1
APEA FNP CARDIO EXAM 2026/2027 | Questions &
Correct Answers | Latest ACC/AHA Guidelines Update
| NP Certification Prep | Pass Guaranteed - A+
Graded
Section 1: Cardiac History & Physical Examination (Q1-30)
Subsection 1A: Symptom Analysis (Chest Pain, Dyspnea, Palpitations, Syncope)
(Q1-12)
Q1. A 62-year-old male reports substernal chest pressure with exertion that resolves
within 5 minutes of rest. The pain does not occur at rest and is not pleuritic. Which
descriptor best classifies this chest pain? A. Typical angina B. Atypical angina C. Non-
cardiac chest pain D. Acute pericarditis
Correct Answer: A Rationale: Typical angina meets all three characteristics:
substernal location, provoked by exertion or stress, and relieved by rest or
nitroglycerin within minutes. Atypical angina (B) lacks one characteristic. Non-cardiac
pain (C) is unrelated to exertion. Pericarditis (D) is pleuritic and positional. 2026
ACC/AHA Chest Pain Guidelines.
Q2. A 58-year-old female with known CAD presents with acute chest pain at rest.
High-sensitivity troponin I at 0 hours is 8 ng/L (normal <4). At 1 hour, it is 12 ng/L
(change = +4 ng/L). According to the 2026 ACC/AHA hs-cTn 0-hour/1-hour
algorithm, what is the interpretation? A. Rule-out NSTEMI; very low risk B. Rule-in
NSTEMI; high risk C. Intermediate zone; requires serial troponin at 3 hours D.
Indeterminate; proceed immediately to coronary angiography
Correct Answer: C Rationale: The 2026 ACC/AHA hs-cTn 0-hour/1-hour algorithm
classifies baseline 4-64 ng/L with moderate 1-hour change as intermediate, requiring
serial testing at 3 hours. Very low baseline (<4 ng/L) with small change rules out (A).
High baseline (≥65 ng/L) or large change (≥12 ng/L) rules in (B). 2026 ACC/AHA
Chest Pain/hs-cTn Algorithm Update.
Q3. A 45-year-old male describes episodes of rapid, irregular heartbeat accompanied
by anxiety and mild dyspnea. Episodes last 10-30 minutes and terminate
,2
spontaneously. ECG during symptoms shows an irregularly irregular rhythm with no P
waves and fibrillatory waves. Which condition is most likely? A. Ventricular
tachycardia B. Atrial fibrillation with rapid ventricular response C. Supraventricular
tachycardia D. Panic disorder without arrhythmia
Correct Answer: B Rationale: Irregularly irregular rhythm with absent P waves and
fibrillatory waves is diagnostic of atrial fibrillation. VT (A) shows wide-complex regular
tachycardia. SVT (C) is regular with narrow complexes. Panic disorder (D) does not
produce AFib on ECG. 2026 ACC/AHA/HRS AFib Guidelines.
Q4. A 28-year-old athlete collapses during a basketball game after a sudden
acceleration. He has no prior symptoms. Family history reveals a father who died
suddenly at age 42. Physical exam reveals a systolic murmur that increases with
Valsalva maneuver. What is the most likely cause of syncope? A. Vasovagal syncope
B. Hypertrophic cardiomyopathy with outflow tract obstruction C. Arrhythmogenic
right ventricular cardiomyopathy D. Long QT syndrome
Correct Answer: B Rationale: Exertional syncope in a young athlete with a harsh
systolic murmur that intensifies with Valsalva (decreased preload worsens
obstruction) and family history of sudden death is classic for HCM. Vasovagal (A)
occurs with triggers like pain or standing. ARVC (C) presents with RV arrhythmias.
LQTS (D) triggers with auditory stimuli or swimming. 2026 ACC/AHA/HRS SCD
Guidelines.
Q5. A 55-year-old male presents to the ED with chest pain that resolved 2 hours ago.
He is now pain-free. ECG shows biphasic T-wave inversions in leads V2 and V3.
