Adult-Gerontology Acute Care NP
Comprehensive ACTUAL EXAM ALL QUESTIONS
AND ANSWERS ALREADY GRADED A+. 100%
CORRECT SOLUTIONS | UPDATED PER LATEST
GUIDELINES |ALREADY GRADED A+
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-15)
1. A 72-year-old patient is admitted with acute decompensated heart failure. The AGACNP
notes jugular venous distention, crackles in both lung bases, and 3+ pitting edema in the
lower extremities. Which hemodynamic profile is most consistent with these findings?
A. Low cardiac output, low systemic vascular resistance
B. High cardiac output, low systemic vascular resistance
C. Low cardiac output, high systemic vascular resistance
D. High cardiac output, high systemic vascular resistance
Answer: C. Low cardiac output, high systemic vascular resistance
Rationale: Acute decompensated heart failure with volume overload typically presents with a
low cardiac output state and compensatory high systemic vascular resistance (afterload). The
elevated JVD, crackles, and edema indicate fluid overload and elevated filling pressures. This
"cold and wet" profile requires diuresis and afterload reduction .
2. A patient with ST-elevation myocardial infarction (STEMI) is being prepared for
percutaneous coronary intervention. Which medication should be administered immediately
upon diagnosis?
A. Beta-blocker, ACE inhibitor, and aspirin
B. Aspirin, heparin, and clopidogrel
C. Aspirin, morphine, and nitroglycerin
D. Heparin, clopidogrel, and beta-blocker
1
, Answer: C. Aspirin, morphine, and nitroglycerin
Rationale: The initial management of STEMI includes aspirin (antiplatelet), morphine (pain relief
and preload reduction), and nitroglycerin (vasodilation). Heparin and clopidogrel are given but
aspirin is the priority. Dual antiplatelet therapy (aspirin + clopidogrel) should be given as soon as
possible, but the question asks for immediate administration upon diagnosis .
3. A 68-year-old patient in the ICU has a pulmonary artery catheter in place. The readings
show CVP 18 mmHg, PAP 35/20 mmHg, PCWP 22 mmHg, and cardiac output 3.2 L/min. What
is the most likely diagnosis?
A. Cardiogenic shock
B. Septic shock
C. Hypovolemic shock
D. Obstructive shock
Answer: A. Cardiogenic shock
Rationale: Elevated CVP (>8 mmHg), elevated PCWP (>15 mmHg), and low cardiac output
(normal 4-8 L/min) indicate cardiogenic shock. These findings suggest impaired pump function
with fluid backup into the pulmonary circulation. Septic shock would show low SVR with high or
normal CO. Hypovolemic shock would show low CVP and PCWP .
4. A 65-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 5. The AGACNP
should initiate which anticoagulation strategy?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0-3.0
C. Direct oral anticoagulant (apixaban, rivaroxaban, or dabigatran)
D. No anticoagulation
Answer: C. Direct oral anticoagulant (apixaban, rivaroxaban, or dabigatran)
Rationale: Patients with CHA₂DS₂-VASc score ≥2 in males or ≥3 in females should be
anticoagulated. DOACs are preferred over warfarin due to fewer drug interactions, no dietary
restrictions, and no routine monitoring. Aspirin is insufficient for stroke prevention in high-risk
atrial fibrillation .
2
, 5. A 78-year-old patient with aortic stenosis is scheduled for valve replacement. Which finding
on echocardiography indicates severe aortic stenosis?
A. Valve area >2.0 cm²
B. Mean gradient <20 mmHg
C. Valve area 1.0 cm²
D. Peak velocity <3.0 m/s
Answer: C. Valve area 1.0 cm²
Rationale: Severe aortic stenosis is defined as aortic valve area <1.0 cm², mean gradient >40
mmHg, or peak velocity >4.0 m/s. Valve area 1.0 cm² represents critical narrowing requiring
valve replacement. Other values represent mild to moderate stenosis .
6. A patient with endocarditis is admitted with fever, new murmur, and positive blood
cultures. Which is the most common causative organism in prosthetic valve endocarditis?
A. Staphylococcus aureus
B. Streptococcus viridans
C. Coagulase-negative staphylococci
D. Enterococcus
Answer: C. Coagulase-negative staphylococci
Rationale: Coagulase-negative staphylococci (particularly S. epidermidis) is the most common
cause of prosthetic valve endocarditis (early and late). S. aureus is the most common cause of
native valve endocarditis. S. viridans is associated with dental procedures. Enterococcus is
common in genitourinary sources .
