Barkley Adult-Gerontology Primary Care NP
(AGPCNP) Certification Review 2026–
2027|||questions and answers with
rationales/graded A+/2026 update/100%
correct /instant download
EXAM FORMAT OVERVIEW
Exam ANCC AGPCNP-BC AANPCB A-GNP
Total
175 (150 scored) 175 (150 scored)
Questions
Time Allowed 3 hours 3 hours
Content Assessment 24%, Plan of Care 60%, Assessment 28%, Diagnosis 25%
Domains Professional Practice 16% Plan 25%, Evaluation 22%
Pass Rate
~83% ~83%
(2023)
PART 1: CARDIOVASCULAR DISORDERS (Questions 1-20)
,Q1. A 72-year-old male with a history of CAD presents with crushing
substernal chest pain radiating to the left arm. Which initial intervention is
MOST appropriate?
• A) Administer morphine IV
• B) Administer 325 mg aspirin PO ✓
• C) Start heparin infusion
• D) Obtain cardiac enzymes
Rational: Aspirin should be administered immediately to inhibit platelet aggregation
and reduce mortality in acute MI. Morphine, heparin, and cardiac enzymes are
important but follow after initial aspirin administration .
Q2. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the
best management to reduce stroke risk?
• A) No anticoagulation needed
• B) Dual antiplatelet therapy
• C) Oral anticoagulation (e.g., apixaban) ✓
• D) Rate control with beta-blocker
Rational: A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants oral
anticoagulation to reduce stroke risk. Antiplatelet therapy alone is insufficient .
Q3. A 68-year-old male with hypertension presents with acute-onset tearing
chest pain radiating to the back. BP is 180/100 in the right arm and 130/70 in
the left arm. What is the most likely diagnosis?
, • A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection ✓
• D) Pericarditis
Rational: This presentation is classic for aortic dissection: tearing chest pain
radiating to the back with significant BP differential between arms (>20 mmHg
difference) .
Q4. A 75-year-old female reports syncope during exercise and a murmur that
decreases with squatting. What is the most likely diagnosis?
• A) Mitral regurgitation
• B) Aortic stenosis ✓
• C) Hypertrophic cardiomyopathy
• D) Mitral valve prolapse
Rational: Exertional syncope is a classic symptom of severe aortic stenosis. The
murmur of aortic stenosis typically decreases with squatting (increased preload) .
Q5. Which ECG finding is most suggestive of pericarditis?
• A) ST elevation in V1-V4
• B) Diffuse ST elevation and PR depression ✓
• C) ST depression in leads II, III, aVF
• D) T-wave inversion only in V5-V6
, Rational: Pericarditis classically shows diffuse ST elevation and PR depression
across multiple leads (not localized like MI) .
Q6. A 65-year-old diabetic with hypertension has a BP of 145/90. According to
current guidelines, what is the target BP for this patient?
• A) <130/80 mmHg ✓
• B) <140/90 mmHg
• C) <150/90 mmHg
• D) <120/80 mmHg
Rational: Current guidelines recommend a BP target of <130/80 mmHg for patients
with diabetes based on ACC/AHA guidelines and SPRINT trial data .
Q7. Which finding is characteristic of right-sided heart failure on physical
examination?
• A) Crackles in lung bases
• B) Jugular venous distention (JVD) ✓
• C) S3 gallop
• D) Orthopnea
Rational: JVD, peripheral edema, hepatomegaly, and ascites are signs of right-
sided heart failure. Crackles, orthopnea, and S3 indicate left-sided failure .
(AGPCNP) Certification Review 2026–
2027|||questions and answers with
rationales/graded A+/2026 update/100%
correct /instant download
EXAM FORMAT OVERVIEW
Exam ANCC AGPCNP-BC AANPCB A-GNP
Total
175 (150 scored) 175 (150 scored)
Questions
Time Allowed 3 hours 3 hours
Content Assessment 24%, Plan of Care 60%, Assessment 28%, Diagnosis 25%
Domains Professional Practice 16% Plan 25%, Evaluation 22%
Pass Rate
~83% ~83%
(2023)
PART 1: CARDIOVASCULAR DISORDERS (Questions 1-20)
,Q1. A 72-year-old male with a history of CAD presents with crushing
substernal chest pain radiating to the left arm. Which initial intervention is
MOST appropriate?
• A) Administer morphine IV
• B) Administer 325 mg aspirin PO ✓
• C) Start heparin infusion
• D) Obtain cardiac enzymes
Rational: Aspirin should be administered immediately to inhibit platelet aggregation
and reduce mortality in acute MI. Morphine, heparin, and cardiac enzymes are
important but follow after initial aspirin administration .
Q2. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the
best management to reduce stroke risk?
• A) No anticoagulation needed
• B) Dual antiplatelet therapy
• C) Oral anticoagulation (e.g., apixaban) ✓
• D) Rate control with beta-blocker
Rational: A CHA₂DS₂-VASc score ≥2 in men (≥3 in women) warrants oral
anticoagulation to reduce stroke risk. Antiplatelet therapy alone is insufficient .
Q3. A 68-year-old male with hypertension presents with acute-onset tearing
chest pain radiating to the back. BP is 180/100 in the right arm and 130/70 in
the left arm. What is the most likely diagnosis?
, • A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection ✓
• D) Pericarditis
Rational: This presentation is classic for aortic dissection: tearing chest pain
radiating to the back with significant BP differential between arms (>20 mmHg
difference) .
Q4. A 75-year-old female reports syncope during exercise and a murmur that
decreases with squatting. What is the most likely diagnosis?
• A) Mitral regurgitation
• B) Aortic stenosis ✓
• C) Hypertrophic cardiomyopathy
• D) Mitral valve prolapse
Rational: Exertional syncope is a classic symptom of severe aortic stenosis. The
murmur of aortic stenosis typically decreases with squatting (increased preload) .
Q5. Which ECG finding is most suggestive of pericarditis?
• A) ST elevation in V1-V4
• B) Diffuse ST elevation and PR depression ✓
• C) ST depression in leads II, III, aVF
• D) T-wave inversion only in V5-V6
, Rational: Pericarditis classically shows diffuse ST elevation and PR depression
across multiple leads (not localized like MI) .
Q6. A 65-year-old diabetic with hypertension has a BP of 145/90. According to
current guidelines, what is the target BP for this patient?
• A) <130/80 mmHg ✓
• B) <140/90 mmHg
• C) <150/90 mmHg
• D) <120/80 mmHg
Rational: Current guidelines recommend a BP target of <130/80 mmHg for patients
with diabetes based on ACC/AHA guidelines and SPRINT trial data .
Q7. Which finding is characteristic of right-sided heart failure on physical
examination?
• A) Crackles in lung bases
• B) Jugular venous distention (JVD) ✓
• C) S3 gallop
• D) Orthopnea
Rational: JVD, peripheral edema, hepatomegaly, and ascites are signs of right-
sided heart failure. Crackles, orthopnea, and S3 indicate left-sided failure .
