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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 erectile dysfunction. Which of the following is appropriate? a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week. b. Vardenafil (Levitra), 5 mg, may be taken with a high-fat meal four hours before sexual activity c. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activity as long as the patient has a resting blood pressure below 170/110 mm Hg d. Avanafil (Stendra) is recommended at 50 mg for all patients, and may be taken 30 minutes before sexual activity. - a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week. 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 - c. Sympathetic tone Virchow's triad is a method of describing the three main factors that lead to a thrombosis -- sympathetic tone is not one of those and doesn't affect blood clotting. Hypercoagulability does lead to clotting, including malignancy, trauma, sepsis, and thrombophilia. Endothelial cell damage is part of Virchow's triad bc it causes blood to clot by promoting platelet adherence to the wall of the vessels; 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, venous obstruction, and ventricular dysfunction You are auscultating Jon's chest. When he sits up and leans forward, you can hear a high pitched, blowing murmur at S2. What does this type of murmur most likely indicate? a. Mitral stenosis b. Aortic Stenosis c. Mitral regurgitation d. Aortic regurgitation - d. Aortic regurgitation Aortic regurg is soft, high pitched, blowing diastolic decrescendo that best heard at the 3rd left interspace at base. Murmur initiated w/ S2 and heard when Pt sits up and leans forward. Mitral Stenosis= low pitched diastolic rumble & doesn't radiate. Best heard in apex when in left lateral position. Aortic stenosis= loud, harsh murmur midsystole, radiated down the side of neck and down apex. Mitral regurg= loud blowing murmur heard at apex and is pansystolic. Which of the following is the most common clinical manifestation of osteoporosis? a. Bone deformity b. Bone pain c. Pathologic fracture d. Fat embolism - a. Bone deformity most common metabolic bone disease, is chronic, progressive, & systemic; Low bone mass and deterioration of bone tissue, = leads to increased skeletal fragility & deformity. Osteoporosis usually not apparent until AFTER

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    a fracture; 2/3 of vertebral fractures are painless. Fat embolism from fat obstruction d/t injury or trauma & not common in osteoporosis. A patient with kidney stones also presents with hypercalcemia and mental confusion. The practitioner should evaluate the patient for which of the following? a. Cushing Syndrome b. Conn's Syndrome c. Hyperparathyroidism d. Addison's disease - c. Hyperparathyroidism Which of the following statements is true regarding contraceptives? a. Because oral contraceptives may cause harm to the fetus, they are pregnancy 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 may increase blood pressure. d. Oral contraceptives may reduce the effects of theophylline, benzodiazepines, and tricyclic antidepressants - c. By increasing angiotensin and aldosterone, oral contraceptives may increase blood pressure. estrogen promotes aldosterone production= sodium retention & HTN. Also believed stimulates hepatic production of angiotensinogen, affecting renal system via elevated angiotensin & BP. OCP are category X, but because serve no use, decrease incidence of ovarian and endometrial ca and don't increase risk of breast ca. OCP containing progestin may enhance effects of theophylline, benzos, and tricyclic antidepressants by decreasing clearance.

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    Upon percussion of the chest, you notice hyperresonance. Of the following choices which would most likely be the cause? a. Atelectasis b. Normal Lung c. Pneumothorax d. Pulmonary embolism - c. Pneumothorax What is the proper order of steps to accurately perform the Ortolani maneuver? a. Extend the legs, adduct the legs, and abduct the knees b. Flex the knees, abduct the knees, and adduct the legs c. Flex the knees, adduct the legs, and abduct the legs d. Extend the knees, abduct the legs, and adduct the knees - b. Flex the knees, abduct the knees, and adduct the legs done on supine infant, flex knees while holding thighs. Adduct legs until thumbs touch, follow with abduct knees until lateral part of knee touch table. You have four patients who all have a family history of developing coronary heart disease at an early age. According to their blood test results, which patient would most likely develop coronary heart disease first? a. Cholesterol: 170; LDL: 120; Triglycerides: 120; HDL: 45 b. Cholesterol: 195; LDL: 110; Triglycerides: 135; HDL: 30 c. Cholesterol: 170; LDL: 100; Triglycerides: 140; HDL: 20 d. 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 in women increase risk, LDL aim is <130, Chol > 200 & trig >150 attributed to increase risk heart disease. This low-molecular-weight heparin is indicated for use with warfarin for the treatment of acute symptomatic deep vein thrombosis, either with or without pulmonary embolism: a. Nadroparin b. Dalteparin c. Tinzaparin d. Fondaparinux - c. Tinzaparin- can be combined with warfarin for DVT, aids warfarin in inhibiting clotting of blood. 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 gain b. Pregnancy c. Breast tenderness d. Irregular bleeding - d. Irregular bleeding For the treatment of relapsing-remitting multiple sclerosis, the nurse practitioner knows that: a. First-line therapy typically involves an immunomodulator b. Natalizumab is one of the safest drugs to use as initial therapy c. A patient using interferon-beta products would have to have renal function monitored.

