Barkley Cardiovascular Practice Exam
200 Original Practice Questions with
Detailed Rationales
Table of Contents
1. Cardiac Physical Assessment and Auscultation (Questions 1–
35)
2. Coronary Artery Disease and Acute Coronary Syndromes
(Questions 36–65)
3. Heart Failure (Questions 66–95)
4. Arrhythmias and Conduction Disorders (Questions 96–120)
5. Valvular Heart Disease (Questions 121–140)
6. Vascular Disorders (Questions 141–160)
7. Cardiovascular Pharmacology (Questions 161–185)
8. Cardiovascular Emergencies (Questions 186–200)
9. Answer Key Summary
10. Exam Preparation Tips
Section 1: Cardiac Physical Assessment and Auscultation
(Questions 1–35)
1. A nurse practitioner is auscultating a patient's chest.
When the patient sits up and leans forward, a high-pitched,
blowing murmur is heard at S2. What does this type of
murmur most likely indicate?
A. Mitral stenosis
B. Aortic stenosis
,C. Mitral regurgitation
D. Aortic regurgitation
Correct Answer: D. Aortic regurgitation
Rationale: Aortic regurgitation is a soft, high-pitched,
blowing diastolic decrescendo murmur best heard at the
3rd left interspace at the base when the patient sits up and
leans forward. Mitral stenosis is a low-pitched diastolic
rumble best heard at the apex in the left lateral position.
Aortic stenosis is a loud, harsh murmur midsystole
radiating to the neck. Mitral regurgitation is a loud blowing
murmur heard at the apex and is pansystolic.
2. Which of the following is NOT part of Virchow's Triad?
A. Hypercoagulability
B. Damage to endothelial cells
C. Sympathetic tone
D. Turbulent blood flow
Correct Answer: C. Sympathetic tone
Rationale: Virchow's triad describes the three main factors
that lead to thrombosis: hypercoagulability, endothelial
damage, and turbulent blood flow (circulatory stasis).
Sympathetic tone is not a component of Virchow's triad
and does not directly affect blood clotting.
3. Regarding the split S2 heart sound, which of these is
false?
A. It is a normal phenomenon
B. The aortic valve closes significantly earlier than the pulmonic
valve
C. It is noted only in the aortic auscultatory area
D. It occurs on end inspiration
,Correct Answer: C. It is noted only in the aortic auscultatory
area
Rationale: A split S2 is a normal phenomenon that can be
heard throughout the precordium, not just in the aortic
area. During inspiration, increased venous return to the
right ventricle delays pulmonic valve closure, causing the
split.
4. Upon percussion of the chest, you notice
hyperresonance. Which of the following choices would
most likely be the cause?
A. Atelectasis
B. Normal lung
C. Pneumothorax
D. Pulmonary embolism
Correct Answer: C. Pneumothorax
Rationale: Hyperresonance on chest percussion is a classic
finding in pneumothorax due to air trapped in the pleural
space. Atelectasis produces dullness, normal lung produces
resonance, and pulmonary embolism typically does not
alter percussion notes.
5. Which of the following is not a common finding of acute
left-sided heart failure?
A. Coarse rales in all lung fields
B. Hepatomegaly
C. Wheezing, frothy cough
D. An S3 gallop sound
Correct Answer: B. Hepatomegaly
, Rationale: Hepatomegaly is common in chronic right-sided
heart failure but is much less common in acute heart
failure. Coarse rales over all lung fields; a wheezing, frothy
cough; and an S3 gallop are all common findings of acute,
left-sided heart failure.
6. With regard to S3 and S4 heart sounds, which statement
is true?
A. An S3 sounds like "Kentucky" and is expected during
pregnancy but otherwise, it is not a normal finding in the adult.
B. An S3 is an atrial gallop and sounds like "Tennessee."
C. An S4 sounds like "Kentucky" and is expected during
pregnancy but otherwise, it is not a normal finding in the adult.
D. An S4 is a ventricular gallop and sounds like "Tennessee."
Correct Answer: A. An S3 sounds like "Kentucky" and is
expected during pregnancy but otherwise, it is not a normal
finding in the adult.
Rationale: An S3 heart sound is a ventricular gallop that
matches the cadence of the word "Kentucky" and typically
presents as a result of increased fluid states; although it
may be normal during pregnancy, presentation of the S3
heart sound at other times may indicate conditions such as
chronic heart failure. An S4 heart sound, on the other hand,
is an atrial gallop that matches the cadence of "Tennessee"
and is often associated with conditions that result in a stiff
ventricular wall, such as myocardial infarction and chronic
hypertension.
7. Which of the following statements is not typical of the
heart murmur with which it is associated?
