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Barkley AGACNP DRT 2026/2027 Exam Test Bank
Adult-Gerontology Acute Care Nurse Practitioner
Diagnostic Readiness Test (DRT) — 2026/2027 Newest Edition
Part 1: Cardiovascular Disorders and Hemodynamic Management (Questions 1–25)
1. A 68-year-old patient in the ICU with cardiogenic shock remains hypotensive despite an
infusion of norepinephrine. 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.
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. Fluids (C) are contraindicated due to already elevated filling pressures.
Vasopressin (D) is a vasoconstrictor, not an inotrope .
2. A 72-year-old male with acute decompensated heart failure presents with bibasilar
crackles, jugular venous distention, and orthopnea. The most appropriate initial
intervention is:
A. Rapid IV fluid bolus
B. Initiation of beta-blocker
C. High-dose NSAIDs
D. IV loop diuretic and oxygen support
Answer: D
Rationale: Management of acute decompensated heart failure with volume overload
includes diuresis, oxygen therapy, and hemodynamic support as needed.
3. A 55-year-old male presents with chest pain and ECG shows ST-segment elevation. The
most likely diagnosis is:
A. Pericarditis
B. ST-elevation myocardial infarction (STEMI)
C. Pulmonary embolism
D. Aortic dissection
, 2
Answer: B
Rationale: ST-segment elevation is the hallmark ECG finding of STEMI and requires emergent
reperfusion therapy.
4. A patient has an irregularly irregular rhythm with a pulse deficit. The most likely
arrhythmia is:
A. Ventricular tachycardia
B. Atrial fibrillation
C. Sinus tachycardia
D. Second-degree heart block
Answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm with a pulse
deficit.
5. A 60-year-old male presents with sudden tearing chest pain radiating to the back with a
significant difference in blood pressure between arms. The most likely diagnosis is:
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pneumothorax
Answer: B
Rationale: Tearing chest pain radiating to the back and interarm blood pressure difference
are the classic triad of aortic dissection.
6. A patient on digoxin for heart failure develops which of the following findings
suggestive of digoxin toxicity?
A. Heart rate 58 bpm
B. Nausea, vomiting, and yellow-green visual changes
C. Blood pressure 140/90 mmHg
D. Increased urine output
Answer: B
Rationale: Classic manifestations of digoxin toxicity include gastrointestinal symptoms
(nausea, vomiting), visual changes (xanthopsia, green/yellow vision), and arrhythmias.
7. A patient presents with jugular venous distention, hypotension, and muffled heart
sounds (Beck's triad). The most likely diagnosis is:
A. Cardiac tamponade
B. Myocardial infarction
C. Heart failure
D. Pneumothorax
, 3
Answer: A
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) is classic for cardiac
tamponade, requiring emergent pericardiocentesis.
8. A 65-year-old female presents with acute pulmonary edema. The most appropriate
initial ventilatory support is:
A. Endotracheal intubation
B. Noninvasive positive pressure ventilation (NIPPV)
C. High-flow nasal cannula
D. Simple face mask oxygen
Answer: B
Rationale: NIPPV (CPAP or BiPAP) is the preferred ventilatory support for acute cardiogenic
pulmonary edema, reducing intubation rates.
9. A patient is started on amiodarone. The major adverse effects requiring monitoring
include:
A. Thyroid dysfunction and pulmonary fibrosis
B. Hyperglycemia
C. Hypokalemia
D. Nephrotoxicity
Answer: A
Rationale: Long-term amiodarone use can cause thyroid dysfunction (hyper- or
hypothyroidism) and pulmonary fibrosis.
10. A patient develops ventricular fibrillation. The immediate intervention is:
A. Synchronized cardioversion
B. Defibrillation
C. Adenosine administration
D. Beta-blocker administration
Answer: B
Rationale: Ventricular fibrillation is an absolute indication for defibrillation, which should be
performed immediately with unsynchronized shocks.
