Barkley AGACNP Practice FLORIDA STATE FIRE
INSTRUCTOR 3 ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST GUIDELINES |
GRADED A+
Questions 1–25: Cardiovascular
1. A 68-year-old patient presents with crushing substernal chest pain, diaphoresis, and
nausea. ECG shows ST elevation in leads II, III, and aVF. What is the priority intervention?
A. Administer IV furosemide
B. Activate the STEMI/reperfusion pathway
C. Schedule an outpatient stress test
D. Administer oral beta-blocker and observe
Answer: B. Activate the STEMI/reperfusion pathway
Rationale: ST elevation in II, III, and aVF indicates an acute inferior STEMI. Rapid reperfusion
with PCI is the priority because myocardial salvage is time dependent.
2. Which finding is most characteristic of cardiogenic shock?
A. Warm extremities and bounding pulses
B. Hypotension with elevated systemic vascular resistance
C. Bradycardia with hypertension
D. Increased urine output
Answer: B. Hypotension with elevated systemic vascular resistance
Rationale: Cardiogenic shock results from severe pump failure. The body compensates through
sympathetic activation, producing vasoconstriction, increased SVR, hypotension, cool
extremities, and oliguria.
,3. A patient with acute decompensated heart failure has severe dyspnea, pulmonary crackles,
and oxygen saturation of 84%. Which intervention is most appropriate initially?
A. Place the patient supine
B. Administer oxygen and support ventilation as needed
C. Give a large IV fluid bolus
D. Encourage ambulation
Answer: B. Administer oxygen and support ventilation as needed
Rationale: Immediate stabilization of airway and breathing takes priority. Supplemental oxygen
and noninvasive ventilation may improve oxygenation and reduce respiratory distress.
4. Which ECG finding is most concerning for hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST elevation in V1–V4
Answer: B. Peaked T waves
Rationale: Early hyperkalemia commonly causes tall, narrow, peaked T waves. Progressive
toxicity can cause PR prolongation, QRS widening, sine-wave morphology, ventricular
arrhythmias, and cardiac arrest.
5. A patient with atrial fibrillation has a ventricular rate of 160/min and hypotension. What is
the priority treatment?
A. Oral digoxin
B. IV fluids only
C. Synchronized cardioversion
D. Oral anticoagulation
Answer: C. Synchronized cardioversion
Rationale: Atrial fibrillation producing hemodynamic instability requires immediate
synchronized cardioversion.
,6. Which medication is commonly used for rate control in stable atrial fibrillation?
A. Diltiazem
B. Alteplase
C. Epinephrine
D. Adenosine
Answer: A. Diltiazem
Rationale: Beta-blockers and nondihydropyridine calcium-channel blockers such as diltiazem
can provide ventricular rate control in hemodynamically stable AF.
7. A patient with suspected acute aortic dissection has severe chest pain and unequal arm
blood pressures. Which medication class should be initiated to reduce shear stress?
A. Beta-blocker
B. Thiazide diuretic
C. Nitrate only
D. Calcium supplement
Answer: A. Beta-blocker
Rationale: IV beta-blockade reduces heart rate and contractility, decreasing aortic wall shear
stress. Additional blood-pressure control may follow.
8. Which presentation is most consistent with right-sided heart failure?
A. Pulmonary edema only
B. Jugular venous distention and peripheral edema
C. Hemoptysis and wheezing
D. Dry mucous membranes
Answer: B. Jugular venous distention and peripheral edema
Rationale: Right-sided failure causes systemic venous congestion, commonly manifested by JVD,
peripheral edema, hepatomegaly, and ascites.
9. A patient taking warfarin has an INR of 7.5 without active bleeding. What is an appropriate
management consideration?
, A. Give another warfarin dose
B. Hold warfarin and assess bleeding risk/need for vitamin K
C. Immediately administer alteplase
D. Start heparin
Answer: B. Hold warfarin and assess bleeding risk/need for vitamin K
Rationale: A markedly supratherapeutic INR requires withholding warfarin and individualized
management based on INR level, bleeding status, and thrombotic risk.
10. Which biomarker is most specific for myocardial injury?
A. BNP
B. Troponin
C. D-dimer
D. Lactate
Answer: B. Troponin
Rationale: Cardiac troponins are highly sensitive and specific markers of myocardial injury and
are central to the evaluation of acute coronary syndrome.
11. A patient with acute pulmonary edema is severely hypertensive. Which treatment may
rapidly reduce preload and afterload?
A. IV nitroglycerin
B. IM epinephrine
C. Oral iron
D. IV potassium
Answer: A. IV nitroglycerin
Rationale: In hypertensive acute pulmonary edema, IV nitrates can rapidly reduce preload and,
at higher doses, afterload.