Troponin is mildly elevated. Which management is most appropriate? A. Exercise
stress test to confirm ischemia B. Immediate referral for invasive coronary
angiography C. Discharge with outpatient cardiology follow-up D. Administer
thrombolytics
Correct Answer: B Rationale: Biphasic or deeply inverted T waves in V2-V3 in a pain-
free patient with recent unstable angina describes Wellens syndrome, indicating
critical proximal LAD stenosis. Stress testing (A) is contraindicated due to high risk of
precipitating MI. Immediate cath (B) is indicated. 2026 ACC/AHA ACS Guidelines.
Q6. A 70-year-old male with COPD and heart failure presents with worsening
dyspnea. Which symptom cluster best distinguishes acute decompensated heart
failure from COPD exacerbation? A. Fever and productive cough B. Orthopnea, JVD
,3
elevation, and peripheral edema C. Pleuritic chest pain and hemoptysis D. Wheezing
and prolonged expiration
Correct Answer: B Rationale: Orthopnea, elevated JVD, and peripheral edema are
hallmarks of volume overload in ADHF. Fever/productive cough (A) favor infection.
Pleuritic pain/hemoptysis (C) suggest PE. Wheezing (D) is nonspecific but more
typical of COPD. 2026 ACC/AHA/HFSA Heart Failure Guidelines.
Q7. A 32-year-old female reports palpitations and near-syncope. ECG shows a short
PR interval (<120 ms), delta wave (slurred upstroke of QRS), and widened QRS
complex. Which arrhythmia mechanism is present? A. AV nodal reentrant tachycardia
B. Wolff-Parkinson-White syndrome C. Atrial flutter with 2:1 block D. Sinus
tachycardia with aberrancy
Correct Answer: B Rationale: Short PR interval with delta wave and widened QRS
constitutes the Wolff-Parkinson-White pattern due to an accessory pathway (bundle
of Kent). AVNRT (A) lacks delta waves. Atrial flutter (C) shows sawtooth flutter waves.
2026 ACC/AHA/HRS SVT Guidelines.
Q8. A 68-year-old female with hypertension experiences syncope while getting out
of bed in the morning. Orthostatic vital signs show BP 142/88 supine and 98/62
standing after 3 minutes with reproduction of symptoms. What is the most likely
mechanism? A. Cardiac arrhythmia B. Neurogenic orthostatic hypotension C.
Vasovagal syncope D. Carotid sinus hypersensitivity
Correct Answer: B Rationale: A drop in SBP ≥20 mmHg or DBP ≥10 mmHg within 3
minutes of standing with symptom reproduction defines orthostatic hypotension. In
elderly hypertensive patients, this often results from autonomic dysfunction or
medication effects (diuretics, vasodilators). Vasovagal (C) typically has a prodrome
and gradual onset. 2026 ACC/AHA Syncope Guidelines.
Q9. A 48-year-old male presents with crushing chest pain. ECG shows upsloping ST-
segment depression at the J-point in leads V1-V6 with tall, symmetrical T waves and
no ST-segment elevation. Which diagnosis does this pattern represent? A. Anterior
NSTEMI B. de Winter sign (proximal LAD occlusion) C. Benign early repolarization D.
LVH with strain
Correct Answer: B Rationale: Upsloping ST depression at the J-point with tall
symmetrical T waves in precordial leads constitutes de Winter sign, a STEMI
, 4
equivalent indicating acute proximal LAD occlusion requiring emergent reperfusion.
NSTEMI (A) lacks this specific pattern. BER (C) shows J-point notching. 2026
ACC/AHA STEMI Guidelines.
Q10. A 55-year-old obese male with sudden-onset dyspnea and pleuritic chest pain
has HR 118, BP 96/60, SpO₂ 88% on room air. D-dimer is elevated. Wells score is 6.
