BARKLEY AGACNP REVIEW QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Advanced Pathophysiology Across the Lifespan
Comprehensive History and Physical Assessment
Diagnostic Reasoning and Interpretation
Pharmacology and Therapeutic Management
Acute and Critical Care Management
Ethical, Legal, and Professional Standards
Health Promotion and Disease Prevention
Evidence-Based Practice and Quality Improvement
Multisystem Organ Failure and Complex Comorbidities
Palliative Care and End-of-Life Decision-Making
Introduction
This comprehensive examination is designed to assess the knowledge, clinical reasoning, and decision-making
skills essential for the Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) in the acute and critical care
setting. The assessment covers foundational pathophysiological concepts, advanced diagnostic interpretation,
pharmacotherapeutic interventions, and the application of evidence-based guidelines to complex, real-world
,patient scenarios. Additionally, this exam evaluates the candidate's understanding of ethical principles, regulatory
compliance, and professional role responsibilities. Each question is structured in a multiple-choice format and is
accompanied by a detailed rationale to reinforce learning and promote clinical excellence. The scenarios presented
require the integration of theoretical knowledge with practical application, emphasizing safe, patient-centered, and
high-quality care delivery in dynamic healthcare environments.
SECTION ONE: QUESTIONS 1–100
Question 1
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presents
to the emergency department with acute onset of severe, ripping chest pain that radiates to his back. His blood
pressure is 180/110 mmHg in the right arm and 140/90 mmHg in the left arm. Which of the following is the
most appropriate initial diagnostic test?
A. Computed tomography angiography (CTA) of the chest
B. Standard chest radiography
C. Transthoracic echocardiography
D. Electrocardiogram (ECG)
,🟢 A. Computed tomography angiography (CTA) of the chest
🔴 RATIONALE: The presentation of acute, severe ripping chest pain radiating to the back with a significant
blood pressure differential between arms is classic for aortic dissection. CTA of the chest is the gold standard
imaging modality for diagnosing aortic dissection due to its high sensitivity and specificity, and it provides
rapid, detailed visualization of the aorta. While an ECG may help rule out myocardial infarction, it is not
diagnostic for dissection. Chest radiography may show a widened mediastinum but is neither sensitive nor
specific. Echocardiography can be useful but is operator-dependent and less definitive than CTA in the acute
setting.
Question 2
A 72-year-old female with a history of heart failure with reduced ejection fraction (HFrEF) is admitted with acute
decompensated heart failure. She is currently on lisinopril, carvedilol, and furosemide. Her laboratory results
show a serum potassium of 5.8 mEq/L and a creatinine of 2.1 mg/dL. Which of the following medications should
be held?
A. Carvedilol
B. Furosemide
C. Lisinopril
D. All of the above
, 🟢 C. Lisinopril
🔴 RATIONALE: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that can cause hyperkalemia,
particularly in patients with renal impairment. With a potassium of 5.8 mEq/L and elevated creatinine, the ACE
inhibitor should be held to prevent further worsening of hyperkalemia and potential acute kidney injury.
Carvedilol (a beta-blocker) and furosemide (a loop diuretic) do not typically cause hyperkalemia; in fact,
furosemide promotes potassium excretion and may be continued to manage fluid overload.
Question 3
A 65-year-old male presents with a 2-day history of fever, productive cough with purulent sputum, and pleuritic
chest pain. His chest radiograph shows a right lower lobe infiltrate. He has a history of diabetes mellitus and
reports a penicillin allergy (anaphylactic reaction). Which of the following is the most appropriate empiric
antibiotic regimen?
A. Azithromycin
B. Levofloxacin
C. Doxycycline
D. Cefepime
🟢 B. Levofloxacin
2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
Advanced Pathophysiology Across the Lifespan
Comprehensive History and Physical Assessment
Diagnostic Reasoning and Interpretation
Pharmacology and Therapeutic Management
Acute and Critical Care Management
Ethical, Legal, and Professional Standards
Health Promotion and Disease Prevention
Evidence-Based Practice and Quality Improvement
Multisystem Organ Failure and Complex Comorbidities
Palliative Care and End-of-Life Decision-Making
Introduction
This comprehensive examination is designed to assess the knowledge, clinical reasoning, and decision-making
skills essential for the Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) in the acute and critical care
setting. The assessment covers foundational pathophysiological concepts, advanced diagnostic interpretation,
pharmacotherapeutic interventions, and the application of evidence-based guidelines to complex, real-world
,patient scenarios. Additionally, this exam evaluates the candidate's understanding of ethical principles, regulatory
compliance, and professional role responsibilities. Each question is structured in a multiple-choice format and is
accompanied by a detailed rationale to reinforce learning and promote clinical excellence. The scenarios presented
require the integration of theoretical knowledge with practical application, emphasizing safe, patient-centered, and
high-quality care delivery in dynamic healthcare environments.
SECTION ONE: QUESTIONS 1–100
Question 1
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presents
to the emergency department with acute onset of severe, ripping chest pain that radiates to his back. His blood
pressure is 180/110 mmHg in the right arm and 140/90 mmHg in the left arm. Which of the following is the
most appropriate initial diagnostic test?
A. Computed tomography angiography (CTA) of the chest
B. Standard chest radiography
C. Transthoracic echocardiography
D. Electrocardiogram (ECG)
,🟢 A. Computed tomography angiography (CTA) of the chest
🔴 RATIONALE: The presentation of acute, severe ripping chest pain radiating to the back with a significant
blood pressure differential between arms is classic for aortic dissection. CTA of the chest is the gold standard
imaging modality for diagnosing aortic dissection due to its high sensitivity and specificity, and it provides
rapid, detailed visualization of the aorta. While an ECG may help rule out myocardial infarction, it is not
diagnostic for dissection. Chest radiography may show a widened mediastinum but is neither sensitive nor
specific. Echocardiography can be useful but is operator-dependent and less definitive than CTA in the acute
setting.
Question 2
A 72-year-old female with a history of heart failure with reduced ejection fraction (HFrEF) is admitted with acute
decompensated heart failure. She is currently on lisinopril, carvedilol, and furosemide. Her laboratory results
show a serum potassium of 5.8 mEq/L and a creatinine of 2.1 mg/dL. Which of the following medications should
be held?
A. Carvedilol
B. Furosemide
C. Lisinopril
D. All of the above
, 🟢 C. Lisinopril
🔴 RATIONALE: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that can cause hyperkalemia,
particularly in patients with renal impairment. With a potassium of 5.8 mEq/L and elevated creatinine, the ACE
inhibitor should be held to prevent further worsening of hyperkalemia and potential acute kidney injury.
Carvedilol (a beta-blocker) and furosemide (a loop diuretic) do not typically cause hyperkalemia; in fact,
furosemide promotes potassium excretion and may be continued to manage fluid overload.
Question 3
A 65-year-old male presents with a 2-day history of fever, productive cough with purulent sputum, and pleuritic
chest pain. His chest radiograph shows a right lower lobe infiltrate. He has a history of diabetes mellitus and
reports a penicillin allergy (anaphylactic reaction). Which of the following is the most appropriate empiric
antibiotic regimen?
A. Azithromycin
B. Levofloxacin
C. Doxycycline
D. Cefepime
🟢 B. Levofloxacin
