Page 1 of 45
BARKLEY CLINICAL MANAGEMENT PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
CLINICAL
Prepare for the Barkley Clinical Management Practice Exam with a focused study
resource covering essential principles of clinical management for advanced nursing
practice. It supports review of patient assessment, diagnosis, treatment planning,
pharmacologic management, follow-up care, and evidence-based clinical decision-
making. Use the material to reinforce clinical knowledge, strengthen management
skills, and identify areas that may require additional study. This resource is best suited
for nurse practitioner students and certification candidates preparing for clinical
management and board-style assessments.
MULTIPLE CHOICE.
1. A 55-year-old female with hypertension and type 2 diabetes presents
with a blood pressure of 148/92 mmHg. She is currently on metformin
1000 mg BID and lisinopril 20 mg daily. What is the most appropriate next
step in managing her hypertension?
A) Add hydrochlorothiazide 25 mg daily
B) Increase lisinopril to 40 mg daily
C) Add amlodipine 5 mg daily
D) Add spironolactone 25 mg daily
Answer: A
Rationale: For patients with hypertension and diabetes, the target BP is <
130/80 mmHg. If BP is uncontrolled on an ACE inhibitor, adding a thiazide
diuretic is a recommended step. Increasing lisinopril may help but adding
a diuretic is often more effective. Amlodipine and spironolactone are
options but thiazide is preferred as an add-on.
, Page 2 of 45
2. A 62-year-old male with a history of heart failure with reduced ejection
fraction (HFrEF) presents with worsening shortness of breath and edema.
His medications include lisinopril, carvedilol, and furosemide. What is
the most appropriate next step?
A) Add digoxin
B) Add spironolactone
C) Add sacubitril/valsartan (Entresto)
D) Increase furosemide dose
Answer: C
Rationale: Sacubitril/valsartan (Entresto) has been shown to reduce
mortality and hospitalizations in HFrEF and is recommended as a first-
line therapy in eligible patients. Spironolactone and digoxin are also
options but Entresto provides the most significant mortality benefit.
3. A 45-year-old female with a history of migraines presents with four
migraines per month. She uses sumatriptan as an abortive therapy. What
is the most appropriate prophylactic therapy?
A) Propranolol
B) Topiramate
C) Amitriptyline
D) All of the above
Answer: D
Rationale: Propranolol, topiramate, and amitriptyline are all first-line
prophylactic therapies for migraines. The choice depends on the patient's
comorbidities and side-effect profile. Propranolol is preferred in patients
with hypertension; topiramate may cause weight loss; amitriptyline may
cause weight gain.
, Page 3 of 45
4. A 68-year-old male with COPD presents with an acute exacerbation. He
has increased shortness of breath, purulent sputum, and fever. His SpO2
is 88% on room air. What is the most appropriate initial management?
A) Oxygen, bronchodilators, corticosteroids, and antibiotics
B) Oxygen and bronchodilators only
C) Antibiotics only
D) Non-invasive ventilation only
Answer: A
Rationale: This patient has an acute exacerbation of COPD with hypoxia
and signs of infection (purulent sputum, fever). Treatment includes
oxygen to maintain SpO2 > 90%, bronchodilators (albuterol/ipratropium),
systemic corticosteroids (prednisone), and antibiotics for the purulent
sputum. All are indicated.
5. A 55-year-old male with a history of hypertension and hyperlipidemia
presents with a 1-week history of chest pain with exertion. He is started
on atorvastatin. What laboratory value should be monitored at baseline
and periodically?
A) Liver function tests
B) Creatine kinase (CK)
C) Lipid panel
D) All of the above
Answer: D
Rationale: Statins require monitoring of liver function tests (ALT, AST) for
hepatotoxicity, creatine kinase (CK) for myopathy, and lipid panel to
assess efficacy. All of these should be monitored at baseline and
periodically.
, Page 4 of 45
6. A 72-year-old female with a history of osteoporosis is on alendronate.
She reports heartburn and difficulty swallowing. What is the most
appropriate next step?
A) Discontinue alendronate and start raloxifene
B) Switch to intravenous zoledronic acid
C) Ensure proper administration (empty stomach, upright for 30 minutes)
D) Add a PPI
Answer: C
Rationale: Alendronate can cause esophageal irritation if not taken
correctly. The nurse should first ensure proper administration: on an
empty stomach with a full glass of water, and remaining upright for 30
minutes. If symptoms persist, switching to IV therapy may be considered.
7. A 45-year-old female with a history of depression is started on
sertraline. She reports that she is feeling better after 2 weeks. What is the
most appropriate management?
A) Increase the dose
B) Continue the current dose and monitor
C) Discontinue the medication
D) Switch to a different SSRI
Answer: B
Rationale: SSRIs typically take 4-6 weeks to achieve full therapeutic
effect. The patient is feeling better at 2 weeks, indicating a positive
response. The current dose should be continued and monitored. Dose
increases are made if there is no response after 4-6 weeks.
8. A 60-year-old male with a history of atrial fibrillation is on warfarin. His
INR is 3.5. He has no bleeding. What is the most appropriate
management?
