ANCC AGACNP Barkley Certification Exam
American Nurses Credentialing Center | Adult-
Gerontology Acute Care Nurse Practitioner
Complete Practice Test Bank | 2026/2027
Academic Year
Instructions: This comprehensive examination consists of 200 multiple-choice
questions designed to assess your knowledge and readiness for the ANCC
AGACNP (Adult-Gerontology Acute Care Nurse Practitioner) board certification
examination. Select the best answer for each question. All questions are weighted
equally.
Time Allowed: 4 Hours
Passing Score: Varies by state/board
1. A 68-year-old male with a history of hypertension presents with sudden
onset of severe, tearing chest pain that radiates to his back. His blood pressure
is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm. Which of
the following is the most likely diagnosis?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain that
radiates to the back, often with a blood pressure differential between arms (≥20
mmHg). Risk factors include hypertension, connective tissue disease (Marfan,
,Ehlers-Danlos), and cocaine use. This is a medical emergency requiring
immediate surgical consultation.
2. A 55-year-old male with a history of coronary artery disease presents with
chest pain that occurs at rest and is not relieved by nitroglycerin. Which of the
following is the most likely diagnosis?
• A) Stable angina
• B) Unstable angina
• C) Prinzmetal's angina
• D) Non-ST elevation myocardial infarction (NSTEMI)
Answer: D
Rationale: Chest pain at rest not relieved by nitroglycerin in a patient with known
CAD is concerning for an acute coronary syndrome. NSTEMI is diagnosed with
elevated cardiac biomarkers (troponin) and ECG changes (ST depression or T-
wave inversion). Unstable angina has similar symptoms but without biomarker
elevation.
3. A 65-year-old male with heart failure is prescribed digoxin. Which of the
following ECG findings indicates digoxin toxicity?
• A) Atrial fibrillation
• B) Atrial flutter
• C) Bradycardia
• D) Ventricular fibrillation
Answer: C
Rationale: Digoxin toxicity can cause bradycardia, heart block, and ventricular
arrhythmias. Classic ECG findings include ventricular bigeminy and "reverse tick"
ST-segment depression. Bradycardia is a common early sign of toxicity.
4. A 72-year-old female with heart failure is prescribed furosemide (Lasix).
Which electrolyte abnormality is the most concerning complication?
, • A) Hyperkalemia
• B) Hypokalemia
• C) Hypercalcemia
• D) Hypoglycemia
Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na-K-ATPase in the thick
ascending limb of the loop of Henle, increasing potassium excretion. Hypokalemia
can precipitate cardiac arrhythmias, especially in patients on digoxin.
5. A 58-year-old male presents with acute onset of chest pain, shortness of
breath, and diaphoresis. His ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the most appropriate immediate intervention?
• A) Administer aspirin and nitroglycerin
• B) Prepare for emergency percutaneous coronary intervention (PCI)
• C) Administer thrombolytics
• D) Administer morphine and observe
Answer: B
Rationale: ST-segment elevation in leads V1-V4 indicates an acute anterior wall
ST-elevation myocardial infarction (STEMI). Emergency PCI is the preferred
reperfusion strategy if available (door-to-balloon time <90 minutes). Aspirin and
nitroglycerin are also given, but PCI is the definitive treatment.
6. A 62-year-old female presents with acute dyspnea, orthopnea, and
paroxysmal nocturnal dyspnea. Physical examination reveals crackles in the
lungs, jugular venous distension, and peripheral edema. Which of the
following is the most appropriate initial medication to improve symptoms and
mortality?
• A) Furosemide
• B) Lisinopril (ACE inhibitor)
• C) Digoxin
, • D) Metoprolol
Answer: B
Rationale: This patient is presenting with heart failure with reduced ejection
fraction (HFrEF). ACE inhibitors (lisinopril) improve symptoms and mortality in
heart failure by reducing afterload and preload. Furosemide improves symptoms
but does not improve mortality. Beta-blockers also improve mortality but are
typically started after stabilization.
7. A 55-year-old female presents with palpitations, fatigue, and weight loss
despite increased appetite. She reports feeling warm even in air conditioning.
Which of the following is the most likely diagnosis?
• A) Hypothyroidism
• B) Hyperthyroidism (Graves' disease)
• C) Thyroiditis
• D) Euthyroid sick syndrome
Answer: B
Rationale: The combination of palpitations, fatigue, weight loss, increased
appetite, heat intolerance, suppressed TSH, and elevated T4 is classic for
hyperthyroidism. Graves' disease is the most common cause of hyperthyroidism,
especially in women.
8. A 70-year-old male with a history of hypertension presents with syncope
after standing from a seated position. His blood pressure is 90/60 mmHg with
no change in heart rate. Which of the following is the most likely diagnosis?
