Barkley AGACNP Practice ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Cardiovascular & Hemodynamic Management
Question 1
A 74-year-old male with a history of CHF presents with an audible S3 gallop and increased
jugular venous distention. This finding most likely indicates:
A. Left ventricular hypertrophy
B. Fluid volume overload
C. Right bundle branch block
D. Normal aging
Correct Answer: B. Fluid volume overload
Rationale: The S3 heart sound is a classic sign of fluid volume overload in heart failure patients,
caused by blood rushing into a distended ventricle during early diastole .
Question 2
A patient with suspected mitral regurgitation presents for evaluation. What physical finding
confirms mitral regurgitation?
A. Loud S1 systolic murmur
B. S3 with systolic murmur
C. Harsh systolic murmur radiating to the neck
D. Low diastolic rumble murmur in left lateral position
Correct Answer: B. S3 with systolic murmur
Rationale: Mitral regurgitation is confirmed by a systolic murmur at the apex that radiates to
the axilla, often accompanied by an S3 gallop due to volume overload of the left ventricle .
,Question 3
A patient with suspected mitral stenosis presents for evaluation. What physical finding is most
consistent with this diagnosis?
A. S3 with systolic murmur
B. Loud S1 and opening snap with diastolic rumble
C. Harsh systolic murmur radiating to neck
D. Systolic ejection murmur
Correct Answer: B. Loud S1 and opening snap with diastolic rumble
Rationale: Mitral stenosis is characterized by a low-pitched diastolic rumble heard at the apex
with the patient in the left lateral position. An opening snap and loud S1 are also classic
findings .
Question 4
A 54-year-old male s/p AMI is on levophed, epinephrine, vasopressin, and NTG. BP drops from
160/75 to 81/50. Which medication should the nurse practitioner decrease?
A. Levophed
B. Epinephrine
C. Vasopressin
D. Nitroglycerin
Correct Answer: D. Nitroglycerin
Rationale: Nitroglycerin is a potent vasodilator that decreases preload and afterload. In a
patient with acute hypotension (BP 81/50), nitroglycerin should be reduced or discontinued to
prevent further hypotension .
Question 5
Which medication's mechanism of action is inaccurately described?
A. Enalapril decreases HR, BP, and myocardial oxygen demands
B. Nitroglycerin decreases venous return and myocardial oxygen requirements
C. Verapamil decreases myocardial contractility and systemic vascular resistance
D. Ramipril may cause cough and/or bronchospasm as a side effect
Correct Answer: A. Enalapril decreases HR, BP, and myocardial oxygen demands
Rationale: Enalapril (ACE inhibitor) decreases blood pressure and myocardial oxygen demands
by reducing afterload and preload, but it does NOT significantly decrease heart rate .
,Question 6
A 65-year-old with chest pain shows ST-elevation in leads II, III, and aVF. Which artery is
occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Circumflex
D. Left Main
Correct Answer: B. Right Coronary Artery (RCA)
Rationale: Elevation in leads II, III, and aVF signifies an inferior wall myocardial infarction,
typically involving the RCA .
Question 7
A patient in cardiogenic shock has which hemodynamic profile?
A. High CI, low SVR, high PCWP
B. Low CI, high SVR, high PCWP
C. Low CI, low SVR, low PCWP
D. High CI, high SVR, normal PCWP
Correct Answer: B. Low CI, high SVR, high PCWP
Rationale: Cardiogenic shock presents with low cardiac index (reduced forward flow), high
afterload (compensatory vasoconstriction/SVR), and pulmonary congestion (high wedge
pressure/PCWP).
Question 8
Which vasopressor is considered first-line for a patient in septic shock who remains hypotensive
despite adequate fluid resuscitation?
A. Epinephrine
B. Norepinephrine
C. Phenylephrine
D. Dopamine
Correct Answer: B. Norepinephrine
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock to achieve a
target MAP of ≥65 mmHg due to its potent alpha-1 effects .
, Question 9
A patient on warfarin has an INR of 5.2 without bleeding. What is the appropriate
management?
A. Hold warfarin and administer vitamin K 2.5 mg PO
B. Hold warfarin and recheck INR in 24 hours
C. Hold warfarin and administer prothrombin complex concentrate
D. Continue warfarin; INR is within therapeutic range
Correct Answer: B. Hold warfarin and recheck INR in 24 hours
Rationale: For an elevated INR >5.0 but <9.0 in a patient without bleeding, hold warfarin and
recheck INR. Vitamin K is indicated for INR >10 or signs of bleeding .
Question 10
A 72-year-old woman with heart failure and reduced ejection fraction is started on
spironolactone. What is the most important monitoring parameter?
A. Blood pressure
B. Potassium level
C. BUN
D. Heart rate
Correct Answer: B. Potassium level
Rationale: Spironolactone is a potassium-sparing diuretic that can cause life-threatening
hyperkalemia, especially in patients with impaired renal function. Potassium levels should be
monitored closely.
Question 11
A 58-year-old man with ST-elevation MI undergoes PCI with drug-eluting stent placement. What
is the recommended duration of dual antiplatelet therapy?
