Adult-Gerontology Acute Care Nurse Practitioner
Certification (AGACNP-BC EXAM LATEST WITH
ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS/ALREADY GRADED A+ 100%
GUARANTEED TO PASS CONCEPTS(ALL WHAT
YOU NEED) LATEST EDITION
,Cardiovascular
1. A 68-year-old patient presents to the emergency department with acute chest pain radiating to the back, blood
pressure differential of 40 mmHg between arms, and a new diastolic murmur. What is the priority diagnostic
study?
A) 12-lead ECG
B) CT angiogram of the chest
C) Transesophageal echocardiogram (TEE)
D) Cardiac enzyme panel
Answer: B) CT angiogram of the chest
Rationale: The classic triad of acute tearing chest pain radiating to the back, pulse deficit/blood pressure
differential, and a new diastolic murmur of aortic regurgitation is highly suggestive of acute aortic dissection. A
CT angiogram of the chest is the most rapid and definitive diagnostic tool. While an ECG and enzymes are
important to rule out MI, and a TEE can visualize the dissection flap, the CT angiogram is the priority to confirm
the diagnosis and determine surgical urgency.
,2. A patient with a history of heart failure with reduced ejection fraction (HFrEF) is admitted with a COPD
exacerbation. They develop supraventricular tachycardia at 150 bpm. Which medication should be avoided?
A) Metoprolol
B) Diltiazem
C) Digoxin
D) Amiodarone
Answer: B) Diltiazem
Rationale: Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) have negative inotropic
effects and are contraindicated in patients with HFrEF due to the risk of worsening heart failure. Metoprolol (a
beta-blocker), digoxin, and amiodarone are all acceptable rate-control options in HFrEF.
3. A 72-year-old post-operative hip repair patient suddenly develops dyspnea, tachypnea, and tachycardia. ECG
shows S1Q3T3 pattern. The AGACNP orders a STAT CT pulmonary angiogram (CTPA), but the patient
becomes hypotensive and is too unstable for transport. What is the next best step?
A) Begin therapeutic heparin infusion immediately.
B) Perform a bedside transthoracic echocardiogram.
C) Administer systemic thrombolytics.
D) Obtain a d-dimer level.
, Answer: B) Perform a bedside transthoracic echocardiogram.
Rationale: In a patient with high clinical suspicion for massive PE who is too unstable for CTPA, a bedside
echocardiogram is the test of choice. The finding of right ventricular strain/dysfunction (RV dilation, McConnell's
sign) in this setting is sufficient to justify emergent thrombolysis or embolectomy. A d-dimer is not indicated in a
high-risk patient. Heparin alone is insufficient for a massive PE with shock.
4. Which hemodynamic profile is characteristic of cardiogenic shock?
A) Increased PCWP, decreased CO, increased SVR
B) Decreased PCWP, decreased CO, increased SVR
C) Increased PCWP, increased CO, decreased SVR
D) Decreased PCWP, decreased CO, decreased SVR
Answer: A) Increased PCWP, decreased CO, increased SVR
Rationale: Cardiogenic shock results from pump failure. This leads to a back-up of fluid, increasing the
pulmonary capillary wedge pressure (PCWP). The failing heart cannot pump effectively, so cardiac output (CO)
is decreased. The body’s natural compensatory mechanism is vasoconstriction to maintain blood pressure,
leading to an increased systemic vascular resistance (SVR).
Certification (AGACNP-BC EXAM LATEST WITH
ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS/ALREADY GRADED A+ 100%
GUARANTEED TO PASS CONCEPTS(ALL WHAT
YOU NEED) LATEST EDITION
,Cardiovascular
1. A 68-year-old patient presents to the emergency department with acute chest pain radiating to the back, blood
pressure differential of 40 mmHg between arms, and a new diastolic murmur. What is the priority diagnostic
study?
A) 12-lead ECG
B) CT angiogram of the chest
C) Transesophageal echocardiogram (TEE)
D) Cardiac enzyme panel
Answer: B) CT angiogram of the chest
Rationale: The classic triad of acute tearing chest pain radiating to the back, pulse deficit/blood pressure
differential, and a new diastolic murmur of aortic regurgitation is highly suggestive of acute aortic dissection. A
CT angiogram of the chest is the most rapid and definitive diagnostic tool. While an ECG and enzymes are
important to rule out MI, and a TEE can visualize the dissection flap, the CT angiogram is the priority to confirm
the diagnosis and determine surgical urgency.
,2. A patient with a history of heart failure with reduced ejection fraction (HFrEF) is admitted with a COPD
exacerbation. They develop supraventricular tachycardia at 150 bpm. Which medication should be avoided?
A) Metoprolol
B) Diltiazem
C) Digoxin
D) Amiodarone
Answer: B) Diltiazem
Rationale: Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) have negative inotropic
effects and are contraindicated in patients with HFrEF due to the risk of worsening heart failure. Metoprolol (a
beta-blocker), digoxin, and amiodarone are all acceptable rate-control options in HFrEF.
3. A 72-year-old post-operative hip repair patient suddenly develops dyspnea, tachypnea, and tachycardia. ECG
shows S1Q3T3 pattern. The AGACNP orders a STAT CT pulmonary angiogram (CTPA), but the patient
becomes hypotensive and is too unstable for transport. What is the next best step?
A) Begin therapeutic heparin infusion immediately.
B) Perform a bedside transthoracic echocardiogram.
C) Administer systemic thrombolytics.
D) Obtain a d-dimer level.
, Answer: B) Perform a bedside transthoracic echocardiogram.
Rationale: In a patient with high clinical suspicion for massive PE who is too unstable for CTPA, a bedside
echocardiogram is the test of choice. The finding of right ventricular strain/dysfunction (RV dilation, McConnell's
sign) in this setting is sufficient to justify emergent thrombolysis or embolectomy. A d-dimer is not indicated in a
high-risk patient. Heparin alone is insufficient for a massive PE with shock.
4. Which hemodynamic profile is characteristic of cardiogenic shock?
A) Increased PCWP, decreased CO, increased SVR
B) Decreased PCWP, decreased CO, increased SVR
C) Increased PCWP, increased CO, decreased SVR
D) Decreased PCWP, decreased CO, decreased SVR
Answer: A) Increased PCWP, decreased CO, increased SVR
Rationale: Cardiogenic shock results from pump failure. This leads to a back-up of fluid, increasing the
pulmonary capillary wedge pressure (PCWP). The failing heart cannot pump effectively, so cardiac output (CO)
is decreased. The body’s natural compensatory mechanism is vasoconstriction to maintain blood pressure,
leading to an increased systemic vascular resistance (SVR).
