Page 1 of 52
BARKLEY ADULT HEALTH PRACTICE EXAM 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
ADULT HEALTH
Prepare for the Barkley Adult Health Practice Exam with a focused study resource
covering essential adult health concepts relevant to advanced nursing practice. It
supports review of common acute and chronic conditions, patient assessment,
diagnostic considerations, pharmacologic management, preventive care, and
evidence-based interventions. Use the material to reinforce clinical knowledge,
strengthen clinical reasoning, and identify areas that may require additional study.
This resource is best suited for nurse practitioner students and certification
candidates preparing for adult health and board-style assessments.
MULTIPLE CHOICE.
CARDIOVASCULAR
1. A 58-year-old woman with a history of hypertension presents with a 2-
week history of progressive shortness of breath, orthopnea, and
paroxysmal nocturnal dyspnea. On auscultation, you hear an S3 gallop.
Which of the following is the most likely diagnosis?
A) Heart failure with preserved ejection fraction
B) Heart failure with reduced ejection fraction
C) Pericarditis
D) Aortic stenosis
Answer: B) Heart failure with reduced ejection fraction
Rationale: An S3 gallop is a classic finding in heart failure with reduced
ejection fraction (HFrEF). It indicates decreased left ventricular
compliance and increased filling pressures. The presence of orthopnea
and PND further supports the diagnosis of left-sided heart failure.
Pericarditis presents with a friction rub. Aortic stenosis presents with a
systolic ejection murmur.
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2. A 65-year-old man presents with a crescendo-decrescendo systolic
murmur best heard at the right upper sternal border that radiates to the
carotids. He reports exertional dyspnea, angina, and near-syncope. What
is the most appropriate next diagnostic test?
A) Chest X-ray
B) Electrocardiogram
C) Echocardiogram
D) Cardiac catheterization
Answer: C) Echocardiogram
Rationale: This patient's presentation—classic systolic ejection murmur
with radiation to carotids plus the triad of exertional dyspnea, angina, and
syncope—is highly suggestive of aortic stenosis. Echocardiography is the
diagnostic test of choice to assess valve morphology, aortic valve area,
and transvalvular pressure gradient. Cardiac catheterization may be
indicated if echo confirms severe stenosis.
3. A 62-year-old woman with a history of atrial fibrillation is on warfarin.
Her INR is 5.8. She has no signs of bleeding. What is the most appropriate
next step?
A) Administer vitamin K 10 mg orally
B) Hold warfarin and recheck INR tomorrow
C) Administer fresh frozen plasma
D) Continue warfarin at the current dose
Answer: B) Hold warfarin and recheck INR tomorrow
Rationale: An INR of 5.8 is above the therapeutic range (2.0-3.0 for atrial
fibrillation) but below the threshold for major bleeding risk (INR > 5.0
without bleeding). The standard approach is to hold the warfarin dose and
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recheck the INR the next day. Vitamin K is reserved for INR > 10 or signs of
bleeding. FFP is for severe bleeding or emergency reversal.
4. A 55-year-old man with a history of hypertension and diabetes presents
with progressive lower extremity pain with walking that is relieved by rest.
He has diminished dorsalis pedis pulses and cool, pale skin on his feet.
What is the most appropriate next step?
A) Measure ankle-brachial index (ABI)
B) Prescribe cilostazol
C) Order duplex ultrasound of the lower extremities
D) Refer for vascular surgery consultation
Answer: A) Measure ankle-brachial index (ABI)
Rationale: This patient has classic symptoms of peripheral arterial
disease (intermittent claudication). The ABI is the initial non-invasive
diagnostic test for PAD. An ABI < 0.90 confirms the diagnosis. Cilostazol is
a treatment option but should be initiated after diagnosis. Duplex
ultrasound may be used for further evaluation, but ABI is the first step.
