Cardiovascular critical care represents one of the most essential and frequently tested domains for Adult-Gerontology Acute Care Nurse Practitioners (AGACNP-BC), comprising a significant portion of the certification examination under Domain II: Clinical Practice. Mastery of cardiovascular critical care concepts is crucial for AGACNPs as they routinely manage complex cardiac conditions in intensive care units, emergency departments, and acute care settings where rapid assessment and intervention can be life-saving. The cardiovascular system’s intricate relationship with other organ systems means that cardiac emergencies often present with multi-system complications, requiring practitioners to demonstrate advanced pathophysiology knowledge, sophisticated diagnostic reasoning, and evidence-based treatment protocols. Key areas of focus include acute coronary syndromes, heart failure management, arrhythmia recognition and treatment, hemodynamic monitoring interpretation, and mechanical circulatory support devices. AGACNPs must be proficient in differentiating between various types of shock, understanding the pharmacokinetics and hemodynamic effects of vasoactive medications, and recognizing when invasive interventions are necessary. The ability to interpret complex diagnostic studies such as echocardiograms, cardiac catheterization results, and hemodynamic parameters from pulmonary artery catheters is essential for optimal patient outcomes. Furthermore, understanding the interplay between cardiovascular medications and their effects on other organ systems, particularly in elderly patients with multiple comorbidities, is critical for safe and effective practice. Contemporary cardiovascular critical care also emphasizes the importance of evidence-based protocols, quality improvement initiatives, and interprofessional collaboration to reduce mortality and improve patient outcomes. The AGACNP-BC examination tests not only clinical knowledge but also the application of research findings, ethical decision-making in end-of-life care, and the ability to educate patients and families about complex cardiovascular conditions and treatments.
Practice Questions
Question 1
A 68-year-old patient presents with acute decompensated heart failure. Which medication should be the first-line therapy for this patient?
A) Furosemide
B) Lisinopril
C) Metoprolol
D) Digoxin
Correct Answer: B) Lisinopril
Explanation: ACE inhibitors like lisinopril are first-line therapy for acute heart failure as they reduce afterload and preload, improving cardiac output while providing long-term cardiovascular protection.
Question 2
A patient in the ICU has a Swan-Ganz catheter in place. The pulmonary capillary wedge pressure (PCWP) reading is 22 mmHg. This finding is most consistent with:
A) Hypovolemia
B) Right heart failure
C) Left heart failure
D) Pulmonary embolism
Correct Answer: C) Left heart failure
Explanation: Normal PCWP is 6-12 mmHg. A PCWP >18 mmHg indicates elevated left atrial pressure, which is consistent with left heart failure or fluid overload.
Question 3
A 45-year-old patient presents with chest pain and ST-elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending (LAD)
B) Left circumflex (LCX)
C) Right coronary artery (RCA)
D) Left main coronary artery
Correct Answer: C) Right coronary artery (RCA)
Explanation: ST-elevation in leads II, III, and aVF indicates an inferior wall MI, which is typically caused by occlusion of the right coronary artery.
Question 4
A patient with cardiogenic shock requires vasopressor support. Which medication is the first-line vasopressor for cardiogenic shock?
A) Norepinephrine
B) Dopamine
C) Epinephrine
D) Vasopressin
Correct Answer: A) Norepinephrine
Explanation: Norepinephrine is the first-line vasopressor for cardiogenic shock as it provides both vasoconstriction and mild inotropic support without significantly increasing myocardial oxygen demand.
Question 5
A 72-year-old patient develops atrial fibrillation with rapid ventricular response (HR 150 bpm) and is hemodynamically stable. What is the most appropriate initial management?
A) Immediate cardioversion
B) Rate control with metoprolol
C) Anticoagulation with heparin
D) Amiodarone loading dose
Correct Answer: B) Rate control with metoprolol
Explanation: For hemodynamically stable patients with new-onset atrial fibrillation, rate control is the initial priority. Beta-blockers like metoprolol are first-line for rate control.
Question 6
A patient presents with acute chest pain and a blood pressure of 200/110 mmHg. The ECG shows ST-depression in leads V4-V6. What is the target blood pressure reduction in the first hour?
A) Reduce by 50%
B) Reduce by 25%
C) Reduce to <140/90 mmHg
D) Reduce by 10-20%
Correct Answer: D) Reduce by 10-20%
Explanation: In hypertensive emergencies with acute coronary syndrome, blood pressure should be reduced gradually by 10-20% in the first hour to avoid compromising coronary perfusion.