BARKLEY CLINICAL MANAGEMENT PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
CLINICAL
Prepare for the Barkley Clinical Management Practice Exam with a focused study
resource covering essential principles of clinical management for advanced nursing
practice. It supports review of patient assessment, diagnosis, treatment planning,
pharmacologic management, follow-up care, and evidence-based clinical decision-
making. Use the material to reinforce clinical knowledge, strengthen management
skills, and identify areas that may require additional study. This resource is best suited
for nurse practitioner students and certification candidates preparing for clinical
management and board-style assessments.
MULTIPLE CHOICE.
1. A 55-year-old female with hypertension and type 2 diabetes presents
with a blood pressure of 148/92 mmHg. She is currently on metformin
1000 mg BID and lisinopril 20 mg daily. What is the most appropriate next
step in managing her hypertension?
A) Add hydrochlorothiazide 25 mg daily
B) Increase lisinopril to 40 mg daily
C) Add amlodipine 5 mg daily
D) Add spironolactone 25 mg daily
Answer: A
Rationale: For patients with hypertension and diabetes, the target BP is <
130/80 mmHg. If BP is uncontrolled on an ACE inhibitor, adding a thiazide
diuretic is a recommended step. Increasing lisinopril may help but adding
a diuretic is often more effective. Amlodipine and spironolactone are
options but thiazide is preferred as an add-on.
, Page 2 of 45
2. A 62-year-old male with a history of heart failure with reduced ejection
fraction (HFrEF) presents with worsening shortness of breath and edema.
His medications include lisinopril, carvedilol, and furosemide. What is
the most appropriate next step?
A) Add digoxin
B) Add spironolactone
C) Add sacubitril/valsartan (Entresto)
D) Increase furosemide dose
Answer: C
Rationale: Sacubitril/valsartan (Entresto) has been shown to reduce
mortality and hospitalizations in HFrEF and is recommended as a first-
line therapy in eligible patients. Spironolactone and digoxin are also
options but Entresto provides the most significant mortality benefit.
3. A 45-year-old female with a history of migraines presents with four
migraines per month. She uses sumatriptan as an abortive therapy. What
is the most appropriate prophylactic therapy?
A) Propranolol
B) Topiramate
C) Amitriptyline
D) All of the above
Answer: D
Rationale: Propranolol, topiramate, and amitriptyline are all first-line
prophylactic therapies for migraines. The choice depends on the patient's
comorbidities and side-effect profile. Propranolol is preferred in patients
with hypertension; topiramate may cause weight loss; amitriptyline may
cause weight gain.
, Page 3 of 45
4. A 68-year-old male with COPD presents with an acute exacerbation. He
has increased shortness of breath, purulent sputum, and fever. His SpO2
is 88% on room air. What is the most appropriate initial management?
A) Oxygen, bronchodilators, corticosteroids, and antibiotics
B) Oxygen and bronchodilators only
C) Antibiotics only
D) Non-invasive ventilation only
Answer: A
Rationale: This patient has an acute exacerbation of COPD with hypoxia
and signs of infection (purulent sputum, fever). Treatment includes
oxygen to maintain SpO2 > 90%, bronchodilators (albuterol/ipratropium),
systemic corticosteroids (prednisone), and antibiotics for the purulent
sputum. All are indicated.
5. A 55-year-old male with a history of hypertension and hyperlipidemia
presents with a 1-week history of chest pain with exertion. He is started
on atorvastatin. What laboratory value should be monitored at baseline
and periodically?
A) Liver function tests
B) Creatine kinase (CK)
C) Lipid panel
D) All of the above
Answer: D
Rationale: Statins require monitoring of liver function tests (ALT, AST) for
hepatotoxicity, creatine kinase (CK) for myopathy, and lipid panel to
assess efficacy. All of these should be monitored at baseline and
periodically.
, Page 4 of 45
6. A 72-year-old female with a history of osteoporosis is on alendronate.
She reports heartburn and difficulty swallowing. What is the most
appropriate next step?
A) Discontinue alendronate and start raloxifene
B) Switch to intravenous zoledronic acid
C) Ensure proper administration (empty stomach, upright for 30 minutes)
D) Add a PPI
Answer: C
Rationale: Alendronate can cause esophageal irritation if not taken
correctly. The nurse should first ensure proper administration: on an
empty stomach with a full glass of water, and remaining upright for 30
minutes. If symptoms persist, switching to IV therapy may be considered.
7. A 45-year-old female with a history of depression is started on
sertraline. She reports that she is feeling better after 2 weeks. What is the
most appropriate management?
A) Increase the dose
B) Continue the current dose and monitor
C) Discontinue the medication
D) Switch to a different SSRI
Answer: B
Rationale: SSRIs typically take 4-6 weeks to achieve full therapeutic
effect. The patient is feeling better at 2 weeks, indicating a positive
response. The current dose should be continued and monitored. Dose
increases are made if there is no response after 4-6 weeks.
8. A 60-year-old male with a history of atrial fibrillation is on warfarin. His
INR is 3.5. He has no bleeding. What is the most appropriate
management?
