Barkley AGPCNP Review ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+,
Questions 1–25: Cardiovascular & Pulmonary
1. Hypertension
A 68-year-old patient has a blood pressure of 168/94 mmHg on two separate office visits. Which
diagnosis is most appropriate?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 2 hypertension
D. Hypertensive emergency
Answer: C. Stage 2 hypertension
Rationale: A persistent BP ≥140/90 mmHg meets the traditional definition of hypertension, with
168/94 representing stage 2 hypertension. A hypertensive emergency requires severe BP
elevation plus acute target-organ damage.
2. Hypertensive Emergency
A 74-year-old patient presents with BP 218/122 mmHg, severe headache, confusion, and new
right-sided weakness. What is the priority?
A. Recheck BP in 1 month
B. Start oral hydrochlorothiazide
C. Send the patient for emergency evaluation
D. Recommend dietary sodium restriction
Answer: C. Send the patient for emergency evaluation
,Rationale: Severe hypertension accompanied by neurologic symptoms suggests possible acute
target-organ injury such as stroke. This requires immediate emergency evaluation rather than
outpatient management.
3. ACE Inhibitor Adverse Effect
A patient taking lisinopril develops persistent dry cough. Which medication is the most
appropriate alternative?
A. Losartan
B. Propranolol
C. Furosemide
D. Diltiazem
Answer: A. Losartan
Rationale: ACE inhibitors can cause a persistent dry cough because of increased bradykinin. An
ARB such as losartan provides renin-angiotensin system blockade without the same frequency
of cough.
4. Heart Failure
Which finding is most concerning for acute decompensated heart failure?
A. Mild ankle edema after prolonged standing
B. Orthopnea and rapidly increasing dyspnea
C. Occasional palpitations
D. BP of 128/76 mmHg
Answer: B. Orthopnea and rapidly increasing dyspnea
Rationale: New or worsening orthopnea and dyspnea can indicate pulmonary congestion and
acute heart failure exacerbation.
5. Stable Angina
A 67-year-old patient reports predictable chest pressure when walking uphill that resolves after
resting. What does this presentation most strongly suggest?
,A. Stable angina
B. Acute pericarditis
C. Pulmonary embolism
D. Aortic dissection
Answer: A. Stable angina
Rationale: Predictable exertional chest discomfort relieved by rest is classic for stable angina
caused by myocardial oxygen supply-demand mismatch.
6. Acute Coronary Syndrome
Which symptom in an older adult should raise strong concern for acute coronary syndrome
even without classic chest pain?
A. Mild rhinorrhea
B. Unexplained dyspnea and diaphoresis
C. Chronic knee pain
D. Increased appetite
Answer: B. Unexplained dyspnea and diaphoresis
Rationale: Older adults may present atypically with dyspnea, fatigue, nausea, diaphoresis, or
weakness rather than classic chest pain.
7. Atrial Fibrillation
A 79-year-old patient has an irregularly irregular pulse. ECG confirms atrial fibrillation. What
major complication must be assessed for?
A. Pneumothorax
B. Stroke
C. Peptic ulcer disease
D. Cataracts
Answer: B. Stroke
Rationale: Atrial fibrillation promotes atrial thrombus formation and increases embolic stroke
risk. Stroke-risk assessment and appropriate anticoagulation consideration are essential.
, 8. Anticoagulation
A patient taking warfarin requires monitoring of which laboratory test?
A. INR
B. Troponin
C. HbA1c
D. Amylase
Answer: A. INR
Rationale: INR is used to monitor the therapeutic effect of warfarin and guide dose adjustment.
9. Statin Therapy
Which laboratory abnormality is particularly important to evaluate when monitoring a patient
taking a statin?
A. Liver enzymes when clinically indicated
B. Serum sodium every week
C. Troponin every month
D. Amylase every week
Answer: A. Liver enzymes when clinically indicated
Rationale: Statins can rarely cause clinically significant hepatotoxicity. Baseline assessment and
follow-up when symptoms or clinical indications occur are appropriate.
10. Peripheral Arterial Disease
A patient reports calf pain that consistently occurs while walking and resolves after several
minutes of rest. This is most consistent with:
A. Venous insufficiency
B. Intermittent claudication
C. Cellulitis
D. Neuropathy
Answer: B. Intermittent claudication
Rationale: Exertional muscle pain relieved by rest is characteristic of peripheral arterial disease.
