,A+ Family Nurse Practitioner (FNP) Barkley Post-Test –
Comprehensive Practice Q Bank
Fall 2025/2026 Update | 250 Questions with Verified Answers & Detailed
Rationales
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–30)
Question 1
A 45-year-old male with a history of hypertension presents with a blood pressure of
148/92 mmHg on two separate occasions. He has no other comorbidities. According to
current guidelines, what is the most appropriate initial management?
A. Begin antihypertensive medication immediately
B. Recommend lifestyle modification and recheck in 3–6 months
C. Refer to cardiology
D. Order a 24-hour ambulatory blood pressure monitor
Answer: B. Recommend lifestyle modification and recheck in 3–6 months
Rationale: According to ACC/AHA hypertension guidelines, stage 1 hypertension (130–
139/80–89 mmHg) in a patient with low ASCVD risk (< 10%) should be managed initially
with lifestyle modifications for 3–6 months before initiating pharmacotherapy.
Question 2
A 68-year-old female with heart failure with reduced ejection fraction (HFrEF) is started
on sacubitril/valsartan. Which laboratory value requires the most careful monitoring?
,A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Sacubitril/valsartan (Entresto) contains an ARB component that can cause
hyperkalemia. Potassium levels should be monitored closely, especially in patients with
renal impairment or those taking potassium-sparing diuretics.
Question 3
Which of the following ECG findings is most characteristic of acute pericarditis?
A. ST-segment elevation in all leads with reciprocal depression
B. Diffuse ST-segment elevation with PR-segment depression
C. Deep Q waves in leads II, III, and aVF
D. Tall peaked T waves
Answer: B. Diffuse ST-segment elevation with PR-segment depression
Rationale: Acute pericarditis typically presents with diffuse ST-segment elevation and
PR-segment depression across multiple leads, reflecting widespread epicardial
inflammation.
Question 4
A 55-year-old male with a 30-pack-year smoking history presents with exertional leg
pain that resolves with rest. On examination, his right foot is cool with decreased hair
growth and a diminished dorsalis pedis pulse. The most likely diagnosis is:
A. Deep vein thrombosis
B. Peripheral artery disease
C. Venous insufficiency
D. Sciatica
, Answer: B. Peripheral artery disease
Rationale: Intermittent claudication (exertional leg pain relieved by rest) with signs of
decreased perfusion (cool extremity, diminished pulses, hair loss) is classic for peripheral
artery disease
Question 5
A patient with atrial fibrillation is prescribed apixaban for stroke prevention. Which
statement by the patient indicates a need for further teaching?
A. "I should take this medication at the same time every day"
B. "I need to avoid aspirin while taking this medication"
C. "I can stop taking this medication if I feel better"
D. "I should report any unusual bruising or bleeding"
Answer: C. "I can stop taking this medication if I feel better"
Rationale: Direct oral anticoagulants (DOACs) like apixaban should not be stopped
without provider guidance, as this increases stroke risk in patients with atrial fibrillation.
Question 6
A 72-year-old female presents with sudden onset of severe chest pain that radiates to
her back. Her blood pressure is 100/60 mmHg in the right arm and 140/85 mmHg in the
left arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe chest or back pain
and a pulse or blood pressure differential between arms.
Comprehensive Practice Q Bank
Fall 2025/2026 Update | 250 Questions with Verified Answers & Detailed
Rationales
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1–30)
Question 1
A 45-year-old male with a history of hypertension presents with a blood pressure of
148/92 mmHg on two separate occasions. He has no other comorbidities. According to
current guidelines, what is the most appropriate initial management?
A. Begin antihypertensive medication immediately
B. Recommend lifestyle modification and recheck in 3–6 months
C. Refer to cardiology
D. Order a 24-hour ambulatory blood pressure monitor
Answer: B. Recommend lifestyle modification and recheck in 3–6 months
Rationale: According to ACC/AHA hypertension guidelines, stage 1 hypertension (130–
139/80–89 mmHg) in a patient with low ASCVD risk (< 10%) should be managed initially
with lifestyle modifications for 3–6 months before initiating pharmacotherapy.
Question 2
A 68-year-old female with heart failure with reduced ejection fraction (HFrEF) is started
on sacubitril/valsartan. Which laboratory value requires the most careful monitoring?
,A. Serum sodium
B. Serum potassium
C. Serum creatinine
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Sacubitril/valsartan (Entresto) contains an ARB component that can cause
hyperkalemia. Potassium levels should be monitored closely, especially in patients with
renal impairment or those taking potassium-sparing diuretics.
Question 3
Which of the following ECG findings is most characteristic of acute pericarditis?
A. ST-segment elevation in all leads with reciprocal depression
B. Diffuse ST-segment elevation with PR-segment depression
C. Deep Q waves in leads II, III, and aVF
D. Tall peaked T waves
Answer: B. Diffuse ST-segment elevation with PR-segment depression
Rationale: Acute pericarditis typically presents with diffuse ST-segment elevation and
PR-segment depression across multiple leads, reflecting widespread epicardial
inflammation.
Question 4
A 55-year-old male with a 30-pack-year smoking history presents with exertional leg
pain that resolves with rest. On examination, his right foot is cool with decreased hair
growth and a diminished dorsalis pedis pulse. The most likely diagnosis is:
A. Deep vein thrombosis
B. Peripheral artery disease
C. Venous insufficiency
D. Sciatica
, Answer: B. Peripheral artery disease
Rationale: Intermittent claudication (exertional leg pain relieved by rest) with signs of
decreased perfusion (cool extremity, diminished pulses, hair loss) is classic for peripheral
artery disease
Question 5
A patient with atrial fibrillation is prescribed apixaban for stroke prevention. Which
statement by the patient indicates a need for further teaching?
A. "I should take this medication at the same time every day"
B. "I need to avoid aspirin while taking this medication"
C. "I can stop taking this medication if I feel better"
D. "I should report any unusual bruising or bleeding"
Answer: C. "I can stop taking this medication if I feel better"
Rationale: Direct oral anticoagulants (DOACs) like apixaban should not be stopped
without provider guidance, as this increases stroke risk in patients with atrial fibrillation.
Question 6
A 72-year-old female presents with sudden onset of severe chest pain that radiates to
her back. Her blood pressure is 100/60 mmHg in the right arm and 140/85 mmHg in the
left arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe chest or back pain
and a pulse or blood pressure differential between arms.
