2025–2026 Barkley Post Test Exam –
Verified Questions and Correct
Answers – Comprehensive Nurse
Practitioner Board Review
EXAM
Cardiology
1. A 68-year-old male with a history of hypertension presents
with acute-onset substernal chest pressure radiating to his
left jaw, accompanied by diaphoresis and nausea. His ECG
shows 2-mm ST-segment elevation in leads V1–V4. Which of
the following is the most appropriate immediate
management?
A) Administer sublingual nitroglycerin and admit for
observation
B) Start aspirin, oxygen, and morphine; activate the
catheterization lab for primary PCI
C) Administer thrombolytic therapy in the emergency
department
D) Obtain a chest X-ray and serial troponins
Correct Answer: B
,Rationale: This patient is presenting with an acute ST-segment
elevation myocardial infarction (STEMI), as evidenced by ST
elevation in the anterior leads (V1–V4). The goal for STEMI is rapid
reperfusion. Primary percutaneous coronary intervention (PCI) is
the preferred strategy if it can be performed within 90 minutes of
first medical contact. Aspirin, oxygen (if hypoxic), and morphine
for pain are initial supportive measures. Thrombolytics are an
alternative if PCI is not available within the timeframe.
2. A 55-year-old female with a history of hypertension and
diabetes presents with progressive exertional dyspnea,
orthopnea, and bilateral lower extremity edema. Her
echocardiogram reveals an ejection fraction of 35%. Which of
the following is the cornerstone of chronic pharmacologic
management for this patient's condition?
A) Digoxin and furosemide
B) Beta-blocker and ACE inhibitor
C) Calcium channel blocker and hydralazine
D) Nitrates and aspirin
Correct Answer: B
Rationale: This patient has heart failure with reduced ejection
fraction (HFrEF). The foundational guideline-directed medical
therapy (GDMT) includes a beta-blocker (e.g., carvedilol,
metoprolol succinate) and an ACE inhibitor (or ARB) to reduce
morbidity and mortality. Digoxin and diuretics are used for
symptom control but are not the cornerstone of mortality
reduction. Calcium channel blockers (especially non-
dihydropyridines) are generally avoided in HFrEF.
,3. A 72-year-old male is noted to have an irregularly irregular
pulse during a routine physical exam. His ECG confirms atrial
fibrillation with a ventricular rate of 110 bpm. He is
asymptomatic. Which of the following is the most important
next step in management?
A) Immediate cardioversion
B) Rate control with a beta-blocker
C) Anticoagulation assessment using the CHA₂DS₂-VASc
score
D) Referral for electrophysiology study
Correct Answer: C
Rationale: In a patient with new-onset atrial fibrillation, the
priority is to assess stroke risk using the CHA₂DS₂-VASc score to
determine the need for anticoagulation. Rate or rhythm control
can be addressed subsequently. Immediate cardioversion is not
indicated in an asymptomatic, hemodynamically stable patient.
4. A 60-year-old male with a 40-pack-year smoking history
presents with a blood pressure of 152/94 mmHg on two
separate occasions. He has no other comorbidities. According
to the Eighth Joint National Committee (JNC 8) guidelines,
what is the target blood pressure for this patient?
A) < 130/80 mmHg
B) < 140/90 mmHg
C) < 150/90 mmHg
D) < 160/100 mmHg
Correct Answer: B
, Rationale: For the general population aged < 60 years, the JNC 8
guideline recommends a target blood pressure of < 140/90
mmHg. For patients aged ≥ 60 years, the target is < 150/90
mmHg. More recent guidelines (e.g., ACC/AHA 2017) recommend
a lower target of < 130/80 mmHg for all adults, but JNC 8 remains
a commonly tested standard.
5. A 48-year-old female presents with episodes of rapid heart
palpitations, sweating, and anxiety that occur suddenly and
resolve spontaneously. Her ECG during an episode shows a
narrow-complex tachycardia at 180 bpm. Which of the
following is the most likely diagnosis?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Supraventricular tachycardia (SVT)
D) Sinus tachycardia
Correct Answer: C
Rationale: The presentation of sudden-onset, self-terminating
palpitations with a narrow-complex tachycardia is classic for
paroxysmal supraventricular tachycardia (SVT). Atrial fibrillation
would show an irregularly irregular rhythm. Ventricular
tachycardia is wide-complex. Sinus tachycardia is typically a
gradual response to a physiologic stressor.
6. A 65-year-old male with a history of peripheral artery
disease presents with a painful, pale, and pulseless left lower
extremity of 4 hours' duration. What is the most appropriate
initial management?
