Barkley Adult-Gerontology
Acute Care NP (AGACNP)
Review Practice Questions
with Answers & Detailed
Rationales
EXAM OVERVIEW
The Adult-Gerontology Acute Care Nurse Practitioner
(AGACNP) certification exam (offered by ANCC or AACN) assesses
advanced practice knowledge across the lifespan in acute and critical
care settings. The exam consists of 175-200 questions completed
within 3-4 hours.
Content Domain Approximate Percentage
Clinical Judgment & Practice 80%
Professional Role & Ethics 20%
Key Content Areas: Cardiovascular (15%), Respiratory (11%),
Renal/Genitourinary, Endocrine (5%), Gastrointestinal, Neurologic,
Hematology/Immunology/Oncology (6%), Infectious Disease,
Multisystem/Failure, and Professional Practice.
,SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–20)
1. A 68-year-old male with a history of hypertension and type 2
diabetes presents with substernal chest pressure radiating to the
jaw, diaphoresis, and nausea. ECG shows 2-mm ST-segment
elevation in leads V1–V4. What is the priority intervention?
A. Administer sublingual nitroglycerin
B. Obtain cardiac enzymes
C. Initiate immediate reperfusion therapy
D. Administer morphine sulfate
Correct Answer: C — Initiate immediate reperfusion therapy
Rationale: ST-segment elevation in V1–V4 indicates an acute anterior
wall ST-elevation myocardial infarction (STEMI). The priority is
immediate reperfusion therapy (PCI or thrombolytics) to restore blood
flow and minimize myocardial damage. "Time is muscle." Nitroglycerin
(A) and morphine (D) are symptomatic treatments but do not address the
underlying occlusion. Cardiac enzymes (B) confirm the diagnosis but
should not delay reperfusion.
2. A 72-year-old female with heart failure presents with worsening
dyspnea, orthopnea, and 3+ pitting edema. Her BNP is 1,200 pg/mL.
Which medication should be initiated first?
A. Digoxin
B. Furosemide
,C. Metoprolol succinate
D. Lisinopril
Correct Answer: B — Furosemide
Rationale: The patient has acute decompensated heart failure with fluid
overload. A loop diuretic (furosemide) is the first-line intervention to
reduce preload and relieve congestion. Digoxin (A) is used for symptom
control in HFrEF but is not first-line. Metoprolol (C) and lisinopril (D) are
chronic HF therapies and should not be initiated in the acute
decompensated state.
3. A 65-year-old male with atrial fibrillation is on warfarin. His INR is
5.2. He has no signs of bleeding. What is the most appropriate
management?
A. Administer vitamin K 2.5 mg PO
B. Hold warfarin and recheck INR tomorrow
C. Administer fresh frozen plasma
D. Administer prothrombin complex concentrate
Correct Answer: B — Hold warfarin and recheck INR tomorrow
Rationale: For an INR of 5.0–9.0 without bleeding, the recommended
management is to hold warfarin and recheck INR the next day. Vitamin K
(A) is indicated for INR >10 or with bleeding. FFP (C) and PCC (D) are for
life-threatening bleeding or emergent reversal.
, 4. A 74-year-old male with a history of aortic stenosis presents with
syncope and exertional dyspnea. On auscultation, you hear a harsh,
crescendo-decrescendo systolic ejection murmur at the right upper
sternal border. What is the most appropriate next step?
A. Order a transthoracic echocardiogram
B. Prescribe a beta-blocker
C. Schedule for cardiac catheterization
D. Start an ACE inhibitor
Correct Answer: A — Order a transthoracic echocardiogram
Rationale: This presentation is classic for severe aortic stenosis. An
echocardiogram is the gold standard for diagnosis, assessing valve area,
gradient, and left ventricular function. Beta-blockers (B) and ACE
inhibitors (C) are contraindicated in severe AS as they can precipitate
hypotension and syncope.
