Barkley AGPCNP Certification Review 2026/2027
– Complete 250+ Practice Questions with
Answers & Detailed Rationales | ANCC & AANP-
Aligned | Graded A+ | Instant Download
1. A 68-year-old patient presents with a 2-week history of fatigue, weight loss, and
night sweats. On examination, you note a palpable spleen tip 3 cm below the left
costal margin. Which laboratory test is most appropriate initially?
• A. Complete blood count with differential
• B. Serum protein electrophoresis
• C. Liver function tests
• D. Thyroid function tests
Answer: A
Rationale: Splenomegaly with constitutional symptoms (fatigue, weight loss, night
sweats) suggests hematologic malignancy. CBC with differential is the first step.
Lymphoma, leukemia, and myeloproliferative disorders can present this way. SPE is for
myeloma. LFTs and thyroid tests are not the initial priority.
2. A 72-year-old patient reports difficulty hearing, especially in crowded rooms.
On otoscopic examination, the tympanic membranes appear intact. Which
screening test is most appropriate?
• A. Audiometry
• B. Weber and Rinne tuning fork tests
• C. Whisper test
• D. CT scan of the temporal bone
Answer: A
Rationale: Audiometry is the gold standard for evaluating hearing loss, especially in
,older adults. Weber and Rinne are screening tests for conductive vs. sensorineural
hearing loss; audiometry provides quantitative data. CT is not needed without structural
concern. Hearing loss in older adults is common and often underdiagnosed.
3. A 65-year-old patient with a history of smoking presents with a new onset of
hoarseness for 3 weeks. What is the most appropriate next step?
• A. Reassurance and follow-up in 1 month
• B. Laryngoscopy
• C. Chest X-ray
• D. Trial of proton pump inhibitor
Answer: B
Rationale: Hoarseness persisting >2 weeks in a smoker requires visualization of the
vocal cords. Laryngoscopy is the standard. Chest X-ray may be appropriate later but
laryngoscopy first. PPI may be appropriate for GERD, but smoking history makes this
concerning for laryngeal cancer. The patient should be evaluated promptly.
4. A 78-year-old patient is brought in by her daughter for a "memory problem."
The daughter reports that the patient has been forgetting appointments and
repeating questions. The patient scores 22/30 on the MMSE. What is the most
appropriate next step?
• A. Reassure the daughter that this is normal aging
• B. Diagnose Alzheimer's disease and start donepezil
• C. Order TSH, B12, and basic metabolic panel
• D. Refer to neurology for further evaluation
Answer: C
Rationale: Before diagnosing dementia, reversible causes such as hypothyroidism, B12
deficiency, and metabolic abnormalities must be ruled out. An MMSE score of 22/30 is
below normal and warrants further investigation. Reassurance alone is insufficient.
,Diagnosing dementia without ruling out reversible causes is inappropriate. Neurology
referral should follow a basic workup.
5. A 55-year-old patient with hypertension and diabetes presents with a 1-week
history of a non-healing ulcer on the foot. On examination, the ulcer is deep, dry,
and located on the tip of the great toe. What is the most likely type of ulcer?
• A. Venous ulcer
• B. Arterial ulcer
• C. Diabetic ulcer
• D. Pressure ulcer
Answer: B
Rationale: Arterial ulcers are deep, dry, and located on the toes or feet. The presence of
risk factors for peripheral arterial disease (hypertension, diabetes) supports this
diagnosis. Venous ulcers are shallow, moist, and on the medial malleolus. Diabetic ulcers
are on pressure points. Pressure ulcers are over bony prominences. Arterial ulcers are
often painful and have a punched-out appearance.
6. A 62-year-old patient presents with a 2-week history of pain in the right
shoulder, worse with overhead reaching. On examination, there is pain with
abduction and external rotation, and the patient has a positive drop arm test.
What is the most likely diagnosis?
• A. Rotator cuff tear
• B. Adhesive capsulitis
• C. Subacromial bursitis
• D. Glenohumeral arthritis
Answer: A
Rationale: Rotator cuff tear presents with shoulder pain and weakness, especially with
abduction and external rotation. The drop arm test is positive. Adhesive capsulitis
(frozen shoulder) has restricted passive and active range of motion, with no specific
, positive drop arm test. Subacromial bursitis causes pain with abduction; glenohumeral
arthritis presents with pain and stiffness. Rotator cuff tears are common in older adults.
7. A 58-year-old patient with a history of GERD presents with progressive
dysphagia, first to solids and now to liquids. What is the most appropriate next
step?
• A. PPI trial
• B. Upper endoscopy
• C. Barium swallow
• D. Esophageal manometry
Answer: B
Rationale: Progressive dysphagia, especially going from solids to liquids (esophageal
cancer), requires prompt evaluation with upper endoscopy. PPI trial would be
appropriate for GERD but not for progressive dysphagia. Barium swallow is less sensitive
than endoscopy for mucosal lesions. Manometry is for motility disorders. The red flag
symptom of progressive dysphagia warrants immediate endoscopic evaluation.
8. A 72-year-old patient with a history of hypertension and diabetes presents with
acute onset of right-sided weakness, facial droop, and difficulty speaking. The
onset of symptoms was 2 hours ago. What is the most appropriate immediate
diagnostic test?
