AANP AGPCNP PSI TEST 1 & 2 FINAL -
Full-Length Practice Examination:
questions and answers with
rationales/graded A+/2026 update/100%
correct /instant download
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes
presents with substernal chest pressure radiating to his left arm,
accompanied by diaphoresis and nausea. The pain began 45 minutes ago
while he was shoveling snow. His ECG shows ST-segment elevation in
leads V1-V4. What is the MOST appropriate immediate management?
A. Administer sublingual nitroglycerin and discharge with cardiology
follow-up
B. Administer aspirin, nitroglycerin, and activate emergency medical
services for urgent reperfusion therapy
C. Order a stress echocardiogram to assess for ischemia
D. Prescribe a beta-blocker and schedule an outpatient catheterization
Correct Answer: B
,Rationale: This patient is experiencing an ST-segment elevation
myocardial infarction (STEMI), as evidenced by the chest pain,
diaphoresis, nausea, and ST-segment elevation in the anterior leads (V1-
V4). Immediate management includes aspirin (antiplatelet), nitroglycerin
(vasodilation), and urgent reperfusion therapy via percutaneous coronary
intervention or fibrinolytics. Option A is incorrect because discharge is
unsafe. Option C delays necessary treatment. Option D is inappropriate
as outpatient management is not indicated for acute STEMI.
Question 2
An 82-year-old female with a history of heart failure with reduced
ejection fraction (HFrEF) presents with worsening dyspnea, orthopnea,
and 3+ pitting edema in her lower extremities. Her medications include
lisinopril, carvedilol, and furosemide. Which laboratory value is MOST
important to monitor in this patient?
A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. Serum glucose
Correct Answer: B
Rationale: This patient is on a combination of lisinopril (an ACE inhibitor,
which can increase potassium) and furosemide (a loop diuretic, which
can decrease potassium). The net effect on potassium can be
unpredictable, and both hypokalemia and hyperkalemia can precipitate
life-threatening cardiac arrhythmias in patients with heart failure. Serum
creatinine (Option C) is also important but less immediately life-
,threatening. Serum sodium (Option A) and glucose (Option D) are less
critical in this scenario.
Question 3
A 55-year-old male presents with a blood pressure of 150/95 mmHg on
three separate occasions over the past month. He has no other medical
problems and is asymptomatic. What is the MOST appropriate initial
management?
A. Start hydrochlorothiazide 12.5 mg daily and counsel on lifestyle
modifications
B. Start amlodipine 10 mg daily immediately
C. Order a renal ultrasound before starting any medication
D. Recheck blood pressure in 6 months
Correct Answer: A
Rationale: This patient has stage 1 hypertension (blood pressure 130-
139/80-89 mmHg according to ACC/AHA guidelines). Initial
management includes lifestyle modifications (dietary changes, exercise,
weight loss, sodium restriction) and pharmacotherapy with a thiazide
diuretic, ACE inhibitor, ARB, or calcium channel blocker.
Hydrochlorothiazide 12.5 mg daily is an appropriate starting dose. Option
B starts at too high a dose. Option C is unnecessary without other
indications. Option D delays treatment.
, Question 4
A 72-year-old male presents with sudden onset of severe, tearing chest
pain radiating to his back. His blood pressure is 180/110 mmHg in the
right arm and 130/80 mmHg in the left arm. What is the MOST likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest
pain that radiates to the back, often with a difference in blood pressure
between the arms. This is a medical emergency requiring immediate
imaging (CT angiography) and surgical consultation. Option A (MI)
typically presents with pressure-type pain. Option B (PE) presents with
pleuritic chest pain and dyspnea. Option D (pericarditis) presents with
positional chest pain and a pericardial friction rub.
Question 5
A 65-year-old female with a history of atrial fibrillation is on warfarin
therapy. Her INR is 4.8. She has no signs of bleeding. What is the MOST
appropriate management?
