BARKLEY AGACNP DIAGNOSTIC READINESS
TEST (DRT) EXAM STYLE V1 | BARKLEY &
ASSOCIATES | ACUTE CARE NP
CERTIFICATION PREP
Core Domains
• Cardiovascular Emergencies and Critical Care
• Pulmonary and Respiratory Disorders
• Neurological Emergencies and Stroke Management
• Infectious Diseases and Immunizations
• Hematologic and Oncologic Emergencies
• Renal and Genitourinary Disorders
• Endocrine and Metabolic Emergencies
• Gastrointestinal and Hepatobiliary Disorders
• Pharmacology and Medication Management
• Multisystem Organ Failure and Shock States
Introduction
This comprehensive Diagnostic Readiness Test (DRT) is designed to assess the
advanced clinical knowledge, diagnostic reasoning, and evidence-based
practice skills required for the Acute Care Nurse Practitioner (AGACNP)
certification examination. Developed in the style of Barkley & Associates, this
rigorous examination assesses advanced clinical reasoning, diagnostic
acumen, and evidence-based management across the breadth of acute care
,conditions encountered by the AGACNP. Through a combination of multiple-
choice questions and clinical vignettes, candidates are expected to demonstrate
proficiency in managing complex, acutely ill patients across the lifespan,
integrating pathophysiology, pharmacology, and systems-based practice at the
highest level of independent practice. Emphasis is placed on applying current
clinical guidelines, making critical decisions in high-acuity environments, and
ensuring patient safety in the acute care setting.
SECTION ONE: QUESTIONS 1–100
Question 1
A 65-year-old man with a history of hypertension and diabetes presents with
substernal chest pressure, diaphoresis, and nausea for 2 hours. ECG shows ST-
segment elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery (LAD)
B. Left circumflex artery (LCx)
C. Right coronary artery (RCA)
D. Left main coronary artery
C. Right coronary artery (RCA)
RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior
wall myocardial infarction. The RCA supplies the inferior wall in the majority
of patients. The LAD supplies the anterior wall (V1-V4), the LCx supplies the
lateral wall (I, aVL, V5-V6), and the left main supplies large territories and is
often fatal.
Question 2
,A patient with an acute anterior STEMI undergoes percutaneous coronary
intervention (PCI) and receives a drug-eluting stent. Dual antiplatelet therapy
(DAPT) with aspirin and a P2Y12 inhibitor should be continued for at least:
A. 1 month
B. 3 months
C. 6–12 months
D. Indefinitely, with only aspirin after the first year
C. 6–12 months
RATIONALE: For patients with acute coronary syndrome treated with a
drug-eluting stent, current guidelines recommend DAPT (aspirin plus
ticagrelor, prasugrel, or clopidogrel) for at least 6–12 months. After that,
aspirin alone continues indefinitely. Shorter durations may be considered in
high bleeding risk patients.
Question 3
A 60-year-old man with a known history of heart failure with reduced
ejection fraction (HFrEF, EF 30%) presents with worsening dyspnea,
orthopnea, and 3+ pitting edema. BNP is 1,500 pg/mL. Which of the following
medication classes has been shown to reduce mortality in HFrEF?
A. Digoxin
B. Loop diuretics
C. Mineralocorticoid receptor antagonists (eplerenone)
D. Calcium channel blockers
C. Mineralocorticoid receptor antagonists (eplerenone)
RATIONALE: Guideline-directed medical therapy for HFrEF includes
ACE inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists
(spironolactone, eplerenone), and SGLT2 inhibitors. These reduce mortality.
Digoxin reduces hospitalizations but not mortality. Loop diuretics control
, symptoms. Calcium channel blockers (except amlodipine) are generally
avoided in HFrEF.
Question 4
A patient with a temporary transvenous pacemaker develops sudden onset of
chest pain, hypotension, and a pericardial friction rub. ECG shows ST
elevation in all leads. What is the most likely complication?
A. Pneumothorax
B. Cardiac tamponade
C. Acute pericarditis from lead perforation
D. Pacemaker malfunction
C. Acute pericarditis from lead perforation
RATIONALE: A transvenous pacemaker lead can perforate the right
ventricular wall, causing acute pericarditis with diffuse ST elevation and a
pericardial friction rub. Tamponade would present with Beck's triad
(hypotension, muffled heart sounds, JVD). Pneumothorax would present with
absent breath sounds.
Question 5
A 55-year-old woman with acute decompensated heart failure has a blood
pressure of 85/50 mmHg, cold extremities, and a cardiac index of 1.8
L/min/m². Which inotropic agent is most appropriate?
