Barkley AGACNP DRT Exam 2026 – 200 Acute Care NP
Practice Questions with Answers & Rationales |
Comprehensive Certification Review //Questions 1–200
with answers| 100% Pass Guaranteed | Graded A+
1. A 68-year-old patient in the ICU with cardiogenic shock remains
hypotensive despite an infusion of norepinephrine. The bedside echo
reveals a cardiac index of 1.6 L/min/m² and a pulmonary artery wedge
pressure of 24 mmHg. Which of the following is the most appropriate next
step?
A. Increase the rate of the norepinephrine infusion to improve systemic vascular
resistance
B. Initiate an infusion of dobutamine to improve myocardial contractility
C. Administer a 500 mL bolus of isotonic saline to improve preload
D. Start an infusion of vasopressin to target the V1 receptors
Correct Answer: B
Rationale: The patient exhibits signs of cardiogenic shock (low cardiac index,
elevated wedge pressure). Dobutamine is the preferred inotrope to increase
cardiac output via beta-1 receptor stimulation. Increasing norepinephrine (A)
would increase afterload, worsening the work of the heart, while fluids (C) are
contraindicated due to already elevated filling pressures, and vasopressin (D) is a
vasoconstrictor, not an inotrope .
1
, 2. A patient is admitted with status asthmaticus. Arterial blood gas results
show pH 7.25, PaCO2 55 mmHg, and PaO2 62 mmHg. The patient is
becoming increasingly lethargic. What is the most critical immediate
intervention?
A. Administer subcutaneous terbutaline to promote bronchodilation
B. Prepare for endotracheal intubation and mechanical ventilation
C. Increase the dose of inhaled ipratropium bromide
D. Initiate non-invasive positive pressure ventilation (NIPPV)
Correct Answer: B
Rationale: The patient's rising PaCO2 (respiratory acidosis) combined with
worsening lethargy indicates impending respiratory failure. Intubation is
required to secure the airway and manage ventilation. Terbutaline (A) and
Ipratropium (C) are adjuncts but do not address ventilatory failure, and NIPPV
(D) is generally avoided in severe status asthmaticus due to the risk of air
trapping and gastric distention .
3. A 55-year-old patient with cirrhosis presents with hematemesis. Vital
signs are BP 88/50 mmHg, HR 118 bpm. After stabilizing the airway and
initiating fluid resuscitation, what is the priority pharmacological
intervention?
A. Administer vitamin K intravenously to correct coagulopathy
B. Initiate an octreotide infusion to decrease splanchnic blood flow
C. Administer lactulose to prevent hepatic encephalopathy
D. Start empiric broad-spectrum antibiotics
2
,Correct Answer: B
Rationale: In patients with suspected variceal hemorrhage, octreotide is the
standard of care to reduce portal venous pressure by constricting splanchnic
vessels. Vitamin K (A) is slow-acting and does not stop acute bleeding, lactulose
(C) is for ammonia management, and while antibiotics (D) are indicated later,
octreotide is the priority for controlling the active hemorrhage .
4. A patient post-craniotomy exhibits signs of diabetes insipidus with a urine
output of 400 mL/hr and a serum sodium of 152 mEq/L. Which of the
following is the most appropriate management?
A. Administer a rapid fluid bolus of D5W
B. Administer desmopressin (DDAVP) and replace free water deficits
C. Start an insulin drip to manage potential hyperglycemia
D. Restrict all free water intake
Correct Answer: B
Rationale: Central diabetes insipidus is caused by a deficiency in antidiuretic
hormone (ADH). Management includes desmopressin (DDAVP) to replace ADH
and free water replacement to correct hypernatremia. Rapid D5W bolus (A) is
inappropriate as it can cause rapid shifts in sodium. Insulin (C) is not indicated.
Restricting free water (D) would worsen hypernatremia .
3
, 5. A 60-year-old man with a known history of HFrEF (EF 30%) presents with
worsening dyspnea and 3+ pitting edema. BNP is 1,500 pg/mL. Which
medication class has been shown to reduce mortality in HFrEF?
A. Digoxin
B. Loop diuretics
C. Mineralocorticoid receptor antagonists
D. Calcium channel blockers
Correct Answer: C
Rationale: Guideline-directed medical therapy for HFrEF includes ACE
inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists
(spironolactone/eplerenone), and SGLT2 inhibitors. These agents reduce
myocardial fibrosis and improve outcomes. Loop diuretics (B) manage symptoms
but do not reduce mortality. CCBs (D) except amlodipine are contraindicated in
HFrEF .
6. A patient with a temporary transvenous pacemaker develops sudden
chest pain, hypotension, and a pericardial friction rub. ECG shows diffuse
ST elevation. What is the most likely complication?