5. A 62-year-old female presents with acute onset of severe, tearing
chest pain radiating to the back. Blood pressure is 198/104 mmHg in
the right arm and 152/88 mmHg in the left arm. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C — Aortic dissection
Acute Care NP (AGACNP)
Review Practice Questions
with Answers & Detailed
Rationales
EXAM OVERVIEW
The Adult-Gerontology Acute Care Nurse Practitioner
(AGACNP) certification exam (offered by ANCC or AACN) assesses
advanced practice knowledge across the lifespan in acute and critical
care settings. The exam consists of 175-200 questions completed
within 3-4 hours.
Content Domain Approximate Percentage
Clinical Judgment & Practice 80%
Professional Role & Ethics 20%
Key Content Areas: Cardiovascular (15%), Respiratory (11%),
Renal/Genitourinary, Endocrine (5%), Gastrointestinal, Neurologic,
Hematology/Immunology/Oncology (6%), Infectious Disease,
Multisystem/Failure, and Professional Practice.
,SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–20)
1. A 68-year-old male with a history of hypertension and type 2
diabetes presents with substernal chest pressure radiating to the
jaw, diaphoresis, and nausea. ECG shows 2-mm ST-segment
elevation in leads V1–V4. What is the priority intervention?
A. Administer sublingual nitroglycerin
B. Obtain cardiac enzymes
C. Initiate immediate reperfusion therapy
D. Administer morphine sulfate
Correct Answer: C — Initiate immediate reperfusion therapy
Rationale: ST-segment elevation in V1–V4 indicates an acute anterior
wall ST-elevation myocardial infarction (STEMI). The priority is
immediate reperfusion therapy (PCI or thrombolytics) to restore blood
flow and minimize myocardial damage. "Time is muscle." Nitroglycerin
(A) and morphine (D) are symptomatic treatments but do not address the
underlying occlusion. Cardiac enzymes (B) confirm the diagnosis but
should not delay reperfusion.
2. A 72-year-old female with heart failure presents with worsening
dyspnea, orthopnea, and 3+ pitting edema. Her BNP is 1,200 pg/mL.
Which medication should be initiated first?
A. Digoxin
B. Furosemide
,C. Metoprolol succinate
D. Lisinopril
Correct Answer: B — Furosemide
Rationale: The patient has acute decompensated heart failure with fluid
overload. A loop diuretic (furosemide) is the first-line intervention to
reduce preload and relieve congestion. Digoxin (A) is used for symptom
control in HFrEF but is not first-line. Metoprolol (C) and lisinopril (D) are
chronic HF therapies and should not be initiated in the acute
decompensated state.
3. A 65-year-old male with atrial fibrillation is on warfarin. His INR is
5.2. He has no signs of bleeding. What is the most appropriate
management?
A. Administer vitamin K 2.5 mg PO
B. Hold warfarin and recheck INR tomorrow
C. Administer fresh frozen plasma
D. Administer prothrombin complex concentrate
Correct Answer: B — Hold warfarin and recheck INR tomorrow
Rationale: For an INR of 5.0–9.0 without bleeding, the recommended
management is to hold warfarin and recheck INR the next day. Vitamin K
(A) is indicated for INR >10 or with bleeding. FFP (C) and PCC (D) are for
life-threatening bleeding or emergent reversal.
, 4. A 74-year-old male with a history of aortic stenosis presents with
syncope and exertional dyspnea. On auscultation, you hear a harsh,
crescendo-decrescendo systolic ejection murmur at the right upper
sternal border. What is the most appropriate next step?
A. Order a transthoracic echocardiogram
B. Prescribe a beta-blocker
C. Schedule for cardiac catheterization
D. Start an ACE inhibitor
Correct Answer: A — Order a transthoracic echocardiogram
Rationale: This presentation is classic for severe aortic stenosis. An
echocardiogram is the gold standard for diagnosis, assessing valve area,
gradient, and left ventricular function. Beta-blockers (B) and ACE
inhibitors (C) are contraindicated in severe AS as they can precipitate
hypotension and syncope.
5. A 62-year-old female presents with acute onset of severe, tearing
chest pain radiating to the back. Blood pressure is 198/104 mmHg in
the right arm and 152/88 mmHg in the left arm. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C — Aortic dissection