5. A 45-year-old woman presents with acute onset of pleuritic chest pain,
dyspnea, and hemoptysis. She is on oral contraceptives and recently
returned from a 10-hour international flight. Her oxygen saturation is 89%
on room air. What is the most appropriate initial diagnostic test?
A) Chest X-ray
B) D-dimer
C) CT pulmonary angiography (CTPA)
D) Ventilation-perfusion (V/Q) scan
Answer: C) CT pulmonary angiography (CTPA)
Rationale: This patient has a high probability of pulmonary embolism
based on the Wells criteria. In patients with high clinical probability, CTPA
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is the diagnostic test of choice. D-dimer is useful for low-to-moderate
probability. V/Q scan is an alternative in patients with contraindications to
CTPA.
6. A 50-year-old woman presents with palpitations, fatigue, and shortness
of breath. ECG shows an irregularly irregular rhythm with no discernible P
waves. Her CHA₂DS₂-VASc score is 3. Which of the following is the most
appropriate management strategy?
A) Aspirin 81 mg daily
B) Rate control with metoprolol and anticoagulation with warfarin or a DOAC
C) Rhythm control with amiodarone alone
D) No treatment needed
Answer: B) Rate control with metoprolol and anticoagulation with warfarin
or a DOAC
Rationale: This patient has atrial fibrillation. A CHA₂DS₂-VASc score of 3
indicates high stroke risk, requiring anticoagulation. Rate control with a
beta-blocker (metoprolol) and anticoagulation is appropriate. Aspirin is
not sufficient for stroke prevention in AF. Rhythm control with amiodarone
is not first-line without rate control.
7. A 60-year-old man with a history of myocardial infarction is on aspirin.
The nurse practitioner understands that aspirin is used for:
A) Pain relief
B) Antiplatelet therapy
C) Anti-inflammatory therapy
D) Anticoagulation therapy
Answer: B) Antiplatelet therapy
Rationale: In patients with cardiovascular disease, aspirin is used for
antiplatelet therapy to reduce the risk of recurrent MI and stroke. It works
BARKLEY ADULT HEALTH PRACTICE EXAM 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
ADULT HEALTH
Prepare for the Barkley Adult Health Practice Exam with a focused study resource
covering essential adult health concepts relevant to advanced nursing practice. It
supports review of common acute and chronic conditions, patient assessment,
diagnostic considerations, pharmacologic management, preventive care, and
evidence-based interventions. Use the material to reinforce clinical knowledge,
strengthen clinical reasoning, and identify areas that may require additional study.
This resource is best suited for nurse practitioner students and certification
candidates preparing for adult health and board-style assessments.
MULTIPLE CHOICE.
CARDIOVASCULAR
1. A 58-year-old woman with a history of hypertension presents with a 2-
week history of progressive shortness of breath, orthopnea, and
paroxysmal nocturnal dyspnea. On auscultation, you hear an S3 gallop.
Which of the following is the most likely diagnosis?
A) Heart failure with preserved ejection fraction
B) Heart failure with reduced ejection fraction
C) Pericarditis
D) Aortic stenosis
Answer: B) Heart failure with reduced ejection fraction
Rationale: An S3 gallop is a classic finding in heart failure with reduced
ejection fraction (HFrEF). It indicates decreased left ventricular
compliance and increased filling pressures. The presence of orthopnea
and PND further supports the diagnosis of left-sided heart failure.
Pericarditis presents with a friction rub. Aortic stenosis presents with a
systolic ejection murmur.
, Page 2 of 52
2. A 65-year-old man presents with a crescendo-decrescendo systolic
murmur best heard at the right upper sternal border that radiates to the
carotids. He reports exertional dyspnea, angina, and near-syncope. What
is the most appropriate next diagnostic test?
A) Chest X-ray
B) Electrocardiogram
C) Echocardiogram
D) Cardiac catheterization
Answer: C) Echocardiogram
Rationale: This patient's presentation—classic systolic ejection murmur
with radiation to carotids plus the triad of exertional dyspnea, angina, and
syncope—is highly suggestive of aortic stenosis. Echocardiography is the
diagnostic test of choice to assess valve morphology, aortic valve area,
and transvalvular pressure gradient. Cardiac catheterization may be
indicated if echo confirms severe stenosis.