• A) Vasovagal syncope
• B) Cardiac arrhythmia
• C) Orthostatic hypotension
• D) Seizure
Answer: C
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure
American Nurses Credentialing Center | Adult-
Gerontology Acute Care Nurse Practitioner
Complete Practice Test Bank | 2026/2027
Academic Year
Instructions: This comprehensive examination consists of 200 multiple-choice
questions designed to assess your knowledge and readiness for the ANCC
AGACNP (Adult-Gerontology Acute Care Nurse Practitioner) board certification
examination. Select the best answer for each question. All questions are weighted
equally.
Time Allowed: 4 Hours
Passing Score: Varies by state/board
1. A 68-year-old male with a history of hypertension presents with sudden
onset of severe, tearing chest pain that radiates to his back. His blood pressure
is 180/100 mmHg in the right arm and 140/90 mmHg in the left arm. Which of
the following is the most likely diagnosis?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain that
radiates to the back, often with a blood pressure differential between arms (≥20
mmHg). Risk factors include hypertension, connective tissue disease (Marfan,
,Ehlers-Danlos), and cocaine use. This is a medical emergency requiring
immediate surgical consultation.
2. A 55-year-old male with a history of coronary artery disease presents with
chest pain that occurs at rest and is not relieved by nitroglycerin. Which of the
following is the most likely diagnosis?
• A) Stable angina
• B) Unstable angina
• C) Prinzmetal's angina
• D) Non-ST elevation myocardial infarction (NSTEMI)
Answer: D
Rationale: Chest pain at rest not relieved by nitroglycerin in a patient with known
CAD is concerning for an acute coronary syndrome. NSTEMI is diagnosed with
elevated cardiac biomarkers (troponin) and ECG changes (ST depression or T-
wave inversion). Unstable angina has similar symptoms but without biomarker
elevation.
3. A 65-year-old male with heart failure is prescribed digoxin. Which of the
following ECG findings indicates digoxin toxicity?
• A) Atrial fibrillation
• B) Atrial flutter
• C) Bradycardia
• D) Ventricular fibrillation
Answer: C
Rationale: Digoxin toxicity can cause bradycardia, heart block, and ventricular
arrhythmias. Classic ECG findings include ventricular bigeminy and "reverse tick"
ST-segment depression. Bradycardia is a common early sign of toxicity.
4. A 72-year-old female with heart failure is prescribed furosemide (Lasix).
Which electrolyte abnormality is the most concerning complication?
, • A) Hyperkalemia
• B) Hypokalemia
• C) Hypercalcemia
• D) Hypoglycemia
Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na-K-ATPase in the thick
ascending limb of the loop of Henle, increasing potassium excretion. Hypokalemia
can precipitate cardiac arrhythmias, especially in patients on digoxin.
5. A 58-year-old male presents with acute onset of chest pain, shortness of
breath, and diaphoresis. His ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the most appropriate immediate intervention?
• A) Administer aspirin and nitroglycerin
• B) Prepare for emergency percutaneous coronary intervention (PCI)
• C) Administer thrombolytics
• D) Administer morphine and observe
Answer: B
Rationale: ST-segment elevation in leads V1-V4 indicates an acute anterior wall
ST-elevation myocardial infarction (STEMI). Emergency PCI is the preferred
reperfusion strategy if available (door-to-balloon time <90 minutes). Aspirin and
nitroglycerin are also given, but PCI is the definitive treatment.
6. A 62-year-old female presents with acute dyspnea, orthopnea, and
paroxysmal nocturnal dyspnea. Physical examination reveals crackles in the
lungs, jugular venous distension, and peripheral edema. Which of the
following is the most appropriate initial medication to improve symptoms and
mortality?
• A) Furosemide
• B) Lisinopril (ACE inhibitor)
• C) Digoxin
, • D) Metoprolol
Answer: B
Rationale: This patient is presenting with heart failure with reduced ejection
fraction (HFrEF). ACE inhibitors (lisinopril) improve symptoms and mortality in
heart failure by reducing afterload and preload. Furosemide improves symptoms
but does not improve mortality. Beta-blockers also improve mortality but are
typically started after stabilization.
7. A 55-year-old female presents with palpitations, fatigue, and weight loss
despite increased appetite. She reports feeling warm even in air conditioning.
Which of the following is the most likely diagnosis?
• A) Hypothyroidism
• B) Hyperthyroidism (Graves' disease)
• C) Thyroiditis
• D) Euthyroid sick syndrome
Answer: B
Rationale: The combination of palpitations, fatigue, weight loss, increased
appetite, heat intolerance, suppressed TSH, and elevated T4 is classic for
hyperthyroidism. Graves' disease is the most common cause of hyperthyroidism,
especially in women.
8. A 70-year-old male with a history of hypertension presents with syncope
after standing from a seated position. His blood pressure is 90/60 mmHg with
no change in heart rate. Which of the following is the most likely diagnosis?
• A) Vasovagal syncope
• B) Cardiac arrhythmia
• C) Orthostatic hypotension
• D) Seizure
Answer: C
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure
