BARKLEY DRT FNP PRACTICE EXAM -
QUESTION HIGH-YIELD PRACTICE TEST WITH
RATIONALES Family Nurse Practitioner
Certification - Primary Care & Acute Care Board
Exam Standard
1. A 60-year-old man with diabetes presents with epigastric discomfort and
nausea. ECG is normal. What is the NEXT best step?
A) Discharge with PPI
B) Exercise stress test
C) Cardiac troponins
D) CT abdomen
Answer: C
Rationale: Diabetes = atypical ACS presentation. Normal ECG does NOT rule out
MI. Barkley prioritizes ruling out lethal causes first. Cardiac troponins (BMP) are
essential to evaluate for MI. PPI (A) assumes GERD without ruling out cardiac,
stress test (B) is inappropriate with acute symptoms, CT (D) is not priority.
2. A Black adult with BP 158/96 mmHg, no comorbidities. First-line therapy?
A) ACE inhibitor
B) Beta-blocker
C) Thiazide diuretic
D) ARB
Answer: C
Rationale: ACC/AHA guidelines: thiazide or CCB first-line in Black patients
without CKD/HF. ACE inhibitors (A) and ARBs (D) are less effective in Black
patients as monotherapy. Beta-blockers (B) are not first-line for HTN.
3. A1C 10.5% with symptoms. What is the appropriate initial treatment?
A) Metformin
B) Sulfonylurea
,C) Insulin
D) lifestyle modification only
Answer: C
Rationale: A1C ≥10% OR symptomatic hyperglycemia = start insulin
immediately. Metformin (A) is for A1C <8-9%, sulfonylurea (B) is add-on,
lifestyle (D) alone is insufficient.
4. Best medication for chronic HTN in pregnancy?
A) Lisinopril
B) Methyldopa
C) Hydrochlorothiazide
D) Losartan
Answer: B
Rationale: Safe options in pregnancy: methyldopa, labetalol, nifedipine. ACE
inhibitors (A) and ARBs (D) are contraindicated (fetal toxicity). Thiazides (C) are
generally avoided.
5. Which finding is MOST specific for pericarditis?
A) Pleuritic chest pain
B) Pericardial friction rub
C) Diffuse ST elevation
D) Dyspnea
Answer: B
Rationale: Pericardial friction rub is the most specific finding for pericarditis
(though only present in 30-50%). Pleuritic pain (A), ST elevation (C), dyspnea (D)
are supportive but less specific.
6. What is the target BP for most adults with hypertension per ACC/AHA
2017?
A) <140/90 mmHg
B) <130/80 mmHg
C) <120/80 mmHg
D) <150/90 mmHg
,Answer: B
Rationale: ACC/AHA 2017 recommends BP <130/80 mmHg for most adults with
hypertension. <140/90 (A) is older guideline, <120/80 (C) is normal, <150/90 (D)
is for elderly in some guidelines.
7. A patient with AFib has CHA2DS2-VASc score of 4. What is the MOST
appropriate management?
A) No anticoagulation
B) Aspirin
C) Anticoagulation (warfarin or DOAC)
D) Beta-blocker only
Answer: C
Rationale: CHA2DS2-VASc ≥2 in men (≥3 in women) = anticoagulation
recommended. Score of 4 = high stroke risk. Aspirin (B) is insufficient, beta-
blocker (D) is for rate control only.
8. Which medication REDUCES mortality in heart failure with reduced
ejection fraction (HFrEF)?
A) Furosemide
B) Metoprolol
C) Digoxin
D) Hydralazine
Answer: B
Rationale: Beta-blockers (metoprolol, carvedilol, bisoprolol) reduce mortality in
HFrEF. Furosemide (A) = symptom relief only, digoxin (C) = symptom relief,
hydralazine (D) = vasodilator (with nitrate).
9. A 75-year-old female presents with exertional dyspnea, fatigue, and
syncope. Harsh crescendo-decrescendo murmur at right 2nd ICS radiating to
carotids. Diagnosis?
A) Mitral stenosis
B) Aortic stenosis
, C) Mitral regurgitation
D) Aortic regurgitation
Answer: B
Rationale: Classic triad of aortic stenosis: dyspnea, fatigue, syncope (SAF). Harsh
crescendo-decrescendo murmur at right 2nd ICS radiating to carotids is diagnostic.
Mitral stenosis (A) = diastolic rumble, mitral regurgitation (C) = holosystolic at
apex, aortic regurgitation (D) = diastolic decrescendo.
10. What is the target LDL for a patient with established coronary artery
disease (CAD)?
A) <100 mg/dL
B) <70 mg/dL
C) <50 mg/dL
D) <130 mg/dL
Answer: B
Rationale: For patients with established CAD (very high risk), ACC/AHA
recommends LDL <70 mg/dL. <100 (A) is for moderate risk, <50 (C) is for
extremely high risk in some guidelines, <130 (D) is for low risk.
11. Which antihypertensive is CONTRAINDICATED in pregnancy?
A) Labetalol
B) Lisinopril
C) Amlodipine
D) Methyldopa
Answer: B
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy → fetal
renal damage, oligohydramnios, death. Labetalol (A), amlodipine (C), and
methyldopa (D) are safe in pregnancy.
