Barkley AGACNP-Style PRACTICE
QUESTIONS |ORIGINAL QUESTIONS &
ANSWERS |DETAILED RATIONALES
|HINTED COMPLETE EXAM PREP GRADED
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1. A 68-year-old patient presents with crushing substernal chest pain,
diaphoresis, and nausea. ECG demonstrates ST elevation in leads II,
III, and aVF. Which coronary artery is most likely involved?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior ST elevation in leads II, III, and aVF most
commonly reflects right coronary artery occlusion.
2. A patient with acute decompensated heart failure has severe
dyspnea, pulmonary crackles, and oxygen saturation of 84%. Which
medication provides rapid symptomatic reduction in pulmonary
congestion?
A. Metoprolol
B. IV loop diuretic
C. Spironolactone
D. Digoxin
Rationale: IV loop diuretics rapidly reduce intravascular volume and
pulmonary congestion in acute decompensated heart failure.
3. A patient with atrial fibrillation has hypotension, altered mental
status, and chest pain. What is the immediate treatment?
,A. IV metoprolol
B. IV amiodarone
C. Oral anticoagulation
D. Synchronized cardioversion
Rationale: Hemodynamically unstable atrial fibrillation requires
immediate synchronized cardioversion.
4. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Tall, peaked T waves
C. U waves
D. ST elevation in contiguous leads
Rationale: Early hyperkalemia classically produces tall, peaked T
waves; progressive toxicity may cause PR prolongation, QRS
widening, and sine-wave morphology.
5. A patient with acute STEMI is awaiting PCI. Which medication is
generally administered promptly unless contraindicated?
A. Warfarin
B. Aspirin
C. Digoxin
D. Verapamil
Rationale: Chewed aspirin rapidly inhibits platelet aggregation and is
a foundational therapy for acute coronary syndrome.
6. Which finding is most consistent with cardiogenic shock?
A. Warm extremities and bounding pulses
B. Bradycardia with hypertension
C. Hypotension with cool extremities and elevated filling pressures
D. Low systemic vascular resistance with warm skin
,Rationale: Cardiogenic shock is characterized by inadequate cardiac
output, hypotension, peripheral vasoconstriction, and elevated
cardiac filling pressures.
7. A patient develops sudden tearing chest pain radiating to the back
with unequal arm blood pressures. Which diagnosis is most
concerning?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Esophageal reflux
Rationale: Abrupt tearing pain radiating to the back with pulse or
blood-pressure asymmetry is highly concerning for acute aortic
dissection.
8. Which medication class improves survival in many patients with
heart failure with reduced ejection fraction?
A. Short-acting nitrates alone
B. Beta blockers with evidence-based heart-failure benefit
C. Non-dihydropyridine calcium-channel blockers
D. Thiazide diuretics alone
Rationale: Evidence-based beta blockers such as carvedilol,
metoprolol succinate, and bisoprolol reduce mortality in appropriate
patients with HFrEF.
9. A patient with suspected acute pericarditis has diffuse ST elevation
and PR depression. Which finding supports the diagnosis?
A. ST elevation limited to V1–V4
B. Diffuse concave ST elevation
C. Pathologic Q waves
D. Reciprocal ST elevation in the inferior leads only
, Rationale: Acute pericarditis commonly causes diffuse, concave ST
elevation with PR-segment depression.
10. Which assessment finding is most suggestive of cardiac
tamponade?
A. Hypertension, bradycardia, and irregular respirations
B. Hypotension, elevated JVP, and muffled heart sounds
C. Pulmonary edema and wide pulse pressure
D. Bounding peripheral pulses
Rationale: Beck's triad consists of hypotension, jugular venous
distention, and muffled heart sounds.
11. A patient taking digoxin develops nausea, visual disturbances,
and ventricular ectopy. Which electrolyte abnormality increases the
risk of digoxin toxicity?
A. Hypernatremia
B. Hyperchloremia
C. Hypokalemia
D. Hypermagnesemia
Rationale: Low potassium increases digoxin binding to the Na/K-
ATPase receptor and increases toxicity risk.
12. A patient has narrow-complex tachycardia at 190/min and
remains hemodynamically stable. Vagal maneuvers are unsuccessful.
Which medication is commonly used next?
A. Lidocaine
B. Amiodarone
C. Adenosine
D. Atropine
Rationale: Adenosine is first-line pharmacologic therapy for many
stable regular narrow-complex SVTs after vagal maneuvers fail.
