Barkley Acute Care Nurse Practitioner Certification
Practice Exam 2026/2027
Section I: Cardiovascular Disorders
Question 1
A 68-year-old male with a history of heart failure presents with increasing
dyspnea and an S3 gallop. BNP is 850 pg/mL. Which diagnostic finding is most
consistent with acute decompensated heart failure?
A. Pulmonary artery wedge pressure of 8 mmHg
B. Cardiac index of 3.2 L/min/m²
C. Pulmonary artery wedge pressure of 22 mmHg
D. Systemic vascular resistance of 800 dynes/sec/cm⁻⁵
Correct Answer: C. Pulmonary artery wedge pressure of 22 mmHg
Rationale: An elevated pulmonary artery wedge pressure (>18 mmHg) is a
hallmark of left-sided heart failure and pulmonary congestion, consistent with the
patient's presentation. Low PAWP would suggest non-cardiac causes of dyspnea.
A normal cardiac index does not rule out decompensation, and SVR can vary
widely.
Question 2
A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular
response. Blood pressure is 82/50 mmHg. What is the priority intervention?
A. Amiodarone infusion
B. Synchronized cardioversion
C. Diltiazem bolus
D. Beta-blocker administration
Correct Answer: B. Synchronized cardioversion
Rationale: Hemodynamic instability in the setting of new-onset
tachycardia requires immediate synchronized cardioversion to restore perfusion.
Pharmacologic rate control may worsen hypotension in an unstable patient.
,Amiodarone is not first-line for unstable AF. Diltiazem and beta-blockers are
contraindicated in hypotension.
Question 3
Which of the following lab findings is most indicative of disseminated
intravascular coagulation (DIC)?
A. Elevated fibrinogen levels
B. Decreased D-dimer levels
C. Prolonged PT/PTT and thrombocytopenia
D. Elevated protein C levels
Correct Answer: C. Prolonged PT/PTT and thrombocytopenia
Rationale: DIC is characterized by widespread activation of clotting,
leading to consumption of clotting factors (prolonged PT/PTT) and platelets
(thrombocytopenia). Fibrinogen levels are typically decreased, D-dimer is
elevated, and protein C is consumed.
Question 4
A patient is receiving mechanical ventilation. The plateau pressure has increased
from 20 cmH₂O to 35 cmH₂O, while peak pressure remains stable. This indicates:
A. Bronchospasm
B. Endotracheal tube obstruction
C. Decreased lung compliance
D. Secretions in the airway
Correct Answer: C. Decreased lung compliance
Rationale: An increase in plateau pressure with a stable peak pressure
difference points to reduced lung compliance, such as in ARDS or pulmonary
edema. Bronchospasm, tube obstruction, and secretions would typically elevate
peak pressure more than plateau pressure.
,Question 5 (SATA)
Which of the following are risk factors for the development of abdominal aortic
aneurysm (AAA)? Select all that apply.
A. Smoking
B. Hypertension
C. Female sex
D. Age >65
E. Hyperlipidemia
Correct Answers: A, B, D, E
Rationale: Smoking, hypertension, age >65, and hyperlipidemia are
established risk factors for AAA. Male sex, not female sex, is a risk factor. AAA is
more common in men.
Question 6
A 55-year-old female presents with sudden-onset tearing chest pain radiating to
the back. BP is 180/100 mmHg, and pulses are unequal. What is the most
appropriate initial diagnostic test?
A. Chest X-ray
B. ECG
C. CT angiography
D. Transthoracic echocardiogram
Correct Answer: C. CT angiography
Rationale: The presentation is classic for aortic dissection. CT angiography
is the diagnostic test of choice to confirm the diagnosis and define the extent of
dissection. Chest X-ray may show widened mediastinum but is not definitive. ECG
is important to rule out MI but does not diagnose dissection.
Question 7
A patient with acute decompensated heart failure is started on furosemide.
, Which monitoring parameter is most important to assess the effectiveness of
therapy?
A. Serum potassium
B. Urine output
C. Daily weight
D. Blood pressure
Correct Answer: C. Daily weight
Rationale: Daily weight is the most reliable indicator of fluid status and
diuretic effectiveness in heart failure. A weight loss of 0.5–1 kg per day is
expected. Urine output is helpful but less precise for cumulative fluid balance.
Potassium and BP must be monitored but do not directly reflect decongestion.
Question 8
Which ECG finding is most consistent with hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. Prominent U waves
D. ST elevation
Correct Answer: B. Peaked T waves
Rationale: Hyperkalemia classically causes tall, peaked T waves, followed
by widening of the QRS complex and eventual sine wave pattern. Prolonged QT
and U waves are associated with hypokalemia. ST elevation suggests ischemia or
pericarditis.
Question 9 (SATA)
A patient is admitted with infective endocarditis. Which of the following are Duke
minor criteria? Select all that apply.
