Page 1 of 56
BARKLEY AGACNP PRACTICE EXAM 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
AGACNP
Prepare for the Barkley AGACNP Practice Exam with a focused study resource covering
essential adult-gerontology acute care nurse practitioner concepts. It supports review
of acute and complex conditions, advanced assessment, diagnostics, pharmacology,
critical care principles, and evidence-based patient management. Use the material to
reinforce clinical knowledge, strengthen clinical reasoning, and identify areas that
may require additional study. This resource is best suited for AGACNP students and
nurse practitioner certification candidates preparing for acute care and board-style
assessments.
MULTIPLE CHOICE.
CARDIOLOGY
1. A 68-year-old man presents to the emergency department with acute
onset of substernal chest pain radiating to his left arm, diaphoresis, and
nausea. His ECG shows ST-segment elevation in leads V1-V4. Which of the
following is the priority intervention?
A) Administer sublingual nitroglycerin
B) Prepare the patient for emergent percutaneous coronary intervention (PCI)
C) Administer aspirin and morphine
D) Obtain a chest X-ray
Answer: B) Prepare the patient for emergent percutaneous coronary
intervention (PCI)
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior wall
STEMI. The priority is emergent reperfusion therapy. PCI is the preferred
method if it can be performed within 90 minutes of arrival. If PCI is not
available within 90 minutes, fibrinolytics should be considered. Aspirin,
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nitroglycerin, and morphine are important but are not the priority
intervention; PCI is time-sensitive and life-saving.
2. A 72-year-old woman with a history of heart failure presents with
worsening dyspnea, orthopnea, and 3+ pitting edema in her lower
extremities. Her ejection fraction is 25%. Which medication has been
shown to reduce mortality in this patient population?
A) Digoxin
B) Furosemide
C) Carvedilol
D) Amlodipine
Answer: C) Carvedilol
Rationale: Carvedilol is a beta-blocker that has been shown to reduce
mortality and hospitalizations in patients with heart failure with reduced
ejection fraction (HFrEF). Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol) block the harmful effects of chronic sympathetic nervous
system activation. Digoxin reduces symptoms but not mortality.
Furosemide manages fluid overload but does not improve survival.
Amlodipine is not recommended as first-line therapy in HFrEF and may
worsen outcomes.
3. A 65-year-old man with a history of hypertension is on lisinopril. He
develops a dry, persistent cough. Which of the following is the most
appropriate next step?
A) Add a beta-blocker
B) Continue lisinopril and treat the cough symptomatically
C) Switch to an angiotensin receptor blocker (ARB)
D) Increase the lisinopril dose
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Answer: C) Switch to an angiotensin receptor blocker (ARB)
Rationale: A dry, persistent cough is a common side effect of ACE
inhibitors due to bradykinin accumulation. Switching to an ARB is
appropriate as ARBs do not cause cough. The cough is unlikely to resolve
with continued use or dose adjustment. Adding a beta-blocker would not
address the cough and is not indicated as a replacement for an ACE
inhibitor.
4. A 58-year-old woman presents with palpitations. Her ECG shows an
irregularly irregular rhythm with no discernible P waves. Her CHA₂DS₂-
VASc score is 3. Which of the following is the most appropriate
management strategy?
A) Aspirin 81 mg daily
B) Rate control with metoprolol and anticoagulation with warfarin or a DOAC
C) Rhythm control with amiodarone alone
D) No treatment needed
Answer: B) Rate control with metoprolol and anticoagulation with warfarin
or a DOAC
Rationale: This patient has atrial fibrillation (irregularly irregular rhythm
with no P waves). A CHA₂DS₂-VASc score of 3 indicates high stroke risk,
requiring anticoagulation. Rate control with a beta-blocker (metoprolol)
and anticoagulation with warfarin or a DOAC is the appropriate
management. Aspirin is not sufficient for stroke prevention in AF. Rhythm
control with amiodarone is not first-line without rate control, especially in
an asymptomatic patient.
5. A 60-year-old man presents with acute onset of severe, tearing chest
pain radiating to his back. His blood pressure is 160/95 mmHg in the right
arm and 110/70 mmHg in the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
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B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B) Aortic dissection
Rationale: The classic presentation of aortic dissection includes acute,
severe, tearing chest pain radiating to the back, often with a pulse or
blood pressure differential between arms. This patient's presentation—
hypertension, pulse differential, and tearing pain—is highly concerning
for aortic dissection. Myocardial infarction typically presents with
crushing chest pain without pulse differential. Pulmonary embolism
presents with dyspnea and pleuritic pain. Pericarditis pain is worse lying
flat and improves leaning forward.
6. A 70-year-old man with a history of myocardial infarction is on aspirin.
Which of the following is the most appropriate rationale for aspirin
therapy?
A) Pain relief
B) Antiplatelet therapy
C) Anti-inflammatory therapy
D) Anticoagulation therapy
Answer: B) Antiplatelet therapy
Rationale: In patients with cardiovascular disease, aspirin is used for
antiplatelet therapy to reduce the risk of recurrent MI and stroke. It works
by irreversibly inhibiting cyclooxygenase and preventing platelet
aggregation. It is not used primarily for pain relief in this context.
Anticoagulation therapy is achieved with medications like warfarin or
heparin.