3. A 62-year-old woman with a history of atrial fibrillation is on warfarin.
Her INR is 5.8. She has no signs of bleeding. What is the most appropriate
next step?
A) Administer vitamin K 10 mg orally
B) Hold warfarin and recheck INR tomorrow
C) Administer fresh frozen plasma
D) Continue warfarin at the current dose
Answer: B) Hold warfarin and recheck INR tomorrow
Rationale: An INR of 5.8 is above the therapeutic range (2.0-3.0 for atrial
fibrillation) but below the threshold for major bleeding risk (INR > 5.0
without bleeding). The standard approach is to hold the warfarin dose and
, Page 3 of 52
recheck the INR the next day. Vitamin K is reserved for INR > 10 or signs of
bleeding. FFP is for severe bleeding or emergency reversal.
4. A 55-year-old man with a history of hypertension and diabetes presents
with progressive lower extremity pain with walking that is relieved by rest.
He has diminished dorsalis pedis pulses and cool, pale skin on his feet.
What is the most appropriate next step?
A) Measure ankle-brachial index (ABI)
B) Prescribe cilostazol
C) Order duplex ultrasound of the lower extremities
D) Refer for vascular surgery consultation
Answer: A) Measure ankle-brachial index (ABI)
Rationale: This patient has classic symptoms of peripheral arterial
disease (intermittent claudication). The ABI is the initial non-invasive
diagnostic test for PAD. An ABI < 0.90 confirms the diagnosis. Cilostazol is
a treatment option but should be initiated after diagnosis. Duplex
ultrasound may be used for further evaluation, but ABI is the first step.
5. A 45-year-old woman presents with acute onset of pleuritic chest pain,
dyspnea, and hemoptysis. She is on oral contraceptives and recently
returned from a 10-hour international flight. Her oxygen saturation is 89%
on room air. What is the most appropriate initial diagnostic test?
A) Chest X-ray
B) D-dimer
C) CT pulmonary angiography (CTPA)
D) Ventilation-perfusion (V/Q) scan
Answer: C) CT pulmonary angiography (CTPA)
Rationale: This patient has a high probability of pulmonary embolism
based on the Wells criteria. In patients with high clinical probability, CTPA
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is the diagnostic test of choice. D-dimer is useful for low-to-moderate
probability. V/Q scan is an alternative in patients with contraindications to
CTPA.
6. A 50-year-old woman presents with palpitations, fatigue, and shortness
of breath. ECG shows an irregularly irregular rhythm with no discernible P
waves. Her CHA₂DS₂-VASc score is 3. Which of the following is the most
appropriate management strategy?
A) Aspirin 81 mg daily
B) Rate control with metoprolol and anticoagulation with warfarin or a DOAC
C) Rhythm control with amiodarone alone
D) No treatment needed
Answer: B) Rate control with metoprolol and anticoagulation with warfarin
or a DOAC
Rationale: This patient has atrial fibrillation. A CHA₂DS₂-VASc score of 3
indicates high stroke risk, requiring anticoagulation. Rate control with a
beta-blocker (metoprolol) and anticoagulation is appropriate. Aspirin is
not sufficient for stroke prevention in AF. Rhythm control with amiodarone
is not first-line without rate control.
7. A 60-year-old man with a history of myocardial infarction is on aspirin.
The nurse practitioner understands that aspirin is used for:
A) Pain relief
B) Antiplatelet therapy
C) Anti-inflammatory therapy
D) Anticoagulation therapy
Answer: B) Antiplatelet therapy
Rationale: In patients with cardiovascular disease, aspirin is used for
antiplatelet therapy to reduce the risk of recurrent MI and stroke. It works
