Barkley AGACNP Predictor/Readiness Exam
Latest Update 2026 Graded A+
Table of Contents
1. Introduction and Exam Overview
2. Section 1: Cardiovascular Disorders (Questions 1-30)
3. Section 2: Pulmonary Disorders & Mechanical Ventilation
(Questions 31-55)
4. Section 3: Neurological Disorders (Questions 56-75)
5. Section 4: Renal & Genitourinary Disorders (Questions 76-
95)
6. Section 5: Endocrine & Metabolic Disorders (Questions 96-
115)
7. Section 6: Gastrointestinal Disorders (Questions 116-130)
8. Section 7: Hematologic & Oncologic Disorders (Questions
131-145)
9. Section 8: Shock States & Multisystem Trauma (Questions
146-165)
10. Section 9: Critical Care Procedures & Pharmacology
(Questions 166-185)
11. Section 10: Professional Practice, Ethics & Evidence-
Based Care (Questions 186-200)
12. Answer Key Summary with Rationales
Introduction and Exam Overview
,The Barkley AGACNP Predictor/Readiness Exam is a 100-item
best-answer multiple-choice Diagnostic Readiness Test (DRT)
designed to assess readiness for the ANCC and AACN Adult-
Gerontology Acute Care Nurse Practitioner board certification
examinations. The test is administered with a 100-minute
testing period, followed by a 45-minute review session.
Achieving ≥80% on Barkley DRTs, both on the total test
percentage and within every subject area, is strongly correlated
with mastery of the material and national certification success .
Core domains covered include Advanced Pathophysiology,
Pharmacology for Acute Care, Diagnostic Reasoning and
Clinical Decision-Making, Multisystem Assessment and
Management, Legal/Ethical/Professional Standards, Evidence-
Based Practice, and Collaborative Interdisciplinary Care .
This comprehensive practice exam contains 200 questions
covering all AGACNP board certification content areas. Each
question includes the correct answer marked in italics with a
detailed rationale in bold.
Section 1: Cardiovascular Disorders (Questions 1-30)
1. A 68-year-old male with a history of heart failure
presents with increasing dyspnea and an S3 gallop. The
BNP is 850 pg/mL. Which diagnostic finding is most
consistent with acute decompensated heart failure?
A. Pulmonary artery wedge pressure of 8 mmHg
B. Cardiac index of 3.2 L/min/m²
C. Pulmonary artery wedge pressure of 22 mmHg
D. Systemic vascular resistance of 800 dynes/sec/cm⁻⁵
,Correct Answer: C
Rationale: An elevated pulmonary artery wedge pressure
(PCWP >18 mmHg) is a hallmark of left-sided heart failure
and pulmonary congestion. Normal PCWP is 6-12 mmHg. A
PCWP of 22 mmHg indicates significant left ventricular
filling pressure elevation, consistent with acute
decompensated heart failure .
2. A patient in the ICU develops new-onset atrial fibrillation
with rapid ventricular response. Blood pressure is 82/50
mmHg. What is the priority intervention?
A. Amiodarone infusion
B. Synchronized cardioversion
C. Diltiazem bolus
D. Beta-blocker administration
Correct Answer: B
Rationale: Hemodynamic instability in the setting of new-
onset tachycardia requires immediate synchronized
cardioversion to restore perfusion. Pharmacologic rate
control (diltiazem, beta-blockers) and antiarrhythmics
(amiodarone) are appropriate for stable patients but would
delay definitive treatment in an unstable patient .
3. A patient presents with acute onset of severe tearing
chest pain radiating to the back. Blood pressure is 180/110
mmHg. What is the priority diagnostic test?
A. ECG
B. Chest X-ray
C. CT angiography
D. Troponin level
, Correct Answer: C
Rationale: Sudden severe tearing chest pain radiating to the
back is classic for aortic dissection. CT angiography is the
diagnostic test of choice to confirm the diagnosis and
determine the extent of dissection. Immediate surgical
consultation is required .
4. A patient with STEMI is being transferred for PCI. Which
medication should be administered first?
A. Aspirin 325 mg chewed
B. Heparin bolus
C. Nitroglycerin sublingual
D. Morphine sulfate
Correct Answer: A
Rationale: Aspirin should be administered immediately
(chewed for rapid absorption) to all patients with suspected
STEMI unless contraindicated. It reduces mortality by
inhibiting platelet aggregation. Heparin, nitroglycerin, and
morphine follow based on patient status.
5. A patient with cardiogenic shock has the following
hemodynamic profile: CO 2.8 L/min, SVR 1800
dynes/sec/cm⁻⁵, PCWP 28 mmHg. What is the most
appropriate initial intervention?
