AGACNP NU 664 Clinical Decision Making for
the AGACNP
Midterms Exam (Qns & Ans)
2025
1. Clinical Scenario – Chest Pain Evaluation
A 68-year-old male with diabetes, hypertension, and a history of
coronary revascularization presents with atypical chest pain in the
emergency department. Which diagnostic test should be the initial
step to assess for myocardial ischemia?
A. Resting ECG
B. Stress echocardiogram
C. Coronary computed tomography angiography (CCTA)
D. Cardiac magnetic resonance imaging (MRI)
- Correct ANS: A. Resting ECG
©2025
, - Rationale: The resting ECG offers a rapid, non-invasive,
and essential first-line appraisal for detecting ischemia—crucial in
high-risk patients even when presentations are atypical.
2. Clinical Scenario – Sepsis Mortality Prediction
A 55-year-old female with pneumonia-related sepsis shows
early signs of organ dysfunction. Which clinical decision support
tool best predicts her in-hospital mortality?
A. CURB-65 score
B. SOFA score
C. CHADS₂ score
D. TIMI risk score
- Correct ANS: B. SOFA score
- Rationale: The Sequential Organ Failure Assessment
(SOFA) score quantifies multi‑organ dysfunction in septic
patients, making it critical in forecasting mortality risk.
3. Clinical Scenario – Acute Stroke Management
A patient exhibits sudden-onset speech difficulties and
unilateral weakness. To determine eligibility for thrombolytic
therapy, what is the most critical immediate step?
A. Perform a rapid NIH Stroke Scale assessment
B. Obtain a detailed past medical history
©2025
, C. Secure extended CT angiography imaging
D. Conduct serial neurologic examinations over 24 hours
- Correct ANS: A. Perform a rapid NIH Stroke Scale
assessment
- Rationale: Immediate quantification of stroke severity using
the NIH Stroke Scale is vital to guide time-sensitive thrombolytic
decisions.
4. Clinical Scenario – Polypharmacy in Geriatrics
A 79-year-old patient with multiple chronic conditions is on
numerous medications. Which strategy is most effective in
optimizing pharmacotherapy and minimizing adverse events?
A. Sole reliance on clinical intuition
B. Comprehensive medication reconciliation and
deprescribing
C. Rely exclusively on the patient’s self-reported history
D. Apply a one-size-fits-all guideline approach
- Correct ANS: B. Comprehensive medication reconciliation
and deprescribing
- Rationale: In patients facing polypharmacy, systematic
review and adjustment of medications reduce the risk of drug
interactions and adverse reactions.
5. Clinical Scenario – Evidence-Based Decision-Making
©2025
, In an acute care situation, which model best integrates high-
quality evidence with clinical expertise and patient values?
A. Evidence-based medicine (EBM)
B. Intuition-based practice
C. Sole reliance on protocol-driven care
D. Pathophysiologic reasoning alone
- Correct ANS: A. Evidence-based medicine (EBM)
- Rationale: EBM merges the best available research,
clinician experience, and patient preferences, ensuring
personalized and effective care.
6. Clinical Scenario – Pulmonary Embolism Risk Stratification
A patient presents with sudden dyspnea and pleuritic chest pain.
To assess the likelihood of pulmonary embolism before imaging,
which tool should be utilized?
A. Wells’ Criteria
B. CHADS₂-VASc Score
C. APACHE II Score
D. Glasgow Coma Scale
- Correct ANS: A. Wells’ Criteria
- Rationale: Wells’ Criteria is specifically developed to
assess clinical probability for pulmonary embolism, guiding
further diagnostic work-up.
©2025
the AGACNP
Midterms Exam (Qns & Ans)
2025
1. Clinical Scenario – Chest Pain Evaluation
A 68-year-old male with diabetes, hypertension, and a history of
coronary revascularization presents with atypical chest pain in the
emergency department. Which diagnostic test should be the initial
step to assess for myocardial ischemia?
A. Resting ECG
B. Stress echocardiogram
C. Coronary computed tomography angiography (CCTA)
D. Cardiac magnetic resonance imaging (MRI)
- Correct ANS: A. Resting ECG
©2025
, - Rationale: The resting ECG offers a rapid, non-invasive,
and essential first-line appraisal for detecting ischemia—crucial in
high-risk patients even when presentations are atypical.
2. Clinical Scenario – Sepsis Mortality Prediction
A 55-year-old female with pneumonia-related sepsis shows
early signs of organ dysfunction. Which clinical decision support
tool best predicts her in-hospital mortality?
A. CURB-65 score
B. SOFA score
C. CHADS₂ score
D. TIMI risk score
- Correct ANS: B. SOFA score
- Rationale: The Sequential Organ Failure Assessment
(SOFA) score quantifies multi‑organ dysfunction in septic
patients, making it critical in forecasting mortality risk.
3. Clinical Scenario – Acute Stroke Management
A patient exhibits sudden-onset speech difficulties and
unilateral weakness. To determine eligibility for thrombolytic
therapy, what is the most critical immediate step?
A. Perform a rapid NIH Stroke Scale assessment
B. Obtain a detailed past medical history
©2025
, C. Secure extended CT angiography imaging
D. Conduct serial neurologic examinations over 24 hours
- Correct ANS: A. Perform a rapid NIH Stroke Scale
assessment
- Rationale: Immediate quantification of stroke severity using
the NIH Stroke Scale is vital to guide time-sensitive thrombolytic
decisions.
4. Clinical Scenario – Polypharmacy in Geriatrics
A 79-year-old patient with multiple chronic conditions is on
numerous medications. Which strategy is most effective in
optimizing pharmacotherapy and minimizing adverse events?
A. Sole reliance on clinical intuition
B. Comprehensive medication reconciliation and
deprescribing
C. Rely exclusively on the patient’s self-reported history
D. Apply a one-size-fits-all guideline approach
- Correct ANS: B. Comprehensive medication reconciliation
and deprescribing
- Rationale: In patients facing polypharmacy, systematic
review and adjustment of medications reduce the risk of drug
interactions and adverse reactions.
5. Clinical Scenario – Evidence-Based Decision-Making
©2025
, In an acute care situation, which model best integrates high-
quality evidence with clinical expertise and patient values?
A. Evidence-based medicine (EBM)
B. Intuition-based practice
C. Sole reliance on protocol-driven care
D. Pathophysiologic reasoning alone
- Correct ANS: A. Evidence-based medicine (EBM)
- Rationale: EBM merges the best available research,
clinician experience, and patient preferences, ensuring
personalized and effective care.
6. Clinical Scenario – Pulmonary Embolism Risk Stratification
A patient presents with sudden dyspnea and pleuritic chest pain.
To assess the likelihood of pulmonary embolism before imaging,
which tool should be utilized?
A. Wells’ Criteria
B. CHADS₂-VASc Score
C. APACHE II Score
D. Glasgow Coma Scale
- Correct ANS: A. Wells’ Criteria
- Rationale: Wells’ Criteria is specifically developed to
assess clinical probability for pulmonary embolism, guiding
further diagnostic work-up.
©2025
