Page 1 of 40
BARKLEY-STYLE PRIMARY CARE PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
PRIMARY CARE
Prepare for the Barkley Primary Care Practice Exam with a focused study resource
covering essential concepts in primary care and advanced practice nursing. It
supports review of health assessment, common acute and chronic conditions,
preventive care, diagnostics, pharmacologic management, and patient education. Use
the material to reinforce clinical knowledge, strengthen diagnostic reasoning, and
identify areas that may require additional review. This resource is best suited for nurse
practitioner students and certification candidates preparing for primary care board
examinations.
MULTIPLE CHOICE.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-15)
1. A 55-year-old male presents with substernal chest pressure that
radiates to his left arm, associated with diaphoresis and nausea. The pain
began 30 minutes ago while shoveling snow. His vitals are BP 160/95, HR
102, RR 22, SpO2 94%. Which is the most appropriate initial action?
a) Administer sublingual nitroglycerin
b) Obtain a 12-lead ECG stat
c) Administer aspirin 324 mg chewed
d) Apply oxygen via nasal cannula
Answer: c) Administer aspirin 324 mg chewed
Rationale: Acute myocardial infarction is suspected. Aspirin 324 mg chewed
is the priority to prevent further platelet aggregation. Oxygen should be
applied if SpO2 <90% (or <94% in some protocols), and ECG should be
obtained rapidly. Nitroglycerin is also indicated but aspirin is the first priority.
The classic "MONA" (Morphine, Oxygen, Nitroglycerin, Aspirin) has been
updated—aspirin is the priority.
, Page 2 of 40
2. A 62-year-old female with a history of hypertension presents with a
blood pressure of 158/96 mmHg on two separate occasions. She has no
other comorbidities. According to JNC 8 guidelines, what is the target
blood pressure for this patient?
a) <120/80 mmHg
b) <130/80 mmHg
c) <140/90 mmHg
d) <150/90 mmHg
Answer: c) <140/90 mmHg
Rationale: According to JNC 8 guidelines, the target BP for patients ≥60 years
is <150/90 mmHg; however, the more current ACC/AHA 2017 guidelines
recommend a target of <130/80 mmHg for all adults with hypertension. The
question references JNC 8, which targets <140/90 for patients <60 and
<150/90 for those ≥60. However, ACC/AHA 2017 recommends <130/80 for all.
The most current standard is <130/80 mmHg. This question tests knowledge
of evolving guidelines—the correct answer is <140/90 based on JNC 8, but
<130/80 is the current standard. The best answer is c) <140/90 mmHg as the
JNC 8 target.
3. A patient with heart failure with reduced ejection fraction (HFrEF) is
being started on carvedilol. The NP should counsel the patient that this
medication:
a) Should be started at a high dose for rapid effect
b) May take several weeks to show benefit and requires slow titration
c) Is used for acute symptom relief
d) Has no effect on mortality
Answer: b) May take several weeks to show benefit and requires slow
titration
Rationale: Carvedilol (and other beta-blockers) should be started at a low
dose and titrated slowly over several weeks to months to reduce the risk of
worsening heart failure. Beta-blockers have been shown to reduce mortality in
HFrEF and are not used for acute symptom relief.
, Page 3 of 40
4. A patient with atrial fibrillation is prescribed warfarin. The NP should
monitor which laboratory value to evaluate therapeutic effect?
a) Platelet count
b) INR
c) aPTT
d) Hemoglobin
Answer: b) INR
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR). The therapeutic target for atrial fibrillation is typically INR 2.0-3.0.
aPTT is used for heparin monitoring. Platelet count and hemoglobin are not
used to monitor warfarin's anticoagulant effect.
5. A 50-year-old patient presents with a cholesterol panel showing LDL
190 mg/dL. According to current guidelines, the NP should:
a) Recommend lifestyle modification only
b) Start a moderate-intensity statin
c) Start a high-intensity statin
d) Refer to a cardiologist
Answer: c) Start a high-intensity statin
Rationale: An LDL ≥190 mg/dL is considered severe hypercholesterolemia
and warrants high-intensity statin therapy regardless of cardiovascular risk.
