NSG 6340 Predictor Study Guide: Comprehensive Q&A
(2025/2026 Syllabus)
Instructions: Use this guide to assess your knowledge across the core domains of the
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) curriculum. Each answer is
prefixed with ANSWER ✓ for clarity.
Section 1: Cardiology & ECG Interpretation
1. A 68-year-old patient with a history of HFrEF (LVEF 30%) presents with acute
dyspnea, bibasilar crackles, JVD, and an S3 gallop. Chest X-ray shows pulmonary
edema. What is the first-line intravenous medication for acute decompensated
heart failure in this scenario?
ANSWER ✓ Intravenous furosemide is the first-line agent for rapid diuresis and
symptom relief in acute decompensated heart failure with volume overload.
2. A patient's ECG shows a rhythm that is irregularly irregular, with no discernible
P waves, and a variable ventricular rate around 110 bpm. What is the most likely
diagnosis and the immediate primary goal of treatment?
ANSWER ✓ The diagnosis is Atrial Fibrillation with Rapid Ventricular Response. The
immediate primary goal is rate control using a beta-blocker (e.g., metoprolol) or a non-
dihydropyridine calcium channel blocker (e.g., diltiazem), provided the patient is
hemodynamically stable.
3. A 55-year-old male presents with sudden, tearing, radiating back pain and a
blood pressure of 180/100 in the right arm and 140/80 in the left arm. What is the
critical diagnosis you must rule out?
ANSWER ✓ Aortic Dissection (likely Stanford Type B). This is a medical emergency
requiring immediate CT angiography, blood pressure control with IV beta-blockers (e.g.,
labetalol), and surgical consultation.
4. What is the first-line, long-term anticoagulant for a patient with non-valvular
atrial fibrillation and a CHA₂DS₂-VASc score of 4?
ANSWER ✓ A Direct Oral Anticoagulant (DOAC) such as apixaban, rivaroxaban, or
dabigatran is preferred over warfarin due to a better safety profile and fewer drug
interactions.
5. A patient with chest pain has an ECG showing ST-segment elevation in leads II,
III, and aVF. What area of the heart is most likely affected?
, ANSWER ✓ The inferior wall of the left ventricle, typically supplied by the Right Coronary
Artery (RCA).
6. What is the initial dual antiplatelet therapy (DAPT) regimen for a patient after
percutaneous coronary intervention (PCI) with stent placement?
ANSWER ✓ Aspirin 81 mg daily indefinitely and a P2Y12 inhibitor (e.g., Clopidogrel,
Prasugrel, or Ticagrelor) for a duration typically between 6-12 months, depending on
the stent type and patient risk.
7. A patient with suspected NSTEMI has a troponin I level of 0.08 ng/mL (normal
<0.04). What is the next step in management?
ANSWER ✓ Admit the patient to a monitored bed, initiate DAPT, anticoagulation, and
serial troponin measurements. Risk stratification with a tool like the TIMI score is
essential.
8. What is the target LDL-C for a patient with established atherosclerotic
cardiovascular disease (ASCVD)?
ANSWER ✓ For high-risk secondary prevention, the target is an LDL-C reduction of
≥50% from baseline and an LDL-C level <55 mg/dL. A high-intensity statin (e.g.,
atorvastatin 40-80 mg) is first-line.
9. Describe the management of symptomatic bradycardia (HR 38, BP 88/50) with
confusion.
ANSWER ✓ This is a medical emergency. Administer Atropine 0.5 mg IV as first-line. If
ineffective, prepare for Transcutaneous Pacing (TCP) and consult Cardiology for possible
transvenous pacemaker placement.
10. What is the most common side effect of Amiodarone that requires long-term
monitoring?
ANSWER ✓ Pulmonary toxicity (interstitial pneumonitis) is the most serious. Other key
monitoring includes thyroid function tests (can cause hypo/hyperthyroidism), LFTs, and
ocular exams.
Section 2: Pulmonology & Critical Care
11. A patient with COPD on home O2 presents with increased dyspnea and
purulent sputum. What is the first-line treatment for an acute exacerbation of
COPD (AECOPHD)?