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+,
Questions 1–25: Cardiovascular & Pulmonary
1. Hypertension
A 68-year-old patient has a blood pressure of 168/94 mmHg on two separate office visits. Which
diagnosis is most appropriate?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 2 hypertension
D. Hypertensive emergency
Answer: C. Stage 2 hypertension
Rationale: A persistent BP ≥140/90 mmHg meets the traditional definition of hypertension, with
168/94 representing stage 2 hypertension. A hypertensive emergency requires severe BP
elevation plus acute target-organ damage.
2. Hypertensive Emergency
A 74-year-old patient presents with BP 218/122 mmHg, severe headache, confusion, and new
right-sided weakness. What is the priority?
A. Recheck BP in 1 month
B. Start oral hydrochlorothiazide
C. Send the patient for emergency evaluation
D. Recommend dietary sodium restriction
Answer: C. Send the patient for emergency evaluation
,Rationale: Severe hypertension accompanied by neurologic symptoms suggests possible acute
target-organ injury such as stroke. This requires immediate emergency evaluation rather than
outpatient management.
3. ACE Inhibitor Adverse Effect
A patient taking lisinopril develops persistent dry cough. Which medication is the most
appropriate alternative?
A. Losartan
B. Propranolol
C. Furosemide
D. Diltiazem
Answer: A. Losartan
Rationale: ACE inhibitors can cause a persistent dry cough because of increased bradykinin. An
ARB such as losartan provides renin-angiotensin system blockade without the same frequency
of cough.
4. Heart Failure
Which finding is most concerning for acute decompensated heart failure?
A. Mild ankle edema after prolonged standing
B. Orthopnea and rapidly increasing dyspnea
C. Occasional palpitations
D. BP of 128/76 mmHg
Answer: B. Orthopnea and rapidly increasing dyspnea
Rationale: New or worsening orthopnea and dyspnea can indicate pulmonary congestion and
acute heart failure exacerbation.
5. Stable Angina
A 67-year-old patient reports predictable chest pressure when walking uphill that resolves after
resting. What does this presentation most strongly suggest?
,A. Stable angina
B. Acute pericarditis
C. Pulmonary embolism
D. Aortic dissection
Answer: A. Stable angina
Rationale: Predictable exertional chest discomfort relieved by rest is classic for stable angina
caused by myocardial oxygen supply-demand mismatch.
6. Acute Coronary Syndrome
Which symptom in an older adult should raise strong concern for acute coronary syndrome
even without classic chest pain?
A. Mild rhinorrhea
B. Unexplained dyspnea and diaphoresis
C. Chronic knee pain
D. Increased appetite
Answer: B. Unexplained dyspnea and diaphoresis
Rationale: Older adults may present atypically with dyspnea, fatigue, nausea, diaphoresis, or
weakness rather than classic chest pain.
7. Atrial Fibrillation
A 79-year-old patient has an irregularly irregular pulse. ECG confirms atrial fibrillation. What
major complication must be assessed for?
A. Pneumothorax
B. Stroke
C. Peptic ulcer disease
D. Cataracts
Answer: B. Stroke
Rationale: Atrial fibrillation promotes atrial thrombus formation and increases embolic stroke
risk. Stroke-risk assessment and appropriate anticoagulation consideration are essential.
, 8. Anticoagulation
A patient taking warfarin requires monitoring of which laboratory test?
A. INR
B. Troponin
C. HbA1c
D. Amylase
Answer: A. INR
Rationale: INR is used to monitor the therapeutic effect of warfarin and guide dose adjustment.
9. Statin Therapy
Which laboratory abnormality is particularly important to evaluate when monitoring a patient
taking a statin?
A. Liver enzymes when clinically indicated
B. Serum sodium every week
C. Troponin every month
D. Amylase every week
Answer: A. Liver enzymes when clinically indicated
Rationale: Statins can rarely cause clinically significant hepatotoxicity. Baseline assessment and
follow-up when symptoms or clinical indications occur are appropriate.
10. Peripheral Arterial Disease
A patient reports calf pain that consistently occurs while walking and resolves after several
minutes of rest. This is most consistent with:
A. Venous insufficiency
B. Intermittent claudication
C. Cellulitis
D. Neuropathy
Answer: B. Intermittent claudication
Rationale: Exertional muscle pain relieved by rest is characteristic of peripheral arterial disease.