QUESTIONS |ORIGINAL QUESTIONS &
ANSWERS |DETAILED RATIONALES
|HINTED COMPLETE EXAM PREP GRADED
A+*INSTANT DOWNLOAD PDF
1. A 68-year-old patient presents with crushing substernal chest pain,
diaphoresis, and nausea. ECG demonstrates ST elevation in leads II,
III, and aVF. Which coronary artery is most likely involved?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior ST elevation in leads II, III, and aVF most
commonly reflects right coronary artery occlusion.
2. A patient with acute decompensated heart failure has severe
dyspnea, pulmonary crackles, and oxygen saturation of 84%. Which
medication provides rapid symptomatic reduction in pulmonary
congestion?
A. Metoprolol
B. IV loop diuretic
C. Spironolactone
D. Digoxin
Rationale: IV loop diuretics rapidly reduce intravascular volume and
pulmonary congestion in acute decompensated heart failure.
3. A patient with atrial fibrillation has hypotension, altered mental
status, and chest pain. What is the immediate treatment?
,A. IV metoprolol
B. IV amiodarone
C. Oral anticoagulation
D. Synchronized cardioversion
Rationale: Hemodynamically unstable atrial fibrillation requires
immediate synchronized cardioversion.
4. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Tall, peaked T waves
C. U waves
D. ST elevation in contiguous leads
Rationale: Early hyperkalemia classically produces tall, peaked T
waves; progressive toxicity may cause PR prolongation, QRS
widening, and sine-wave morphology.
5. A patient with acute STEMI is awaiting PCI. Which medication is
generally administered promptly unless contraindicated?
A. Warfarin
B. Aspirin
C. Digoxin
D. Verapamil
Rationale: Chewed aspirin rapidly inhibits platelet aggregation and is
a foundational therapy for acute coronary syndrome.
6. Which finding is most consistent with cardiogenic shock?
A. Warm extremities and bounding pulses
B. Bradycardia with hypertension
C. Hypotension with cool extremities and elevated filling pressures
D. Low systemic vascular resistance with warm skin
,Rationale: Cardiogenic shock is characterized by inadequate cardiac
output, hypotension, peripheral vasoconstriction, and elevated
cardiac filling pressures.
7. A patient develops sudden tearing chest pain radiating to the back
with unequal arm blood pressures. Which diagnosis is most
concerning?
A. Acute pericarditis
B. Pulmonary embolism
C. Aortic dissection
D. Esophageal reflux
Rationale: Abrupt tearing pain radiating to the back with pulse or
blood-pressure asymmetry is highly concerning for acute aortic
dissection.
8. Which medication class improves survival in many patients with
heart failure with reduced ejection fraction?
A. Short-acting nitrates alone
B. Beta blockers with evidence-based heart-failure benefit
C. Non-dihydropyridine calcium-channel blockers
D. Thiazide diuretics alone
Rationale: Evidence-based beta blockers such as carvedilol,
metoprolol succinate, and bisoprolol reduce mortality in appropriate
patients with HFrEF.
9. A patient with suspected acute pericarditis has diffuse ST elevation
and PR depression. Which finding supports the diagnosis?
A. ST elevation limited to V1–V4
B. Diffuse concave ST elevation
C. Pathologic Q waves
D. Reciprocal ST elevation in the inferior leads only
, Rationale: Acute pericarditis commonly causes diffuse, concave ST
elevation with PR-segment depression.
10. Which assessment finding is most suggestive of cardiac
tamponade?
A. Hypertension, bradycardia, and irregular respirations
B. Hypotension, elevated JVP, and muffled heart sounds
C. Pulmonary edema and wide pulse pressure
D. Bounding peripheral pulses
Rationale: Beck's triad consists of hypotension, jugular venous
distention, and muffled heart sounds.
11. A patient taking digoxin develops nausea, visual disturbances,
and ventricular ectopy. Which electrolyte abnormality increases the
risk of digoxin toxicity?
A. Hypernatremia
B. Hyperchloremia
C. Hypokalemia
D. Hypermagnesemia
Rationale: Low potassium increases digoxin binding to the Na/K-
ATPase receptor and increases toxicity risk.
12. A patient has narrow-complex tachycardia at 190/min and
remains hemodynamically stable. Vagal maneuvers are unsuccessful.
Which medication is commonly used next?
A. Lidocaine
B. Amiodarone
C. Adenosine
D. Atropine
Rationale: Adenosine is first-line pharmacologic therapy for many
stable regular narrow-complex SVTs after vagal maneuvers fail.
