Page 1 of 60
BARKLEY AGACNP DRT EXAM 2026
COMPLETE (115) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
AGACNP
Prepare for the Barkley AGACNP DRT Exam with focused review materials
covering cardiovascular disorders, advanced pathophysiology, health
assessment, diagnostic reasoning, interpretation of laboratory and
diagnostic findings, pharmacologic management, and evidence-based
care of acutely and critically ill adult-gerontology patients. Suitable for
AGACNP students and candidates preparing for Barkley review
examinations and certification readiness assessments.
MULTIPLE CHOICE.
CARDIOVASCULAR DISORDERS
1. A 72-year-old male presents with substernal chest pressure
radiating to the jaw, diaphoresis, and nausea. ECG shows ST-
segment elevation of 3mm in leads V2-V4. What is the most
appropriate immediate management?
• A. Administer sublingual nitroglycerin and observe
• B. Obtain serial cardiac enzymes and admit for observation
• C. Activate the STEMI protocol for emergent percutaneous
coronary intervention
, Page 2 of 60
• D. Administer thrombolytic therapy in the emergency
department
• Correct answer: C. Activate the STEMI protocol for
emergent percutaneous coronary intervention
• Rationale: ST-segment elevation in leads V2-V4 indicates an
anterior wall STEMI. The standard of care is emergent PCI
within 90 minutes of arrival. Thrombolytics are an
alternative if PCI is not available within 120 minutes.
2. A 65-year-old female with a history of hypertension presents
with acute onset of severe "tearing" chest pain radiating to the
back. Blood pressure is 190/110 mmHg in the right arm and
140/85 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
• Rationale: Aortic dissection classically presents with acute
severe tearing chest pain radiating to the back, with
differential blood pressures between arms. Immediate CT
angiography is diagnostic.
3. A 68-year-old male with a history of heart failure presents with
worsening dyspnea, orthopnea, and bilateral lower extremity
edema. Which medication is most appropriate for acute
decompensated heart failure with volume overload?
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• A. Digoxin
• B. Intravenous furosemide
• C. Spironolactone
• D. Metoprolol
• Correct answer: B. Intravenous furosemide
• Rationale: Loop diuretics such as IV furosemide are the
mainstay of treatment for acute decompensated heart
failure with volume overload to reduce preload and relieve
symptoms.
4. A 55-year-old male with a history of atrial fibrillation presents
with sudden onset of left-sided weakness and facial droop.
Symptoms began 2 hours ago. CT head shows no hemorrhage.
What is the most appropriate treatment?
• A. Aspirin 325 mg
• B. Heparin drip
• C. Tissue plasminogen activator (tPA) if no contraindications
• D. Warfarin loading dose
• Correct answer: C. Tissue plasminogen activator (tPA) if no
contraindications
• Rationale: For acute ischemic stroke within 4.5 hours of
symptom onset, IV tPA is indicated if no contraindications
exist. Atrial fibrillation is a risk factor for cardioembolic
stroke.
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5. A 60-year-old female with a history of hypertension and
diabetes presents with chest pain that occurs with exertion and
resolves with rest. ECG is normal. What is the most likely
diagnosis?
• A. Unstable angina
• B. Stable angina
• C. Prinzmetal's angina
• D. Pericarditis
• Correct answer: B. Stable angina
• Rationale: Stable angina is characterized by chest pain that
occurs with exertion and resolves with rest. It is typically
due to fixed coronary artery stenosis.
6. A 75-year-old male with a history of coronary artery disease
presents with palpitations. ECG shows an irregularly irregular
rhythm with no discernible P waves. What is the most
appropriate management for rate control?
• A. Amiodarone
• B. Metoprolol
• C. Adenosine
• D. Lidocaine
• Correct answer: B. Metoprolol
• Rationale: Atrial fibrillation is characterized by an
irregularly irregular rhythm with no P waves. Beta-blockers
such as metoprolol are first-line for rate control.