A. Administer vitamin K 10 mg orally immediately
B. Hold the next dose and reduce the maintenance dose
Full-Length Practice Examination:
questions and answers with
rationales/graded A+/2026 update/100%
correct /instant download
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes
presents with substernal chest pressure radiating to his left arm,
accompanied by diaphoresis and nausea. The pain began 45 minutes ago
while he was shoveling snow. His ECG shows ST-segment elevation in
leads V1-V4. What is the MOST appropriate immediate management?
A. Administer sublingual nitroglycerin and discharge with cardiology
follow-up
B. Administer aspirin, nitroglycerin, and activate emergency medical
services for urgent reperfusion therapy
C. Order a stress echocardiogram to assess for ischemia
D. Prescribe a beta-blocker and schedule an outpatient catheterization
Correct Answer: B
,Rationale: This patient is experiencing an ST-segment elevation
myocardial infarction (STEMI), as evidenced by the chest pain,
diaphoresis, nausea, and ST-segment elevation in the anterior leads (V1-
V4). Immediate management includes aspirin (antiplatelet), nitroglycerin
(vasodilation), and urgent reperfusion therapy via percutaneous coronary
intervention or fibrinolytics. Option A is incorrect because discharge is
unsafe. Option C delays necessary treatment. Option D is inappropriate
as outpatient management is not indicated for acute STEMI.
Question 2
An 82-year-old female with a history of heart failure with reduced
ejection fraction (HFrEF) presents with worsening dyspnea, orthopnea,
and 3+ pitting edema in her lower extremities. Her medications include
lisinopril, carvedilol, and furosemide. Which laboratory value is MOST
important to monitor in this patient?
A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. Serum glucose
Correct Answer: B
Rationale: This patient is on a combination of lisinopril (an ACE inhibitor,
which can increase potassium) and furosemide (a loop diuretic, which
can decrease potassium). The net effect on potassium can be
unpredictable, and both hypokalemia and hyperkalemia can precipitate
life-threatening cardiac arrhythmias in patients with heart failure. Serum
creatinine (Option C) is also important but less immediately life-
,threatening. Serum sodium (Option A) and glucose (Option D) are less
critical in this scenario.
Question 3
A 55-year-old male presents with a blood pressure of 150/95 mmHg on
three separate occasions over the past month. He has no other medical
problems and is asymptomatic. What is the MOST appropriate initial
management?
A. Start hydrochlorothiazide 12.5 mg daily and counsel on lifestyle
modifications
B. Start amlodipine 10 mg daily immediately
C. Order a renal ultrasound before starting any medication
D. Recheck blood pressure in 6 months
Correct Answer: A
Rationale: This patient has stage 1 hypertension (blood pressure 130-
139/80-89 mmHg according to ACC/AHA guidelines). Initial
management includes lifestyle modifications (dietary changes, exercise,
weight loss, sodium restriction) and pharmacotherapy with a thiazide
diuretic, ACE inhibitor, ARB, or calcium channel blocker.
Hydrochlorothiazide 12.5 mg daily is an appropriate starting dose. Option
B starts at too high a dose. Option C is unnecessary without other
indications. Option D delays treatment.
, Question 4
A 72-year-old male presents with sudden onset of severe, tearing chest
pain radiating to his back. His blood pressure is 180/110 mmHg in the
right arm and 130/80 mmHg in the left arm. What is the MOST likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest
pain that radiates to the back, often with a difference in blood pressure
between the arms. This is a medical emergency requiring immediate
imaging (CT angiography) and surgical consultation. Option A (MI)
typically presents with pressure-type pain. Option B (PE) presents with
pleuritic chest pain and dyspnea. Option D (pericarditis) presents with
positional chest pain and a pericardial friction rub.
Question 5
A 65-year-old female with a history of atrial fibrillation is on warfarin
therapy. Her INR is 4.8. She has no signs of bleeding. What is the MOST
appropriate management?
A. Administer vitamin K 10 mg orally immediately
B. Hold the next dose and reduce the maintenance dose