A. Fluid bolus of 1L normal saline
B. Norepinephrine infusion
C. Dobutamine infusion
D. Nitroprusside infusion
Correct Answer: C
Latest Update 2026 Graded A+
Table of Contents
1. Introduction and Exam Overview
2. Section 1: Cardiovascular Disorders (Questions 1-30)
3. Section 2: Pulmonary Disorders & Mechanical Ventilation
(Questions 31-55)
4. Section 3: Neurological Disorders (Questions 56-75)
5. Section 4: Renal & Genitourinary Disorders (Questions 76-
95)
6. Section 5: Endocrine & Metabolic Disorders (Questions 96-
115)
7. Section 6: Gastrointestinal Disorders (Questions 116-130)
8. Section 7: Hematologic & Oncologic Disorders (Questions
131-145)
9. Section 8: Shock States & Multisystem Trauma (Questions
146-165)
10. Section 9: Critical Care Procedures & Pharmacology
(Questions 166-185)
11. Section 10: Professional Practice, Ethics & Evidence-
Based Care (Questions 186-200)
12. Answer Key Summary with Rationales
Introduction and Exam Overview
,The Barkley AGACNP Predictor/Readiness Exam is a 100-item
best-answer multiple-choice Diagnostic Readiness Test (DRT)
designed to assess readiness for the ANCC and AACN Adult-
Gerontology Acute Care Nurse Practitioner board certification
examinations. The test is administered with a 100-minute
testing period, followed by a 45-minute review session.
Achieving ≥80% on Barkley DRTs, both on the total test
percentage and within every subject area, is strongly correlated
with mastery of the material and national certification success .
Core domains covered include Advanced Pathophysiology,
Pharmacology for Acute Care, Diagnostic Reasoning and
Clinical Decision-Making, Multisystem Assessment and
Management, Legal/Ethical/Professional Standards, Evidence-
Based Practice, and Collaborative Interdisciplinary Care .
This comprehensive practice exam contains 200 questions
covering all AGACNP board certification content areas. Each
question includes the correct answer marked in italics with a
detailed rationale in bold.
Section 1: Cardiovascular Disorders (Questions 1-30)
1. A 68-year-old male with a history of heart failure
presents with increasing dyspnea and an S3 gallop. The
BNP is 850 pg/mL. Which diagnostic finding is most
consistent with acute decompensated heart failure?
A. Pulmonary artery wedge pressure of 8 mmHg
B. Cardiac index of 3.2 L/min/m²
C. Pulmonary artery wedge pressure of 22 mmHg
D. Systemic vascular resistance of 800 dynes/sec/cm⁻⁵
,Correct Answer: C
Rationale: An elevated pulmonary artery wedge pressure
(PCWP >18 mmHg) is a hallmark of left-sided heart failure
and pulmonary congestion. Normal PCWP is 6-12 mmHg. A
PCWP of 22 mmHg indicates significant left ventricular
filling pressure elevation, consistent with acute
decompensated heart failure .
2. A patient in the ICU develops new-onset atrial fibrillation
with rapid ventricular response. Blood pressure is 82/50
mmHg. What is the priority intervention?
A. Amiodarone infusion
B. Synchronized cardioversion
C. Diltiazem bolus
D. Beta-blocker administration
Correct Answer: B
Rationale: Hemodynamic instability in the setting of new-
onset tachycardia requires immediate synchronized
cardioversion to restore perfusion. Pharmacologic rate
control (diltiazem, beta-blockers) and antiarrhythmics
(amiodarone) are appropriate for stable patients but would
delay definitive treatment in an unstable patient .
3. A patient presents with acute onset of severe tearing
chest pain radiating to the back. Blood pressure is 180/110
mmHg. What is the priority diagnostic test?
A. ECG
B. Chest X-ray
C. CT angiography
D. Troponin level
, Correct Answer: C
Rationale: Sudden severe tearing chest pain radiating to the
back is classic for aortic dissection. CT angiography is the
diagnostic test of choice to confirm the diagnosis and
determine the extent of dissection. Immediate surgical
consultation is required .
4. A patient with STEMI is being transferred for PCI. Which
medication should be administered first?
A. Aspirin 325 mg chewed
B. Heparin bolus
C. Nitroglycerin sublingual
D. Morphine sulfate
Correct Answer: A
Rationale: Aspirin should be administered immediately
(chewed for rapid absorption) to all patients with suspected
STEMI unless contraindicated. It reduces mortality by
inhibiting platelet aggregation. Heparin, nitroglycerin, and
morphine follow based on patient status.
5. A patient with cardiogenic shock has the following
hemodynamic profile: CO 2.8 L/min, SVR 1800
dynes/sec/cm⁻⁵, PCWP 28 mmHg. What is the most
appropriate initial intervention?
A. Fluid bolus of 1L normal saline
B. Norepinephrine infusion
C. Dobutamine infusion
D. Nitroprusside infusion
Correct Answer: C
