(FNP) Barkley Post-Test Fall 2025
Comprehensive Final Exam with Verified
Rationales Practice Questions and
Answers 2026 with complete solution
Question 1
A 55-year-old male with a 20-year history of hypertension presents for follow-up.
His blood pressure today is 148/92 mm Hg despite taking lisinopril 20 mg daily. He
reports no side effects. What is the most appropriate next step in management?
,,,,ANSWER,,,: Add a thiazide diuretic (e.g., hydrochlorothiazide).
Rationale: For a patient not at goal BP on a single agent (ACE inhibitor), guidelines
recommend adding a second agent from a different class (thiazide or CCB) rather
than simply increasing the dose of the initial drug, as this provides a synergistic
effect and better cardiovascular protection.
Question 2
A 68-year-old male with a 40-pack-year smoking history presents with chronic
productive cough and dyspnea on exertion. Spirometry shows FEV₁/FVC < 0.70 and
FEV₁ at 55% of predicted. According to GOLD criteria, what is the stage of COPD?
,,,,ANSWER,,,: GOLD stage 2 (moderate).
,Rationale: GOLD staging is based on FEV₁ percent predicted: stage 1 (mild) is
≥80%, stage 2 (moderate) is 50–79%, stage 3 (severe) is 30–49%, and stage 4 (very
severe) is <30%. This patient's FEV₁ of 55% places him in stage 2.
Question 3
A 65-year-old male presents with sudden onset of right-sided weakness and
difficulty speaking. Symptoms began 2 hours ago. A non-contrast CT head shows
no hemorrhage. What is the most appropriate immediate treatment?
,,,,ANSWER,,,: Administer tPA (alteplase) if no contraindications.
Rationale: The patient is within the 3- to 4.5-hour window for acute ischemic
stroke. After CT rules out hemorrhage, IV tPA is indicated to dissolve the clot and
preserve brain tissue, provided there are no contraindications such as recent
surgery, bleeding disorder, or uncontrolled hypertension.
Question 4
A 16-year-old female requests birth control pills. She is sexually active and does
not want her parents to know. What is the nurse practitioner's legal obligation in
most states?
,,,,ANSWER,,,: Respect minor consent laws and prescribe contraception.
Rationale: Under Title X and in all 50 states, minors may consent to contraceptive
services without parental permission to reduce barriers to reproductive healthcare.
The NP should maintain confidentiality while encouraging the patient to involve a
trusted adult if safe to do so.
, Question 5
A nurse practitioner takes medication samples from a pharmaceutical
representative and gives them to a family member without performing an exam or
creating a chart entry. Which ethical or legal principle does this violate?
,,,,ANSWER,,,: Prescribing for family without a professional relationship.
Rationale: Establishing a provider-patient relationship requires a history, physical
examination, and documentation. Prescribing for family or self, especially with free
samples, violates the standard of care and legal prescribing laws due to the lack of
objective medical judgment and record-keeping.
Question 6
A 22-year-old sexually active male presents with dysuria and thin, clear urethral
discharge. Gram stain shows no intracellular diplococci. What is the most likely
pathogen?
,,,,ANSWER,,,: Chlamydia trachomatis.
Rationale: Chlamydia often presents with thin, clear to white discharge and lacks
the gram-negative intracellular diplococci seen in Neisseria gonorrhoeae (which
typically causes thick, purulent discharge). Treatment is doxycycline 100 mg twice
daily for 7 days.
Question 7
A 22-year-old college student presents with five days of elevated mood,
grandiosity, decreased need for sleep, pressured speech, and excessive spending
on risky ventures. He denies any history of depressive episodes. What is the most
likely diagnosis?
Comprehensive Final Exam with Verified
Rationales Practice Questions and
Answers 2026 with complete solution
Question 1
A 55-year-old male with a 20-year history of hypertension presents for follow-up.
His blood pressure today is 148/92 mm Hg despite taking lisinopril 20 mg daily. He
reports no side effects. What is the most appropriate next step in management?
,,,,ANSWER,,,: Add a thiazide diuretic (e.g., hydrochlorothiazide).
Rationale: For a patient not at goal BP on a single agent (ACE inhibitor), guidelines
recommend adding a second agent from a different class (thiazide or CCB) rather
than simply increasing the dose of the initial drug, as this provides a synergistic
effect and better cardiovascular protection.
Question 2
A 68-year-old male with a 40-pack-year smoking history presents with chronic
productive cough and dyspnea on exertion. Spirometry shows FEV₁/FVC < 0.70 and
FEV₁ at 55% of predicted. According to GOLD criteria, what is the stage of COPD?
,,,,ANSWER,,,: GOLD stage 2 (moderate).
,Rationale: GOLD staging is based on FEV₁ percent predicted: stage 1 (mild) is
≥80%, stage 2 (moderate) is 50–79%, stage 3 (severe) is 30–49%, and stage 4 (very
severe) is <30%. This patient's FEV₁ of 55% places him in stage 2.
Question 3
A 65-year-old male presents with sudden onset of right-sided weakness and
difficulty speaking. Symptoms began 2 hours ago. A non-contrast CT head shows
no hemorrhage. What is the most appropriate immediate treatment?
,,,,ANSWER,,,: Administer tPA (alteplase) if no contraindications.
Rationale: The patient is within the 3- to 4.5-hour window for acute ischemic
stroke. After CT rules out hemorrhage, IV tPA is indicated to dissolve the clot and
preserve brain tissue, provided there are no contraindications such as recent
surgery, bleeding disorder, or uncontrolled hypertension.
Question 4
A 16-year-old female requests birth control pills. She is sexually active and does
not want her parents to know. What is the nurse practitioner's legal obligation in
most states?
,,,,ANSWER,,,: Respect minor consent laws and prescribe contraception.
Rationale: Under Title X and in all 50 states, minors may consent to contraceptive
services without parental permission to reduce barriers to reproductive healthcare.
The NP should maintain confidentiality while encouraging the patient to involve a
trusted adult if safe to do so.
, Question 5
A nurse practitioner takes medication samples from a pharmaceutical
representative and gives them to a family member without performing an exam or
creating a chart entry. Which ethical or legal principle does this violate?
,,,,ANSWER,,,: Prescribing for family without a professional relationship.
Rationale: Establishing a provider-patient relationship requires a history, physical
examination, and documentation. Prescribing for family or self, especially with free
samples, violates the standard of care and legal prescribing laws due to the lack of
objective medical judgment and record-keeping.
Question 6
A 22-year-old sexually active male presents with dysuria and thin, clear urethral
discharge. Gram stain shows no intracellular diplococci. What is the most likely
pathogen?
,,,,ANSWER,,,: Chlamydia trachomatis.
Rationale: Chlamydia often presents with thin, clear to white discharge and lacks
the gram-negative intracellular diplococci seen in Neisseria gonorrhoeae (which
typically causes thick, purulent discharge). Treatment is doxycycline 100 mg twice
daily for 7 days.
Question 7
A 22-year-old college student presents with five days of elevated mood,
grandiosity, decreased need for sleep, pressured speech, and excessive spending
on risky ventures. He denies any history of depressive episodes. What is the most
likely diagnosis?