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    d. Fingolimod is given intravenously for patients with resistant remitting- relapsing multiple sclerosis. - a. First-line therapy typically involves an immune modulator therapy 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 and need liver function monitoring. Fingolimod is 1st ORAL disease modifying med 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 is necessary d. It induces diabetes and myocarditis in certain patients - b. It is a dopamine system stabilizer with affects against schizophrenia, mania, and agitation. All of the following facial movements are still possible after a cerebrovascular accident except: a. Raising the eyebrows b. Wrinkling the forehead c. Raising both sides of the mouth d. Closing both eyes - c. Raising both sides of the mouth Which 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 no hypoglycemia during the night. b. It is more common in type 2 diabetics c. It presents with a combination of hypoglycemia followed by rebound hyperglycemia. d. It is more common in elderly patients with poorly controlled blood sugars. - c. It presents with a combination of hypoglycemia followed by rebound hyperglycemia - Nocturnal hypoglycemia stimulates hyperglycemia counter-regulation in am. No hypoglycemia in night is Dawn phenomenon, more common in T1DM, esp children w/ T1DM Which of the following is a characteristic of B cell deficiency? a. Inability to fight off cancer cells. b. Inability to make antibodies c. Increased incidence of granulomas d. Increased incidence of anemia - b. Inability to make antibodies When counseling a pregnant patient on drug use during pregnancy, it is important that the nurse practitioner advises her: a. "The placenta provides a good protective barrier for your baby against almost all drugs you might ingest." b. "The placenta will screen out most harmful drugs, so they will never reach significant levels in your baby." c. "The placenta will protect your baby against narcotic exposure, but all other 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 a barrier as far as time is concerned only- ultimately, your baby will be exposed 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 following patients? a. The 2-year-old with onset of mucopurulent rhinitis two days ago b. The 10-year-old with dry cough lasting 7 days c. The 60-year-old with clear rhinorrhea for 3 weeks. d. The 5-year-old with cough and mucopurulent rhinitis for 3 weeks - d. The 5-year-old with cough and mucopurulent rhinitis for 3 weeks In 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 retention b. Solute retention and water loss c. Solute dilution and water retention d. Solute dilution and water loss - c. Solute dilution and water retention SIADH (syndrome of inappropriate antidiuretic hormone) defined as hyponatremia despite NL or increased plasma volume= impaired water excretion. Result of excess H2O vs deficiency of sodium. Sandra comes into the clinic complaining of the inability to discern touch as well as she used to. During the physical examination, you tell Sandra to close 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. Graphesthesia b. Position c. Stereognosis d. Vibration - a. Graphesthesia A 68-year-old male patient desires testosterone replacement to enhance his libido. His testosterone level is found to be 250 ng/dL. The nurse practitioner knows that a. AndroGel once daily would restore sex drive and fertility in this client b. 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 for this patient. d. Testosterone replacement is known to suppress the development of prostate cancer, which would be a benefit. - b. Testosterone replacement is associated with cardiovascular risks, including myocardial infarction, and is not indicated for this patient. 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. - c. It is noted only in the aortic auscultatory area - normal & can be heard throughout precordium, not just aortic area. In split S2, 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 ONLY happens during end of inspiration. Azole antifungals are most likely to cause torsades de pointes in which patient population? a. Patients taking isoproterenol b. African- Americans c. Females d. Adults over the age of 65 - c. Females- Azole can cause in Men and women, but 2-3x more common in Women. Prolonged QT interval is 10 microseconds longer in women= more recorded dysrhythmias. Isoproterenol is beta agonist used in tx of torsades & no significant interaction w/ azoles. African Americans less susceptible to torsades than Caucasians, & most common ages 35-50. Which of the following is the most effective agent to help a patient with insomnia 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 alignment b. Assess reflection of light on the corneas c. Hold the light about 12 inches from the patient d. Ask the patient to stare straight ahead at your nose - d. Ask the patient to stare 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 is designed to assess symmetry of the light reflex within the corneas. It is performed by shining a light towards the patient's eyes and directing them to stare ahead as the nurse holds the light 12 inches away. Symmetrical light reflection in the eye indicates that they eye muscles are properly aligned. Jenny, age 32, comes into the clinic complaining of severe acid reflux. When taking her health history, you try to identify aggravating factors and things that make the pain a little more manageable. Jenny tells you that when she remains active and doesn't lie down, the pain almost completely disappears. Which part of the PQRSTU method is designed to acquire information about what makes the symptoms worse? a. T b. S c. Q d. P - d. P- P is for provocative or palliative so what have tried to make better, or has made worse. T= timing of sx, S= scale of pain, Q= quantity and quality of pain. U= understanding of problem. The nurse practitioner is examining a patient with a presumed diagnosis of Osgood-Schlatter disease. Which of the following is true regarding this condition and/or patient? a. This patient is a postmenopausal female who should have calcium and vitamin d supplementation as part of her treatment plan b. This patient is an adult athlete with a repetitive use injury of the anterior tibial tubercle

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