• A. Carotid ultrasound
• B. CT scan of the head without contrast
• C. MRI of the brain
• D. ECG
Answer: B
Rationale: In acute stroke, a non-contrast CT head is the first imaging study to rule out
hemorrhage. Time is brain; tPA can be given within 4.5 hours of symptom onset if there
is no hemorrhage. MRI may be more sensitive but is less readily available; CT is the
– Complete 250+ Practice Questions with
Answers & Detailed Rationales | ANCC & AANP-
Aligned | Graded A+ | Instant Download
1. A 68-year-old patient presents with a 2-week history of fatigue, weight loss, and
night sweats. On examination, you note a palpable spleen tip 3 cm below the left
costal margin. Which laboratory test is most appropriate initially?
• A. Complete blood count with differential
• B. Serum protein electrophoresis
• C. Liver function tests
• D. Thyroid function tests
Answer: A
Rationale: Splenomegaly with constitutional symptoms (fatigue, weight loss, night
sweats) suggests hematologic malignancy. CBC with differential is the first step.
Lymphoma, leukemia, and myeloproliferative disorders can present this way. SPE is for
myeloma. LFTs and thyroid tests are not the initial priority.
2. A 72-year-old patient reports difficulty hearing, especially in crowded rooms.
On otoscopic examination, the tympanic membranes appear intact. Which
screening test is most appropriate?
• A. Audiometry
• B. Weber and Rinne tuning fork tests
• C. Whisper test
• D. CT scan of the temporal bone
Answer: A
Rationale: Audiometry is the gold standard for evaluating hearing loss, especially in
,older adults. Weber and Rinne are screening tests for conductive vs. sensorineural
hearing loss; audiometry provides quantitative data. CT is not needed without structural
concern. Hearing loss in older adults is common and often underdiagnosed.
3. A 65-year-old patient with a history of smoking presents with a new onset of
hoarseness for 3 weeks. What is the most appropriate next step?
• A. Reassurance and follow-up in 1 month
• B. Laryngoscopy
• C. Chest X-ray
• D. Trial of proton pump inhibitor
Answer: B
Rationale: Hoarseness persisting >2 weeks in a smoker requires visualization of the
vocal cords. Laryngoscopy is the standard. Chest X-ray may be appropriate later but
laryngoscopy first. PPI may be appropriate for GERD, but smoking history makes this
concerning for laryngeal cancer. The patient should be evaluated promptly.
4. A 78-year-old patient is brought in by her daughter for a "memory problem."
The daughter reports that the patient has been forgetting appointments and
repeating questions. The patient scores 22/30 on the MMSE. What is the most
appropriate next step?
• A. Reassure the daughter that this is normal aging
• B. Diagnose Alzheimer's disease and start donepezil
• C. Order TSH, B12, and basic metabolic panel
• D. Refer to neurology for further evaluation
Answer: C
Rationale: Before diagnosing dementia, reversible causes such as hypothyroidism, B12
deficiency, and metabolic abnormalities must be ruled out. An MMSE score of 22/30 is
below normal and warrants further investigation. Reassurance alone is insufficient.
,Diagnosing dementia without ruling out reversible causes is inappropriate. Neurology
referral should follow a basic workup.
5. A 55-year-old patient with hypertension and diabetes presents with a 1-week
history of a non-healing ulcer on the foot. On examination, the ulcer is deep, dry,
and located on the tip of the great toe. What is the most likely type of ulcer?
• A. Venous ulcer
• B. Arterial ulcer
• C. Diabetic ulcer
• D. Pressure ulcer
Answer: B
Rationale: Arterial ulcers are deep, dry, and located on the toes or feet. The presence of
risk factors for peripheral arterial disease (hypertension, diabetes) supports this
diagnosis. Venous ulcers are shallow, moist, and on the medial malleolus. Diabetic ulcers
are on pressure points. Pressure ulcers are over bony prominences. Arterial ulcers are
often painful and have a punched-out appearance.
6. A 62-year-old patient presents with a 2-week history of pain in the right
shoulder, worse with overhead reaching. On examination, there is pain with
abduction and external rotation, and the patient has a positive drop arm test.
What is the most likely diagnosis?
• A. Rotator cuff tear
• B. Adhesive capsulitis
• C. Subacromial bursitis
• D. Glenohumeral arthritis
Answer: A
Rationale: Rotator cuff tear presents with shoulder pain and weakness, especially with
abduction and external rotation. The drop arm test is positive. Adhesive capsulitis
(frozen shoulder) has restricted passive and active range of motion, with no specific
, positive drop arm test. Subacromial bursitis causes pain with abduction; glenohumeral
arthritis presents with pain and stiffness. Rotator cuff tears are common in older adults.
7. A 58-year-old patient with a history of GERD presents with progressive
dysphagia, first to solids and now to liquids. What is the most appropriate next
step?
• A. PPI trial
• B. Upper endoscopy
• C. Barium swallow
• D. Esophageal manometry
Answer: B
Rationale: Progressive dysphagia, especially going from solids to liquids (esophageal
cancer), requires prompt evaluation with upper endoscopy. PPI trial would be
appropriate for GERD but not for progressive dysphagia. Barium swallow is less sensitive
than endoscopy for mucosal lesions. Manometry is for motility disorders. The red flag
symptom of progressive dysphagia warrants immediate endoscopic evaluation.
8. A 72-year-old patient with a history of hypertension and diabetes presents with
acute onset of right-sided weakness, facial droop, and difficulty speaking. The
onset of symptoms was 2 hours ago. What is the most appropriate immediate
diagnostic test?
• A. Carotid ultrasound
• B. CT scan of the head without contrast
• C. MRI of the brain
• D. ECG
Answer: B
Rationale: In acute stroke, a non-contrast CT head is the first imaging study to rule out
hemorrhage. Time is brain; tPA can be given within 4.5 hours of symptom onset if there
is no hemorrhage. MRI may be more sensitive but is less readily available; CT is the
