ACNPC-AG Practice Exam 2026(150
Questions with Answers)
Cardiovascular (1–20)
1. A 68-year-old male with STEMI develops crackles to the
mid-scapulae, O2 sat 88%, BP 158/92. What is the priority
intervention?
Answer: B. Nitroglycerin drip (Reduces preload,
improves oxygenation; revascularization is definitive but
not first if unstable)
2. Which finding is most concerning in a patient with acute
decompensated heart failure?
Answer: B. Cool, clammy extremities (Indicates low
cardiac output and impending cardiogenic shock)
3. A 72-year-old with atrial fibrillation on apixaban has an
acute ischemic stroke 2 hours ago. Next step?
Answer: A. tPA if no contraindications (DOAC alone is
not a contraindication; tPA is time-dependent)
4. Which ECG finding suggests hyperkalemia?
Answer: D. All of the above (Peaked T waves, prolonged
PR, wide QRS – severity progression)
,5. First-line vasopressor for septic shock with LV
dysfunction?
Answer: C. Norepinephrine (First-line per Surviving
Sepsis Campaign; dobutamine added if low cardiac
output)
6. A 74-year-old post-op day 3 has sudden-onset pleuritic
chest pain, hypoxia, and tachycardia. D-dimer elevated.
Next best test?
Answer: B. CTA chest (Gold standard for PE; V/Q scan if
contrast allergy)
7. Which beta-blocker is preferred in acute
decompensated heart failure with reduced EF?
Answer: D. None – hold in acute
decompensation (Beta-blockers should not be initiated
acutely; continue if stable)
8. A 65-year-old with hypertension and DM has BP 182/94,
asymptomatic. Best initial management?
Answer: B. Oral antihypertensive agent (Asymptomatic
severe HTN does not require IV therapy; oral treatment
and follow-up)
9. Which murmur is most consistent with hypertrophic
obstructive cardiomyopathy (HOCM)?
Answer: C. Crescendo-decrescendo murmur at left
, sternal border that increases with Valsalva (Decreased
preload increases obstruction)
10. A 70-year-old with aortic stenosis presents with
syncope on exertion. Next best step?
Answer: D. Surgical or transcatheter
AVR (Symptomatic severe AS is a Class I indication for
valve replacement)
11. Which medication reduces mortality in heart failure
with reduced EF?
Answer: A. Spironolactone (Aldosterone antagonist –
RALES trial)
12. A 66-year-old has acute inferior STEMI. HR 48, BP
88/54. Which intervention first?
Answer: B. Atropine 0.5 mg IV (Treat symptomatic
bradycardia; if no response, pacing)
13. Which antiarrhythmic is contraindicated in heart failure
with reduced EF?
Answer: C. Dronedarone (Increases mortality in
permanent AF and HF; dofetilide or amiodarone safer)
14. A patient with pacemaker has new-onset hiccups.
Likely cause?
Answer: A. Lead perforation / phrenic nerve
stimulation (Requires interrogation and possible lead
revision)
Questions with Answers)
Cardiovascular (1–20)
1. A 68-year-old male with STEMI develops crackles to the
mid-scapulae, O2 sat 88%, BP 158/92. What is the priority
intervention?
Answer: B. Nitroglycerin drip (Reduces preload,
improves oxygenation; revascularization is definitive but
not first if unstable)
2. Which finding is most concerning in a patient with acute
decompensated heart failure?
Answer: B. Cool, clammy extremities (Indicates low
cardiac output and impending cardiogenic shock)
3. A 72-year-old with atrial fibrillation on apixaban has an
acute ischemic stroke 2 hours ago. Next step?
Answer: A. tPA if no contraindications (DOAC alone is
not a contraindication; tPA is time-dependent)
4. Which ECG finding suggests hyperkalemia?
Answer: D. All of the above (Peaked T waves, prolonged
PR, wide QRS – severity progression)
,5. First-line vasopressor for septic shock with LV
dysfunction?
Answer: C. Norepinephrine (First-line per Surviving
Sepsis Campaign; dobutamine added if low cardiac
output)
6. A 74-year-old post-op day 3 has sudden-onset pleuritic
chest pain, hypoxia, and tachycardia. D-dimer elevated.
Next best test?
Answer: B. CTA chest (Gold standard for PE; V/Q scan if
contrast allergy)
7. Which beta-blocker is preferred in acute
decompensated heart failure with reduced EF?
Answer: D. None – hold in acute
decompensation (Beta-blockers should not be initiated
acutely; continue if stable)
8. A 65-year-old with hypertension and DM has BP 182/94,
asymptomatic. Best initial management?
Answer: B. Oral antihypertensive agent (Asymptomatic
severe HTN does not require IV therapy; oral treatment
and follow-up)
9. Which murmur is most consistent with hypertrophic
obstructive cardiomyopathy (HOCM)?
Answer: C. Crescendo-decrescendo murmur at left
, sternal border that increases with Valsalva (Decreased
preload increases obstruction)
10. A 70-year-old with aortic stenosis presents with
syncope on exertion. Next best step?
Answer: D. Surgical or transcatheter
AVR (Symptomatic severe AS is a Class I indication for
valve replacement)
11. Which medication reduces mortality in heart failure
with reduced EF?
Answer: A. Spironolactone (Aldosterone antagonist –
RALES trial)
12. A 66-year-old has acute inferior STEMI. HR 48, BP
88/54. Which intervention first?
Answer: B. Atropine 0.5 mg IV (Treat symptomatic
bradycardia; if no response, pacing)
13. Which antiarrhythmic is contraindicated in heart failure
with reduced EF?
Answer: C. Dronedarone (Increases mortality in
permanent AF and HF; dofetilide or amiodarone safer)
14. A patient with pacemaker has new-onset hiccups.
Likely cause?
Answer: A. Lead perforation / phrenic nerve
stimulation (Requires interrogation and possible lead
revision)