What is the next diagnostic step? A. CT pulmonary angiography B. Ventilation-
perfusion scan C. Lower extremity venous Doppler D. Empiric anticoagulation without
imaging
Correct Answer: A Rationale: In intermediate-to-high probability PE (Wells >4), CTPA
is the diagnostic test of choice due to high sensitivity/specificity. V/Q scan (B) is
reserved for CTPA contraindications (renal failure, pregnancy). Doppler (C) confirms
DVT but does not diagnose PE. 2026 ESC/ERS PE Guidelines.
Q11. A 60-year-old female reports episodes of palpitations associated with
lightheadedness. Event monitor shows a regular narrow-complex tachycardia at 180
bpm with absent P waves and retrograde P waves following the QRS. Which
arrhythmia is most likely? A. Atrial fibrillation B. Atrioventricular nodal reentrant
tachycardia C. Ventricular tachycardia D. Sinus node reentrant tachycardia
Correct Answer: B Rationale: AVNRT is a regular narrow-complex tachycardia (150-
250 bpm) with absent or retrograde P waves due to reentry within the AV node. AFib
(A) is irregularly irregular. VT (C) is wide-complex. SNRT (D) shows upright P waves
with normal morphology. 2026 ACC/AHA/HRS SVT Guidelines.
Q12. A 75-year-old male with severe aortic stenosis reports syncope during exertion.
No prodrome is reported. Which mechanism best explains this presentation? A.
Vasodepressor response to emotional stress B. Fixed cardiac output with cerebral
hypoperfusion during exertion C. Cerebrovascular steal phenomenon D. Malignant
vagal arrhythmia
Correct Answer: B Rationale: Exertional syncope in severe AS results from inability to
increase cardiac output across a fixed valvular obstruction, causing cerebral
hypoperfusion. This is a Class I indication for valve replacement. Vasovagal syncope
(A) typically has a prodrome. 2026 ACC/AHA Valvular Heart Disease Guidelines.
Subsection 1B: Cardiac Auscultation (Murmurs, S3, S4, Rubs, Clicks) (Q13-22)
APEA FNP CARDIO EXAM 2026/2027 | Questions &
Correct Answers | Latest ACC/AHA Guidelines Update
| NP Certification Prep | Pass Guaranteed - A+
Graded
Section 1: Cardiac History & Physical Examination (Q1-30)
Subsection 1A: Symptom Analysis (Chest Pain, Dyspnea, Palpitations, Syncope)
(Q1-12)
Q1. A 62-year-old male reports substernal chest pressure with exertion that resolves
within 5 minutes of rest. The pain does not occur at rest and is not pleuritic. Which
descriptor best classifies this chest pain? A. Typical angina B. Atypical angina C. Non-
cardiac chest pain D. Acute pericarditis
Correct Answer: A Rationale: Typical angina meets all three characteristics:
substernal location, provoked by exertion or stress, and relieved by rest or
nitroglycerin within minutes. Atypical angina (B) lacks one characteristic. Non-cardiac
pain (C) is unrelated to exertion. Pericarditis (D) is pleuritic and positional. 2026
ACC/AHA Chest Pain Guidelines.
Q2. A 58-year-old female with known CAD presents with acute chest pain at rest.
High-sensitivity troponin I at 0 hours is 8 ng/L (normal <4). At 1 hour, it is 12 ng/L
(change = +4 ng/L). According to the 2026 ACC/AHA hs-cTn 0-hour/1-hour
algorithm, what is the interpretation? A. Rule-out NSTEMI; very low risk B. Rule-in
NSTEMI; high risk C. Intermediate zone; requires serial troponin at 3 hours D.
Indeterminate; proceed immediately to coronary angiography
Correct Answer: C Rationale: The 2026 ACC/AHA hs-cTn 0-hour/1-hour algorithm
classifies baseline 4-64 ng/L with moderate 1-hour change as intermediate, requiring
serial testing at 3 hours. Very low baseline (<4 ng/L) with small change rules out (A).