A. Positive blood cultures for typical organisms
B. Fever >38.0°C
C. Predisposing heart condition
Practice Exam 2026/2027
Section I: Cardiovascular Disorders
Question 1
A 68-year-old male with a history of heart failure presents with increasing
dyspnea and an S3 gallop. BNP is 850 pg/mL. Which diagnostic finding is most
consistent with acute decompensated heart failure?
A. Pulmonary artery wedge pressure of 8 mmHg
B. Cardiac index of 3.2 L/min/m²
C. Pulmonary artery wedge pressure of 22 mmHg
D. Systemic vascular resistance of 800 dynes/sec/cm⁻⁵
Correct Answer: C. Pulmonary artery wedge pressure of 22 mmHg
Rationale: An elevated pulmonary artery wedge pressure (>18 mmHg) is a
hallmark of left-sided heart failure and pulmonary congestion, consistent with the
patient's presentation. Low PAWP would suggest non-cardiac causes of dyspnea.
A normal cardiac index does not rule out decompensation, and SVR can vary
widely.
Question 2
A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular
response. Blood pressure is 82/50 mmHg. What is the priority intervention?
A. Amiodarone infusion
B. Synchronized cardioversion
C. Diltiazem bolus
D. Beta-blocker administration
Correct Answer: B. Synchronized cardioversion
Rationale: Hemodynamic instability in the setting of new-onset
tachycardia requires immediate synchronized cardioversion to restore perfusion.
Pharmacologic rate control may worsen hypotension in an unstable patient.
,Amiodarone is not first-line for unstable AF. Diltiazem and beta-blockers are
contraindicated in hypotension.
Question 3
Which of the following lab findings is most indicative of disseminated
intravascular coagulation (DIC)?
A. Elevated fibrinogen levels
B. Decreased D-dimer levels
C. Prolonged PT/PTT and thrombocytopenia
D. Elevated protein C levels
Correct Answer: C. Prolonged PT/PTT and thrombocytopenia
Rationale: DIC is characterized by widespread activation of clotting,
leading to consumption of clotting factors (prolonged PT/PTT) and platelets
(thrombocytopenia). Fibrinogen levels are typically decreased, D-dimer is
elevated, and protein C is consumed.
Question 4
A patient is receiving mechanical ventilation. The plateau pressure has increased
from 20 cmH₂O to 35 cmH₂O, while peak pressure remains stable. This indicates:
A. Bronchospasm
B. Endotracheal tube obstruction
C. Decreased lung compliance
D. Secretions in the airway
Correct Answer: C. Decreased lung compliance
Rationale: An increase in plateau pressure with a stable peak pressure
difference points to reduced lung compliance, such as in ARDS or pulmonary
edema. Bronchospasm, tube obstruction, and secretions would typically elevate
peak pressure more than plateau pressure.
,Question 5 (SATA)
Which of the following are risk factors for the development of abdominal aortic
aneurysm (AAA)? Select all that apply.
A. Smoking
B. Hypertension
C. Female sex
D. Age >65
E. Hyperlipidemia
Correct Answers: A, B, D, E
Rationale: Smoking, hypertension, age >65, and hyperlipidemia are
established risk factors for AAA. Male sex, not female sex, is a risk factor. AAA is
more common in men.
Question 6
A 55-year-old female presents with sudden-onset tearing chest pain radiating to
the back. BP is 180/100 mmHg, and pulses are unequal. What is the most
appropriate initial diagnostic test?
A. Chest X-ray
B. ECG
C. CT angiography
D. Transthoracic echocardiogram
Correct Answer: C. CT angiography
Rationale: The presentation is classic for aortic dissection. CT angiography
is the diagnostic test of choice to confirm the diagnosis and define the extent of
dissection. Chest X-ray may show widened mediastinum but is not definitive. ECG
is important to rule out MI but does not diagnose dissection.
Question 7
A patient with acute decompensated heart failure is started on furosemide.
, Which monitoring parameter is most important to assess the effectiveness of
therapy?
A. Serum potassium
B. Urine output
C. Daily weight
D. Blood pressure
Correct Answer: C. Daily weight
Rationale: Daily weight is the most reliable indicator of fluid status and
diuretic effectiveness in heart failure. A weight loss of 0.5–1 kg per day is
expected. Urine output is helpful but less precise for cumulative fluid balance.
Potassium and BP must be monitored but do not directly reflect decongestion.
Question 8
Which ECG finding is most consistent with hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. Prominent U waves
D. ST elevation
Correct Answer: B. Peaked T waves
Rationale: Hyperkalemia classically causes tall, peaked T waves, followed
by widening of the QRS complex and eventual sine wave pattern. Prolonged QT
and U waves are associated with hypokalemia. ST elevation suggests ischemia or
pericarditis.
Question 9 (SATA)
A patient is admitted with infective endocarditis. Which of the following are Duke
minor criteria? Select all that apply.
A. Positive blood cultures for typical organisms
B. Fever >38.0°C
C. Predisposing heart condition
