AGACNP-BC Study Guide: 2025/2026 Syllabus
Disclaimer: This guide is a comprehensive review tool based on the core competencies
for the AGACNP-BC exam. It is not a substitute for official curriculum materials,
textbooks, or clinical experience. Always refer to the most current guidelines from
authoritative sources like the American Heart Association (AHA), Infectious Diseases
Society of America (IDSA), and professional organizations.
Cardiology (15 Questions)
1. A 68-year-old patient with a history of HFrEF (LVEF 30%) presents with
worsening dyspnea and weight gain. Current medications include lisinopril,
metoprolol, and furosemide. What is the NEXT best pharmacologic agent to add?
ANSWER ✓ According to current heart failure guidelines (ACC/AHA/HFSA), the next
evidence-based agent to add for a patient with HFrEF already on an ACE-I/ARB/ARNI,
beta-blocker, and diuretic is a SGLT2 inhibitor (e.g., empagliflozin or dapagliflozin).
These agents have been shown to reduce cardiovascular death and heart failure
hospitalizations regardless of diabetes status.
2. A 55-year-old male presents with sudden, "tearing" chest and back pain. BP is
180/100 in the right arm and 140/80 in the left arm. What is the most critical
initial diagnostic test?
ANSWER ✓ The clinical presentation is highly suggestive of an aortic dissection. The
most critical initial diagnostic test is an emergent computed tomography
angiography (CTA) of the chest to confirm the diagnosis, classify it as Stanford Type A
or B, and guide urgent management (surgery vs. medical therapy).
3. A patient with atrial fibrillation (CHADS-VASc score of 4) is started on
anticoagulation. Which medication requires the most frequent initial monitoring
for adverse effects?
ANSWER ✓ While DOACs are often first-line, if Warfarin is chosen, it requires the most
frequent initial monitoring with daily INR checks until stable, followed by periodic
monitoring, to ensure therapeutic efficacy and avoid bleeding complications.
, 4. What is the first-line management for a stable, wide-complex monomorphic
tachycardia?
ANSWER ✓ For a stable, wide-complex monomorphic tachycardia where the diagnosis is
uncertain (VT vs. SVT with aberrancy), the first-line management per ACLS guidelines
is intravenous procainamide (or amiodarone if procainamide is unavailable).
5. A patient with an acute STEMI is managed with primary PCI. What is the goal
time for door-to-balloon inflation?
ANSWER ✓ The goal door-to-balloon (D2B) time for a patient with STEMI undergoing
primary PCI is 90 minutes or less to minimize myocardial necrosis and improve
outcomes.
6. What is the most common ECG finding in a patient with a pulmonary embolism?
ANSWER ✓ The most common ECG finding in pulmonary embolism is sinus
tachycardia. While S1Q3T3 is classic, it is neither highly sensitive nor specific.
7. Which lab value is most indicative of a poor long-term prognosis in chronic
heart failure?
ANSWER ✓ An elevated B-type Natriuretic Peptide (BNP) or NT-proBNP is the lab
value most directly correlated with the severity of heart failure and poor long-term
prognosis.
8. What is the mechanism of action of sacubitril in the ARNI (Entresto)
combination?
ANSWER ✓ Sacubitril is a neprilysin inhibitor. It works by inhibiting the breakdown of
natriuretic peptides, leading to increased vasodilation, natriuresis, and diuresis.
9. A patient with hypertrophic cardiomyopathy presents with syncope. What is the
most likely mechanism?
ANSWER ✓ The most likely mechanism of syncope in hypertrophic cardiomyopathy
is dynamic left ventricular outflow tract obstruction, which can be exacerbated by
exercise, leading to a dramatic drop in cardiac output.
10. Which beta-blocker is preferred in a patient with concomitant heart failure and
atrial fibrillation due to its additional rate-control properties?
, ANSWER ✓ Carvedilol or metoprolol succinate are preferred beta-blockers in heart
failure. For rate control in AF, metoprolol is often used for its rapid onset when
intravenous administration is needed, but both are cornerstone therapies.
11. What is the primary preventive therapy for a patient with a St. Jude's
mechanical aortic valve replacement?
ANSWER ✓ Lifelong warfarin anticoagulation with a target INR of 2.5-3.5 is required to
prevent valve thrombosis and thromboembolic events.
12. A patient's telemetry shows a rhythm that is irregularly irregular with no
discernible P waves and a ventricular rate of 140. What is the immediate rate-
control goal?
ANSWER ✓ The immediate goal in acute rate control for atrial fibrillation with a rapid
ventricular response is to achieve a ventricular rate of <110 bpm at rest.
13. What is the most common cause of cardiogenic shock?
ANSWER ✓ The most common cause of cardiogenic shock is extensive acute
myocardial infarction, typically involving >40% of the left ventricular myocardium.
14. Which finding on an echocardiogram is diagnostic for cardiac tamponade?
ANSWER ✓ While clinical signs (hypotension, JVD, muffled heart sounds) are key, the
echocardiographic finding diagnostic of cardiac tamponade is diastolic collapse of the
right atrium and/or right ventricle.
15. What is the first-line therapy for vasospastic (Prinzmetal's) angina?
ANSWER ✓ The first-line therapy for vasospastic angina is high-dose calcium channel
blockers (e.g., nifedipine, diltiazem) to prevent coronary artery spasm.
Pulmonary (12 Questions)
16. What is the initial ventilator mode of choice for a patient with acute
respiratory distress syndrome (ARDS)?