12. Which finding suggests tamponade physiology?
A. Hypertension and bradycardia
B. Hypotension, JVD, and muffled heart sounds
INSTRUCTOR 3 ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST GUIDELINES |
GRADED A+
Questions 1–25: Cardiovascular
1. A 68-year-old patient presents with crushing substernal chest pain, diaphoresis, and
nausea. ECG shows ST elevation in leads II, III, and aVF. What is the priority intervention?
A. Administer IV furosemide
B. Activate the STEMI/reperfusion pathway
C. Schedule an outpatient stress test
D. Administer oral beta-blocker and observe
Answer: B. Activate the STEMI/reperfusion pathway
Rationale: ST elevation in II, III, and aVF indicates an acute inferior STEMI. Rapid reperfusion
with PCI is the priority because myocardial salvage is time dependent.
2. Which finding is most characteristic of cardiogenic shock?
A. Warm extremities and bounding pulses
B. Hypotension with elevated systemic vascular resistance
C. Bradycardia with hypertension
D. Increased urine output
Answer: B. Hypotension with elevated systemic vascular resistance
Rationale: Cardiogenic shock results from severe pump failure. The body compensates through
sympathetic activation, producing vasoconstriction, increased SVR, hypotension, cool
extremities, and oliguria.
,3. A patient with acute decompensated heart failure has severe dyspnea, pulmonary crackles,
and oxygen saturation of 84%. Which intervention is most appropriate initially?
A. Place the patient supine
B. Administer oxygen and support ventilation as needed
C. Give a large IV fluid bolus
D. Encourage ambulation
Answer: B. Administer oxygen and support ventilation as needed
Rationale: Immediate stabilization of airway and breathing takes priority. Supplemental oxygen
and noninvasive ventilation may improve oxygenation and reduce respiratory distress.
4. Which ECG finding is most concerning for hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST elevation in V1–V4
Answer: B. Peaked T waves
Rationale: Early hyperkalemia commonly causes tall, narrow, peaked T waves. Progressive
toxicity can cause PR prolongation, QRS widening, sine-wave morphology, ventricular
arrhythmias, and cardiac arrest.
5. A patient with atrial fibrillation has a ventricular rate of 160/min and hypotension. What is
the priority treatment?
A. Oral digoxin
B. IV fluids only
C. Synchronized cardioversion
D. Oral anticoagulation
Answer: C. Synchronized cardioversion
Rationale: Atrial fibrillation producing hemodynamic instability requires immediate
synchronized cardioversion.
,6. Which medication is commonly used for rate control in stable atrial fibrillation?
A. Diltiazem
B. Alteplase
C. Epinephrine
D. Adenosine
Answer: A. Diltiazem
Rationale: Beta-blockers and nondihydropyridine calcium-channel blockers such as diltiazem
can provide ventricular rate control in hemodynamically stable AF.
7. A patient with suspected acute aortic dissection has severe chest pain and unequal arm
blood pressures. Which medication class should be initiated to reduce shear stress?
A. Beta-blocker
B. Thiazide diuretic
C. Nitrate only
D. Calcium supplement
Answer: A. Beta-blocker
Rationale: IV beta-blockade reduces heart rate and contractility, decreasing aortic wall shear
stress. Additional blood-pressure control may follow.
8. Which presentation is most consistent with right-sided heart failure?
A. Pulmonary edema only
B. Jugular venous distention and peripheral edema
C. Hemoptysis and wheezing
D. Dry mucous membranes
Answer: B. Jugular venous distention and peripheral edema
Rationale: Right-sided failure causes systemic venous congestion, commonly manifested by JVD,
peripheral edema, hepatomegaly, and ascites.
9. A patient taking warfarin has an INR of 7.5 without active bleeding. What is an appropriate
management consideration?
, A. Give another warfarin dose
B. Hold warfarin and assess bleeding risk/need for vitamin K
C. Immediately administer alteplase
D. Start heparin
Answer: B. Hold warfarin and assess bleeding risk/need for vitamin K
Rationale: A markedly supratherapeutic INR requires withholding warfarin and individualized
management based on INR level, bleeding status, and thrombotic risk.
10. Which biomarker is most specific for myocardial injury?
A. BNP
B. Troponin
C. D-dimer
D. Lactate
Answer: B. Troponin
Rationale: Cardiac troponins are highly sensitive and specific markers of myocardial injury and
are central to the evaluation of acute coronary syndrome.
11. A patient with acute pulmonary edema is severely hypertensive. Which treatment may
rapidly reduce preload and afterload?
A. IV nitroglycerin
B. IM epinephrine
C. Oral iron
D. IV potassium
Answer: A. IV nitroglycerin
Rationale: In hypertensive acute pulmonary edema, IV nitrates can rapidly reduce preload and,
at higher doses, afterload.
12. Which finding suggests tamponade physiology?
A. Hypertension and bradycardia
B. Hypotension, JVD, and muffled heart sounds