Question 7
A patient with acute MI develops mechanical complications. Which finding is most consistent with papillary muscle rupture?
A) New systolic murmur at the apex
B) Elevated jugular venous pressure
C) S3 gallop
D) Pericardial friction rub
Correct Answer: A) New systolic murmur at the apex
Explanation: Papillary muscle rupture causes acute mitral regurgitation, presenting as a new holosystolic murmur best heard at the apex, often with rapid hemodynamic deterioration.
Question 8
A 55-year-old patient is admitted with acute heart failure. The BNP level is 1,200 pg/mL. What does this finding indicate?
A) Normal cardiac function
B) Mild heart failure
C) Moderate to severe heart failure
D) Renal dysfunction
Correct Answer: C) Moderate to severe heart failure
Explanation: BNP levels >400 pg/mL indicate heart failure, with levels >1,000 pg/mL suggesting moderate to severe heart failure and correlating with worse prognosis.
Question 9
A patient with aortic stenosis develops syncope. What is the most likely mechanism?
A) Arrhythmia
B) Reduced cardiac output during exertion
C) Orthostatic hypotension
D) Vasovagal response
Correct Answer: B) Reduced cardiac output during exertion
Explanation: In severe aortic stenosis, the fixed obstruction prevents adequate increase in cardiac output during exertion, leading to cerebral hypoperfusion and syncope.
Question 10
A patient presents with acute pericarditis. Which ECG finding is most characteristic?
A) ST-elevation in leads II, III, aVF
B) Diffuse ST-elevation with PR depression
C) Q-waves in anterior leads
D) T-wave inversions in lateral leads
Correct Answer: B) Diffuse ST-elevation with PR depression
Explanation: Acute pericarditis typically shows diffuse ST-elevation (not localized to a coronary distribution) with PR segment depression, distinguishing it from acute MI.
Question 11
A patient with heart failure is started on spironolactone. What laboratory value requires the most frequent monitoring?
A) Sodium
B) Potassium
C) Magnesium
D) Phosphorus
Correct Answer: B) Potassium
Explanation: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, especially in patients with renal dysfunction or those taking ACE inhibitors or ARBs.
Question 12
A 60-year-old patient develops cardiogenic pulmonary edema. Which position is most appropriate?
A) Trendelenburg position
B) Supine with legs elevated
C) High Fowler’s position
D) Left lateral decubitus
Correct Answer: C) High Fowler’s position
Explanation: High Fowler’s position (sitting upright at 90 degrees) reduces venous return and improves respiratory mechanics in patients with acute pulmonary edema.
Question 13
A patient with acute coronary syndrome is allergic to aspirin. What is the most appropriate antiplatelet alternative?
A) Warfarin
B) Clopidogrel
C) Heparin
D) Ticagrelor
Correct Answer: B) Clopidogrel
Explanation: Clopidogrel is the preferred alternative antiplatelet agent for patients with aspirin allergy in acute coronary syndrome, providing similar cardiovascular protection.
Question 14
A patient presents with chest pain and elevated troponin but normal coronary arteries on angiography. What is the most likely diagnosis?
A) Unstable angina
B) Takotsubo cardiomyopathy
C) Aortic dissection
D) Pulmonary embolism
Correct Answer: B) Takotsubo cardiomyopathy
Explanation: Takotsubo cardiomyopathy (stress cardiomyopathy) presents with chest pain, elevated cardiac enzymes, and ECG changes but normal coronary arteries, often triggered by emotional or physical stress.
Question 15
A patient with acute heart failure has a serum creatinine of 2.5 mg/dL. Which diuretic adjustment is most appropriate?
A) Discontinue all diuretics
B) Switch to a thiazide diuretic
C) Increase loop diuretic dose
D) Add acetazolamide
Correct Answer: C) Increase loop diuretic dose
Explanation: In heart failure patients with renal dysfunction, higher doses of loop diuretics are often needed to achieve adequate diuresis due to decreased drug delivery to the site of action in the kidney.
Summary
These practice questions cover essential cardiovascular critical care topics for the AGACNP-BC examination, including acute coronary syndromes, heart failure management, hemodynamic monitoring, arrhythmias, and pharmacological interventions. Regular practice with these types of questions will help reinforce key concepts and improve test-taking strategies for certification success.