A. 1 month
B. 6 months
C. 12 months
D. Lifelong
Correct Answer: C. 12 months
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Cardiovascular & Hemodynamic Management
Question 1
A 74-year-old male with a history of CHF presents with an audible S3 gallop and increased
jugular venous distention. This finding most likely indicates:
A. Left ventricular hypertrophy
B. Fluid volume overload
C. Right bundle branch block
D. Normal aging
Correct Answer: B. Fluid volume overload
Rationale: The S3 heart sound is a classic sign of fluid volume overload in heart failure patients,
caused by blood rushing into a distended ventricle during early diastole .
Question 2
A patient with suspected mitral regurgitation presents for evaluation. What physical finding
confirms mitral regurgitation?
A. Loud S1 systolic murmur
B. S3 with systolic murmur
C. Harsh systolic murmur radiating to the neck
D. Low diastolic rumble murmur in left lateral position
Correct Answer: B. S3 with systolic murmur
Rationale: Mitral regurgitation is confirmed by a systolic murmur at the apex that radiates to
the axilla, often accompanied by an S3 gallop due to volume overload of the left ventricle .
,Question 3
A patient with suspected mitral stenosis presents for evaluation. What physical finding is most
consistent with this diagnosis?
A. S3 with systolic murmur
B. Loud S1 and opening snap with diastolic rumble
C. Harsh systolic murmur radiating to neck
D. Systolic ejection murmur
Correct Answer: B. Loud S1 and opening snap with diastolic rumble
Rationale: Mitral stenosis is characterized by a low-pitched diastolic rumble heard at the apex
with the patient in the left lateral position. An opening snap and loud S1 are also classic
findings .
Question 4
A 54-year-old male s/p AMI is on levophed, epinephrine, vasopressin, and NTG. BP drops from
160/75 to 81/50. Which medication should the nurse practitioner decrease?
A. Levophed
B. Epinephrine
C. Vasopressin
D. Nitroglycerin
Correct Answer: D. Nitroglycerin
Rationale: Nitroglycerin is a potent vasodilator that decreases preload and afterload. In a
patient with acute hypotension (BP 81/50), nitroglycerin should be reduced or discontinued to
prevent further hypotension .
Question 5
Which medication's mechanism of action is inaccurately described?
A. Enalapril decreases HR, BP, and myocardial oxygen demands
B. Nitroglycerin decreases venous return and myocardial oxygen requirements
C. Verapamil decreases myocardial contractility and systemic vascular resistance
D. Ramipril may cause cough and/or bronchospasm as a side effect
Correct Answer: A. Enalapril decreases HR, BP, and myocardial oxygen demands
Rationale: Enalapril (ACE inhibitor) decreases blood pressure and myocardial oxygen demands
by reducing afterload and preload, but it does NOT significantly decrease heart rate .
,Question 6
A 65-year-old with chest pain shows ST-elevation in leads II, III, and aVF. Which artery is
occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Circumflex
D. Left Main
Correct Answer: B. Right Coronary Artery (RCA)
Rationale: Elevation in leads II, III, and aVF signifies an inferior wall myocardial infarction,
typically involving the RCA .
Question 7
A patient in cardiogenic shock has which hemodynamic profile?
A. High CI, low SVR, high PCWP
B. Low CI, high SVR, high PCWP
C. Low CI, low SVR, low PCWP
D. High CI, high SVR, normal PCWP
Correct Answer: B. Low CI, high SVR, high PCWP
Rationale: Cardiogenic shock presents with low cardiac index (reduced forward flow), high
afterload (compensatory vasoconstriction/SVR), and pulmonary congestion (high wedge
pressure/PCWP).
Question 8
Which vasopressor is considered first-line for a patient in septic shock who remains hypotensive
despite adequate fluid resuscitation?
A. Epinephrine
B. Norepinephrine
C. Phenylephrine
D. Dopamine
Correct Answer: B. Norepinephrine
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock to achieve a
target MAP of ≥65 mmHg due to its potent alpha-1 effects .
, Question 9
A patient on warfarin has an INR of 5.2 without bleeding. What is the appropriate
management?
A. Hold warfarin and administer vitamin K 2.5 mg PO
B. Hold warfarin and recheck INR in 24 hours
C. Hold warfarin and administer prothrombin complex concentrate
D. Continue warfarin; INR is within therapeutic range
Correct Answer: B. Hold warfarin and recheck INR in 24 hours
Rationale: For an elevated INR >5.0 but <9.0 in a patient without bleeding, hold warfarin and
recheck INR. Vitamin K is indicated for INR >10 or signs of bleeding .
Question 10
A 72-year-old woman with heart failure and reduced ejection fraction is started on
spironolactone. What is the most important monitoring parameter?
A. Blood pressure
B. Potassium level
C. BUN
D. Heart rate
Correct Answer: B. Potassium level
Rationale: Spironolactone is a potassium-sparing diuretic that can cause life-threatening
hyperkalemia, especially in patients with impaired renal function. Potassium levels should be
monitored closely.
Question 11
A 58-year-old man with ST-elevation MI undergoes PCI with drug-eluting stent placement. What
is the recommended duration of dual antiplatelet therapy?
A. 1 month
B. 6 months
C. 12 months
D. Lifelong
Correct Answer: C. 12 months