BARKLEY AGACNP DRT EXAM 2026
COMPLETE (115) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES.
AGACNP
Prepare for the Barkley AGACNP DRT Exam with focused review materials
covering cardiovascular disorders, advanced pathophysiology, health
assessment, diagnostic reasoning, interpretation of laboratory and
diagnostic findings, pharmacologic management, and evidence-based
care of acutely and critically ill adult-gerontology patients. Suitable for
AGACNP students and candidates preparing for Barkley review
examinations and certification readiness assessments.
MULTIPLE CHOICE.
CARDIOVASCULAR DISORDERS
1. A 72-year-old male presents with substernal chest pressure
radiating to the jaw, diaphoresis, and nausea. ECG shows ST-
segment elevation of 3mm in leads V2-V4. What is the most
appropriate immediate management?
• A. Administer sublingual nitroglycerin and observe
• B. Obtain serial cardiac enzymes and admit for observation
• C. Activate the STEMI protocol for emergent percutaneous
coronary intervention
, Page 2 of 60
• D. Administer thrombolytic therapy in the emergency
department
• Correct answer: C. Activate the STEMI protocol for
emergent percutaneous coronary intervention
• Rationale: ST-segment elevation in leads V2-V4 indicates an
anterior wall STEMI. The standard of care is emergent PCI
within 90 minutes of arrival. Thrombolytics are an
alternative if PCI is not available within 120 minutes.
2. A 65-year-old female with a history of hypertension presents
with acute onset of severe "tearing" chest pain radiating to the
back. Blood pressure is 190/110 mmHg in the right arm and
140/85 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
• Rationale: Aortic dissection classically presents with acute
severe tearing chest pain radiating to the back, with
differential blood pressures between arms. Immediate CT
angiography is diagnostic.
3. A 68-year-old male with a history of heart failure presents with
worsening dyspnea, orthopnea, and bilateral lower extremity
edema. Which medication is most appropriate for acute
decompensated heart failure with volume overload?
, Page 3 of 60
• A. Digoxin
• B. Intravenous furosemide
• C. Spironolactone
• D. Metoprolol
• Correct answer: B. Intravenous furosemide
• Rationale: Loop diuretics such as IV furosemide are the
mainstay of treatment for acute decompensated heart
failure with volume overload to reduce preload and relieve
symptoms.
4. A 55-year-old male with a history of atrial fibrillation presents
with sudden onset of left-sided weakness and facial droop.
Symptoms began 2 hours ago. CT head shows no hemorrhage.
What is the most appropriate treatment?
• A. Aspirin 325 mg
• B. Heparin drip
• C. Tissue plasminogen activator (tPA) if no contraindications
• D. Warfarin loading dose
• Correct answer: C. Tissue plasminogen activator (tPA) if no
contraindications
• Rationale: For acute ischemic stroke within 4.5 hours of
symptom onset, IV tPA is indicated if no contraindications
exist. Atrial fibrillation is a risk factor for cardioembolic
stroke.
, Page 4 of 60
5. A 60-year-old female with a history of hypertension and
diabetes presents with chest pain that occurs with exertion and
resolves with rest. ECG is normal. What is the most likely
diagnosis?
• A. Unstable angina
• B. Stable angina
• C. Prinzmetal's angina
• D. Pericarditis
• Correct answer: B. Stable angina
• Rationale: Stable angina is characterized by chest pain that
occurs with exertion and resolves with rest. It is typically
due to fixed coronary artery stenosis.
6. A 75-year-old male with a history of coronary artery disease
presents with palpitations. ECG shows an irregularly irregular
rhythm with no discernible P waves. What is the most
appropriate management for rate control?
• A. Amiodarone
• B. Metoprolol
• C. Adenosine
• D. Lidocaine
• Correct answer: B. Metoprolol
• Rationale: Atrial fibrillation is characterized by an
irregularly irregular rhythm with no P waves. Beta-blockers
such as metoprolol are first-line for rate control.