(2025/2026 Syllabus)
Instructions: Use this guide to assess your knowledge across the core domains of the
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) curriculum. Each answer is
prefixed with ANSWER ✓ for clarity.
Section 1: Cardiology & ECG Interpretation
1. A 68-year-old patient with a history of HFrEF (LVEF 30%) presents with acute
dyspnea, bibasilar crackles, JVD, and an S3 gallop. Chest X-ray shows pulmonary
edema. What is the first-line intravenous medication for acute decompensated
heart failure in this scenario?
ANSWER ✓ Intravenous furosemide is the first-line agent for rapid diuresis and
symptom relief in acute decompensated heart failure with volume overload.
2. A patient's ECG shows a rhythm that is irregularly irregular, with no discernible
P waves, and a variable ventricular rate around 110 bpm. What is the most likely
diagnosis and the immediate primary goal of treatment?
ANSWER ✓ The diagnosis is Atrial Fibrillation with Rapid Ventricular Response. The
immediate primary goal is rate control using a beta-blocker (e.g., metoprolol) or a non-
dihydropyridine calcium channel blocker (e.g., diltiazem), provided the patient is
hemodynamically stable.
3. A 55-year-old male presents with sudden, tearing, radiating back pain and a
blood pressure of 180/100 in the right arm and 140/80 in the left arm. What is the
critical diagnosis you must rule out?
ANSWER ✓ Aortic Dissection (likely Stanford Type B). This is a medical emergency
requiring immediate CT angiography, blood pressure control with IV beta-blockers (e.g.,
labetalol), and surgical consultation.
4. What is the first-line, long-term anticoagulant for a patient with non-valvular
atrial fibrillation and a CHA₂DS₂-VASc score of 4?
ANSWER ✓ A Direct Oral Anticoagulant (DOAC) such as apixaban, rivaroxaban, or
dabigatran is preferred over warfarin due to a better safety profile and fewer drug
interactions.
5. A patient with chest pain has an ECG showing ST-segment elevation in leads II,
III, and aVF. What area of the heart is most likely affected?
, ANSWER ✓ The inferior wall of the left ventricle, typically supplied by the Right Coronary
Artery (RCA).
6. What is the initial dual antiplatelet therapy (DAPT) regimen for a patient after
percutaneous coronary intervention (PCI) with stent placement?
ANSWER ✓ Aspirin 81 mg daily indefinitely and a P2Y12 inhibitor (e.g., Clopidogrel,
Prasugrel, or Ticagrelor) for a duration typically between 6-12 months, depending on
the stent type and patient risk.
7. A patient with suspected NSTEMI has a troponin I level of 0.08 ng/mL (normal
<0.04). What is the next step in management?
ANSWER ✓ Admit the patient to a monitored bed, initiate DAPT, anticoagulation, and
serial troponin measurements. Risk stratification with a tool like the TIMI score is
essential.
8. What is the target LDL-C for a patient with established atherosclerotic
cardiovascular disease (ASCVD)?
ANSWER ✓ For high-risk secondary prevention, the target is an LDL-C reduction of
≥50% from baseline and an LDL-C level <55 mg/dL. A high-intensity statin (e.g.,
atorvastatin 40-80 mg) is first-line.
9. Describe the management of symptomatic bradycardia (HR 38, BP 88/50) with
confusion.
ANSWER ✓ This is a medical emergency. Administer Atropine 0.5 mg IV as first-line. If
ineffective, prepare for Transcutaneous Pacing (TCP) and consult Cardiology for possible
transvenous pacemaker placement.
10. What is the most common side effect of Amiodarone that requires long-term
monitoring?
ANSWER ✓ Pulmonary toxicity (interstitial pneumonitis) is the most serious. Other key
monitoring includes thyroid function tests (can cause hypo/hyperthyroidism), LFTs, and
ocular exams.
Section 2: Pulmonology & Critical Care
11. A patient with COPD on home O2 presents with increased dyspnea and
purulent sputum. What is the first-line treatment for an acute exacerbation of
COPD (AECOPHD)?