Lifestyle modifications should be initiated as well, but high-intensity statin
therapy is indicated. Moderate-intensity statins are used for moderate risk
patients.
6. A patient presents with sudden onset of unilateral leg swelling, pain,
and warmth. The leg is erythematous and tender to palpation. Which is
the most appropriate initial diagnostic test?
a) D-dimer
b) Venous duplex ultrasound
c) CT pulmonary angiogram
d) Venography
, Page 4 of 40
Answer: b) Venous duplex ultrasound
Rationale: Venous duplex ultrasound is the gold-standard initial imaging
study for suspected deep vein thrombosis (DVT). D-dimer has high sensitivity
but low specificity and is not diagnostic. CT pulmonary angiogram is for
pulmonary embolism. Venography is rarely used now.
7. A patient with hypertension is started on lisinopril. The NP should
monitor for which side effect?
a) Hypokalemia
b) Dry cough
c) Tachycardia
d) Weight gain
Answer: b) Dry cough
Rationale: ACE inhibitors (lisinopril) commonly cause a dry, non-productive
cough due to increased bradykinin levels. This may require a change to an
ARB. Hyperkalemia (not hypokalemia) is also a concern. Tachycardia and
weight gain are not typical side effects.
8. A 45-year-old female presents with palpitations, heat intolerance,
weight loss, and a fine tremor. Her TSH is 0.01 mIU/L. The NP should
suspect:
a) Hypothyroidism
b) Hyperthyroidism
c) Thyroiditis
d) Panic disorder
Answer: b) Hyperthyroidism
Rationale: Hyperthyroidism is characterized by a low TSH and elevated T4.
Symptoms include palpitations, heat intolerance, weight loss, and tremor.
Graves' disease is the most common cause. Treatment includes antithyroid
medications, radioactive iodine, or thyroidectomy.
BARKLEY-STYLE PRIMARY CARE PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
PRIMARY CARE
Prepare for the Barkley Primary Care Practice Exam with a focused study resource
covering essential concepts in primary care and advanced practice nursing. It
supports review of health assessment, common acute and chronic conditions,
preventive care, diagnostics, pharmacologic management, and patient education. Use
the material to reinforce clinical knowledge, strengthen diagnostic reasoning, and
identify areas that may require additional review. This resource is best suited for nurse
practitioner students and certification candidates preparing for primary care board
examinations.
MULTIPLE CHOICE.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-15)
1. A 55-year-old male presents with substernal chest pressure that
radiates to his left arm, associated with diaphoresis and nausea. The pain
began 30 minutes ago while shoveling snow. His vitals are BP 160/95, HR
102, RR 22, SpO2 94%. Which is the most appropriate initial action?
a) Administer sublingual nitroglycerin
b) Obtain a 12-lead ECG stat
c) Administer aspirin 324 mg chewed
d) Apply oxygen via nasal cannula
Answer: c) Administer aspirin 324 mg chewed
Rationale: Acute myocardial infarction is suspected. Aspirin 324 mg chewed
is the priority to prevent further platelet aggregation. Oxygen should be
applied if SpO2 <90% (or <94% in some protocols), and ECG should be
obtained rapidly. Nitroglycerin is also indicated but aspirin is the first priority.
The classic "MONA" (Morphine, Oxygen, Nitroglycerin, Aspirin) has been
updated—aspirin is the priority.
, Page 2 of 40
2. A 62-year-old female with a history of hypertension presents with a
blood pressure of 158/96 mmHg on two separate occasions. She has no
other comorbidities. According to JNC 8 guidelines, what is the target
blood pressure for this patient?
a) <120/80 mmHg
b) <130/80 mmHg
c) <140/90 mmHg
d) <150/90 mmHg
Answer: c) <140/90 mmHg
Rationale: According to JNC 8 guidelines, the target BP for patients ≥60 years
is <150/90 mmHg; however, the more current ACC/AHA 2017 guidelines
recommend a target of <130/80 mmHg for all adults with hypertension. The
question references JNC 8, which targets <140/90 for patients <60 and
<150/90 for those ≥60. However, ACC/AHA 2017 recommends <130/80 for all.
