BARKLEY 3P Practice Exam with Answers (92 Solved Questions)

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BARKLEY 3P EXAM WITH 75 VERIFIED QUESTIONS AND ANSWERS (WITH RATIONALE)A male patient requests a phosphodiesterase inhibitor to treat erectiledysfunction. Which of the following is appropriate?a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activitywill take place two or more times per week.b. Vardenafil (Levitra), 5 mg, may be taken with a high-fat meal four hoursbefore sexual activityc. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activityas long as the patient has a resting blood pressure below 170/110 mm Hgd. Avanafil (Stendra) is recommended at 50 mg for all patients, and may betaken 30 minutes before sexual activity. - a. Tadalafil (Cialis) may be used ata dose of 2.5 mg daily if sexual activity will take place two or more timesper week.Which of the following is NOT part of Virchow's Triad?a. Hypercoagulabilityb. Damage to endothelial cellsc. Sympathetic toned. Turbulent blood flow - c. Sympathetic toneVirchow's triad is a method of describing the three main factors that lead toa thrombosis -- sympathetic tone is not one of those and doesn't affectblood clotting.Hypercoagulability does lead to clotting, including malignancy, trauma,sepsis, and thrombophilia. Endothelial cell damage is part of Virchow's triadbc it causes blood to clot by promoting platelet adherence to the wall of thevessels; vascular wall injury is the second aspect of Virchow's triad. Lastly,turbulent blood flow is a constituent of circulatory stasis the third

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component of the triad, which can be caused by atrial fibrillation, venousobstruction, and ventricular dysfunctionYou are auscultating Jon's chest. When he sits up and leans forward, youcan hear a high pitched, blowing murmur at S2. What does this type ofmurmur most likely indicate?a. Mitral stenosisb. Aortic Stenosisc. Mitral regurgitationd. Aortic regurgitation - d. Aortic regurgitationAortic regurg is soft, high pitched, blowing diastolic decrescendo that bestheard at the 3rd left interspace at base. Murmur initiated w/ S2 and heardwhen Pt sits up and leans forward. Mitral Stenosis= low pitched diastolicrumble & doesn't radiate. Best heard in apex when in left lateral position.Aortic stenosis= loud, harsh murmur midsystole, radiated down the side ofneck and down apex. Mitral regurg= loud blowing murmur heard at apex andis pansystolic.Which of the following is the most common clinical manifestation ofosteoporosis?a. Bone deformityb. Bone painc. Pathologic fractured. Fat embolism - a. Bone deformitymost common metabolic bone disease, is chronic, progressive, & systemic;Low bone mass and deterioration of bone tissue, = leads to increasedskeletal fragility & deformity. Osteoporosis usually not apparent until AFTER

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a fracture; 2/3 of vertebral fractures are painless. Fat embolism from fatobstruction d/t injury or trauma & not common in osteoporosis.A patient with kidney stones also presents with hypercalcemia and mentalconfusion. The practitioner should evaluate the patient for which of thefollowing?a. Cushing Syndromeb. Conn's Syndromec. Hyperparathyroidismd. Addison's disease - c. HyperparathyroidismWhich of the following statements is true regarding contraceptives?a. Because oral contraceptives may cause harm to the fetus, they arepregnancy category X drugs in pregnancy.b. Oral contraceptives are linked to the promotion of ovarian, endometrial,and breast cancer.c. By increasing angiotensin and aldosterone, oral contraceptives mayincrease blood pressure.d. Oral contraceptives may reduce the effects of theophylline,benzodiazepines, and tricyclic antidepressants - c. By increasingangiotensin and aldosterone, oral contraceptives may increase bloodpressure.estrogen promotes aldosterone production= sodium retention & HTN. Alsobelieved stimulates hepatic production of angiotensinogen, affecting renalsystem via elevated angiotensin & BP. OCP are category X, but becauseserve no use, decrease incidence of ovarian and endometrial ca and don'tincrease risk of breast ca. OCP containing progestin may enhance effects oftheophylline, benzos, and tricyclic antidepressants by decreasing clearance.

