Family Nurse Practitioner (FNP) Barkley
Post-Test Fall 2025 Comprehensive Final
Exam with Verified Rationales Practice
Questions and Answers 2026 with
complete solution
Barkley & Associates FNP Comprehensive Final Exam |
Fall 2025
High-Yield Practice Questions with Expert Rationales
Question 1:
A 65-year-old female with osteoporosis presents with
acute onset of severe mid-back pain after lifting a light
bag. X-ray confirms a new vertebral compression fracture
at T8. What is the most appropriate initial pain
management?
A. Oxycodone 5 mg every 4 hours as needed
B. Calcitonin nasal spray 200 IU daily
C. Ibuprofen 600 mg every 6 hours with acetaminophen
650 mg every 6 hours
D. Referral for vertebroplasty
,Answer: C. Ibuprofen 600 mg every 6 hours with
acetaminophen 650 mg every 6 hours
Rationale: For acute vertebral compression
fractures, NSAIDs plus acetaminophen is first-line pain
management. Opioids (A) are reserved for severe pain not
controlled with first-line agents due to risk of dependence
and side effects in elderly. Calcitonin (B) has modest
analgesic effects but is not first-line. Vertebroplasty (D)
may be considered if pain persists for 6+ weeks despite
conservative therapy.
Question 2:
A 28-year-old G1P0 at 12 weeks gestation presents for
prenatal care. Her rubella titer shows IgG 0.8 IU/mL
(indeterminate). What is the most appropriate
management?
A. Administer MMR vaccine today
B. Repeat titer at 28 weeks
C. No action needed
D. Counsel about congenital rubella syndrome risks
Answer: A. Administer MMR vaccine today
Rationale: Live vaccines (MMR) are contraindicated in
pregnancy, but rubella-susceptible pregnant women
should be vaccinated immediately postpartum.
,However, this patient is at 12 weeks with
an indeterminate titer - she is NOT currently immune.
The correct action is to counsel her to avoid exposure
and vaccinate postpartum. The answer would be to
counsel (D) and plan for postpartum vaccination, but given
options, D is best. Wait - re-reading: Actually, you
CANNOT give MMR during pregnancy. So answer is D.
Important distinction.
Question 3:
A 4-year-old child presents with 3 days of fever to 104°F,
now with a maculopapular rash that started on trunk and
spread to extremities. The child appears well despite high
fever. What is the most likely diagnosis?
A. Measles
B. Scarlet fever
C. Roseola
D. Rubella
Answer: C. Roseola
Rationale: Roseola (HHV-6) classically presents with 3-5
days of high fever in a well-appearing child, followed
by rash appearing as fever defervesces. The rash is rose-
pink macules starting on trunk then spreading. Measles
(A) has prodrome of cough/coryza/conjunctivitis + Koplik
, spots. Scarlet fever (B) has sandpaper rash + strawberry
tongue. Rubella (D) has postauricular lymphadenopathy.
Question 4:
A 55-year-old male with hypertension presents with
sudden onset of "worst headache of my life." He describes
it as explosive in onset. Neurologic exam is normal. What
is the most appropriate initial imaging?
A. Non-contrast head CT
B. MRI brain with contrast
C. Lumbar puncture
D. Cerebral angiography
Answer: A. Non-contrast head CT
Rationale: For suspected subarachnoid
hemorrhage ("thunderclap headache"), non-contrast
head CT is the initial test of choice (sensitivity ~95%
within first 24 hours). If CT negative but high clinical
suspicion, proceed to lumbar puncture (C) to look for
xanthochromia. MRI (B) is less sensitive for acute blood.
Angiography (D) is for locating aneurysm after SAH
confirmed.
Post-Test Fall 2025 Comprehensive Final
Exam with Verified Rationales Practice
Questions and Answers 2026 with
complete solution
Barkley & Associates FNP Comprehensive Final Exam |
Fall 2025
High-Yield Practice Questions with Expert Rationales
Question 1:
A 65-year-old female with osteoporosis presents with
acute onset of severe mid-back pain after lifting a light
bag. X-ray confirms a new vertebral compression fracture
at T8. What is the most appropriate initial pain
management?
A. Oxycodone 5 mg every 4 hours as needed
B. Calcitonin nasal spray 200 IU daily
C. Ibuprofen 600 mg every 6 hours with acetaminophen
650 mg every 6 hours
D. Referral for vertebroplasty
,Answer: C. Ibuprofen 600 mg every 6 hours with
acetaminophen 650 mg every 6 hours
Rationale: For acute vertebral compression
fractures, NSAIDs plus acetaminophen is first-line pain
management. Opioids (A) are reserved for severe pain not
controlled with first-line agents due to risk of dependence
and side effects in elderly. Calcitonin (B) has modest
analgesic effects but is not first-line. Vertebroplasty (D)
may be considered if pain persists for 6+ weeks despite
conservative therapy.
Question 2:
A 28-year-old G1P0 at 12 weeks gestation presents for
prenatal care. Her rubella titer shows IgG 0.8 IU/mL
(indeterminate). What is the most appropriate
management?
A. Administer MMR vaccine today
B. Repeat titer at 28 weeks
C. No action needed
D. Counsel about congenital rubella syndrome risks
Answer: A. Administer MMR vaccine today
Rationale: Live vaccines (MMR) are contraindicated in
pregnancy, but rubella-susceptible pregnant women
should be vaccinated immediately postpartum.
,However, this patient is at 12 weeks with
an indeterminate titer - she is NOT currently immune.
The correct action is to counsel her to avoid exposure
and vaccinate postpartum. The answer would be to
counsel (D) and plan for postpartum vaccination, but given
options, D is best. Wait - re-reading: Actually, you
CANNOT give MMR during pregnancy. So answer is D.
Important distinction.
Question 3:
A 4-year-old child presents with 3 days of fever to 104°F,
now with a maculopapular rash that started on trunk and
spread to extremities. The child appears well despite high
fever. What is the most likely diagnosis?
A. Measles
B. Scarlet fever
C. Roseola
D. Rubella
Answer: C. Roseola
Rationale: Roseola (HHV-6) classically presents with 3-5
days of high fever in a well-appearing child, followed
by rash appearing as fever defervesces. The rash is rose-
pink macules starting on trunk then spreading. Measles
(A) has prodrome of cough/coryza/conjunctivitis + Koplik
, spots. Scarlet fever (B) has sandpaper rash + strawberry
tongue. Rubella (D) has postauricular lymphadenopathy.
Question 4:
A 55-year-old male with hypertension presents with
sudden onset of "worst headache of my life." He describes
it as explosive in onset. Neurologic exam is normal. What
is the most appropriate initial imaging?
A. Non-contrast head CT
B. MRI brain with contrast
C. Lumbar puncture
D. Cerebral angiography
Answer: A. Non-contrast head CT
Rationale: For suspected subarachnoid
hemorrhage ("thunderclap headache"), non-contrast
head CT is the initial test of choice (sensitivity ~95%
within first 24 hours). If CT negative but high clinical
suspicion, proceed to lumbar puncture (C) to look for
xanthochromia. MRI (B) is less sensitive for acute blood.
Angiography (D) is for locating aneurysm after SAH
confirmed.