11. A patient has a blood pressure of 80/50 mmHg, heart rate of 120 bpm, and cool,
clammy skin. This represents which type of shock?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock
D. Obstructive shock
Barkley AGACNP DRT 2026/2027 Exam Test Bank
Adult-Gerontology Acute Care Nurse Practitioner
Diagnostic Readiness Test (DRT) — 2026/2027 Newest Edition
Part 1: Cardiovascular Disorders and Hemodynamic Management (Questions 1–25)
1. A 68-year-old patient in the ICU with cardiogenic shock remains hypotensive despite an
infusion of norepinephrine. 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.
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. Fluids (C) are contraindicated due to already elevated filling pressures.
Vasopressin (D) is a vasoconstrictor, not an inotrope .
2. A 72-year-old male with acute decompensated heart failure presents with bibasilar
crackles, jugular venous distention, and orthopnea. The most appropriate initial
intervention is:
A. Rapid IV fluid bolus
B. Initiation of beta-blocker
C. High-dose NSAIDs
D. IV loop diuretic and oxygen support
Answer: D
Rationale: Management of acute decompensated heart failure with volume overload
includes diuresis, oxygen therapy, and hemodynamic support as needed.
3. A 55-year-old male presents with chest pain and ECG shows ST-segment elevation. The
most likely diagnosis is:
A. Pericarditis
B. ST-elevation myocardial infarction (STEMI)
C. Pulmonary embolism
D. Aortic dissection
, 2
Answer: B
Rationale: ST-segment elevation is the hallmark ECG finding of STEMI and requires emergent
reperfusion therapy.
4. A patient has an irregularly irregular rhythm with a pulse deficit. The most likely
arrhythmia is:
A. Ventricular tachycardia
B. Atrial fibrillation
C. Sinus tachycardia
D. Second-degree heart block
Answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm with a pulse
deficit.
5. A 60-year-old male presents with sudden tearing chest pain radiating to the back with a
significant difference in blood pressure between arms. The most likely diagnosis is:
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pneumothorax
Answer: B
Rationale: Tearing chest pain radiating to the back and interarm blood pressure difference
are the classic triad of aortic dissection.
6. A patient on digoxin for heart failure develops which of the following findings
suggestive of digoxin toxicity?
A. Heart rate 58 bpm
B. Nausea, vomiting, and yellow-green visual changes
C. Blood pressure 140/90 mmHg
D. Increased urine output
Answer: B
Rationale: Classic manifestations of digoxin toxicity include gastrointestinal symptoms
(nausea, vomiting), visual changes (xanthopsia, green/yellow vision), and arrhythmias.
7. A patient presents with jugular venous distention, hypotension, and muffled heart
sounds (Beck's triad). The most likely diagnosis is:
A. Cardiac tamponade
B. Myocardial infarction
C. Heart failure
D. Pneumothorax
, 3
Answer: A
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) is classic for cardiac
tamponade, requiring emergent pericardiocentesis.
8. A 65-year-old female presents with acute pulmonary edema. The most appropriate
initial ventilatory support is:
A. Endotracheal intubation
B. Noninvasive positive pressure ventilation (NIPPV)
C. High-flow nasal cannula
D. Simple face mask oxygen
Answer: B
Rationale: NIPPV (CPAP or BiPAP) is the preferred ventilatory support for acute cardiogenic
pulmonary edema, reducing intubation rates.
9. A patient is started on amiodarone. The major adverse effects requiring monitoring
include:
A. Thyroid dysfunction and pulmonary fibrosis
B. Hyperglycemia
C. Hypokalemia
D. Nephrotoxicity
Answer: A
Rationale: Long-term amiodarone use can cause thyroid dysfunction (hyper- or
hypothyroidism) and pulmonary fibrosis.
10. A patient develops ventricular fibrillation. The immediate intervention is:
A. Synchronized cardioversion
B. Defibrillation
C. Adenosine administration
D. Beta-blocker administration
Answer: B
Rationale: Ventricular fibrillation is an absolute indication for defibrillation, which should be
performed immediately with unsynchronized shocks.
11. A patient has a blood pressure of 80/50 mmHg, heart rate of 120 bpm, and cool,
clammy skin. This represents which type of shock?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock
D. Obstructive shock