The most current standard is <130/80 mmHg. This question tests knowledge
of evolving guidelines—the correct answer is <140/90 based on JNC 8, but
<130/80 is the current standard. The best answer is c) <140/90 mmHg as the
JNC 8 target.
3. A patient with heart failure with reduced ejection fraction (HFrEF) is
being started on carvedilol. The NP should counsel the patient that this
medication:
a) Should be started at a high dose for rapid effect
b) May take several weeks to show benefit and requires slow titration
c) Is used for acute symptom relief
d) Has no effect on mortality
Answer: b) May take several weeks to show benefit and requires slow
titration
Rationale: Carvedilol (and other beta-blockers) should be started at a low
dose and titrated slowly over several weeks to months to reduce the risk of
worsening heart failure. Beta-blockers have been shown to reduce mortality in
HFrEF and are not used for acute symptom relief.
, Page 3 of 40
4. A patient with atrial fibrillation is prescribed warfarin. The NP should
monitor which laboratory value to evaluate therapeutic effect?
a) Platelet count
b) INR
c) aPTT
d) Hemoglobin
Answer: b) INR
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR). The therapeutic target for atrial fibrillation is typically INR 2.0-3.0.
aPTT is used for heparin monitoring. Platelet count and hemoglobin are not
used to monitor warfarin's anticoagulant effect.
5. A 50-year-old patient presents with a cholesterol panel showing LDL
190 mg/dL. According to current guidelines, the NP should:
a) Recommend lifestyle modification only
b) Start a moderate-intensity statin
c) Start a high-intensity statin
d) Refer to a cardiologist
Answer: c) Start a high-intensity statin
Rationale: An LDL ≥190 mg/dL is considered severe hypercholesterolemia
and warrants high-intensity statin therapy regardless of cardiovascular risk.
Lifestyle modifications should be initiated as well, but high-intensity statin
therapy is indicated. Moderate-intensity statins are used for moderate risk
patients.
6. A patient presents with sudden onset of unilateral leg swelling, pain,
and warmth. The leg is erythematous and tender to palpation. Which is
the most appropriate initial diagnostic test?
a) D-dimer
b) Venous duplex ultrasound
c) CT pulmonary angiogram
d) Venography
, Page 4 of 40
Answer: b) Venous duplex ultrasound
Rationale: Venous duplex ultrasound is the gold-standard initial imaging
study for suspected deep vein thrombosis (DVT). D-dimer has high sensitivity
but low specificity and is not diagnostic. CT pulmonary angiogram is for
pulmonary embolism. Venography is rarely used now.
7. A patient with hypertension is started on lisinopril. The NP should
monitor for which side effect?
a) Hypokalemia
b) Dry cough
c) Tachycardia
d) Weight gain
Answer: b) Dry cough
Rationale: ACE inhibitors (lisinopril) commonly cause a dry, non-productive
cough due to increased bradykinin levels. This may require a change to an
ARB. Hyperkalemia (not hypokalemia) is also a concern. Tachycardia and
weight gain are not typical side effects.
8. A 45-year-old female presents with palpitations, heat intolerance,
weight loss, and a fine tremor. Her TSH is 0.01 mIU/L. The NP should
suspect:
a) Hypothyroidism
b) Hyperthyroidism
c) Thyroiditis
d) Panic disorder
Answer: b) Hyperthyroidism
Rationale: Hyperthyroidism is characterized by a low TSH and elevated T4.
Symptoms include palpitations, heat intolerance, weight loss, and tremor.
Graves' disease is the most common cause. Treatment includes antithyroid
medications, radioactive iodine, or thyroidectomy.