7. A 74-year-old patient with heart failure and reduced ejection fraction (HFrEF) is started on a
foundational quadruple therapy. Which medication is NOT part of this regimen?
A. ACE inhibitor
B. Beta-blocker
C. Calcium channel blocker
D. Mineralocorticoid receptor antagonist
Answer: C. Calcium channel blocker
Rationale: Foundational quadruple therapy for HFrEF includes ACE inhibitor (or ARB/ARNI),
beta-blocker, SGLT-2 inhibitor, and mineralocorticoid receptor antagonist. Calcium channel
3
, blockers (especially non-dihydropyridines) can worsen heart failure and are not recommended
in HFrEF .
8. A 65-year-old patient with chest pain has ECG showing ST-segment elevation in leads V1-
V4. Which coronary artery is most likely involved?
A. Right coronary artery
B. Left main coronary artery
C. Left anterior descending artery
D. Circumflex artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in leads V1-V4 is consistent with anterior wall MI, which is
caused by occlusion of the left anterior descending artery (LAD). RCA occlusion causes inferior
wall MI (leads II, III, aVF). Circumflex artery occlusion causes lateral wall MI (leads I, aVL, V5-
V6) .
9. A 72-year-old patient in the ICU has a new diagnosis of atrial fibrillation with rapid
ventricular response. What is the appropriate rate control medication for a patient with heart
failure and reduced ejection fraction?
A. Metoprolol succinate
B. Diltiazem
C. Digoxin
D. Verapamil
Answer: A. Metoprolol succinate
Rationale: Beta-blockers (metoprolol) are preferred for rate control in atrial fibrillation with
HFrEF. Calcium channel blockers (diltiazem, verapamil) are avoided in HFrEF. Digoxin is second-
line. Amiodarone is for rhythm control in unstable patients .
10. A patient with acute pericarditis presents with chest pain. Which characteristic finding
distinguishes pericarditis from myocardial ischemia?
A. Pain improves with rest
B. Pain improves with sitting forward and worsens with lying flat
4
Comprehensive ACTUAL EXAM ALL QUESTIONS
AND ANSWERS ALREADY GRADED A+. 100%
CORRECT SOLUTIONS | UPDATED PER LATEST
GUIDELINES |ALREADY GRADED A+
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-15)
1. A 72-year-old patient is admitted with acute decompensated heart failure. The AGACNP
notes jugular venous distention, crackles in both lung bases, and 3+ pitting edema in the
lower extremities. Which hemodynamic profile is most consistent with these findings?
A. Low cardiac output, low systemic vascular resistance
B. High cardiac output, low systemic vascular resistance
C. Low cardiac output, high systemic vascular resistance
D. High cardiac output, high systemic vascular resistance
Answer: C. Low cardiac output, high systemic vascular resistance
Rationale: Acute decompensated heart failure with volume overload typically presents with a
low cardiac output state and compensatory high systemic vascular resistance (afterload). The
elevated JVD, crackles, and edema indicate fluid overload and elevated filling pressures. This
"cold and wet" profile requires diuresis and afterload reduction .
2. A patient with ST-elevation myocardial infarction (STEMI) is being prepared for
percutaneous coronary intervention. Which medication should be administered immediately
upon diagnosis?
A. Beta-blocker, ACE inhibitor, and aspirin
B. Aspirin, heparin, and clopidogrel
C. Aspirin, morphine, and nitroglycerin
D. Heparin, clopidogrel, and beta-blocker
1
, Answer: C. Aspirin, morphine, and nitroglycerin
Rationale: The initial management of STEMI includes aspirin (antiplatelet), morphine (pain relief
and preload reduction), and nitroglycerin (vasodilation). Heparin and clopidogrel are given but
aspirin is the priority. Dual antiplatelet therapy (aspirin + clopidogrel) should be given as soon as
possible, but the question asks for immediate administration upon diagnosis .
3. A 68-year-old patient in the ICU has a pulmonary artery catheter in place. The readings
show CVP 18 mmHg, PAP 35/20 mmHg, PCWP 22 mmHg, and cardiac output 3.2 L/min. What
is the most likely diagnosis?