BARKLEY AGACNP PRACTICE EXAM 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
AGACNP
Prepare for the Barkley AGACNP Practice Exam with a focused study resource covering
essential adult-gerontology acute care nurse practitioner concepts. It supports review
of acute and complex conditions, advanced assessment, diagnostics, pharmacology,
critical care principles, and evidence-based patient management. Use the material to
reinforce clinical knowledge, strengthen clinical reasoning, and identify areas that
may require additional study. This resource is best suited for AGACNP students and
nurse practitioner certification candidates preparing for acute care and board-style
assessments.
MULTIPLE CHOICE.
CARDIOLOGY
1. A 68-year-old man presents to the emergency department with acute
onset of substernal chest pain radiating to his left arm, diaphoresis, and
nausea. His ECG shows ST-segment elevation in leads V1-V4. Which of the
following is the priority intervention?
A) Administer sublingual nitroglycerin
B) Prepare the patient for emergent percutaneous coronary intervention (PCI)
C) Administer aspirin and morphine
D) Obtain a chest X-ray
Answer: B) Prepare the patient for emergent percutaneous coronary
intervention (PCI)
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior wall
STEMI. The priority is emergent reperfusion therapy. PCI is the preferred
method if it can be performed within 90 minutes of arrival. If PCI is not
available within 90 minutes, fibrinolytics should be considered. Aspirin,
, Page 2 of 56
nitroglycerin, and morphine are important but are not the priority
intervention; PCI is time-sensitive and life-saving.
2. A 72-year-old woman with a history of heart failure presents with
worsening dyspnea, orthopnea, and 3+ pitting edema in her lower
extremities. Her ejection fraction is 25%. Which medication has been
shown to reduce mortality in this patient population?
A) Digoxin
B) Furosemide
C) Carvedilol
D) Amlodipine
Answer: C) Carvedilol
Rationale: Carvedilol is a beta-blocker that has been shown to reduce
mortality and hospitalizations in patients with heart failure with reduced
ejection fraction (HFrEF). Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol) block the harmful effects of chronic sympathetic nervous
system activation. Digoxin reduces symptoms but not mortality.
Furosemide manages fluid overload but does not improve survival.
Amlodipine is not recommended as first-line therapy in HFrEF and may
worsen outcomes.
3. A 65-year-old man with a history of hypertension is on lisinopril. He
develops a dry, persistent cough. Which of the following is the most
appropriate next step?
A) Add a beta-blocker
B) Continue lisinopril and treat the cough symptomatically
C) Switch to an angiotensin receptor blocker (ARB)
D) Increase the lisinopril dose
, Page 3 of 56
Answer: C) Switch to an angiotensin receptor blocker (ARB)
Rationale: A dry, persistent cough is a common side effect of ACE
inhibitors due to bradykinin accumulation. Switching to an ARB is
appropriate as ARBs do not cause cough. The cough is unlikely to resolve
with continued use or dose adjustment. Adding a beta-blocker would not
address the cough and is not indicated as a replacement for an ACE
inhibitor.
4. A 58-year-old woman presents with palpitations. Her ECG shows an
irregularly irregular rhythm with no discernible P waves. Her CHA₂DS₂-
VASc score is 3. Which of the following is the most appropriate
management strategy?
A) Aspirin 81 mg daily
B) Rate control with metoprolol and anticoagulation with warfarin or a DOAC
C) Rhythm control with amiodarone alone
D) No treatment needed
Answer: B) Rate control with metoprolol and anticoagulation with warfarin
or a DOAC
Rationale: This patient has atrial fibrillation (irregularly irregular rhythm
with no P waves). A CHA₂DS₂-VASc score of 3 indicates high stroke risk,
requiring anticoagulation. Rate control with a beta-blocker (metoprolol)
and anticoagulation with warfarin or a DOAC is the appropriate
management. Aspirin is not sufficient for stroke prevention in AF. Rhythm
control with amiodarone is not first-line without rate control, especially in
an asymptomatic patient.
5. A 60-year-old man presents with acute onset of severe, tearing chest
pain radiating to his back. His blood pressure is 160/95 mmHg in the right
arm and 110/70 mmHg in the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
, Page 4 of 56
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B) Aortic dissection
Rationale: The classic presentation of aortic dissection includes acute,
severe, tearing chest pain radiating to the back, often with a pulse or
blood pressure differential between arms. This patient's presentation—
hypertension, pulse differential, and tearing pain—is highly concerning
for aortic dissection. Myocardial infarction typically presents with
crushing chest pain without pulse differential. Pulmonary embolism
presents with dyspnea and pleuritic pain. Pericarditis pain is worse lying
flat and improves leaning forward.
6. A 70-year-old man with a history of myocardial infarction is on aspirin.
Which of the following is the most appropriate rationale for aspirin
therapy?
A) Pain relief
B) Antiplatelet therapy
C) Anti-inflammatory therapy
D) Anticoagulation therapy
Answer: B) Antiplatelet therapy
Rationale: In patients with cardiovascular disease, aspirin is used for
antiplatelet therapy to reduce the risk of recurrent MI and stroke. It works
by irreversibly inhibiting cyclooxygenase and preventing platelet
aggregation. It is not used primarily for pain relief in this context.
Anticoagulation therapy is achieved with medications like warfarin or
heparin.
