Barkley AGACNP ACTUAL EXAM ALL QUESTIONS
AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Cardiovascular — Questions 1–25
1.
A 68-year-old male presents with acute onset of severe chest pain radiating to the back,
unequal blood pressures in both arms, and a new diastolic murmur. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Tearing chest pain radiating to the back, unequal arm blood pressures, and a
new diastolic murmur (aortic regurgitation) are classic for aortic dissection.
High-Yield Takeaway: Unequal BP + tearing pain = aortic dissection.
2.
A 72-year-old female with a history of heart failure presents with acute dyspnea, pink
frothy sputum, and bibasilar crackles. What is the priority intervention?
A. Administer IV furosemide
B. Position supine
C. Administer oral fluids
D. Obtain chest X-ray first
,Correct Answer: A
Rationale: Acute pulmonary edema requires immediate diuresis, oxygen, and
positioning upright. IV furosemide reduces preload rapidly.
High-Yield Takeaway: Pink frothy sputum = acute pulmonary edema → IV furosemide.
3.
A 65-year-old male is admitted with STEMI. He develops a new holosystolic murmur and
acute decompensation. What complication should the AGACNP suspect?
A. Papillary muscle rupture
B. Pericarditis
C. Aortic stenosis
D. Ventricular aneurysm
Correct Answer: A
Rationale: Papillary muscle rupture after MI causes acute mitral regurgitation with a
new holosystolic murmur and cardiogenic shock.
High-Yield Takeaway: Post-MI holosystolic murmur = papillary muscle rupture.
4.
A 58-year-old male with atrial fibrillation has a CHA2DS2-VASc score of 5. What is the
recommended anticoagulation?
A. Aspirin 81 mg daily
B. Warfarin with INR 2–3 or DOAC
C. Clopidogrel 75 mg daily
D. No anticoagulation
Correct Answer: B
Rationale: CHA2DS2-VASc ≥2 warrants anticoagulation with warfarin or a DOAC.
High-Yield Takeaway: CHA2DS2-VASc ≥2 = anticoagulate.
,5.
A 70-year-old male on warfarin for AF presents with an INR of 8.0 and epistaxis. What is
the most appropriate management?
A. Hold warfarin only
B. Administer vitamin K 10 mg IV
C. Administer protamine sulfate
D. Transfuse platelets
Correct Answer: B
Rationale: INR >8 with bleeding requires vitamin K administration and possibly FFP.
High-Yield Takeaway: INR >8 + bleeding = vitamin K.
6.
A 62-year-old female presents with syncope, exertional dyspnea, and a harsh systolic
murmur radiating to the carotids. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Mitral stenosis
Correct Answer: A
Rationale: Syncope, dyspnea, and a systolic murmur radiating to the carotids are classic
for aortic stenosis.
High-Yield Takeaway: Systolic murmur radiating to carotids = aortic stenosis.
7.
A 75-year-old male with heart failure has an ejection fraction of 25%. Which medication
class improves survival?
A. Beta-blockers
, B. Calcium channel blockers
C. NSAIDs
D. Class I antiarrhythmics
Correct Answer: A
Rationale: Beta-blockers, ACE inhibitors/ARBs, and aldosterone antagonists improve
survival in HFrEF.
High-Yield Takeaway: HFrEF = beta-blocker improves survival.
8.
A 60-year-old male presents with chest pain and ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main
Correct Answer: C
Rationale: Leads II, III, aVF are inferior leads supplied by the right coronary artery.
High-Yield Takeaway: Inferior MI = RCA.
9.
A 55-year-old male with a history of DVT presents with sudden dyspnea, pleuritic chest
pain, and tachycardia. What is the most appropriate initial diagnostic test?
A. CT pulmonary angiogram
B. Chest X-ray
C. D-dimer
D. V/Q scan
AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Section 1: Cardiovascular — Questions 1–25
1.
A 68-year-old male presents with acute onset of severe chest pain radiating to the back,
unequal blood pressures in both arms, and a new diastolic murmur. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Rationale: Tearing chest pain radiating to the back, unequal arm blood pressures, and a
new diastolic murmur (aortic regurgitation) are classic for aortic dissection.
High-Yield Takeaway: Unequal BP + tearing pain = aortic dissection.
2.
A 72-year-old female with a history of heart failure presents with acute dyspnea, pink
frothy sputum, and bibasilar crackles. What is the priority intervention?
A. Administer IV furosemide
B. Position supine
C. Administer oral fluids
D. Obtain chest X-ray first
,Correct Answer: A
Rationale: Acute pulmonary edema requires immediate diuresis, oxygen, and
positioning upright. IV furosemide reduces preload rapidly.
High-Yield Takeaway: Pink frothy sputum = acute pulmonary edema → IV furosemide.
3.
A 65-year-old male is admitted with STEMI. He develops a new holosystolic murmur and
acute decompensation. What complication should the AGACNP suspect?
A. Papillary muscle rupture
B. Pericarditis
C. Aortic stenosis
D. Ventricular aneurysm
Correct Answer: A
Rationale: Papillary muscle rupture after MI causes acute mitral regurgitation with a
new holosystolic murmur and cardiogenic shock.
High-Yield Takeaway: Post-MI holosystolic murmur = papillary muscle rupture.
4.
A 58-year-old male with atrial fibrillation has a CHA2DS2-VASc score of 5. What is the
recommended anticoagulation?
A. Aspirin 81 mg daily
B. Warfarin with INR 2–3 or DOAC
C. Clopidogrel 75 mg daily
D. No anticoagulation
Correct Answer: B
Rationale: CHA2DS2-VASc ≥2 warrants anticoagulation with warfarin or a DOAC.
High-Yield Takeaway: CHA2DS2-VASc ≥2 = anticoagulate.
,5.
A 70-year-old male on warfarin for AF presents with an INR of 8.0 and epistaxis. What is
the most appropriate management?
A. Hold warfarin only
B. Administer vitamin K 10 mg IV
C. Administer protamine sulfate
D. Transfuse platelets
Correct Answer: B
Rationale: INR >8 with bleeding requires vitamin K administration and possibly FFP.
High-Yield Takeaway: INR >8 + bleeding = vitamin K.
6.
A 62-year-old female presents with syncope, exertional dyspnea, and a harsh systolic
murmur radiating to the carotids. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Mitral stenosis
Correct Answer: A
Rationale: Syncope, dyspnea, and a systolic murmur radiating to the carotids are classic
for aortic stenosis.
High-Yield Takeaway: Systolic murmur radiating to carotids = aortic stenosis.
7.
A 75-year-old male with heart failure has an ejection fraction of 25%. Which medication
class improves survival?
A. Beta-blockers
, B. Calcium channel blockers
C. NSAIDs
D. Class I antiarrhythmics
Correct Answer: A
Rationale: Beta-blockers, ACE inhibitors/ARBs, and aldosterone antagonists improve
survival in HFrEF.
High-Yield Takeaway: HFrEF = beta-blocker improves survival.
8.
A 60-year-old male presents with chest pain and ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main
Correct Answer: C
Rationale: Leads II, III, aVF are inferior leads supplied by the right coronary artery.
High-Yield Takeaway: Inferior MI = RCA.
9.
A 55-year-old male with a history of DVT presents with sudden dyspnea, pleuritic chest
pain, and tachycardia. What is the most appropriate initial diagnostic test?
A. CT pulmonary angiogram
B. Chest X-ray
C. D-dimer
D. V/Q scan