A. Cardiogenic shock
B. Septic shock
C. Hypovolemic shock
D. Obstructive shock
Answer: A. Cardiogenic shock
Rationale: Elevated CVP (>8 mmHg), elevated PCWP (>15 mmHg), and low cardiac output
(normal 4-8 L/min) indicate cardiogenic shock. These findings suggest impaired pump function
with fluid backup into the pulmonary circulation. Septic shock would show low SVR with high or
normal CO. Hypovolemic shock would show low CVP and PCWP .
4. A 65-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 5. The AGACNP
should initiate which anticoagulation strategy?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0-3.0
C. Direct oral anticoagulant (apixaban, rivaroxaban, or dabigatran)
D. No anticoagulation
Answer: C. Direct oral anticoagulant (apixaban, rivaroxaban, or dabigatran)
Rationale: Patients with CHA₂DS₂-VASc score ≥2 in males or ≥3 in females should be
anticoagulated. DOACs are preferred over warfarin due to fewer drug interactions, no dietary
restrictions, and no routine monitoring. Aspirin is insufficient for stroke prevention in high-risk
atrial fibrillation .
2
, 5. A 78-year-old patient with aortic stenosis is scheduled for valve replacement. Which finding
on echocardiography indicates severe aortic stenosis?
A. Valve area >2.0 cm²
B. Mean gradient <20 mmHg
C. Valve area 1.0 cm²
D. Peak velocity <3.0 m/s
Answer: C. Valve area 1.0 cm²
Rationale: Severe aortic stenosis is defined as aortic valve area <1.0 cm², mean gradient >40
mmHg, or peak velocity >4.0 m/s. Valve area 1.0 cm² represents critical narrowing requiring
valve replacement. Other values represent mild to moderate stenosis .
6. A patient with endocarditis is admitted with fever, new murmur, and positive blood
cultures. Which is the most common causative organism in prosthetic valve endocarditis?
A. Staphylococcus aureus
B. Streptococcus viridans
C. Coagulase-negative staphylococci
D. Enterococcus
Answer: C. Coagulase-negative staphylococci
Rationale: Coagulase-negative staphylococci (particularly S. epidermidis) is the most common
cause of prosthetic valve endocarditis (early and late). S. aureus is the most common cause of
native valve endocarditis. S. viridans is associated with dental procedures. Enterococcus is
common in genitourinary sources .
7. A 74-year-old patient with heart failure and reduced ejection fraction (HFrEF) is started on a
foundational quadruple therapy. Which medication is NOT part of this regimen?
A. ACE inhibitor
B. Beta-blocker
C. Calcium channel blocker
D. Mineralocorticoid receptor antagonist
Answer: C. Calcium channel blocker
Rationale: Foundational quadruple therapy for HFrEF includes ACE inhibitor (or ARB/ARNI),
beta-blocker, SGLT-2 inhibitor, and mineralocorticoid receptor antagonist. Calcium channel
3
, blockers (especially non-dihydropyridines) can worsen heart failure and are not recommended
in HFrEF .
8. A 65-year-old patient with chest pain has ECG showing ST-segment elevation in leads V1-
V4. Which coronary artery is most likely involved?
A. Right coronary artery
B. Left main coronary artery
C. Left anterior descending artery
D. Circumflex artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in leads V1-V4 is consistent with anterior wall MI, which is
caused by occlusion of the left anterior descending artery (LAD). RCA occlusion causes inferior
wall MI (leads II, III, aVF). Circumflex artery occlusion causes lateral wall MI (leads I, aVL, V5-
V6) .
9. A 72-year-old patient in the ICU has a new diagnosis of atrial fibrillation with rapid
ventricular response. What is the appropriate rate control medication for a patient with heart
failure and reduced ejection fraction?
A. Metoprolol succinate
B. Diltiazem
C. Digoxin
D. Verapamil
Answer: A. Metoprolol succinate
Rationale: Beta-blockers (metoprolol) are preferred for rate control in atrial fibrillation with
HFrEF. Calcium channel blockers (diltiazem, verapamil) are avoided in HFrEF. Digoxin is second-
line. Amiodarone is for rhythm control in unstable patients .
10. A patient with acute pericarditis presents with chest pain. Which characteristic finding
distinguishes pericarditis from myocardial ischemia?
A. Pain improves with rest
B. Pain improves with sitting forward and worsens with lying flat
4