High baseline (≥65 ng/L) or large change (≥12 ng/L) rules in (B). 2026 ACC/AHA
Chest Pain/hs-cTn Algorithm Update.
Q3. A 45-year-old male describes episodes of rapid, irregular heartbeat accompanied
by anxiety and mild dyspnea. Episodes last 10-30 minutes and terminate
,2
spontaneously. ECG during symptoms shows an irregularly irregular rhythm with no P
waves and fibrillatory waves. Which condition is most likely? A. Ventricular
tachycardia B. Atrial fibrillation with rapid ventricular response C. Supraventricular
tachycardia D. Panic disorder without arrhythmia
Correct Answer: B Rationale: Irregularly irregular rhythm with absent P waves and
fibrillatory waves is diagnostic of atrial fibrillation. VT (A) shows wide-complex regular
tachycardia. SVT (C) is regular with narrow complexes. Panic disorder (D) does not
produce AFib on ECG. 2026 ACC/AHA/HRS AFib Guidelines.
Q4. A 28-year-old athlete collapses during a basketball game after a sudden
acceleration. He has no prior symptoms. Family history reveals a father who died
suddenly at age 42. Physical exam reveals a systolic murmur that increases with
Valsalva maneuver. What is the most likely cause of syncope? A. Vasovagal syncope
B. Hypertrophic cardiomyopathy with outflow tract obstruction C. Arrhythmogenic
right ventricular cardiomyopathy D. Long QT syndrome
Correct Answer: B Rationale: Exertional syncope in a young athlete with a harsh
systolic murmur that intensifies with Valsalva (decreased preload worsens
obstruction) and family history of sudden death is classic for HCM. Vasovagal (A)
occurs with triggers like pain or standing. ARVC (C) presents with RV arrhythmias.
LQTS (D) triggers with auditory stimuli or swimming. 2026 ACC/AHA/HRS SCD
Guidelines.
Q5. A 55-year-old male presents to the ED with chest pain that resolved 2 hours ago.
He is now pain-free. ECG shows biphasic T-wave inversions in leads V2 and V3.
Troponin is mildly elevated. Which management is most appropriate? A. Exercise
stress test to confirm ischemia B. Immediate referral for invasive coronary
angiography C. Discharge with outpatient cardiology follow-up D. Administer
thrombolytics
Correct Answer: B Rationale: Biphasic or deeply inverted T waves in V2-V3 in a pain-
free patient with recent unstable angina describes Wellens syndrome, indicating
critical proximal LAD stenosis. Stress testing (A) is contraindicated due to high risk of
precipitating MI. Immediate cath (B) is indicated. 2026 ACC/AHA ACS Guidelines.
Q6. A 70-year-old male with COPD and heart failure presents with worsening
dyspnea. Which symptom cluster best distinguishes acute decompensated heart
failure from COPD exacerbation? A. Fever and productive cough B. Orthopnea, JVD
,3
elevation, and peripheral edema C. Pleuritic chest pain and hemoptysis D. Wheezing
and prolonged expiration
Correct Answer: B Rationale: Orthopnea, elevated JVD, and peripheral edema are
hallmarks of volume overload in ADHF. Fever/productive cough (A) favor infection.
Pleuritic pain/hemoptysis (C) suggest PE. Wheezing (D) is nonspecific but more
typical of COPD. 2026 ACC/AHA/HFSA Heart Failure Guidelines.
Q7. A 32-year-old female reports palpitations and near-syncope. ECG shows a short
PR interval (<120 ms), delta wave (slurred upstroke of QRS), and widened QRS
complex. Which arrhythmia mechanism is present? A. AV nodal reentrant tachycardia
B. Wolff-Parkinson-White syndrome C. Atrial flutter with 2:1 block D. Sinus
tachycardia with aberrancy
Correct Answer: B Rationale: Short PR interval with delta wave and widened QRS
constitutes the Wolff-Parkinson-White pattern due to an accessory pathway (bundle
of Kent). AVNRT (A) lacks delta waves. Atrial flutter (C) shows sawtooth flutter waves.
