,Barkley Family Nurse Practitioner (FNP) 2026–2027
250 Practice Questions with Answers & Detailed Rationales |
Updated for 2026/2027 Exam Cycles | 100% Verified
PRACTICE QUESTIONS WITH RATIONALES
SECTION 1: CARDIOVASCULAR CONDITIONS
Q1. A 62-year-old male with a history of hypertension
presents with substernal chest pressure that radiates to his
left jaw, occurring at rest and lasting 15 minutes. He is
diaphoretic and nauseated. Vital signs: HR 102 bpm, BP
158/92 mmHg, RR 20/min, SpO₂ 96%. What is the priority
action?
• A) Administer sublingual nitroglycerin and monitor for
relief
• B) Obtain a 12-lead ECG within 10 minutes of arrival
• C) Administer aspirin 324 mg orally
• D) Draw cardiac enzymes (troponin)
,Answer: B – Obtain a 12-lead ECG within 10 minutes of arrival
Rationale: The priority in suspected acute coronary syndrome
(ACS) is rapid ECG acquisition to identify ST-segment elevation
MI (STEMI) within 10 minutes. While aspirin and nitroglycerin
are important, the ECG is the diagnostic priority for time-
sensitive reperfusion therapy. Troponin levels are diagnostic
but take time to rise, so they should not delay initial
management.
Why Wrong:
• A – Nitroglycerin is appropriate but should follow ECG to
determine if STEMI is present
• C – Aspirin should be given but is not the priority action
• D – Troponin is important but ECG is the priority
Q2. Which of the following findings is most characteristic of
heart failure with reduced ejection fraction (HFrEF)?
• A) Ejection fraction < 40%
• B) Normal left ventricular size
• C) Ejection fraction > 50%
• D) Right ventricular hypertrophy
Answer: A – Ejection fraction < 40%
Rationale: HFrEF is defined by an ejection fraction of ≤ 40%.
This represents systolic dysfunction where the heart cannot
adequately pump blood forward. An EF of 40-49% is considered
, HF with mildly reduced EF (HFmrEF), and EF ≥ 50% with
diastolic dysfunction is HF with preserved EF (HFpEF). The other
options describe findings not typically associated with HFrEF.
Q3. A 65-year-old female reports palpitations and
lightheadedness. ECG shows an irregularly irregular rhythm
with no distinct P waves. What is the most likely diagnosis?
• A) Atrial fibrillation
• B) Atrial flutter
• C) Supraventricular tachycardia
• D) Premature atrial contractions
Answer: A – Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an irregularly
irregular rhythm with no discernible P waves. This is the most
common sustained cardiac arrhythmia and increases the risk of
stroke. Atrial flutter typically shows saw-tooth flutter waves (F
waves) with a regular or regularly irregular rhythm. The other
options have different ECG characteristics.
Q4. A patient with chronic atrial fibrillation has a CHA₂DS₂-
VASc score of 4. What is the recommended management?
• A) Aspirin 81 mg daily
• B) Antiplatelet therapy only
250 Practice Questions with Answers & Detailed Rationales |
Updated for 2026/2027 Exam Cycles | 100% Verified
PRACTICE QUESTIONS WITH RATIONALES
SECTION 1: CARDIOVASCULAR CONDITIONS
Q1. A 62-year-old male with a history of hypertension
presents with substernal chest pressure that radiates to his
left jaw, occurring at rest and lasting 15 minutes. He is
diaphoretic and nauseated. Vital signs: HR 102 bpm, BP
158/92 mmHg, RR 20/min, SpO₂ 96%. What is the priority
action?
• A) Administer sublingual nitroglycerin and monitor for
relief
• B) Obtain a 12-lead ECG within 10 minutes of arrival
• C) Administer aspirin 324 mg orally
• D) Draw cardiac enzymes (troponin)
,Answer: B – Obtain a 12-lead ECG within 10 minutes of arrival
Rationale: The priority in suspected acute coronary syndrome
(ACS) is rapid ECG acquisition to identify ST-segment elevation
MI (STEMI) within 10 minutes. While aspirin and nitroglycerin
are important, the ECG is the diagnostic priority for time-
sensitive reperfusion therapy. Troponin levels are diagnostic
but take time to rise, so they should not delay initial
management.
Why Wrong:
• A – Nitroglycerin is appropriate but should follow ECG to
determine if STEMI is present
• C – Aspirin should be given but is not the priority action
• D – Troponin is important but ECG is the priority
Q2. Which of the following findings is most characteristic of
heart failure with reduced ejection fraction (HFrEF)?
• A) Ejection fraction < 40%
• B) Normal left ventricular size
• C) Ejection fraction > 50%
• D) Right ventricular hypertrophy
Answer: A – Ejection fraction < 40%
Rationale: HFrEF is defined by an ejection fraction of ≤ 40%.
This represents systolic dysfunction where the heart cannot
adequately pump blood forward. An EF of 40-49% is considered
, HF with mildly reduced EF (HFmrEF), and EF ≥ 50% with
diastolic dysfunction is HF with preserved EF (HFpEF). The other
options describe findings not typically associated with HFrEF.
Q3. A 65-year-old female reports palpitations and
lightheadedness. ECG shows an irregularly irregular rhythm
with no distinct P waves. What is the most likely diagnosis?
• A) Atrial fibrillation
• B) Atrial flutter
• C) Supraventricular tachycardia
• D) Premature atrial contractions
Answer: A – Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an irregularly
irregular rhythm with no discernible P waves. This is the most
common sustained cardiac arrhythmia and increases the risk of
stroke. Atrial flutter typically shows saw-tooth flutter waves (F
waves) with a regular or regularly irregular rhythm. The other
options have different ECG characteristics.
Q4. A patient with chronic atrial fibrillation has a CHA₂DS₂-
VASc score of 4. What is the recommended management?
• A) Aspirin 81 mg daily
• B) Antiplatelet therapy only