A. Dobutamine
B. Milrinone
C. Norepinephrine
D. Digoxin
A. Dobutamine
TEST (DRT) EXAM STYLE V1 | BARKLEY &
ASSOCIATES | ACUTE CARE NP
CERTIFICATION PREP
Core Domains
• Cardiovascular Emergencies and Critical Care
• Pulmonary and Respiratory Disorders
• Neurological Emergencies and Stroke Management
• Infectious Diseases and Immunizations
• Hematologic and Oncologic Emergencies
• Renal and Genitourinary Disorders
• Endocrine and Metabolic Emergencies
• Gastrointestinal and Hepatobiliary Disorders
• Pharmacology and Medication Management
• Multisystem Organ Failure and Shock States
Introduction
This comprehensive Diagnostic Readiness Test (DRT) is designed to assess the
advanced clinical knowledge, diagnostic reasoning, and evidence-based
practice skills required for the Acute Care Nurse Practitioner (AGACNP)
certification examination. Developed in the style of Barkley & Associates, this
rigorous examination assesses advanced clinical reasoning, diagnostic
acumen, and evidence-based management across the breadth of acute care
,conditions encountered by the AGACNP. Through a combination of multiple-
choice questions and clinical vignettes, candidates are expected to demonstrate
proficiency in managing complex, acutely ill patients across the lifespan,
integrating pathophysiology, pharmacology, and systems-based practice at the
highest level of independent practice. Emphasis is placed on applying current
clinical guidelines, making critical decisions in high-acuity environments, and
ensuring patient safety in the acute care setting.
SECTION ONE: QUESTIONS 1–100
Question 1
A 65-year-old man with a history of hypertension and diabetes presents with
substernal chest pressure, diaphoresis, and nausea for 2 hours. ECG shows ST-
segment elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery (LAD)
B. Left circumflex artery (LCx)
C. Right coronary artery (RCA)
D. Left main coronary artery
C. Right coronary artery (RCA)
RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior
wall myocardial infarction. The RCA supplies the inferior wall in the majority
of patients. The LAD supplies the anterior wall (V1-V4), the LCx supplies the
lateral wall (I, aVL, V5-V6), and the left main supplies large territories and is
often fatal.
Question 2
,A patient with an acute anterior STEMI undergoes percutaneous coronary
intervention (PCI) and receives a drug-eluting stent. Dual antiplatelet therapy
(DAPT) with aspirin and a P2Y12 inhibitor should be continued for at least:
A. 1 month
B. 3 months
C. 6–12 months
D. Indefinitely, with only aspirin after the first year
C. 6–12 months
RATIONALE: For patients with acute coronary syndrome treated with a
drug-eluting stent, current guidelines recommend DAPT (aspirin plus
ticagrelor, prasugrel, or clopidogrel) for at least 6–12 months. After that,
aspirin alone continues indefinitely. Shorter durations may be considered in
high bleeding risk patients.
Question 3
A 60-year-old man with a known history of heart failure with reduced
ejection fraction (HFrEF, EF 30%) presents with worsening dyspnea,
orthopnea, and 3+ pitting edema. BNP is 1,500 pg/mL. Which of the following
medication classes has been shown to reduce mortality in HFrEF?
A. Digoxin
B. Loop diuretics
C. Mineralocorticoid receptor antagonists (eplerenone)
D. Calcium channel blockers
C. Mineralocorticoid receptor antagonists (eplerenone)
RATIONALE: Guideline-directed medical therapy for HFrEF includes
ACE inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists
(spironolactone, eplerenone), and SGLT2 inhibitors. These reduce mortality.
Digoxin reduces hospitalizations but not mortality. Loop diuretics control
, symptoms. Calcium channel blockers (except amlodipine) are generally
avoided in HFrEF.
Question 4
A patient with a temporary transvenous pacemaker develops sudden onset of
chest pain, hypotension, and a pericardial friction rub. ECG shows ST
elevation in all leads. What is the most likely complication?
A. Pneumothorax
B. Cardiac tamponade
C. Acute pericarditis from lead perforation
D. Pacemaker malfunction
C. Acute pericarditis from lead perforation
RATIONALE: A transvenous pacemaker lead can perforate the right
ventricular wall, causing acute pericarditis with diffuse ST elevation and a
pericardial friction rub. Tamponade would present with Beck's triad
(hypotension, muffled heart sounds, JVD). Pneumothorax would present with
absent breath sounds.
Question 5
A 55-year-old woman with acute decompensated heart failure has a blood
pressure of 85/50 mmHg, cold extremities, and a cardiac index of 1.8
L/min/m². Which inotropic agent is most appropriate?
A. Dobutamine
B. Milrinone
C. Norepinephrine
D. Digoxin
A. Dobutamine
