1
ANCC Family Nurse Practitioner (FNP) Certification
Barkley Examination Format and Content
Overview
EXAM FORMAT OVERVIEW
• Number of questions: 150 scored + 25 pretest (175 total)
• Time allowed: 3.5 hours
• Domain weighting (ANCC test content outline, effective October
2026):
o Assessment & Diagnosis (34%)
o Clinical Management (41%)
o Professional Role & Health Promotion (25%)
• Passing standard: Scaled score determined by ANCC
• Question format: Multiple choice, single best answer
DOMAIN 1: ASSESSMENT & DIAGNOSIS (Questions 1–30)
Orthopedic & Musculoskeletal
Q1. A 10-year-old soccer player injures their knee during a game. On
physical exam, you perform a posterior drawer test and find excessive
posterior translation of the tibia on the femur. What does this finding
most likely indicate?
A) Anterior cruciate ligament (ACL) tear
B) Posterior cruciate ligament (PCL) tear
pg. 1
,2
C) Medial collateral ligament (MCL) sprain
D) Meniscal tear
: Answer : B – Posterior cruciate ligament (PCL) tear
Rationale: The posterior drawer test specifically assesses the integrity
of the PCL. A positive test (excessive posterior translation of the tibia) is
highly suggestive of a PCL injury. It is less common than ACL tears and
often occurs with a dashboard injury mechanism. The anterior drawer
test is for ACL evaluation, and valgus/varus stress tests assess the MCL
and LCL.
Q2. A 10-year-old soccer player has an acute knee injury. On
examination, you note a positive anterior drawer sign. Which ligament
is most likely injured?
A) Posterior cruciate ligament (PCL)
B) Medial collateral ligament (MCL)
C) Anterior cruciate ligament (ACL)
D) Lateral collateral ligament (LCL)
: Answer : C – Anterior cruciate ligament (ACL)
Rationale: The anterior drawer test assesses the integrity of the ACL. A
positive test (anterior translation of the tibia) is characteristic of an ACL
tear. It is one of the most common knee injuries in young athletes. The
examiner holds the tibia and pulls it anteriorly while the patient is
supine with the knee flexed to 90 degrees.
Q3. A 10-year-old soccer player presents with a swollen knee and pain
along the medial joint line. McMurray's test is positive. What is the
most likely diagnosis?
pg. 2
,3
A) Anterior cruciate ligament tear
B) Posterior cruciate ligament tear
C) Medial meniscus tear
D) Patellar dislocation
: Answer : C – Medial meniscus tear
Rationale: McMurray's test is a specific provocative maneuver used to
identify meniscal tears. A positive test (palpable or audible click over
the joint line) is highly suggestive of a meniscal tear. The medial
meniscus is more commonly injured than the lateral meniscus. The test
is performed by flexing the patient's knee and then rotating the tibia
while extending the knee.
Q4. A 10-year-old soccer player fell and has immediate swelling of the
lateral ankle. He is able to bear weight and denies an audible sound at
the time of injury. What does this history most likely indicate?
A) Lateral ankle sprain with possible fracture
B) Mild soft tissue injury only
C) Serious ankle injury with certain fracture
D) Achilles tendon rupture
: Answer : A – Lateral ankle sprain with possible fracture
Rationale: Immediate swelling of the joint raises suspicion for a
fracture or significant ligamentous injury. The mechanism described
(rolling the foot inward while falling) is classic for an inversion injury of
the ankle, which most commonly results in tearing of the anterior
talofibular ligament (ATFL) – a lateral ankle sprain. However, because of
the rapid onset of swelling, a fracture (e.g., of the lateral malleolus or
base of the fifth metatarsal) cannot be ruled out without radiographs.
The ability to bear weight is reassuring but does not exclude fracture.
pg. 3
, 4
Q5. A distance runner reports pain in one heel that is worse in the
morning and seems to improve with exercise. On physical exam, you
note localized swelling and a bony prominence at the heel. What is the
most likely diagnosis, and what is an appropriate initial treatment?
A) Achilles tendinitis; complete cessation of running
B) Plantar fasciitis with heel spur; stretching exercises, supportive
footwear, and NSAIDs
C) Calcaneal stress fracture; crutches and partial weight bearing
D) Retrocalcaneal bursitis; aspiration and corticosteroid injection
: Answer : B – Plantar fasciitis with heel spur; stretching exercises,
supportive footwear, and NSAIDs
Rationale: The presentation of morning pain (first-step pain) that
improves with activity is classic for plantar fasciitis. The bony
prominence is likely a calcaneal heel spur, which may or may not be
related to the pain. Initial treatment should focus on plantar-specific
stretching, activity modification, supportive shoes with good arch
support, and NSAIDs for pain. Cessation of all activities (A) is not
recommended; gentle exercise is beneficial. Achilles tendinitis (A)
typically presents with pain slightly above the heel that worsens with
activity. A stress fracture (C) would be more likely to cause pain that
worsens with weight-bearing and improves with rest, not morning pain.
Retrocalcaneal bursitis (D) typically causes pain at the back of the heel,
and aspiration is not usually first-line.