Verified Questions and Correct
Answers – Comprehensive Nurse
Practitioner Board Review
EXAM
Cardiology
1. A 68-year-old male with a history of hypertension presents
with acute-onset substernal chest pressure radiating to his
left jaw, accompanied by diaphoresis and nausea. His ECG
shows 2-mm ST-segment elevation in leads V1–V4. Which of
the following is the most appropriate immediate
management?
A) Administer sublingual nitroglycerin and admit for
observation
B) Start aspirin, oxygen, and morphine; activate the
catheterization lab for primary PCI
C) Administer thrombolytic therapy in the emergency
department
D) Obtain a chest X-ray and serial troponins
Correct Answer: B
,Rationale: This patient is presenting with an acute ST-segment
elevation myocardial infarction (STEMI), as evidenced by ST
elevation in the anterior leads (V1–V4). The goal for STEMI is rapid
reperfusion. Primary percutaneous coronary intervention (PCI) is
the preferred strategy if it can be performed within 90 minutes of
first medical contact. Aspirin, oxygen (if hypoxic), and morphine
for pain are initial supportive measures. Thrombolytics are an
alternative if PCI is not available within the timeframe.
2. A 55-year-old female with a history of hypertension and
diabetes presents with progressive exertional dyspnea,
orthopnea, and bilateral lower extremity edema. Her
echocardiogram reveals an ejection fraction of 35%. Which of
the following is the cornerstone of chronic pharmacologic
management for this patient's condition?
A) Digoxin and furosemide
B) Beta-blocker and ACE inhibitor
C) Calcium channel blocker and hydralazine
D) Nitrates and aspirin
Correct Answer: B
Rationale: This patient has heart failure with reduced ejection
fraction (HFrEF). The foundational guideline-directed medical
therapy (GDMT) includes a beta-blocker (e.g., carvedilol,
metoprolol succinate) and an ACE inhibitor (or ARB) to reduce
morbidity and mortality. Digoxin and diuretics are used for
symptom control but are not the cornerstone of mortality
reduction. Calcium channel blockers (especially non-
dihydropyridines) are generally avoided in HFrEF.
,3. A 72-year-old male is noted to have an irregularly irregular
pulse during a routine physical exam. His ECG confirms atrial
fibrillation with a ventricular rate of 110 bpm. He is
asymptomatic. Which of the following is the most important
next step in management?
A) Immediate cardioversion
B) Rate control with a beta-blocker
C) Anticoagulation assessment using the CHA₂DS₂-VASc
score
D) Referral for electrophysiology study
Correct Answer: C
Rationale: In a patient with new-onset atrial fibrillation, the
priority is to assess stroke risk using the CHA₂DS₂-VASc score to
determine the need for anticoagulation. Rate or rhythm control
can be addressed subsequently. Immediate cardioversion is not
indicated in an asymptomatic, hemodynamically stable patient.
4. A 60-year-old male with a 40-pack-year smoking history
presents with a blood pressure of 152/94 mmHg on two
separate occasions. He has no other comorbidities. According
to the Eighth Joint National Committee (JNC 8) guidelines,
what is the target blood pressure for this patient?
A) < 130/80 mmHg
B) < 140/90 mmHg
C) < 150/90 mmHg
D) < 160/100 mmHg
Correct Answer: B
, Rationale: For the general population aged < 60 years, the JNC 8
guideline recommends a target blood pressure of < 140/90
mmHg. For patients aged ≥ 60 years, the target is < 150/90
mmHg. More recent guidelines (e.g., ACC/AHA 2017) recommend
a lower target of < 130/80 mmHg for all adults, but JNC 8 remains
a commonly tested standard.
5. A 48-year-old female presents with episodes of rapid heart
palpitations, sweating, and anxiety that occur suddenly and
resolve spontaneously. Her ECG during an episode shows a
narrow-complex tachycardia at 180 bpm. Which of the
following is the most likely diagnosis?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Supraventricular tachycardia (SVT)
D) Sinus tachycardia
Correct Answer: C
Rationale: The presentation of sudden-onset, self-terminating
palpitations with a narrow-complex tachycardia is classic for
paroxysmal supraventricular tachycardia (SVT). Atrial fibrillation
would show an irregularly irregular rhythm. Ventricular
tachycardia is wide-complex. Sinus tachycardia is typically a
gradual response to a physiologic stressor.
6. A 65-year-old male with a history of peripheral artery
disease presents with a painful, pale, and pulseless left lower
extremity of 4 hours' duration. What is the most appropriate
initial management?
