Adult-Gerontology Acute Care NP Comprehensive
ACTUAL EXAM ALL QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Section 1: Cardiovascular (Questions 1-15)
Question 1
A 72-year-old male with a history of CAD and HFrEF (EF 25%) presents with acute onset of
severe dyspnea, orthopnea, and pink, frothy sputum. BP 160/95, HR 115, RR 32, SpO₂ 88% on 4L
NC. Lung auscultation reveals diffuse crackles. Which of the following is the priority
intervention?
A) Administer IV nitroglycerin and high-dose IV furosemide
B) Start dobutamine infusion for inotropic support
C) Prepare for immediate endotracheal intubation
D) Place the patient in a high Fowler's position and apply BiPAP
Answer: D) Place the patient in a high Fowler's position and apply BiPAP
Rationale: This patient is in acute cardiogenic pulmonary edema. The priority is to support
oxygenation and ventilation. High Fowler's position optimizes lung expansion. Non-invasive
positive pressure ventilation (BiPAP) reduces preload and afterload, improves oxygenation, and
may prevent the need for intubation. Intubation is a rescue therapy if the patient fails BiPAP or is
unable to protect their airway. While IV nitroglycerin and furosemide are appropriate,
supporting the airway and breathing is the immediate priority.
Question 2
A 65-year-old female post-cardiac arrest is receiving targeted temperature management (TTM).
The nurse practitioner knows that the primary goal of TTM is to:
A) Reduce intracranial pressure
B) Improve cardiac output
,C) Reduce cerebral oxygen demand and mitigate reperfusion injury
D) Prevent systemic inflammatory response syndrome
Answer: C) Reduce cerebral oxygen demand and mitigate reperfusion injury
Rationale: Targeted temperature management (therapeutic hypothermia) is used to improve
neurological outcomes after cardiac arrest. Cooling reduces cerebral metabolic rate and oxygen
demand, decreases intracranial pressure, and attenuates the inflammatory cascade associated
with reperfusion injury. The target temperature is typically 32-36°C for 24 hours.
Question 3
A 78-year-old male with a history of end-stage renal disease on hemodialysis presents with
chest pain. ECG shows ST-segment elevation in leads V1-V4. Which medication is relatively
contraindicated in this patient?
A) Aspirin
B) Morphine
C) Nitroglycerin
D) Fentanyl
Answer: C) Nitroglycerin
Rationale: Nitroglycerin is a vasodilator that can cause significant hypotension in patients who
are preload-dependent, such as those with right ventricular infarction or significant
hypovolemia. In patients with ESRD who are dialyzed, use caution due to potential hypotension
from recent fluid removal. If blood pressure is adequate, nitroglycerin can still be considered but
with close monitoring. Aspirin should be given immediately.
Question 4
A 69-year-old patient with suspected acute coronary syndrome has an elevated troponin but no
ST-segment elevations. The ECG shows dynamic T-wave inversions. What is the most
appropriate initial management strategy?
A) Immediate coronary angiography and PCI
B) IV heparin and clopidogrel, with urgent cardiology consultation
C) Aspirin, nitroglycerin, and outpatient stress testing
D) Thrombolytic therapy
Answer: B) IV heparin and clopidogrel, with urgent cardiology consultation
,Rationale: This patient has a Non-ST-Elevation Myocardial Infarction (NSTEMI). Management
includes anti-ischemic therapy, anticoagulation, antiplatelet therapy, and an "early invasive"
strategy (angiography within 24 hours) for high-risk patients. Immediate angiography is
reserved for patients with hemodynamic instability, refractory ischemia, or arrhythmias.
Thrombolytics are contraindicated in NSTEMI.
Question 5
A 74-year-old patient is 4 hours post-cardiac catheterization via the right femoral approach. The
nurse practitioner notes a new onset of severe right leg pain, paresthesia, and pallor. The
femoral pulse is absent. What is the most likely diagnosis and appropriate next step?
A) Deep vein thrombosis; start heparin
B) Retroperitoneal hematoma; check hemoglobin
C) Acute arterial occlusion; immediate vascular surgery consult
D) Compartment syndrome; measure compartment pressures
Answer: C) Acute arterial occlusion; immediate vascular surgery consult
Rationale: This is a classic presentation of acute arterial occlusion post-catheterization, likely
from a thrombus or embolus at the access site. The absence of pulse, pain, pallor, and
paresthesia are the "P's" of acute limb ischemia. Immediate vascular surgery consultation is
required for possible embolectomy or thrombectomy. Delays can lead to limb loss.