Q6. A patient who is a long-distance runner complains of heel pain that
is worst when first rising in the morning and improves after walking for
a few minutes. What is the most appropriate initial intervention?
pg. 4
ANCC Family Nurse Practitioner (FNP) Certification
Barkley Examination Format and Content
Overview
EXAM FORMAT OVERVIEW
• Number of questions: 150 scored + 25 pretest (175 total)
• Time allowed: 3.5 hours
• Domain weighting (ANCC test content outline, effective October
2026):
o Assessment & Diagnosis (34%)
o Clinical Management (41%)
o Professional Role & Health Promotion (25%)
• Passing standard: Scaled score determined by ANCC
• Question format: Multiple choice, single best answer
DOMAIN 1: ASSESSMENT & DIAGNOSIS (Questions 1–30)
Orthopedic & Musculoskeletal
Q1. A 10-year-old soccer player injures their knee during a game. On
physical exam, you perform a posterior drawer test and find excessive
posterior translation of the tibia on the femur. What does this finding
most likely indicate?
A) Anterior cruciate ligament (ACL) tear
B) Posterior cruciate ligament (PCL) tear
pg. 1
,2
C) Medial collateral ligament (MCL) sprain
D) Meniscal tear
: Answer : B – Posterior cruciate ligament (PCL) tear
Rationale: The posterior drawer test specifically assesses the integrity
of the PCL. A positive test (excessive posterior translation of the tibia) is
highly suggestive of a PCL injury. It is less common than ACL tears and
often occurs with a dashboard injury mechanism. The anterior drawer
test is for ACL evaluation, and valgus/varus stress tests assess the MCL
and LCL.
Q2. A 10-year-old soccer player has an acute knee injury. On
examination, you note a positive anterior drawer sign. Which ligament
is most likely injured?
A) Posterior cruciate ligament (PCL)
B) Medial collateral ligament (MCL)
C) Anterior cruciate ligament (ACL)
D) Lateral collateral ligament (LCL)
: Answer : C – Anterior cruciate ligament (ACL)
Rationale: The anterior drawer test assesses the integrity of the ACL. A
positive test (anterior translation of the tibia) is characteristic of an ACL
tear. It is one of the most common knee injuries in young athletes. The
examiner holds the tibia and pulls it anteriorly while the patient is
supine with the knee flexed to 90 degrees.
Q3. A 10-year-old soccer player presents with a swollen knee and pain
along the medial joint line. McMurray's test is positive. What is the
most likely diagnosis?
pg. 2
,3
A) Anterior cruciate ligament tear
B) Posterior cruciate ligament tear
C) Medial meniscus tear
D) Patellar dislocation
: Answer : C – Medial meniscus tear
Rationale: McMurray's test is a specific provocative maneuver used to
identify meniscal tears. A positive test (palpable or audible click over
the joint line) is highly suggestive of a meniscal tear. The medial
meniscus is more commonly injured than the lateral meniscus. The test
is performed by flexing the patient's knee and then rotating the tibia
while extending the knee.
Q4. A 10-year-old soccer player fell and has immediate swelling of the
lateral ankle. He is able to bear weight and denies an audible sound at
the time of injury. What does this history most likely indicate?
A) Lateral ankle sprain with possible fracture
B) Mild soft tissue injury only
C) Serious ankle injury with certain fracture
D) Achilles tendon rupture
: Answer : A – Lateral ankle sprain with possible fracture
Rationale: Immediate swelling of the joint raises suspicion for a
fracture or significant ligamentous injury. The mechanism described
(rolling the foot inward while falling) is classic for an inversion injury of
the ankle, which most commonly results in tearing of the anterior
talofibular ligament (ATFL) – a lateral ankle sprain. However, because of
the rapid onset of swelling, a fracture (e.g., of the lateral malleolus or
base of the fifth metatarsal) cannot be ruled out without radiographs.
The ability to bear weight is reassuring but does not exclude fracture.
pg. 3
, 4
Q5. A distance runner reports pain in one heel that is worse in the
morning and seems to improve with exercise. On physical exam, you
note localized swelling and a bony prominence at the heel. What is the
most likely diagnosis, and what is an appropriate initial treatment?
A) Achilles tendinitis; complete cessation of running
B) Plantar fasciitis with heel spur; stretching exercises, supportive
footwear, and NSAIDs
C) Calcaneal stress fracture; crutches and partial weight bearing
D) Retrocalcaneal bursitis; aspiration and corticosteroid injection
: Answer : B – Plantar fasciitis with heel spur; stretching exercises,
supportive footwear, and NSAIDs
Rationale: The presentation of morning pain (first-step pain) that
improves with activity is classic for plantar fasciitis. The bony
prominence is likely a calcaneal heel spur, which may or may not be
related to the pain. Initial treatment should focus on plantar-specific
stretching, activity modification, supportive shoes with good arch
support, and NSAIDs for pain. Cessation of all activities (A) is not
recommended; gentle exercise is beneficial. Achilles tendinitis (A)
typically presents with pain slightly above the heel that worsens with
activity. A stress fracture (C) would be more likely to cause pain that
worsens with weight-bearing and improves with rest, not morning pain.
Retrocalcaneal bursitis (D) typically causes pain at the back of the heel,
and aspiration is not usually first-line.
Q6. A patient who is a long-distance runner complains of heel pain that
is worst when first rising in the morning and improves after walking for
a few minutes. What is the most appropriate initial intervention?
pg. 4
