Barkley Acute Nurse Practitioner Exams Test Bank
2026/2027
Section 1: Cardiovascular Disorders
1. Prophylactic treatment for migraine headaches includes the use
of:
A. amitriptyline
B. ergot derivative
C. naproxen sodium
D. clonidine
Correct Answer: A. amitriptyline
Rationale: Amitriptyline is a tricyclic antidepressant commonly used
for migraine prophylaxis. Ergot derivatives (B) and naproxen (C)
are abortive treatments. Clonidine (D) is not first-line.
2. Antiepileptic drugs useful for preventing migraine headaches
include all of the following except:
A. divalproex
B. valproate
C. lamotrigine
D. topiramate
,Correct Answer: C. lamotrigine
Rationale: Lamotrigine is not effective for migraine prophylaxis.
Divalproex (A), valproate (B), and topiramate (D) are all effective.
3. In tension-type headache, which of the following is true?
A. Photophobia is seldom reported.
B. The pain is typically described as "pressing" in quality.
C. The headache is usually unilateral.
D. Physical activity usually makes the discomfort worse.
Correct Answer: B. The pain is typically described as "pressing" in quality.
Rationale: Tension-type headaches are bilateral, pressing/tightening
in quality, and not worsened by physical activity.
4. The mechanism of action of triptans is as a(n):
A. selective serotonin receptor agonist.
B. dopamine antagonist.
C. vasoconstrictor.
D. inhibitor of leukotriene synthesis.
Correct Answer: A. selective serotonin receptor agonist.
Rationale: Triptans are 5-HT1B/1D agonists that cause cranial
vasoconstriction and inhibit neurogenic inflammation.
5. The use of neuroleptics such as prochlorperazine (Compazine)
and promethazine (Phenergan) in migraine therapy should be limited
to less than three times per week because of their:
A. addictive potential.
,B. extrapyramidal movement risk.
C. ability to cause rebound headache.
D. sedative effect.
Correct Answer: B. extrapyramidal movement risk.
Rationale: Neuroleptics can cause extrapyramidal symptoms,
including dystonia and tardive dyskinesia.
6. With appropriately prescribed headache prophylactic therapy, the
patient should be informed to expect:
A. virtual resolution of headaches.
B. no fewer but less severe headaches.
C. approximately 50% reduction in the number of headaches.
D. that lifelong therapy is advised.
Correct Answer: C. approximately 50% reduction in the number of
headaches.
Rationale: Prophylactic therapy aims for a 50% reduction in
headache frequency.
7. A 48-year-old woman presents with a monthly 4-day
premenstrual migraine headache, poorly responsive to triptans and
analgesics, and accompanied by vasomotor symptoms (hot flashes).
The clinician considers pre-scribing all of the following except:
A. continuous monophasic oral contraceptive.
B. phasic combined oral contraceptive with a 7-day-per-month withdrawal
period.
, C. low-dose estrogen patch use during the premenstrual week.
D. triptan prophylaxis.
Correct Answer: B. phasic combined oral contraceptive with a 7-day-per-
month withdrawal period.
Rationale: Phasic COCs with a withdrawal period can trigger
menstrual migraines. Continuous or extended-cycle COCs are
preferred.
8. A first-line prophylactic treatment option for the prevention of
tension-type headache is:
A. nortriptyline.
B. verapamil.
C. carbamazepine.
D. valproate.
Correct Answer: A. nortriptyline.
Rationale: Nortriptyline is a first-line prophylactic treatment for
tension-type headaches.
9. A 47-year-old woman experiences occasional migraine with aura
and reports partial relief with zolmitriptan. You decide to add which
of the following to augment the pain control by the triptan?
A. lamotrigine
B. gabapentin
C. naproxen sodium
D. magnesium
2026/2027
Section 1: Cardiovascular Disorders
1. Prophylactic treatment for migraine headaches includes the use
of:
A. amitriptyline
B. ergot derivative
C. naproxen sodium
D. clonidine
Correct Answer: A. amitriptyline
Rationale: Amitriptyline is a tricyclic antidepressant commonly used
for migraine prophylaxis. Ergot derivatives (B) and naproxen (C)
are abortive treatments. Clonidine (D) is not first-line.
2. Antiepileptic drugs useful for preventing migraine headaches
include all of the following except:
A. divalproex
B. valproate
C. lamotrigine
D. topiramate
,Correct Answer: C. lamotrigine
Rationale: Lamotrigine is not effective for migraine prophylaxis.
Divalproex (A), valproate (B), and topiramate (D) are all effective.
3. In tension-type headache, which of the following is true?
A. Photophobia is seldom reported.
B. The pain is typically described as "pressing" in quality.
C. The headache is usually unilateral.
D. Physical activity usually makes the discomfort worse.
Correct Answer: B. The pain is typically described as "pressing" in quality.
Rationale: Tension-type headaches are bilateral, pressing/tightening
in quality, and not worsened by physical activity.
4. The mechanism of action of triptans is as a(n):
A. selective serotonin receptor agonist.
B. dopamine antagonist.
C. vasoconstrictor.
D. inhibitor of leukotriene synthesis.
Correct Answer: A. selective serotonin receptor agonist.
Rationale: Triptans are 5-HT1B/1D agonists that cause cranial
vasoconstriction and inhibit neurogenic inflammation.
5. The use of neuroleptics such as prochlorperazine (Compazine)
and promethazine (Phenergan) in migraine therapy should be limited
to less than three times per week because of their:
A. addictive potential.
,B. extrapyramidal movement risk.
C. ability to cause rebound headache.
D. sedative effect.
Correct Answer: B. extrapyramidal movement risk.
Rationale: Neuroleptics can cause extrapyramidal symptoms,
including dystonia and tardive dyskinesia.
6. With appropriately prescribed headache prophylactic therapy, the
patient should be informed to expect:
A. virtual resolution of headaches.
B. no fewer but less severe headaches.
C. approximately 50% reduction in the number of headaches.
D. that lifelong therapy is advised.
Correct Answer: C. approximately 50% reduction in the number of
headaches.
Rationale: Prophylactic therapy aims for a 50% reduction in
headache frequency.
7. A 48-year-old woman presents with a monthly 4-day
premenstrual migraine headache, poorly responsive to triptans and
analgesics, and accompanied by vasomotor symptoms (hot flashes).
The clinician considers pre-scribing all of the following except:
A. continuous monophasic oral contraceptive.
B. phasic combined oral contraceptive with a 7-day-per-month withdrawal
period.
, C. low-dose estrogen patch use during the premenstrual week.
D. triptan prophylaxis.
Correct Answer: B. phasic combined oral contraceptive with a 7-day-per-
month withdrawal period.
Rationale: Phasic COCs with a withdrawal period can trigger
menstrual migraines. Continuous or extended-cycle COCs are
preferred.
8. A first-line prophylactic treatment option for the prevention of
tension-type headache is:
A. nortriptyline.
B. verapamil.
C. carbamazepine.
D. valproate.
Correct Answer: A. nortriptyline.
Rationale: Nortriptyline is a first-line prophylactic treatment for
tension-type headaches.
9. A 47-year-old woman experiences occasional migraine with aura
and reports partial relief with zolmitriptan. You decide to add which
of the following to augment the pain control by the triptan?
A. lamotrigine
B. gabapentin
C. naproxen sodium
D. magnesium