A. Pneumothorax
B. Cardiac tamponade
C. Acute pericarditis from lead perforation
D. Pacemaker malfunction
4
Practice Questions with Answers & Rationales |
Comprehensive Certification Review //Questions 1–200
with answers| 100% Pass Guaranteed | Graded A+
1. A 68-year-old patient in the ICU with cardiogenic shock remains
hypotensive despite an infusion of norepinephrine. The bedside echo
reveals a cardiac index of 1.6 L/min/m² and a pulmonary artery wedge
pressure of 24 mmHg. Which of the following is the most appropriate next
step?
A. Increase the rate of the norepinephrine infusion to improve systemic vascular
resistance
B. Initiate an infusion of dobutamine to improve myocardial contractility
C. Administer a 500 mL bolus of isotonic saline to improve preload
D. Start an infusion of vasopressin to target the V1 receptors
Correct Answer: B
Rationale: The patient exhibits signs of cardiogenic shock (low cardiac index,
elevated wedge pressure). Dobutamine is the preferred inotrope to increase
cardiac output via beta-1 receptor stimulation. Increasing norepinephrine (A)
would increase afterload, worsening the work of the heart, while fluids (C) are
contraindicated due to already elevated filling pressures, and vasopressin (D) is a
vasoconstrictor, not an inotrope .
1
, 2. A patient is admitted with status asthmaticus. Arterial blood gas results
show pH 7.25, PaCO2 55 mmHg, and PaO2 62 mmHg. The patient is
becoming increasingly lethargic. What is the most critical immediate
intervention?
A. Administer subcutaneous terbutaline to promote bronchodilation
B. Prepare for endotracheal intubation and mechanical ventilation
C. Increase the dose of inhaled ipratropium bromide
D. Initiate non-invasive positive pressure ventilation (NIPPV)
Correct Answer: B
Rationale: The patient's rising PaCO2 (respiratory acidosis) combined with
worsening lethargy indicates impending respiratory failure. Intubation is
required to secure the airway and manage ventilation. Terbutaline (A) and
Ipratropium (C) are adjuncts but do not address ventilatory failure, and NIPPV
(D) is generally avoided in severe status asthmaticus due to the risk of air
trapping and gastric distention .
3. A 55-year-old patient with cirrhosis presents with hematemesis. Vital
signs are BP 88/50 mmHg, HR 118 bpm. After stabilizing the airway and
initiating fluid resuscitation, what is the priority pharmacological
intervention?
A. Administer vitamin K intravenously to correct coagulopathy
B. Initiate an octreotide infusion to decrease splanchnic blood flow
C. Administer lactulose to prevent hepatic encephalopathy
D. Start empiric broad-spectrum antibiotics
2
,Correct Answer: B
Rationale: In patients with suspected variceal hemorrhage, octreotide is the
standard of care to reduce portal venous pressure by constricting splanchnic
vessels. Vitamin K (A) is slow-acting and does not stop acute bleeding, lactulose
(C) is for ammonia management, and while antibiotics (D) are indicated later,
octreotide is the priority for controlling the active hemorrhage .
4. A patient post-craniotomy exhibits signs of diabetes insipidus with a urine
output of 400 mL/hr and a serum sodium of 152 mEq/L. Which of the
following is the most appropriate management?
A. Administer a rapid fluid bolus of D5W
B. Administer desmopressin (DDAVP) and replace free water deficits
C. Start an insulin drip to manage potential hyperglycemia
D. Restrict all free water intake
Correct Answer: B
Rationale: Central diabetes insipidus is caused by a deficiency in antidiuretic
hormone (ADH). Management includes desmopressin (DDAVP) to replace ADH
and free water replacement to correct hypernatremia. Rapid D5W bolus (A) is
inappropriate as it can cause rapid shifts in sodium. Insulin (C) is not indicated.
Restricting free water (D) would worsen hypernatremia .
3
, 5. A 60-year-old man with a known history of HFrEF (EF 30%) presents with
worsening dyspnea and 3+ pitting edema. BNP is 1,500 pg/mL. Which
medication class has been shown to reduce mortality in HFrEF?
A. Digoxin
B. Loop diuretics
C. Mineralocorticoid receptor antagonists
D. Calcium channel blockers
Correct Answer: C
Rationale: Guideline-directed medical therapy for HFrEF includes ACE
inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists
(spironolactone/eplerenone), and SGLT2 inhibitors. These agents reduce
myocardial fibrosis and improve outcomes. Loop diuretics (B) manage symptoms
but do not reduce mortality. CCBs (D) except amlodipine are contraindicated in
HFrEF .
6. A patient with a temporary transvenous pacemaker develops sudden
chest pain, hypotension, and a pericardial friction rub. ECG shows diffuse
ST elevation. What is the most likely complication?
A. Pneumothorax
B. Cardiac tamponade
C. Acute pericarditis from lead perforation
D. Pacemaker malfunction
4
