AACN- ACNPC-AG American Association of Critical-
Care Nurses (AACN AGACNP) Adult-Gerontology
Acute. Care Nurse Practitioner Certification (ACNPC-
AG) 2026 Actual Exam Questions and Answers
ACNPC-AG Certification Exam Practice Questions (2026
Blueprint)
Source: AACN ACNPC-AG Certification Exam Complete Practice
Questions and ,,answer,,,,s
Cardiovascular Disorders
Question 1: A 68-year-old man presents with crushing chest pain
radiating to the left arm, ST-segment elevation in leads II, III, aVF.
Which pharmacologic agent should be administered immediately in
addition to aspirin?
A) Metoprolol
B) Alteplase
C) Nitroglycerin
D) Atorvastatin
,,answer,,,,: B. Alteplase
Rationale: ST-segment elevation myocardial infarction (STEMI)
requires prompt reperfusion. Alteplase (a fibrinolytic) is indicated when
primary PCI is not available within the recommended time frame.
Inferior wall STEMI (leads II, III, aVF) requires careful hemodynamic
monitoring as right ventricular involvement may occur.
Question 2: A patient with atrial fibrillation has a CHA₂DS₂-VASc score
of 3. What is the best management to reduce stroke risk?
,A) No anticoagulation needed
B) Dual antiplatelet therapy
C) Oral anticoagulation (e.g., apixaban)
D) Rate control with beta-blocker
,,answer,,,,: C. Oral anticoagulation (e.g., apixaban)
Rationale: A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants
oral anticoagulation to reduce stroke risk. Direct oral anticoagulants
(apixaban, rivaroxaban, dabigatran) are preferred over warfarin for non-
valvular atrial fibrillation.
Question 3: A patient has an ejection fraction of 27%. Which of the
following is the best treatment for primary prevention of sudden death?
A) Implantable cardiac defibrillator (ICD)
B) Beta-blockers
C) Bi-ventricular pacemaker
D) Class III anti-arrhythmics
,,answer,,,,: A. Implantable cardiac defibrillator (ICD)
Rationale: An ICD is indicated for primary prevention of sudden
cardiac death in patients with heart failure and left ventricular ejection
fraction ≤35% despite optimal medical therapy for at least 3 months.
Question 4: In cardiogenic shock, which hemodynamic profile is
expected?
A) High CI, low SVR, high PCWP
B) Low CI, high SVR, high PCWP
C) Low CI, low SVR, low PCWP
D) High CI, high SVR, normal PCWP
,,answer,,,,: B. Low CI, high SVR, high PCWP
,Rationale: Cardiogenic shock presents with low cardiac index (impaired
pump function), high afterload (compensatory vasoconstriction/SVR),
and pulmonary congestion (high wedge pressure/PCWP).
Question 5: Which murmur is associated with hypertrophic obstructive
cardiomyopathy (HOCM)?
A) Holosystolic murmur at apex
B) Systolic crescendo-decrescendo murmur louder with Valsalva
C) Diastolic rumble at left sternal border
D) Continuous murmur at upper chest
,,answer,,,,: B. Systolic crescendo-decrescendo murmur louder with
Valsalva
Rationale: HOCM murmur increases with decreased preload (e.g.,
Valsalva, standing) and decreases with increased preload (squatting,
hand grip). This distinguishes it from aortic stenosis.
Question 6: A patient with a mechanical aortic valve replacement
presents for follow-up. What is the target INR?
A) 1.5–2.0
B) 2.0–2.5
C) 2.5–3.5
D) >4.0
,,answer,,,,: C. 2.5–3.5
Rationale: Mechanical valves require higher INR targets (2.5–3.5 for
aortic, 3.0–4.0 for mitral) to prevent valve thrombosis. Bileaflet aortic
valves may have lower targets (2.0–3.0) depending on additional risk
factors.
Question 7: Which ECG finding is most suggestive of pericarditis?
, A) ST elevation in V1–V4
B) Diffuse ST elevation and PR depression
C) ST depression in leads II, III, aVF
D) T-wave inversion only in V5–V6
,,answer,,,,: B. Diffuse ST elevation and PR depression
Rationale: Pericarditis classically shows diffuse ST elevation (concave
up) and PR depression across multiple leads. These changes reflect
inflammation of the epicardium.
Question 8: A patient with decompensated HFrEF is admitted. Which
medication improves long-term mortality?
A) IV furosemide
B) Digoxin
C) Sacubitril/valsartan
D) IV milrinone
,,answer,,,,: C. Sacubitril/valsartan
Rationale: ARNI (sacubitril/valsartan) improves survival in HFrEF,
while diuretics and inotropes only provide symptomatic relief. ARNI is
now recommended as first-line therapy in many guidelines.
Question 9: Which drug should be avoided in acute decompensated
heart failure with reduced ejection fraction?