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Upon percussion of the chest, you notice hyperresonance. Of the followingchoices which would most likely be the cause?a. Atelectasisb. Normal Lungc. Pneumothoraxd. Pulmonary embolism - c. PneumothoraxWhat is the proper order of steps to accurately perform the Ortolanimaneuver?a. Extend the legs, adduct the legs, and abduct the kneesb. Flex the knees, abduct the knees, and adduct the legsc. Flex the knees, adduct the legs, and abduct the legsd. Extend the knees, abduct the legs, and adduct the knees - b. Flex theknees, abduct the knees, and adduct the legsdone on supine infant, flex knees while holding thighs. Adduct legs untilthumbs touch, follow with abduct knees until lateral part of knee touch table.You have four patients who all have a family history of developing coronaryheart disease at an early age. According to their blood test results, whichpatient would most likely develop coronary heart disease first?a. Cholesterol: 170; LDL: 120; Triglycerides: 120; HDL: 45b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20d. Cholesterol: 190; LDL: 140; Triglycerides: 151; HDL: 50 - d. Cholesterol: 190;LDL: 140; Triglycerides: 151; HDL: 50

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3 of the 4 measurements are above what should be; HDL <40 in men & 50 inwomen increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed toincrease risk heart disease.This low-molecular-weight heparin is indicated for use with warfarin for thetreatment of acute symptomatic deep vein thrombosis, either with orwithout pulmonary embolism:a. Nadroparinb. Dalteparinc. Tinzaparind. Fondaparinux - c. Tinzaparin-can be combined with warfarin for DVT, aids warfarin in inhibiting clotting ofblood. Nadroparin & Dalteparin don't use w/ warfarin, use independently.Fondaparinux is a Xa inhibitor NOT LMWH.he main reason for discontinuance of implanted etonogestrel (Nexplanon) is:a. Weight gainb. Pregnancyc. Breast tendernessd. Irregular bleeding - d. Irregular bleedingFor the treatment of relapsing-remitting multiple sclerosis, the nursepractitioner knows that:a. First-line therapy typically involves an immunomodulatorb. Natalizumab is one of the safest drugs to use as initial therapyc. A patient using interferon-beta products would have to have renalfunction monitored.

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d. Fingolimod is given intravenously for patients with resistant remitting-relapsing multiple sclerosis. - a. First-line therapy typically involves animmune modulatortherapy begins with interferon-beta products (fingolimod, glatiramer,natalizumab) which are immune modulator. Natalizumab limited (assoc w/infections in brain) are used if others don't work. Meds are hepatotoxic andneed liver function monitoring. Fingolimod is 1st ORAL disease modifyingmed approved for MS.Which of these are unique features of aripiprazole (Abilify)?a. It causes hyperprolactinemia and gynecomastia as side effects.b. It is a dopamine system stabilizer with affects against schizophrenia,mania, and agitation.c. It causes agranulocytosis, which may be fatal; patient monitoring isnecessaryd. It induces diabetes and myocarditis in certain patients - b. It is adopamine system stabilizer with affects against schizophrenia, mania, andagitation.All of the following facial movements are still possible after acerebrovascular accident except:a. Raising the eyebrowsb. Wrinkling the foreheadc. Raising both sides of the mouthd. Closing both eyes - c. Raising both sides of the mouthWhich of the following is a characteristic of Somogyi effect?

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a. It is characterized by an early morning rise in blood glucose, with nohypoglycemia during the night.b. It is more common in type 2 diabeticsc. It presents with a combination of hypoglycemia followed by reboundhyperglycemia.d. It is more common in elderly patients with poorly controlled blood sugars.- c. It presents with a combination of hypoglycemia followed by reboundhyperglycemia- Nocturnal hypoglycemia stimulates hyperglycemia counter-regulation inam. No hypoglycemia in night is Dawn phenomenon, more common in T1DM,esp children w/ T1DMWhich of the following is a characteristic of B cell deficiency?a. Inability to fight off cancer cells.b. Inability to make antibodiesc. Increased incidence of granulomasd. Increased incidence of anemia - b. Inability to make antibodiesWhen counseling a pregnant patient on drug use during pregnancy, it isimportant that the nurse practitioner advises her:a. "The placenta provides a good protective barrier for your baby againstalmost all drugs you might ingest."b. "The placenta will screen out most harmful drugs, so they will neverreach significant levels in your baby."c. "The placenta will protect your baby against narcotic exposure, but allother drugs will permeate within 15 minutes to an hour."

