Barkley 3P Comprehensive Practice Exam with correct answers with rationales
2026/2027 version A+ Graded
1.A 68-year-old client with a history of hypertension presents with increasing
shortness of breath, orthopnea, and bilateral lower-extremity edema. Which
pathophysiologic mechanism is primarily responsible for these findings?
A. Increased plasma oncotic pressure
B. Decreased pulmonary capillary pressure
C. Increased left ventricular end-diastolic pressure
D. Increased red blood cell production
Correct Answer: C. Increased left ventricular end-diastolic pressure
Rationale: Left ventricular dysfunction increases end-diastolic pressure, leading to
elevated pulmonary venous pressure and fluid accumulation in the lungs, resulting
in dyspnea and orthopnea. Systemic venous congestion also contributes to
peripheral edema.
2. A patient taking lisinopril reports a persistent, dry cough that began several
weeks after starting therapy. What is the most likely cause?
A. Histamine release
B. Increased bradykinin levels
C. Excess aldosterone production
D. β-adrenergic stimulation
Correct Answer: B. Increased bradykinin levels
Rationale: ACE inhibitors decrease the breakdown of bradykinin, resulting in
accumulation that commonly produces a dry, persistent cough.
, 3. During a cardiovascular examination, a harsh systolic murmur radiating to
both carotid arteries is heard. Which diagnosis is most likely?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary stenosis
Correct Answer: B. Aortic stenosis
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic murmur best
heard at the right upper sternal border that frequently radiates to the carotids.
4. Which laboratory value is most concerning in a patient receiving
spironolactone?
A. Potassium 5.9 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: A. Potassium 5.9 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia is a
significant adverse effect that can cause life-threatening cardiac dysrhythmias.
, 5. A patient presents with sudden unilateral facial drooping, arm weakness, and
slurred speech that began 45 minutes ago. What is the nurse practitioner's
priority action?
A. Administer aspirin immediately.
B. Obtain an emergent noncontrast CT scan of the head.
C. Schedule an outpatient MRI.
D. Observe the patient for 24 hours.
Correct Answer: B. Obtain an emergent noncontrast CT scan of the head.
Rationale: Rapid neuroimaging is essential to distinguish ischemic from
hemorrhagic stroke and determine eligibility for time-sensitive therapies.
6. Which assessment finding is most consistent with diabetic ketoacidosis
(DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia without dehydration
D. Hypertension
Correct Answer: B. Kussmaul respirations
Rationale: DKA commonly presents with metabolic acidosis, producing deep,
rapid Kussmaul respirations as the body attempts to reduce carbon dioxide.
7. Which medication is considered first-line therapy for most adults with newly
diagnosed hypertension and no compelling comorbidities?
, A. Digoxin
B. ACE inhibitor, thiazide diuretic, calcium channel blocker, or ARB (depending
on patient factors)
C. Amiodarone
D. Warfarin
Correct Answer: B. ACE inhibitor, thiazide diuretic, calcium channel blocker,
or ARB (depending on patient factors)
Rationale: Current hypertension guidelines recommend these medication classes as
first-line options, with selection individualized to the patient's clinical profile.
8. Which cranial nerve is assessed by asking a patient to shrug the shoulders
against resistance?
A. Cranial Nerve VII
B. Cranial Nerve VIII
C. Cranial Nerve XI
D. Cranial Nerve XII
Correct Answer: C. Cranial Nerve XI
Rationale: The spinal accessory nerve (CN XI) innervates the sternocleidomastoid
and trapezius muscles.
9. A patient develops wheezing, hypotension, and facial swelling immediately
after receiving penicillin. Which medication should be administered first?
A. Diphenhydramine
2026/2027 version A+ Graded
1.A 68-year-old client with a history of hypertension presents with increasing
shortness of breath, orthopnea, and bilateral lower-extremity edema. Which
pathophysiologic mechanism is primarily responsible for these findings?
A. Increased plasma oncotic pressure
B. Decreased pulmonary capillary pressure
C. Increased left ventricular end-diastolic pressure
D. Increased red blood cell production
Correct Answer: C. Increased left ventricular end-diastolic pressure
Rationale: Left ventricular dysfunction increases end-diastolic pressure, leading to
elevated pulmonary venous pressure and fluid accumulation in the lungs, resulting
in dyspnea and orthopnea. Systemic venous congestion also contributes to
peripheral edema.
2. A patient taking lisinopril reports a persistent, dry cough that began several
weeks after starting therapy. What is the most likely cause?
A. Histamine release
B. Increased bradykinin levels
C. Excess aldosterone production
D. β-adrenergic stimulation
Correct Answer: B. Increased bradykinin levels
Rationale: ACE inhibitors decrease the breakdown of bradykinin, resulting in
accumulation that commonly produces a dry, persistent cough.
, 3. During a cardiovascular examination, a harsh systolic murmur radiating to
both carotid arteries is heard. Which diagnosis is most likely?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary stenosis
Correct Answer: B. Aortic stenosis
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic murmur best
heard at the right upper sternal border that frequently radiates to the carotids.
4. Which laboratory value is most concerning in a patient receiving
spironolactone?
A. Potassium 5.9 mEq/L
B. Sodium 138 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: A. Potassium 5.9 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic. Hyperkalemia is a
significant adverse effect that can cause life-threatening cardiac dysrhythmias.
, 5. A patient presents with sudden unilateral facial drooping, arm weakness, and
slurred speech that began 45 minutes ago. What is the nurse practitioner's
priority action?
A. Administer aspirin immediately.
B. Obtain an emergent noncontrast CT scan of the head.
C. Schedule an outpatient MRI.
D. Observe the patient for 24 hours.
Correct Answer: B. Obtain an emergent noncontrast CT scan of the head.
Rationale: Rapid neuroimaging is essential to distinguish ischemic from
hemorrhagic stroke and determine eligibility for time-sensitive therapies.
6. Which assessment finding is most consistent with diabetic ketoacidosis
(DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia without dehydration
D. Hypertension
Correct Answer: B. Kussmaul respirations
Rationale: DKA commonly presents with metabolic acidosis, producing deep,
rapid Kussmaul respirations as the body attempts to reduce carbon dioxide.
7. Which medication is considered first-line therapy for most adults with newly
diagnosed hypertension and no compelling comorbidities?
, A. Digoxin
B. ACE inhibitor, thiazide diuretic, calcium channel blocker, or ARB (depending
on patient factors)
C. Amiodarone
D. Warfarin
Correct Answer: B. ACE inhibitor, thiazide diuretic, calcium channel blocker,
or ARB (depending on patient factors)
Rationale: Current hypertension guidelines recommend these medication classes as
first-line options, with selection individualized to the patient's clinical profile.
8. Which cranial nerve is assessed by asking a patient to shrug the shoulders
against resistance?
A. Cranial Nerve VII
B. Cranial Nerve VIII
C. Cranial Nerve XI
D. Cranial Nerve XII
Correct Answer: C. Cranial Nerve XI
Rationale: The spinal accessory nerve (CN XI) innervates the sternocleidomastoid
and trapezius muscles.
9. A patient develops wheezing, hypotension, and facial swelling immediately
after receiving penicillin. Which medication should be administered first?
A. Diphenhydramine
