Page 1 of 48
BARKLEY AGPCNP REVIEW EXAM 2026/2027 COMPLETE
(100) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
AGPCNP
Prepare for the Barkley AGPCNP Review Exam with a focused study resource covering
essential adult-gerontology primary care nurse practitioner concepts. It supports
review of health assessment, common acute and chronic conditions, geriatric
considerations, preventive care, pharmacology, diagnostics, and evidence-based
patient management. Use the material to reinforce clinical knowledge, strengthen
clinical reasoning, and identify areas that may require additional review before
certification testing. This resource is best suited for AGPCNP students and nurse
practitioner certification candidates preparing for adult-gerontology primary care
board-style assessments.
MULTIPLE CHOICE.
1. A 68-year-old male with a history of hypertension and type 2 diabetes
presents for a routine follow-up. His blood pressure today is 142/88
mmHg. He is currently on lisinopril 20 mg daily and metformin 1000 mg
BID. What is the most appropriate next step in managing his
hypertension?
A) Add hydrochlorothiazide 25 mg daily
B) Increase lisinopril to 40 mg daily
C) Add amlodipine 5 mg daily
D) Add spironolactone 25 mg daily
Answer: A
Rationale: For patients with hypertension and diabetes, the target BP is <
130/80 mmHg. If BP is uncontrolled on an ACE inhibitor, adding a thiazide
diuretic is a recommended step. Amlodipine is also an option, but
thiazide diuretics are preferred as an add-on in patients with diabetes.
Increasing lisinopril may help but is less effective than adding a diuretic.
, Page 2 of 48
2. A 72-year-old female with a history of heart failure with reduced
ejection fraction (HFrEF) presents with worsening shortness of breath and
3+ pitting edema. Her medications include lisinopril, carvedilol, and
furosemide. What is the most appropriate next step?
A) Add digoxin
B) Add spironolactone
C) Add sacubitril/valsartan (Entresto)
D) Increase furosemide dose
Answer: C
Rationale: Sacubitril/valsartan (Entresto) has been shown to reduce
mortality and hospitalizations in HFrEF and is recommended as a first-
line therapy in eligible patients. It should replace an ACE inhibitor or ARB
in patients with NYHA class II-III HFrEF. Spironolactone and digoxin are
also options but Entresto provides the most significant mortality benefit.
3. A 55-year-old female with a history of migraines presents with four
migraines per month. She uses sumatriptan as an abortive therapy. What
is the most appropriate prophylactic therapy?
A) Propranolol
B) Topiramate
C) Amitriptyline
D) All of the above
Answer: D
Rationale: Propranolol, topiramate, and amitriptyline are all first-line
prophylactic therapies for migraines. The choice depends on the patient's
comorbidities and side-effect profile. Propranolol is preferred in patients
with hypertension; topiramate may cause weight loss and cognitive
dulling; amitriptyline may cause weight gain and sedation.
, Page 3 of 48
4. A 68-year-old male with COPD presents with an acute exacerbation. He
has increased shortness of breath, purulent sputum, and fever. His SpO2
is 88% on room air. What is the most appropriate initial management?
A) Oxygen, bronchodilators, corticosteroids, and antibiotics
B) Oxygen and bronchodilators only
C) Antibiotics only
D) Non-invasive ventilation only
Answer: A
Rationale: This patient has an acute exacerbation of COPD with hypoxia
and signs of infection (purulent sputum, fever). Treatment includes
oxygen to maintain SpO2 > 90%, bronchodilators (albuterol/ipratropium),
systemic corticosteroids (prednisone), and antibiotics for the purulent
sputum. All are indicated. Non-invasive ventilation may be needed but is
not the only intervention.
5. A 55-year-old male with a history of hypertension and hyperlipidemia
presents with a 1-week history of chest pain with exertion. He is started
on atorvastatin. What laboratory value should be monitored at baseline
and periodically?
A) Liver function tests
B) Creatine kinase (CK)
C) Lipid panel
D) All of the above
Answer: D
Rationale: Statins require monitoring of liver function tests (ALT, AST) for
hepatotoxicity, creatine kinase (CK) for myopathy, and lipid panel to
assess efficacy. All of these should be monitored at baseline and
, Page 4 of 48
periodically. CK is especially important if the patient develops muscle
symptoms.
6. A 72-year-old female with a history of osteoporosis is on alendronate.
She reports heartburn and difficulty swallowing. What is the most
appropriate next step?
A) Discontinue alendronate and start raloxifene
B) Switch to intravenous zoledronic acid
C) Ensure proper administration (empty stomach, upright for 30 minutes)
D) Add a PPI
Answer: C
Rationale: Alendronate can cause esophageal irritation if not taken
correctly. The nurse practitioner should first ensure proper
administration: on an empty stomach with a full glass of water, and
remaining upright for at least 30 minutes. If symptoms persist, switching
to intravenous zoledronic acid or another bisphosphonate may be
considered. Adding a PPI may help but does not address the underlying
cause.
7. A 45-year-old female with a history of depression is started on
sertraline. She reports that she is feeling better after 2 weeks. What is the
most appropriate management?
