ANCC AGACNP Barkley Certification Exam American
Nurses Credentialing Center | Adult Gerontology
Acute Care Nurse Practitioner Complete Practice
Test Bank | 2026/2027 Academic Year
Section I: Cardiovascular Clinical Management
1. A 68-year-old male with a history of hypertension presents with
sudden onset of severe, tearing chest pain that radiates to his back.
His blood pressure is 180/100 mmHg in the right arm and 140/90
mmHg in the left arm. Which of the following is the most likely
diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing
chest pain that radiates to the back, often with a blood pressure
differential between arms (≥20 mmHg). Risk factors include
hypertension, connective tissue disease (Marfan, Ehlers-Danlos),
and cocaine use. This is a medical emergency requiring immediate
surgical consultation.
,2. A 55-year-old male with a history of coronary artery disease
presents with chest pain that occurs at rest and is not relieved by
nitroglycerin. Which of the following is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) Non-ST elevation myocardial infarction (NSTEMI)
Answer: D
Rationale: Chest pain at rest not relieved by nitroglycerin in a
patient with known CAD is concerning for an acute coronary
syndrome. NSTEMI is diagnosed with elevated cardiac biomarkers
(troponin) and ECG changes (ST depression or T-wave inversion).
Unstable angina has similar symptoms but without biomarker
elevation.
3. A 65-year-old male with heart failure is prescribed digoxin. Which
of the following ECG findings indicates digoxin toxicity?
A) Atrial fibrillation
B) Atrial flutter
C) Bradycardia
D) Ventricular fibrillation
Answer: C
Rationale: Digoxin toxicity can cause bradycardia, heart block, and
ventricular arrhythmias. Classic ECG findings include ventricular
,bigeminy and "reverse tick" ST-segment depression. Bradycardia is
a common early sign of toxicity.
4. A 72-year-old female with heart failure is prescribed furosemide
(Lasix). Which electrolyte abnormality is the most concerning
complication?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypoglycemia
Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na-K-
ATPase in the thick ascending limb of the loop of Henle, increasing
potassium excretion. Hypokalemia can precipitate cardiac
arrhythmias, especially in patients on digoxin.
5. A 58-year-old male presents with acute onset of chest pain,
shortness of breath, and diaphoresis. His ECG shows ST-segment
elevation in leads V1-V4. Which of the following is the most
appropriate immediate intervention?
A) Administer aspirin and nitroglycerin
B) Prepare for emergency percutaneous coronary intervention (PCI)
C) Administer thrombolytics
D) Administer morphine and observe
Answer: B
Rationale: ST-segment elevation in leads V1-V4 indicates an acute
, anterior wall ST-elevation myocardial infarction (STEMI). Emergency
PCI is the preferred reperfusion strategy if available (door-to-
balloon time ≤90 minutes). Aspirin and nitroglycerin are also given,
but PCI is the definitive treatment.
6. A 62-year-old female presents with acute dyspnea, orthopnea,
and paroxysmal nocturnal dyspnea. Physical examination reveals
crackles in the lungs, jugular venous distension, and peripheral
edema. Which of the following is the most appropriate initial
medication to improve symptoms and mortality?
A) Furosemide
B) Lisinopril (ACE inhibitor)
C) Digoxin
D) Metoprolol
Answer: B
Rationale: This patient is presenting with heart failure with reduced
ejection fraction (HFrEF). ACE inhibitors (lisinopril) improve
symptoms and mortality in heart failure by reducing afterload and
preload. Furosemide improves symptoms but does not improve
mortality. Beta-blockers also improve mortality but are typically
started after stabilization.
7. A 55-year-old female presents with palpitations, fatigue, and
weight loss despite increased appetite. She reports feeling warm
even in air conditioning. Which of the following is the most likely
diagnosis?
Nurses Credentialing Center | Adult Gerontology
Acute Care Nurse Practitioner Complete Practice
Test Bank | 2026/2027 Academic Year
Section I: Cardiovascular Clinical Management
1. A 68-year-old male with a history of hypertension presents with
sudden onset of severe, tearing chest pain that radiates to his back.
His blood pressure is 180/100 mmHg in the right arm and 140/90
mmHg in the left arm. Which of the following is the most likely
diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Aortic dissection presents with sudden, severe, tearing
chest pain that radiates to the back, often with a blood pressure
differential between arms (≥20 mmHg). Risk factors include
hypertension, connective tissue disease (Marfan, Ehlers-Danlos),
and cocaine use. This is a medical emergency requiring immediate
surgical consultation.
,2. A 55-year-old male with a history of coronary artery disease
presents with chest pain that occurs at rest and is not relieved by
nitroglycerin. Which of the following is the most likely diagnosis?
A) Stable angina
B) Unstable angina
C) Prinzmetal's angina
D) Non-ST elevation myocardial infarction (NSTEMI)
Answer: D
Rationale: Chest pain at rest not relieved by nitroglycerin in a
patient with known CAD is concerning for an acute coronary
syndrome. NSTEMI is diagnosed with elevated cardiac biomarkers
(troponin) and ECG changes (ST depression or T-wave inversion).
Unstable angina has similar symptoms but without biomarker
elevation.
3. A 65-year-old male with heart failure is prescribed digoxin. Which
of the following ECG findings indicates digoxin toxicity?
A) Atrial fibrillation
B) Atrial flutter
C) Bradycardia
D) Ventricular fibrillation
Answer: C
Rationale: Digoxin toxicity can cause bradycardia, heart block, and
ventricular arrhythmias. Classic ECG findings include ventricular
,bigeminy and "reverse tick" ST-segment depression. Bradycardia is
a common early sign of toxicity.
4. A 72-year-old female with heart failure is prescribed furosemide
(Lasix). Which electrolyte abnormality is the most concerning
complication?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypoglycemia
Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na-K-
ATPase in the thick ascending limb of the loop of Henle, increasing
potassium excretion. Hypokalemia can precipitate cardiac
arrhythmias, especially in patients on digoxin.
5. A 58-year-old male presents with acute onset of chest pain,
shortness of breath, and diaphoresis. His ECG shows ST-segment
elevation in leads V1-V4. Which of the following is the most
appropriate immediate intervention?
A) Administer aspirin and nitroglycerin
B) Prepare for emergency percutaneous coronary intervention (PCI)
C) Administer thrombolytics
D) Administer morphine and observe
Answer: B
Rationale: ST-segment elevation in leads V1-V4 indicates an acute
, anterior wall ST-elevation myocardial infarction (STEMI). Emergency
PCI is the preferred reperfusion strategy if available (door-to-
balloon time ≤90 minutes). Aspirin and nitroglycerin are also given,
but PCI is the definitive treatment.
6. A 62-year-old female presents with acute dyspnea, orthopnea,
and paroxysmal nocturnal dyspnea. Physical examination reveals
crackles in the lungs, jugular venous distension, and peripheral
edema. Which of the following is the most appropriate initial
medication to improve symptoms and mortality?
A) Furosemide
B) Lisinopril (ACE inhibitor)
C) Digoxin
D) Metoprolol
Answer: B
Rationale: This patient is presenting with heart failure with reduced
ejection fraction (HFrEF). ACE inhibitors (lisinopril) improve
symptoms and mortality in heart failure by reducing afterload and
preload. Furosemide improves symptoms but does not improve
mortality. Beta-blockers also improve mortality but are typically
started after stabilization.
7. A 55-year-old female presents with palpitations, fatigue, and
weight loss despite increased appetite. She reports feeling warm
even in air conditioning. Which of the following is the most likely
diagnosis?
