BARKLEY ADULT-GERONTOLOGY
ACUTE CARE NURSE PRACTITIONER
(AGACNP) PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
CORE DOMAINS
• Cardiovascular Acute Care
• Pulmonary and Respiratory Critical Care
• Neurological and Neurocritical Care
• Renal and Fluid/Electrolyte Management
• Infectious Disease and Sepsis Management
• Gastrointestinal and Hepatic Emergencies
• Endocrine and Metabolic Emergencies
• Multisystem Organ Dysfunction and Shock
• Pharmacology and Medication Management
• Professional Role, Ethics, and End-of-Life Care
INTRODUCTION
,This comprehensive practice examination is designed to prepare
candidates for the Barkley AGACNP board certification examination, a
rigorous assessment of advanced practice nursing competence in acute
care settings. The test covers the full spectrum of adult-gerontology acute
care practice including hemodynamic monitoring, mechanical ventilation,
sepsis management, and critical care pharmacology. Questions are
structured to reflect the complexity and clinical decision-making required
in intensive care units, emergency departments, and acute care hospital
settings. Emphasis is placed on evidence-based practice, rapid clinical
assessment, and prioritization of interventions in life-threatening situations.
Successful completion of this practice test indicates readiness for board
certification and entry into advanced acute care practice. This assessment
serves as a valuable tool for identifying knowledge gaps and strengthening
clinical judgment in acute care environments.
SECTION ONE: QUESTIONS 1–100
Question 1
A 72-year-old patient is admitted to the ICU with septic shock. The
patient is hypotensive despite fluid resuscitation. Which vasopressor
should the AGACNP initiate as the first-line agent?
A. Dobutamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
B. Norepinephrine
RATIONALE: Norepinephrine is the first-line vasopressor for septic
shock according to Surviving Sepsis Campaign guidelines. It increases
mean arterial pressure through alpha-adrenergic vasoconstriction with
less chronotropic effect than dopamine. Dobutamine is an inotrope, not a
,first-line vasopressor. Phenylephrine is a pure alpha-agonist used as a
second-line agent. Vasopressin is used as an adjunctive therapy.
Question 2
A 68-year-old patient with acute respiratory distress syndrome (ARDS) is
on mechanical ventilation. Which ventilator strategy is recommended to
reduce mortality?
A. Tidal volume of 10-12 mL/kg of ideal body weight
B. Tidal volume of 6-8 mL/kg of ideal body weight
C. Plateau pressure greater than 30 cm H₂O
D. High positive end-expiratory pressure (PEEP) only
B. Tidal volume of 6-8 mL/kg of ideal body weight
RATIONALE: The ARDSNet protocol recommends low tidal volume
ventilation (6-8 mL/kg ideal body weight) and plateau pressure less than
30 cm H₂O to reduce ventilator-induced lung injury and mortality.
Higher tidal volumes increase the risk of barotrauma and volutrauma.
High PEEP alone without low tidal volume is insufficient.
Question 3
A 75-year-old patient presents with acute onset of severe headache,
nausea, and photophobia. The patient's neck is stiff on examination. The
AGACNP suspects meningitis. What is the priority diagnostic test?
A. CT scan of the head without contrast
B. Lumbar puncture immediately without imaging
C. CT scan of the head with contrast
D. MRI of the brain
A. CT scan of the head without contrast
, RATIONALE: Before performing a lumbar puncture in a patient with
suspected meningitis, a CT scan without contrast should be obtained to
rule out elevated intracranial pressure, mass lesions, or cerebral edema
that could cause brain herniation. Lumbar puncture is performed after
imaging. MRI is not the initial imaging choice in this scenario.
Question 4
A 65-year-old patient is 3 days post-operative following abdominal
surgery and develops acute onset of shortness of breath, pleuritic chest
pain, and tachycardia. The patient's oxygen saturation is 88% on room
air. What is the most appropriate initial diagnostic test?
A. Chest X-ray
B. CT pulmonary angiography
C. Ventilation-perfusion (V/Q) scan
D. D-dimer
B. CT pulmonary angiography
RATIONALE: CT pulmonary angiography is the gold standard for
diagnosing pulmonary embolism in patients with high clinical suspicion.
This patient has classic signs of PE (acute dyspnea, pleuritic chest pain,
tachycardia, and hypoxia) with a significant risk factor (recent surgery).
D-dimer would be elevated but is less specific. Chest X-ray may show
nonspecific findings.
Question 5
A 70-year-old patient with heart failure is receiving furosemide IV. The
patient's urine output has decreased to 20 mL/hr over the past 2 hours.
Which laboratory value should the AGACNP monitor most closely?