A) Increase the dose
B) Continue the current dose and monitor
C) Discontinue the medication
D) Switch to a different SSRI
Answer: B
Rationale: SSRIs typically take 4-6 weeks to achieve full therapeutic
effect. The patient is feeling better at 2 weeks, indicating a positive
BARKLEY AGPCNP REVIEW EXAM 2026/2027 COMPLETE
(100) CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
AGPCNP
Prepare for the Barkley AGPCNP Review Exam with a focused study resource covering
essential adult-gerontology primary care nurse practitioner concepts. It supports
review of health assessment, common acute and chronic conditions, geriatric
considerations, preventive care, pharmacology, diagnostics, and evidence-based
patient management. Use the material to reinforce clinical knowledge, strengthen
clinical reasoning, and identify areas that may require additional review before
certification testing. This resource is best suited for AGPCNP students and nurse
practitioner certification candidates preparing for adult-gerontology primary care
board-style assessments.
MULTIPLE CHOICE.
1. A 68-year-old male with a history of hypertension and type 2 diabetes
presents for a routine follow-up. His blood pressure today is 142/88
mmHg. He is currently on lisinopril 20 mg daily and metformin 1000 mg
BID. What is the most appropriate next step in managing his
hypertension?
A) Add hydrochlorothiazide 25 mg daily
B) Increase lisinopril to 40 mg daily
C) Add amlodipine 5 mg daily
D) Add spironolactone 25 mg daily
Answer: A
Rationale: For patients with hypertension and diabetes, the target BP is <
130/80 mmHg. If BP is uncontrolled on an ACE inhibitor, adding a thiazide
diuretic is a recommended step. Amlodipine is also an option, but
thiazide diuretics are preferred as an add-on in patients with diabetes.
Increasing lisinopril may help but is less effective than adding a diuretic.
, Page 2 of 48
2. A 72-year-old female with a history of heart failure with reduced
ejection fraction (HFrEF) presents with worsening shortness of breath and
3+ pitting edema. Her medications include lisinopril, carvedilol, and
furosemide. What is the most appropriate next step?
A) Add digoxin
B) Add spironolactone
C) Add sacubitril/valsartan (Entresto)
D) Increase furosemide dose
Answer: C
Rationale: Sacubitril/valsartan (Entresto) has been shown to reduce
mortality and hospitalizations in HFrEF and is recommended as a first-
line therapy in eligible patients. It should replace an ACE inhibitor or ARB
in patients with NYHA class II-III HFrEF. Spironolactone and digoxin are
also options but Entresto provides the most significant mortality benefit.
3. A 55-year-old female with a history of migraines presents with four
migraines per month. She uses sumatriptan as an abortive therapy. What
is the most appropriate prophylactic therapy?
A) Propranolol
B) Topiramate
C) Amitriptyline
D) All of the above
Answer: D
Rationale: Propranolol, topiramate, and amitriptyline are all first-line
prophylactic therapies for migraines. The choice depends on the patient's
comorbidities and side-effect profile. Propranolol is preferred in patients
with hypertension; topiramate may cause weight loss and cognitive
dulling; amitriptyline may cause weight gain and sedation.
, Page 3 of 48
4. A 68-year-old male with COPD presents with an acute exacerbation. He
has increased shortness of breath, purulent sputum, and fever. His SpO2
is 88% on room air. What is the most appropriate initial management?
A) Oxygen, bronchodilators, corticosteroids, and antibiotics
B) Oxygen and bronchodilators only
C) Antibiotics only
D) Non-invasive ventilation only
Answer: A
Rationale: This patient has an acute exacerbation of COPD with hypoxia
and signs of infection (purulent sputum, fever). Treatment includes
oxygen to maintain SpO2 > 90%, bronchodilators (albuterol/ipratropium),
systemic corticosteroids (prednisone), and antibiotics for the purulent
sputum. All are indicated. Non-invasive ventilation may be needed but is
not the only intervention.
5. A 55-year-old male with a history of hypertension and hyperlipidemia
presents with a 1-week history of chest pain with exertion. He is started
on atorvastatin. What laboratory value should be monitored at baseline
and periodically?
A) Liver function tests
B) Creatine kinase (CK)
C) Lipid panel
D) All of the above
Answer: D
Rationale: Statins require monitoring of liver function tests (ALT, AST) for
hepatotoxicity, creatine kinase (CK) for myopathy, and lipid panel to
assess efficacy. All of these should be monitored at baseline and
, Page 4 of 48
periodically. CK is especially important if the patient develops muscle
symptoms.
6. A 72-year-old female with a history of osteoporosis is on alendronate.
She reports heartburn and difficulty swallowing. What is the most
appropriate next step?
A) Discontinue alendronate and start raloxifene
B) Switch to intravenous zoledronic acid
C) Ensure proper administration (empty stomach, upright for 30 minutes)
D) Add a PPI
Answer: C
Rationale: Alendronate can cause esophageal irritation if not taken
correctly. The nurse practitioner should first ensure proper
administration: on an empty stomach with a full glass of water, and
remaining upright for at least 30 minutes. If symptoms persist, switching
to intravenous zoledronic acid or another bisphosphonate may be
considered. Adding a PPI may help but does not address the underlying
cause.
7. A 45-year-old female with a history of depression is started on
sertraline. She reports that she is feeling better after 2 weeks. What is the
most appropriate management?
A) Increase the dose
B) Continue the current dose and monitor
C) Discontinue the medication
D) Switch to a different SSRI
Answer: B
Rationale: SSRIs typically take 4-6 weeks to achieve full therapeutic
effect. The patient is feeling better at 2 weeks, indicating a positive