A) Loop diuretic
B) Non-dihydropyridine CCB (verapamil, diltiazem)
C) Beta-blocker (low-dose)
D) Vasodilator (nitroglycerin)
,,answer,,,,: B. Non-dihydropyridine CCB (verapamil, diltiazem)
Care Nurses (AACN AGACNP) Adult-Gerontology
Acute. Care Nurse Practitioner Certification (ACNPC-
AG) 2026 Actual Exam Questions and Answers
ACNPC-AG Certification Exam Practice Questions (2026
Blueprint)
Source: AACN ACNPC-AG Certification Exam Complete Practice
Questions and ,,answer,,,,s
Cardiovascular Disorders
Question 1: A 68-year-old man presents with crushing chest pain
radiating to the left arm, ST-segment elevation in leads II, III, aVF.
Which pharmacologic agent should be administered immediately in
addition to aspirin?
A) Metoprolol
B) Alteplase
C) Nitroglycerin
D) Atorvastatin
,,answer,,,,: B. Alteplase
Rationale: ST-segment elevation myocardial infarction (STEMI)
requires prompt reperfusion. Alteplase (a fibrinolytic) is indicated when
primary PCI is not available within the recommended time frame.
Inferior wall STEMI (leads II, III, aVF) requires careful hemodynamic
monitoring as right ventricular involvement may occur.
Question 2: A patient with atrial fibrillation has a CHA₂DS₂-VASc score
of 3. What is the best management to reduce stroke risk?
,A) No anticoagulation needed
B) Dual antiplatelet therapy
C) Oral anticoagulation (e.g., apixaban)
D) Rate control with beta-blocker
,,answer,,,,: C. Oral anticoagulation (e.g., apixaban)
Rationale: A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants
oral anticoagulation to reduce stroke risk. Direct oral anticoagulants
(apixaban, rivaroxaban, dabigatran) are preferred over warfarin for non-
valvular atrial fibrillation.
Question 3: A patient has an ejection fraction of 27%. Which of the
following is the best treatment for primary prevention of sudden death?
A) Implantable cardiac defibrillator (ICD)
B) Beta-blockers
C) Bi-ventricular pacemaker
D) Class III anti-arrhythmics
,,answer,,,,: A. Implantable cardiac defibrillator (ICD)
Rationale: An ICD is indicated for primary prevention of sudden
cardiac death in patients with heart failure and left ventricular ejection
fraction ≤35% despite optimal medical therapy for at least 3 months.
Question 4: In cardiogenic shock, which hemodynamic profile is
expected?
A) High CI, low SVR, high PCWP
B) Low CI, high SVR, high PCWP
C) Low CI, low SVR, low PCWP
D) High CI, high SVR, normal PCWP
,,answer,,,,: B. Low CI, high SVR, high PCWP
,Rationale: Cardiogenic shock presents with low cardiac index (impaired
pump function), high afterload (compensatory vasoconstriction/SVR),
and pulmonary congestion (high wedge pressure/PCWP).
Question 5: Which murmur is associated with hypertrophic obstructive
cardiomyopathy (HOCM)?
A) Holosystolic murmur at apex
B) Systolic crescendo-decrescendo murmur louder with Valsalva
C) Diastolic rumble at left sternal border
D) Continuous murmur at upper chest
,,answer,,,,: B. Systolic crescendo-decrescendo murmur louder with
Valsalva
Rationale: HOCM murmur increases with decreased preload (e.g.,
Valsalva, standing) and decreases with increased preload (squatting,
hand grip). This distinguishes it from aortic stenosis.
Question 6: A patient with a mechanical aortic valve replacement
presents for follow-up. What is the target INR?
A) 1.5–2.0
B) 2.0–2.5
C) 2.5–3.5
D) >4.0
,,answer,,,,: C. 2.5–3.5
Rationale: Mechanical valves require higher INR targets (2.5–3.5 for
aortic, 3.0–4.0 for mitral) to prevent valve thrombosis. Bileaflet aortic
valves may have lower targets (2.0–3.0) depending on additional risk
factors.
Question 7: Which ECG finding is most suggestive of pericarditis?
, A) ST elevation in V1–V4
B) Diffuse ST elevation and PR depression
C) ST depression in leads II, III, aVF
D) T-wave inversion only in V5–V6
,,answer,,,,: B. Diffuse ST elevation and PR depression
Rationale: Pericarditis classically shows diffuse ST elevation (concave
up) and PR depression across multiple leads. These changes reflect
inflammation of the epicardium.
Question 8: A patient with decompensated HFrEF is admitted. Which
medication improves long-term mortality?
A) IV furosemide
B) Digoxin
C) Sacubitril/valsartan
D) IV milrinone
,,answer,,,,: C. Sacubitril/valsartan
Rationale: ARNI (sacubitril/valsartan) improves survival in HFrEF,
while diuretics and inotropes only provide symptomatic relief. ARNI is
now recommended as first-line therapy in many guidelines.
Question 9: Which drug should be avoided in acute decompensated
heart failure with reduced ejection fraction?
A) Loop diuretic
B) Non-dihydropyridine CCB (verapamil, diltiazem)
C) Beta-blocker (low-dose)
D) Vasodilator (nitroglycerin)
,,answer,,,,: B. Non-dihydropyridine CCB (verapamil, diltiazem)