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d. "The placenta is a barrier as far as time is concerned only- ultimately,your baby will be exposed to any drug that you take." - d. "The placenta is abarrier as far as time is concerned only- ultimately, your baby will beexposed to any drug that you take."Assuming these do not present with symptoms other than those stated,antibiotic use is most likely to be appropriate for which of the followingpatients?a. The 2-year-old with onset of mucopurulent rhinitis two days agob. The 10-year-old with dry cough lasting 7 daysc. The 60-year-old with clear rhinorrhea for 3 weeks.d. The 5-year-old with cough and mucopurulent rhinitis for 3 weeks - d. The5-year-old with cough and mucopurulent rhinitis for 3 weeksIn a patient diagnosed with syndrome of inappropriate antidiuretic hormone,the nurse practitioner would expect to find which of the following?a. Solute retention and water retentionb. Solute retention and water lossc. Solute dilution and water retentiond. Solute dilution and water loss - c. Solute dilution and water retentionSIADH (syndrome of inappropriate antidiuretic hormone) defined ashyponatremia despite NL or increased plasma volume= impaired waterexcretion. Result of excess H2O vs deficiency of sodium.Sandra comes into the clinic complaining of the inability to discern touch aswell as she used to. During the physical examination, you tell Sandra toclose her eyes and trace the outline of a number into the palm of her hand.Which of the following tests have you performed?

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a. Graphesthesiab. Positionc. Stereognosisd. Vibration - a. GraphesthesiaA 68-year-old male patient desires testosterone replacement to enhancehis libido. His testosterone level is found to be 250 ng/dL. The nursepractitioner knows thata. AndroGel once daily would restore sex drive and fertility in this clientb. Testosterone replacement is associated with cardiovascular risks,including myocardial infarction, and is not indicated for this patient.c. Testosterone cypionate injections would be a good treatment option forthis patient.d. Testosterone replacement is known to suppress the development ofprostate cancer, which would be a benefit. - b. Testosterone replacement isassociated with cardiovascular risks, including myocardial infarction, and isnot indicated for this patient.Regarding the split S2 heart sound, which of these is false?a. It is a normal phenomenonb. The aortic valve closes significantly earlier than the pulmonic valvec. It is noted only in the aortic auscultatory aread. It occurs on end inspiration. - c. It is noted only in the aortic auscultatoryarea -normal & can be heard throughout precordium, not just aortic area. In splitS2, more blood present on left side= decrease LV stroke volume & shortens

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LV systole, allows aortic valve to close earlier than NL. Split S2 ONLYhappens during end of inspiration.Azole antifungals are most likely to cause torsades de pointes in whichpatient population?a. Patients taking isoproterenolb. African- Americansc. Femalesd. Adults over the age of 65 - c. Females- Azole can cause in Men andwomen, but 2-3x more common in Women. Prolonged QT interval is 10microseconds longer in women= more recorded dysrhythmias.Isoproterenol is beta agonist used in tx of torsades & no significantinteraction w/ azoles. African Americans less susceptible to torsades thanCaucasians, & most common ages 35-50.Which of the following is the most effective agent to help a patient withinsomnia that involves both difficulty falling asleep and maintaining sleep?a. Triazolam (Halcion)b. Zolpidem (Ambien CR)c. Zaleplon (Sonata)d. Ramelteon (Rozerem) - b. Zolpidem (Ambien CR)Which of the following is not a step in the Hirschberg test?a. Shine a light towards patient's eyes to assess parallel alignmentb. Assess reflection of light on the corneasc. Hold the light about 12 inches from the patientd. Ask the patient to stare straight ahead at your nose - d. Ask the patient tostare straight ahead at your nose

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Asking patient to stare at the nose is one of the steps of the COVER test,which assesses muscle weakness in the eye. The Hirschberg test isdesigned to assess symmetry of the light reflex within the corneas. It isperformed by shining a light towards the patient's eyes and directing themto stare ahead as the nurse holds the light 12 inches away. Symmetricallight reflection in the eye indicates that they eye muscles are properlyaligned.Jenny, age 32, comes into the clinic complaining of severe acid reflux. Whentaking her health history, you try to identify aggravating factors and thingsthat make the pain a little more manageable. Jenny tells you that when sheremains active and doesn't lie down, the pain almost completely disappears.Which part of the PQRSTU method is designed to acquire information aboutwhat makes the symptoms worse?a. Tb. Sc. Qd. P - d. P-P is for provocative or palliative so what have tried to make better, or hasmade worse. T= timing of sx, S= scale of pain, Q= quantity and quality ofpain. U= understanding of problem.The nurse practitioner is examining a patient with a presumed diagnosis ofOsgood-Schlatter disease. Which of the following is true regarding thiscondition and/or patient?a. This patient is a postmenopausal female who should have calcium andvitamin d supplementation as part of her treatment planb. This patient is an adult athlete with a repetitive use injury of the anteriortibial tubercle

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