Disclaimer: This guide is a comprehensive review tool based on the core competencies
for the AGACNP-BC exam. It is not a substitute for official curriculum materials,
textbooks, or clinical experience. Always refer to the most current guidelines from
authoritative sources like the American Heart Association (AHA), Infectious Diseases
Society of America (IDSA), and professional organizations.
Cardiology (15 Questions)
1. A 68-year-old patient with a history of HFrEF (LVEF 30%) presents with
worsening dyspnea and weight gain. Current medications include lisinopril,
metoprolol, and furosemide. What is the NEXT best pharmacologic agent to add?
ANSWER ✓ According to current heart failure guidelines (ACC/AHA/HFSA), the next
evidence-based agent to add for a patient with HFrEF already on an ACE-I/ARB/ARNI,
beta-blocker, and diuretic is a SGLT2 inhibitor (e.g., empagliflozin or dapagliflozin).
These agents have been shown to reduce cardiovascular death and heart failure
hospitalizations regardless of diabetes status.
2. A 55-year-old male presents with sudden, "tearing" chest and back pain. BP is
180/100 in the right arm and 140/80 in the left arm. What is the most critical
initial diagnostic test?
ANSWER ✓ The clinical presentation is highly suggestive of an aortic dissection. The
most critical initial diagnostic test is an emergent computed tomography
angiography (CTA) of the chest to confirm the diagnosis, classify it as Stanford Type A
or B, and guide urgent management (surgery vs. medical therapy).
3. A patient with atrial fibrillation (CHADS-VASc score of 4) is started on
anticoagulation. Which medication requires the most frequent initial monitoring
for adverse effects?
ANSWER ✓ While DOACs are often first-line, if Warfarin is chosen, it requires the most
frequent initial monitoring with daily INR checks until stable, followed by periodic
monitoring, to ensure therapeutic efficacy and avoid bleeding complications.
, 4. What is the first-line management for a stable, wide-complex monomorphic
tachycardia?
ANSWER ✓ For a stable, wide-complex monomorphic tachycardia where the diagnosis is
uncertain (VT vs. SVT with aberrancy), the first-line management per ACLS guidelines
is intravenous procainamide (or amiodarone if procainamide is unavailable).
5. A patient with an acute STEMI is managed with primary PCI. What is the goal
time for door-to-balloon inflation?
ANSWER ✓ The goal door-to-balloon (D2B) time for a patient with STEMI undergoing
primary PCI is 90 minutes or less to minimize myocardial necrosis and improve
outcomes.
6. What is the most common ECG finding in a patient with a pulmonary embolism?
ANSWER ✓ The most common ECG finding in pulmonary embolism is sinus
tachycardia. While S1Q3T3 is classic, it is neither highly sensitive nor specific.
7. Which lab value is most indicative of a poor long-term prognosis in chronic
heart failure?
ANSWER ✓ An elevated B-type Natriuretic Peptide (BNP) or NT-proBNP is the lab
value most directly correlated with the severity of heart failure and poor long-term
prognosis.
8. What is the mechanism of action of sacubitril in the ARNI (Entresto)
combination?
ANSWER ✓ Sacubitril is a neprilysin inhibitor. It works by inhibiting the breakdown of
natriuretic peptides, leading to increased vasodilation, natriuresis, and diuresis.
9. A patient with hypertrophic cardiomyopathy presents with syncope. What is the
most likely mechanism?
ANSWER ✓ The most likely mechanism of syncope in hypertrophic cardiomyopathy
is dynamic left ventricular outflow tract obstruction, which can be exacerbated by
exercise, leading to a dramatic drop in cardiac output.
10. Which beta-blocker is preferred in a patient with concomitant heart failure and
atrial fibrillation due to its additional rate-control properties?
, ANSWER ✓ Carvedilol or metoprolol succinate are preferred beta-blockers in heart
failure. For rate control in AF, metoprolol is often used for its rapid onset when
intravenous administration is needed, but both are cornerstone therapies.
11. What is the primary preventive therapy for a patient with a St. Jude's
mechanical aortic valve replacement?
ANSWER ✓ Lifelong warfarin anticoagulation with a target INR of 2.5-3.5 is required to
prevent valve thrombosis and thromboembolic events.
12. A patient's telemetry shows a rhythm that is irregularly irregular with no
discernible P waves and a ventricular rate of 140. What is the immediate rate-
control goal?
ANSWER ✓ The immediate goal in acute rate control for atrial fibrillation with a rapid
ventricular response is to achieve a ventricular rate of <110 bpm at rest.
13. What is the most common cause of cardiogenic shock?
ANSWER ✓ The most common cause of cardiogenic shock is extensive acute
myocardial infarction, typically involving >40% of the left ventricular myocardium.
14. Which finding on an echocardiogram is diagnostic for cardiac tamponade?
ANSWER ✓ While clinical signs (hypotension, JVD, muffled heart sounds) are key, the
echocardiographic finding diagnostic of cardiac tamponade is diastolic collapse of the
right atrium and/or right ventricle.
15. What is the first-line therapy for vasospastic (Prinzmetal's) angina?
ANSWER ✓ The first-line therapy for vasospastic angina is high-dose calcium channel
blockers (e.g., nifedipine, diltiazem) to prevent coronary artery spasm.
Pulmonary (12 Questions)
16. What is the initial ventilator mode of choice for a patient with acute
respiratory distress syndrome (ARDS)?