Question 6
A 76-year-old patient with a history of chronic AFib presents with new left-sided weakness and
an initial NIHSS of 18. Last known well was 90 minutes ago. Which action is most appropriate if
the patient is found to have a large vessel occlusion?
A) Administer IV tPA only
B) Administer IV tPA and consider endovascular thrombectomy
C) Proceed directly to endovascular thrombectomy
D) Administer aspirin and heparin
Answer: B) Administer IV tPA and consider endovascular thrombectomy
Rationale: For patients with acute ischemic stroke within 4.5 hours of symptom onset, IV tPA is
indicated. Additionally, patients with large vessel occlusions (LVO) benefit from endovascular
thrombectomy (EVT), which can be performed up to 24 hours after onset in select patients based
on imaging. EVT should be pursued if the patient is a candidate and resources are available.
, Question 7
A patient with sepsis develops new-onset atrial fibrillation with rapid ventricular response (HR
155). BP is 110/68, and the patient is hemodynamically stable. What is the most appropriate
first-line treatment?
A) Immediate synchronized cardioversion
B) IV amiodarone bolus and infusion
C) IV metoprolol
D) IV diltiazem
Answer: D) IV diltiazem
Rationale: In a hemodynamically stable patient with atrial fibrillation and rapid ventricular
response (RVR), rate control is the first step. IV diltiazem is an effective rate-controlling agent
that works quickly. Amiodarone is used for rhythm control in hemodynamically unstable or
refractory cases. Metoprolol may also be used, but diltiazem is often preferred in acute settings
for rapid control of rate. Cardioversion is for unstable patients.
Question 8
A patient with acute decompensated heart failure is started on milrinone. Which of the
following is a major side effect requiring close monitoring?
A) Hyperkalemia
B) Tachyphylaxis
C) Hypotension and thrombocytopenia
D) Nephrotoxicity
Answer: C) Hypotension and thrombocytopenia
Rationale: Milrinone is a phosphodiesterase inhibitor with positive inotropic and vasodilatory
effects. It can cause significant hypotension due to vasodilation and requires careful
hemodynamic monitoring. It is also associated with a reversible thrombocytopenia. Other side
effects include arrhythmias and gastrointestinal symptoms.
Question 9
A patient has a temporary transvenous pacemaker inserted. The chest x-ray shows the pacing
wire tip over the left ventricle. The pacemaker is not capturing. The AGACNP should recognize
this as which finding?
ACTUAL EXAM ALL QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Section 1: Cardiovascular (Questions 1-15)
Question 1
A 72-year-old male with a history of CAD and HFrEF (EF 25%) presents with acute onset of
severe dyspnea, orthopnea, and pink, frothy sputum. BP 160/95, HR 115, RR 32, SpO₂ 88% on 4L
NC. Lung auscultation reveals diffuse crackles. Which of the following is the priority
intervention?
A) Administer IV nitroglycerin and high-dose IV furosemide
B) Start dobutamine infusion for inotropic support
C) Prepare for immediate endotracheal intubation
D) Place the patient in a high Fowler's position and apply BiPAP
Answer: D) Place the patient in a high Fowler's position and apply BiPAP
Rationale: This patient is in acute cardiogenic pulmonary edema. The priority is to support
oxygenation and ventilation. High Fowler's position optimizes lung expansion. Non-invasive
positive pressure ventilation (BiPAP) reduces preload and afterload, improves oxygenation, and
may prevent the need for intubation. Intubation is a rescue therapy if the patient fails BiPAP or is
unable to protect their airway. While IV nitroglycerin and furosemide are appropriate,
supporting the airway and breathing is the immediate priority.
Question 2
A 65-year-old female post-cardiac arrest is receiving targeted temperature management (TTM).
The nurse practitioner knows that the primary goal of TTM is to:
A) Reduce intracranial pressure
B) Improve cardiac output
,C) Reduce cerebral oxygen demand and mitigate reperfusion injury
D) Prevent systemic inflammatory response syndrome
Answer: C) Reduce cerebral oxygen demand and mitigate reperfusion injury
Rationale: Targeted temperature management (therapeutic hypothermia) is used to improve
neurological outcomes after cardiac arrest. Cooling reduces cerebral metabolic rate and oxygen
demand, decreases intracranial pressure, and attenuates the inflammatory cascade associated
with reperfusion injury. The target temperature is typically 32-36°C for 24 hours.
Question 3
A 78-year-old male with a history of end-stage renal disease on hemodialysis presents with
chest pain. ECG shows ST-segment elevation in leads V1-V4. Which medication is relatively
contraindicated in this patient?