A. A grade I/VI murmur is barely audible.
B. A grade II/VI murmur is associated with a thrill.
200 Original Practice Questions with
Detailed Rationales
Table of Contents
1. Cardiac Physical Assessment and Auscultation (Questions 1–
35)
2. Coronary Artery Disease and Acute Coronary Syndromes
(Questions 36–65)
3. Heart Failure (Questions 66–95)
4. Arrhythmias and Conduction Disorders (Questions 96–120)
5. Valvular Heart Disease (Questions 121–140)
6. Vascular Disorders (Questions 141–160)
7. Cardiovascular Pharmacology (Questions 161–185)
8. Cardiovascular Emergencies (Questions 186–200)
9. Answer Key Summary
10. Exam Preparation Tips
Section 1: Cardiac Physical Assessment and Auscultation
(Questions 1–35)
1. A nurse practitioner is auscultating a patient's chest.
When the patient sits up and leans forward, a high-pitched,
blowing murmur is heard at S2. What does this type of
murmur most likely indicate?
A. Mitral stenosis
B. Aortic stenosis
,C. Mitral regurgitation
D. Aortic regurgitation
Correct Answer: D. Aortic regurgitation
Rationale: Aortic regurgitation is a soft, high-pitched,
blowing diastolic decrescendo murmur best heard at the
3rd left interspace at the base when the patient sits up and
leans forward. Mitral stenosis is a low-pitched diastolic
rumble best heard at the apex in the left lateral position.
Aortic stenosis is a loud, harsh murmur midsystole
radiating to the neck. Mitral regurgitation is a loud blowing
murmur heard at the apex and is pansystolic.
2. Which of the following is NOT part of Virchow's Triad?
A. Hypercoagulability
B. Damage to endothelial cells
C. Sympathetic tone
D. Turbulent blood flow
Correct Answer: C. Sympathetic tone
Rationale: Virchow's triad describes the three main factors
that lead to thrombosis: hypercoagulability, endothelial
damage, and turbulent blood flow (circulatory stasis).
Sympathetic tone is not a component of Virchow's triad
and does not directly affect blood clotting.
3. Regarding the split S2 heart sound, which of these is
false?
A. It is a normal phenomenon
B. The aortic valve closes significantly earlier than the pulmonic
valve
C. It is noted only in the aortic auscultatory area
D. It occurs on end inspiration
,Correct Answer: C. It is noted only in the aortic auscultatory
area
Rationale: A split S2 is a normal phenomenon that can be
heard throughout the precordium, not just in the aortic
area. During inspiration, increased venous return to the
right ventricle delays pulmonic valve closure, causing the
split.
4. Upon percussion of the chest, you notice
hyperresonance. Which of the following choices would
most likely be the cause?
A. Atelectasis
B. Normal lung
C. Pneumothorax
D. Pulmonary embolism
Correct Answer: C. Pneumothorax
Rationale: Hyperresonance on chest percussion is a classic
finding in pneumothorax due to air trapped in the pleural
space. Atelectasis produces dullness, normal lung produces
resonance, and pulmonary embolism typically does not
alter percussion notes.
5. Which of the following is not a common finding of acute
left-sided heart failure?
A. Coarse rales in all lung fields
B. Hepatomegaly
C. Wheezing, frothy cough
D. An S3 gallop sound
Correct Answer: B. Hepatomegaly
, Rationale: Hepatomegaly is common in chronic right-sided
heart failure but is much less common in acute heart
failure. Coarse rales over all lung fields; a wheezing, frothy
cough; and an S3 gallop are all common findings of acute,
left-sided heart failure.
6. With regard to S3 and S4 heart sounds, which statement
is true?
A. An S3 sounds like "Kentucky" and is expected during
pregnancy but otherwise, it is not a normal finding in the adult.
B. An S3 is an atrial gallop and sounds like "Tennessee."
C. An S4 sounds like "Kentucky" and is expected during
pregnancy but otherwise, it is not a normal finding in the adult.
D. An S4 is a ventricular gallop and sounds like "Tennessee."
Correct Answer: A. An S3 sounds like "Kentucky" and is
expected during pregnancy but otherwise, it is not a normal
finding in the adult.
Rationale: An S3 heart sound is a ventricular gallop that
matches the cadence of the word "Kentucky" and typically
presents as a result of increased fluid states; although it
may be normal during pregnancy, presentation of the S3
heart sound at other times may indicate conditions such as
chronic heart failure. An S4 heart sound, on the other hand,
is an atrial gallop that matches the cadence of "Tennessee"
and is often associated with conditions that result in a stiff
ventricular wall, such as myocardial infarction and chronic
hypertension.
7. Which of the following statements is not typical of the
heart murmur with which it is associated?
A. A grade I/VI murmur is barely audible.
B. A grade II/VI murmur is associated with a thrill.