2026 ACC/AHA/HRS SVT Guidelines.
Q8. A 68-year-old female with hypertension experiences syncope while getting out
of bed in the morning. Orthostatic vital signs show BP 142/88 supine and 98/62
standing after 3 minutes with reproduction of symptoms. What is the most likely
mechanism? A. Cardiac arrhythmia B. Neurogenic orthostatic hypotension C.
Vasovagal syncope D. Carotid sinus hypersensitivity
Correct Answer: B Rationale: A drop in SBP ≥20 mmHg or DBP ≥10 mmHg within 3
minutes of standing with symptom reproduction defines orthostatic hypotension. In
elderly hypertensive patients, this often results from autonomic dysfunction or
medication effects (diuretics, vasodilators). Vasovagal (C) typically has a prodrome
and gradual onset. 2026 ACC/AHA Syncope Guidelines.
Q9. A 48-year-old male presents with crushing chest pain. ECG shows upsloping ST-
segment depression at the J-point in leads V1-V6 with tall, symmetrical T waves and
no ST-segment elevation. Which diagnosis does this pattern represent? A. Anterior
NSTEMI B. de Winter sign (proximal LAD occlusion) C. Benign early repolarization D.
LVH with strain
Correct Answer: B Rationale: Upsloping ST depression at the J-point with tall
symmetrical T waves in precordial leads constitutes de Winter sign, a STEMI
, 4
equivalent indicating acute proximal LAD occlusion requiring emergent reperfusion.
NSTEMI (A) lacks this specific pattern. BER (C) shows J-point notching. 2026
ACC/AHA STEMI Guidelines.
Q10. A 55-year-old obese male with sudden-onset dyspnea and pleuritic chest pain
has HR 118, BP 96/60, SpO₂ 88% on room air. D-dimer is elevated. Wells score is 6.
What is the next diagnostic step? A. CT pulmonary angiography B. Ventilation-
perfusion scan C. Lower extremity venous Doppler D. Empiric anticoagulation without
imaging
Correct Answer: A Rationale: In intermediate-to-high probability PE (Wells >4), CTPA
is the diagnostic test of choice due to high sensitivity/specificity. V/Q scan (B) is
reserved for CTPA contraindications (renal failure, pregnancy). Doppler (C) confirms
DVT but does not diagnose PE. 2026 ESC/ERS PE Guidelines.
Q11. A 60-year-old female reports episodes of palpitations associated with
lightheadedness. Event monitor shows a regular narrow-complex tachycardia at 180
bpm with absent P waves and retrograde P waves following the QRS. Which
arrhythmia is most likely? A. Atrial fibrillation B. Atrioventricular nodal reentrant
tachycardia C. Ventricular tachycardia D. Sinus node reentrant tachycardia
Correct Answer: B Rationale: AVNRT is a regular narrow-complex tachycardia (150-
250 bpm) with absent or retrograde P waves due to reentry within the AV node. AFib
(A) is irregularly irregular. VT (C) is wide-complex. SNRT (D) shows upright P waves
with normal morphology. 2026 ACC/AHA/HRS SVT Guidelines.
Q12. A 75-year-old male with severe aortic stenosis reports syncope during exertion.
No prodrome is reported. Which mechanism best explains this presentation? A.
Vasodepressor response to emotional stress B. Fixed cardiac output with cerebral
hypoperfusion during exertion C. Cerebrovascular steal phenomenon D. Malignant
vagal arrhythmia
Correct Answer: B Rationale: Exertional syncope in severe AS results from inability to
increase cardiac output across a fixed valvular obstruction, causing cerebral
hypoperfusion. This is a Class I indication for valve replacement. Vasovagal syncope
(A) typically has a prodrome. 2026 ACC/AHA Valvular Heart Disease Guidelines.
Subsection 1B: Cardiac Auscultation (Murmurs, S3, S4, Rubs, Clicks) (Q13-22)