A) Aspirin
B) Morphine
C) Nitroglycerin
D) Fentanyl
Answer: C) Nitroglycerin
Rationale: Nitroglycerin is a vasodilator that can cause significant hypotension in patients who
are preload-dependent, such as those with right ventricular infarction or significant
hypovolemia. In patients with ESRD who are dialyzed, use caution due to potential hypotension
from recent fluid removal. If blood pressure is adequate, nitroglycerin can still be considered but
with close monitoring. Aspirin should be given immediately.
Question 4
A 69-year-old patient with suspected acute coronary syndrome has an elevated troponin but no
ST-segment elevations. The ECG shows dynamic T-wave inversions. What is the most
appropriate initial management strategy?
A) Immediate coronary angiography and PCI
B) IV heparin and clopidogrel, with urgent cardiology consultation
C) Aspirin, nitroglycerin, and outpatient stress testing
D) Thrombolytic therapy
Answer: B) IV heparin and clopidogrel, with urgent cardiology consultation
,Rationale: This patient has a Non-ST-Elevation Myocardial Infarction (NSTEMI). Management
includes anti-ischemic therapy, anticoagulation, antiplatelet therapy, and an "early invasive"
strategy (angiography within 24 hours) for high-risk patients. Immediate angiography is
reserved for patients with hemodynamic instability, refractory ischemia, or arrhythmias.
Thrombolytics are contraindicated in NSTEMI.
Question 5
A 74-year-old patient is 4 hours post-cardiac catheterization via the right femoral approach. The
nurse practitioner notes a new onset of severe right leg pain, paresthesia, and pallor. The
femoral pulse is absent. What is the most likely diagnosis and appropriate next step?
A) Deep vein thrombosis; start heparin
B) Retroperitoneal hematoma; check hemoglobin
C) Acute arterial occlusion; immediate vascular surgery consult
D) Compartment syndrome; measure compartment pressures
Answer: C) Acute arterial occlusion; immediate vascular surgery consult
Rationale: This is a classic presentation of acute arterial occlusion post-catheterization, likely
from a thrombus or embolus at the access site. The absence of pulse, pain, pallor, and
paresthesia are the "P's" of acute limb ischemia. Immediate vascular surgery consultation is
required for possible embolectomy or thrombectomy. Delays can lead to limb loss.
Question 6
A 76-year-old patient with a history of chronic AFib presents with new left-sided weakness and
an initial NIHSS of 18. Last known well was 90 minutes ago. Which action is most appropriate if
the patient is found to have a large vessel occlusion?
A) Administer IV tPA only
B) Administer IV tPA and consider endovascular thrombectomy
C) Proceed directly to endovascular thrombectomy
D) Administer aspirin and heparin
Answer: B) Administer IV tPA and consider endovascular thrombectomy
Rationale: For patients with acute ischemic stroke within 4.5 hours of symptom onset, IV tPA is
indicated. Additionally, patients with large vessel occlusions (LVO) benefit from endovascular
thrombectomy (EVT), which can be performed up to 24 hours after onset in select patients based
on imaging. EVT should be pursued if the patient is a candidate and resources are available.
, Question 7
A patient with sepsis develops new-onset atrial fibrillation with rapid ventricular response (HR
155). BP is 110/68, and the patient is hemodynamically stable. What is the most appropriate
first-line treatment?
A) Immediate synchronized cardioversion
B) IV amiodarone bolus and infusion
C) IV metoprolol
D) IV diltiazem
Answer: D) IV diltiazem
Rationale: In a hemodynamically stable patient with atrial fibrillation and rapid ventricular
response (RVR), rate control is the first step. IV diltiazem is an effective rate-controlling agent
that works quickly. Amiodarone is used for rhythm control in hemodynamically unstable or
refractory cases. Metoprolol may also be used, but diltiazem is often preferred in acute settings
for rapid control of rate. Cardioversion is for unstable patients.
Question 8
A patient with acute decompensated heart failure is started on milrinone. Which of the
following is a major side effect requiring close monitoring?
A) Hyperkalemia
B) Tachyphylaxis
C) Hypotension and thrombocytopenia
D) Nephrotoxicity
Answer: C) Hypotension and thrombocytopenia
Rationale: Milrinone is a phosphodiesterase inhibitor with positive inotropic and vasodilatory
effects. It can cause significant hypotension due to vasodilation and requires careful
hemodynamic monitoring. It is also associated with a reversible thrombocytopenia. Other side
effects include arrhythmias and gastrointestinal symptoms.
Question 9
A patient has a temporary transvenous pacemaker inserted. The chest x-ray shows the pacing
wire tip over the left ventricle. The pacemaker is not capturing. The AGACNP should recognize
this as which finding?