A. Serum sodium
B. Serum potassium
ACUTE CARE NURSE PRACTITIONER
(AGACNP) PRACTICE EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
CORE DOMAINS
• Cardiovascular Acute Care
• Pulmonary and Respiratory Critical Care
• Neurological and Neurocritical Care
• Renal and Fluid/Electrolyte Management
• Infectious Disease and Sepsis Management
• Gastrointestinal and Hepatic Emergencies
• Endocrine and Metabolic Emergencies
• Multisystem Organ Dysfunction and Shock
• Pharmacology and Medication Management
• Professional Role, Ethics, and End-of-Life Care
INTRODUCTION
,This comprehensive practice examination is designed to prepare
candidates for the Barkley AGACNP board certification examination, a
rigorous assessment of advanced practice nursing competence in acute
care settings. The test covers the full spectrum of adult-gerontology acute
care practice including hemodynamic monitoring, mechanical ventilation,
sepsis management, and critical care pharmacology. Questions are
structured to reflect the complexity and clinical decision-making required
in intensive care units, emergency departments, and acute care hospital
settings. Emphasis is placed on evidence-based practice, rapid clinical
assessment, and prioritization of interventions in life-threatening situations.
Successful completion of this practice test indicates readiness for board
certification and entry into advanced acute care practice. This assessment
serves as a valuable tool for identifying knowledge gaps and strengthening
clinical judgment in acute care environments.
SECTION ONE: QUESTIONS 1–100
Question 1
A 72-year-old patient is admitted to the ICU with septic shock. The
patient is hypotensive despite fluid resuscitation. Which vasopressor
should the AGACNP initiate as the first-line agent?
A. Dobutamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
B. Norepinephrine
RATIONALE: Norepinephrine is the first-line vasopressor for septic
shock according to Surviving Sepsis Campaign guidelines. It increases
mean arterial pressure through alpha-adrenergic vasoconstriction with
less chronotropic effect than dopamine. Dobutamine is an inotrope, not a
,first-line vasopressor. Phenylephrine is a pure alpha-agonist used as a
second-line agent. Vasopressin is used as an adjunctive therapy.
Question 2
A 68-year-old patient with acute respiratory distress syndrome (ARDS) is
on mechanical ventilation. Which ventilator strategy is recommended to
reduce mortality?
A. Tidal volume of 10-12 mL/kg of ideal body weight
B. Tidal volume of 6-8 mL/kg of ideal body weight
C. Plateau pressure greater than 30 cm H₂O
D. High positive end-expiratory pressure (PEEP) only
B. Tidal volume of 6-8 mL/kg of ideal body weight
RATIONALE: The ARDSNet protocol recommends low tidal volume
ventilation (6-8 mL/kg ideal body weight) and plateau pressure less than
30 cm H₂O to reduce ventilator-induced lung injury and mortality.
Higher tidal volumes increase the risk of barotrauma and volutrauma.
High PEEP alone without low tidal volume is insufficient.
Question 3
A 75-year-old patient presents with acute onset of severe headache,
nausea, and photophobia. The patient's neck is stiff on examination. The
AGACNP suspects meningitis. What is the priority diagnostic test?
A. CT scan of the head without contrast
B. Lumbar puncture immediately without imaging
C. CT scan of the head with contrast
D. MRI of the brain
A. CT scan of the head without contrast
, RATIONALE: Before performing a lumbar puncture in a patient with
suspected meningitis, a CT scan without contrast should be obtained to
rule out elevated intracranial pressure, mass lesions, or cerebral edema
that could cause brain herniation. Lumbar puncture is performed after
imaging. MRI is not the initial imaging choice in this scenario.
Question 4
A 65-year-old patient is 3 days post-operative following abdominal
surgery and develops acute onset of shortness of breath, pleuritic chest
pain, and tachycardia. The patient's oxygen saturation is 88% on room
air. What is the most appropriate initial diagnostic test?
A. Chest X-ray
B. CT pulmonary angiography
C. Ventilation-perfusion (V/Q) scan
D. D-dimer
B. CT pulmonary angiography
RATIONALE: CT pulmonary angiography is the gold standard for
diagnosing pulmonary embolism in patients with high clinical suspicion.
This patient has classic signs of PE (acute dyspnea, pleuritic chest pain,
tachycardia, and hypoxia) with a significant risk factor (recent surgery).
D-dimer would be elevated but is less specific. Chest X-ray may show
nonspecific findings.
Question 5
A 70-year-old patient with heart failure is receiving furosemide IV. The
patient's urine output has decreased to 20 mL/hr over the past 2 hours.
Which laboratory value should the AGACNP monitor most closely?
A. Serum sodium
B. Serum potassium
