhabdomyolysis risk. LFTs should also be monitored but are not
the most urgent test for muscle symptoms.
6. A patient with end-stage heart failure has a left ventricular
assist device (LVAD). Which finding requires the MOST