12. What is the hallmark symptom of peripheral arterial disease (PAD)?
A) Rest pain
B) Intermittent claudication
QUESTION HIGH-YIELD PRACTICE TEST WITH
RATIONALES Family Nurse Practitioner
Certification - Primary Care & Acute Care Board
Exam Standard
1. A 60-year-old man with diabetes presents with epigastric discomfort and
nausea. ECG is normal. What is the NEXT best step?
A) Discharge with PPI
B) Exercise stress test
C) Cardiac troponins
D) CT abdomen
Answer: C
Rationale: Diabetes = atypical ACS presentation. Normal ECG does NOT rule out
MI. Barkley prioritizes ruling out lethal causes first. Cardiac troponins (BMP) are
essential to evaluate for MI. PPI (A) assumes GERD without ruling out cardiac,
stress test (B) is inappropriate with acute symptoms, CT (D) is not priority.
2. A Black adult with BP 158/96 mmHg, no comorbidities. First-line therapy?
A) ACE inhibitor
B) Beta-blocker
C) Thiazide diuretic
D) ARB
Answer: C
Rationale: ACC/AHA guidelines: thiazide or CCB first-line in Black patients
without CKD/HF. ACE inhibitors (A) and ARBs (D) are less effective in Black
patients as monotherapy. Beta-blockers (B) are not first-line for HTN.
3. A1C 10.5% with symptoms. What is the appropriate initial treatment?
A) Metformin
B) Sulfonylurea
,C) Insulin
D) lifestyle modification only
Answer: C
Rationale: A1C ≥10% OR symptomatic hyperglycemia = start insulin
immediately. Metformin (A) is for A1C <8-9%, sulfonylurea (B) is add-on,
lifestyle (D) alone is insufficient.
4. Best medication for chronic HTN in pregnancy?
A) Lisinopril
B) Methyldopa
C) Hydrochlorothiazide
D) Losartan
Answer: B
Rationale: Safe options in pregnancy: methyldopa, labetalol, nifedipine. ACE
inhibitors (A) and ARBs (D) are contraindicated (fetal toxicity). Thiazides (C) are
generally avoided.
5. Which finding is MOST specific for pericarditis?
A) Pleuritic chest pain
B) Pericardial friction rub
C) Diffuse ST elevation
D) Dyspnea
Answer: B
Rationale: Pericardial friction rub is the most specific finding for pericarditis
(though only present in 30-50%). Pleuritic pain (A), ST elevation (C), dyspnea (D)
are supportive but less specific.
6. What is the target BP for most adults with hypertension per ACC/AHA
2017?
A) <140/90 mmHg
B) <130/80 mmHg
C) <120/80 mmHg
D) <150/90 mmHg
,Answer: B
Rationale: ACC/AHA 2017 recommends BP <130/80 mmHg for most adults with
hypertension. <140/90 (A) is older guideline, <120/80 (C) is normal, <150/90 (D)
is for elderly in some guidelines.
7. A patient with AFib has CHA2DS2-VASc score of 4. What is the MOST
appropriate management?
A) No anticoagulation
B) Aspirin
C) Anticoagulation (warfarin or DOAC)
D) Beta-blocker only
Answer: C
Rationale: CHA2DS2-VASc ≥2 in men (≥3 in women) = anticoagulation
recommended. Score of 4 = high stroke risk. Aspirin (B) is insufficient, beta-
blocker (D) is for rate control only.
8. Which medication REDUCES mortality in heart failure with reduced
ejection fraction (HFrEF)?
A) Furosemide
B) Metoprolol
C) Digoxin
D) Hydralazine
Answer: B
Rationale: Beta-blockers (metoprolol, carvedilol, bisoprolol) reduce mortality in
HFrEF. Furosemide (A) = symptom relief only, digoxin (C) = symptom relief,
hydralazine (D) = vasodilator (with nitrate).
9. A 75-year-old female presents with exertional dyspnea, fatigue, and
syncope. Harsh crescendo-decrescendo murmur at right 2nd ICS radiating to
carotids. Diagnosis?
A) Mitral stenosis
B) Aortic stenosis
, C) Mitral regurgitation
D) Aortic regurgitation
Answer: B
Rationale: Classic triad of aortic stenosis: dyspnea, fatigue, syncope (SAF). Harsh
crescendo-decrescendo murmur at right 2nd ICS radiating to carotids is diagnostic.
Mitral stenosis (A) = diastolic rumble, mitral regurgitation (C) = holosystolic at
apex, aortic regurgitation (D) = diastolic decrescendo.
10. What is the target LDL for a patient with established coronary artery
disease (CAD)?
A) <100 mg/dL
B) <70 mg/dL
C) <50 mg/dL
D) <130 mg/dL
Answer: B
Rationale: For patients with established CAD (very high risk), ACC/AHA
recommends LDL <70 mg/dL. <100 (A) is for moderate risk, <50 (C) is for
extremely high risk in some guidelines, <130 (D) is for low risk.
11. Which antihypertensive is CONTRAINDICATED in pregnancy?
A) Labetalol
B) Lisinopril
C) Amlodipine
D) Methyldopa
Answer: B
Rationale: ACE inhibitors (lisinopril) are contraindicated in pregnancy → fetal
renal damage, oligohydramnios, death. Labetalol (A), amlodipine (C), and
methyldopa (D) are safe in pregnancy.
12. What is the hallmark symptom of peripheral arterial disease (PAD)?
A) Rest pain
B) Intermittent claudication
