“AGACNP-BC® 2025/2026 Verified Exam Questions (Q160) – 100% Correct,
Real & Current with Rationales | Guaranteed ANCC Pass”
1. A 68-year-old male presents with chest pain radiating to the left arm,
diaphoresis, and shortness of breath. ECG shows ST elevation in leads II, III,
and aVF. What is the most likely diagnosis?
A. Anterior myocardial infarction
B. Inferior myocardial infarction
C. Lateral myocardial infarction
D. Posterior myocardial infarction
✅ Correct Answer: B. Inferior myocardial infarction
Rationale: ST elevation in leads II, III, and aVF localizes the infarct to the inferior
wall, which is supplied by the right coronary artery.
2. Which of the following is a contraindication for the use of beta-blockers in
acute decompensated heart failure?
A. Active pulmonary edema
B. Chronic atrial fibrillation
C. History of myocardial infarction
D. Hypertension
,✅ Correct Answer: A. Active pulmonary edema
Rationale: Beta-blockers can worsen acute decompensated heart failure by
reducing myocardial contractility, especially in cases with active pulmonary
congestion.
3. What is the first-line pharmacologic agent for hypertensive emergency with
aortic dissection?
A. Hydralazine
B. Esmolol
C. Nitroprusside
D. Labetalol
✅ Correct Answer: B. Esmolol
Rationale: Esmolol is preferred to reduce heart rate and shear stress. Vasodilators
like nitroprusside are used only after beta-blockade is initiated.
4. Which physical exam finding is most indicative of cardiac tamponade?
A. Displaced PMI
B. Loud S1
C. Pulsus paradoxus
D. Harsh systolic murmur
✅ Correct Answer: C. Pulsus paradoxus
Rationale: A drop in systolic BP >10 mmHg during inspiration is classic for
tamponade, due to reduced left ventricular filling.
,5. A patient develops chest pain and hypotension after central line insertion.
What is the most likely diagnosis?
A. Acute coronary syndrome
B. Cardiac tamponade
C. Tension pneumothorax
D. Pulmonary embolism
✅ Correct Answer: C. Tension pneumothorax
Rationale: A central line can cause lung injury leading to tension pneumothorax,
which presents with hypotension, unilateral breath sounds, and tracheal deviation.
6. Which laboratory marker is the most sensitive for detecting early
myocardial injury?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
✅ Correct Answer: B. Troponin I
Rationale: Troponin I is highly specific and sensitive for myocardial damage and
rises within 3–6 hours of infarction.
7. A patient with atrial fibrillation is hemodynamically unstable. What is the
next best step?
A. Start amiodarone
B. Give metoprolol
, C. Perform synchronized cardioversion
D. Initiate anticoagulation
✅ Correct Answer: C. Perform synchronized cardioversion
Rationale: Unstable AF (e.g., hypotension, altered mental status) requires
immediate cardioversion to restore perfusion.
8. What is the primary mechanism of action of nitroglycerin in treating chest
pain?
A. Increases cardiac output
B. Decreases preload
C. Enhances contractility
D. Lowers heart rate
✅ Correct Answer: B. Decreases preload
Rationale: Nitroglycerin dilates veins, decreasing venous return (preload) and
reducing myocardial oxygen demand.
9. A new systolic murmur after myocardial infarction suggests which
mechanical complication?
A. Ventricular free wall rupture
B. Dressler's syndrome
C. Papillary muscle rupture
D. Pericardial effusion
Real & Current with Rationales | Guaranteed ANCC Pass”
1. A 68-year-old male presents with chest pain radiating to the left arm,
diaphoresis, and shortness of breath. ECG shows ST elevation in leads II, III,
and aVF. What is the most likely diagnosis?
A. Anterior myocardial infarction
B. Inferior myocardial infarction
C. Lateral myocardial infarction
D. Posterior myocardial infarction
✅ Correct Answer: B. Inferior myocardial infarction
Rationale: ST elevation in leads II, III, and aVF localizes the infarct to the inferior
wall, which is supplied by the right coronary artery.
2. Which of the following is a contraindication for the use of beta-blockers in
acute decompensated heart failure?
A. Active pulmonary edema
B. Chronic atrial fibrillation
C. History of myocardial infarction
D. Hypertension
,✅ Correct Answer: A. Active pulmonary edema
Rationale: Beta-blockers can worsen acute decompensated heart failure by
reducing myocardial contractility, especially in cases with active pulmonary
congestion.
3. What is the first-line pharmacologic agent for hypertensive emergency with
aortic dissection?
A. Hydralazine
B. Esmolol
C. Nitroprusside
D. Labetalol
✅ Correct Answer: B. Esmolol
Rationale: Esmolol is preferred to reduce heart rate and shear stress. Vasodilators
like nitroprusside are used only after beta-blockade is initiated.
4. Which physical exam finding is most indicative of cardiac tamponade?
A. Displaced PMI
B. Loud S1
C. Pulsus paradoxus
D. Harsh systolic murmur
✅ Correct Answer: C. Pulsus paradoxus
Rationale: A drop in systolic BP >10 mmHg during inspiration is classic for
tamponade, due to reduced left ventricular filling.
,5. A patient develops chest pain and hypotension after central line insertion.
What is the most likely diagnosis?
A. Acute coronary syndrome
B. Cardiac tamponade
C. Tension pneumothorax
D. Pulmonary embolism
✅ Correct Answer: C. Tension pneumothorax
Rationale: A central line can cause lung injury leading to tension pneumothorax,
which presents with hypotension, unilateral breath sounds, and tracheal deviation.
6. Which laboratory marker is the most sensitive for detecting early
myocardial injury?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
✅ Correct Answer: B. Troponin I
Rationale: Troponin I is highly specific and sensitive for myocardial damage and
rises within 3–6 hours of infarction.
7. A patient with atrial fibrillation is hemodynamically unstable. What is the
next best step?
A. Start amiodarone
B. Give metoprolol
, C. Perform synchronized cardioversion
D. Initiate anticoagulation
✅ Correct Answer: C. Perform synchronized cardioversion
Rationale: Unstable AF (e.g., hypotension, altered mental status) requires
immediate cardioversion to restore perfusion.
8. What is the primary mechanism of action of nitroglycerin in treating chest
pain?
A. Increases cardiac output
B. Decreases preload
C. Enhances contractility
D. Lowers heart rate
✅ Correct Answer: B. Decreases preload
Rationale: Nitroglycerin dilates veins, decreasing venous return (preload) and
reducing myocardial oxygen demand.
9. A new systolic murmur after myocardial infarction suggests which
mechanical complication?
A. Ventricular free wall rupture
B. Dressler's syndrome
C. Papillary muscle rupture
D. Pericardial effusion
