Barkley AGACNP Predictor/Readiness FLORIDA
STATE FIRE INSTRUCTOR 3 ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
.
Section 1: Cardiovascular System (Questions 1-25)
Question 1
A 72-year-old male with a history of CAD presents with crushing substernal chest pain radiating
to the left arm. What is the MOST appropriate initial intervention?
A. Administer morphine IV
B. Administer 325 mg aspirin PO
C. Start heparin infusion
D. Obtain cardiac enzymes
Correct Answer: B
Rationale: Aspirin should be administered immediately to inhibit platelet aggregation and
reduce mortality in acute MI. Other interventions (morphine, heparin, enzymes) follow
afterward.
Question 2
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the best management to
reduce stroke risk?
A. No anticoagulation needed
B. Dual antiplatelet therapy
C. Oral anticoagulation (e.g., apixaban)
D. Rate control with beta-blocker
Correct Answer: C
,Rationale: A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants oral anticoagulation to
reduce stroke risk. Antiplatelet therapy alone is insufficient.
Question 3
A 65-year-old male 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
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 4
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
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 5
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
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 6
In cardiogenic shock, which hemodynamic profile is expected?
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
Rationale: Cardiogenic shock presents with low cardiac index (reduced forward flow), high
afterload (compensatory vasoconstriction/SVR), and pulmonary congestion (high wedge
pressure/PCWP).
Question 7
Which ECG finding is most suggestive of pericarditis?
A. ST elevation in V1-V4
B. Diffuse ST elevation and PR depression
C. ST depression in leads II, III, aVF
D. T-wave inversion only in V5-V6
Correct Answer: B
Rationale: Pericarditis classically shows diffuse ST elevation and PR depression across multiple
leads (not localized like MI).
Question 8
A patient with decompensated HFrEF is admitted. Which medication improves long-term
mortality?
, A. IV furosemide
B. Digoxin
C. Sacubitril/valsartan
D. IV milrinone
Correct Answer: C
Rationale: ARNI (sacubitril/valsartan) improves survival in HFrEF, while diuretics and inotropes
only provide symptomatic relief without mortality benefit.
Question 9
The best diagnostic imaging for suspected aortic dissection is:
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. MRI of the chest
D. Transesophageal echocardiogram
Correct Answer: B
Rationale: CT angiography of the chest is the preferred initial imaging modality for aortic
dissection due to rapid acquisition and high sensitivity. TEE is an alternative but is invasive.
Question 10
A 62-year-old male with end-stage renal disease on hemodialysis presents with chest pain. ECG
shows peaked T waves and wide QRS complexes. Potassium level is 6.8 mEq/L. What is the
priority intervention?
A. Calcium gluconate IV
B. Insulin with dextrose IV
C. Sodium bicarbonate IV
D. Albuterol nebulized
Correct Answer: A
Rationale: Hyperkalemia with ECG changes (peaked T waves, wide QRS) is a life-threatening
emergency. Calcium gluconate stabilizes the cardiac membrane and should be given first. Insulin
with dextrose and other measures shift potassium intracellularly but take longer to work.
STATE FIRE INSTRUCTOR 3 ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
.
Section 1: Cardiovascular System (Questions 1-25)
Question 1
A 72-year-old male with a history of CAD presents with crushing substernal chest pain radiating
to the left arm. What is the MOST appropriate initial intervention?
A. Administer morphine IV
B. Administer 325 mg aspirin PO
C. Start heparin infusion
D. Obtain cardiac enzymes
Correct Answer: B
Rationale: Aspirin should be administered immediately to inhibit platelet aggregation and
reduce mortality in acute MI. Other interventions (morphine, heparin, enzymes) follow
afterward.
Question 2
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the best management to
reduce stroke risk?
A. No anticoagulation needed
B. Dual antiplatelet therapy
C. Oral anticoagulation (e.g., apixaban)
D. Rate control with beta-blocker
Correct Answer: C
,Rationale: A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants oral anticoagulation to
reduce stroke risk. Antiplatelet therapy alone is insufficient.
Question 3
A 65-year-old male 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
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 4
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
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 5
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
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 6
In cardiogenic shock, which hemodynamic profile is expected?
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
Rationale: Cardiogenic shock presents with low cardiac index (reduced forward flow), high
afterload (compensatory vasoconstriction/SVR), and pulmonary congestion (high wedge
pressure/PCWP).
Question 7
Which ECG finding is most suggestive of pericarditis?
A. ST elevation in V1-V4
B. Diffuse ST elevation and PR depression
C. ST depression in leads II, III, aVF
D. T-wave inversion only in V5-V6
Correct Answer: B
Rationale: Pericarditis classically shows diffuse ST elevation and PR depression across multiple
leads (not localized like MI).
Question 8
A patient with decompensated HFrEF is admitted. Which medication improves long-term
mortality?
, A. IV furosemide
B. Digoxin
C. Sacubitril/valsartan
D. IV milrinone
Correct Answer: C
Rationale: ARNI (sacubitril/valsartan) improves survival in HFrEF, while diuretics and inotropes
only provide symptomatic relief without mortality benefit.
Question 9
The best diagnostic imaging for suspected aortic dissection is:
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. MRI of the chest
D. Transesophageal echocardiogram
Correct Answer: B
Rationale: CT angiography of the chest is the preferred initial imaging modality for aortic
dissection due to rapid acquisition and high sensitivity. TEE is an alternative but is invasive.
Question 10
A 62-year-old male with end-stage renal disease on hemodialysis presents with chest pain. ECG
shows peaked T waves and wide QRS complexes. Potassium level is 6.8 mEq/L. What is the
priority intervention?
A. Calcium gluconate IV
B. Insulin with dextrose IV
C. Sodium bicarbonate IV
D. Albuterol nebulized
Correct Answer: A
Rationale: Hyperkalemia with ECG changes (peaked T waves, wide QRS) is a life-threatening
emergency. Calcium gluconate stabilizes the cardiac membrane and should be given first. Insulin
with dextrose and other measures shift potassium intracellularly but take longer to work.
