NUR 509 - FNP Adults Final Exam |St. Thomas
University Exam with Verified Rationales Practice
Questions and Answers 2026 with complete solution
NUR 509 – FNP ADULTS FINAL EXAM
St. Thomas University
25 Most Tested & Most Difficult Questions
1.
A 58-year-old male with diabetes presents with exertional chest pressure relieved by rest. Resting ECG is
normal. Best initial diagnostic test?
A. Coronary angiography
B. Exercise stress test
C. Cardiac MRI
D. CT coronary angiography
✅ Correct Answer: B
Explanation
• Stable angina + able to exercise + normal ECG → exercise stress test
• Angiography is invasive and not first-line
Exam Pearl:
Stress test FIRST unless ECG uninterpretable or patient cannot exercise.
2.
Which medication is contraindicated in heart failure with reduced EF?
A. ACE inhibitor
B. Spironolactone
C. Metoprolol succinate
D. Diltiazem
,✅ Correct Answer: D
Explanation
Non-dihydropyridine CCBs (diltiazem, verapamil) decrease contractility and worsen HFrEF.
Faculty favorite contraindication
3.
A patient with atrial fibrillation has CHA₂DS₂-VASc = 4. Best management?
A. Aspirin only
B. No therapy
C. Dual antiplatelet therapy
D. Oral anticoagulation
✅ Correct Answer: D
Explanation
CHA₂DS₂-VASc ≥2 → anticoagulation required
Aspirin is not adequate stroke prevention
4.
Which murmur increases with Valsalva maneuver?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Tricuspid regurgitation
✅ Correct Answer: C
Explanation
Valsalva ↓ preload → worsens LV outflow obstruction in HCM
5.
Most specific ECG finding for acute pericarditis?
A. ST elevation in one lead group
B. PR depression and diffuse ST elevation
C. Q waves
D. T-wave inversion only
,✅ Correct Answer: B
6.
Which antihypertensive is preferred in diabetic nephropathy?
A. Thiazide diuretic
B. Beta-blocker
C. ACE inhibitor
D. Alpha-blocker
✅ Correct Answer: C
Renal-protective effect tested heavily
7.
Which condition defines HFpEF?
A. EF <40%
B. Systolic dysfunction
C. Diastolic dysfunction with normal EF
D. Dilated cardiomyopathy
✅ Correct Answer: C
8.
Best initial therapy for acute pulmonary edema?
A. IV fluids
B. Oral beta-blocker
C. IV furosemide
D. Digoxin
✅ Correct Answer: C
9.
A 64-year-old smoker has sudden tearing chest pain radiating to the back. Next step?
A. Troponin
B. ECG
C. CT angiography
D. Stress test
, ✅ Correct Answer: C
Suspected aortic dissection = immediate CT
10.
Which lab is most helpful to confirm heart failure?
A. Troponin
B. BNP
C. CK-MB
D. ESR
✅ Correct Answer: B
11.
Which rhythm requires immediate defibrillation?
A. Ventricular fibrillation
B. Atrial flutter
C. Sinus tachycardia
D. First-degree AV block
✅ Correct Answer: A
12.
Which medication improves survival in HFrEF?
A. Loop diuretics
B. Digoxin
C. ACE inhibitors
D. Nitrates
✅ Correct Answer: C
Diuretics = symptoms, not mortality
13.
Classic triad of aortic stenosis?
A. Edema, dyspnea, cough
B. Syncope, angina, dyspnea
University Exam with Verified Rationales Practice
Questions and Answers 2026 with complete solution
NUR 509 – FNP ADULTS FINAL EXAM
St. Thomas University
25 Most Tested & Most Difficult Questions
1.
A 58-year-old male with diabetes presents with exertional chest pressure relieved by rest. Resting ECG is
normal. Best initial diagnostic test?
A. Coronary angiography
B. Exercise stress test
C. Cardiac MRI
D. CT coronary angiography
✅ Correct Answer: B
Explanation
• Stable angina + able to exercise + normal ECG → exercise stress test
• Angiography is invasive and not first-line
Exam Pearl:
Stress test FIRST unless ECG uninterpretable or patient cannot exercise.
2.
Which medication is contraindicated in heart failure with reduced EF?
A. ACE inhibitor
B. Spironolactone
C. Metoprolol succinate
D. Diltiazem
,✅ Correct Answer: D
Explanation
Non-dihydropyridine CCBs (diltiazem, verapamil) decrease contractility and worsen HFrEF.
Faculty favorite contraindication
3.
A patient with atrial fibrillation has CHA₂DS₂-VASc = 4. Best management?
A. Aspirin only
B. No therapy
C. Dual antiplatelet therapy
D. Oral anticoagulation
✅ Correct Answer: D
Explanation
CHA₂DS₂-VASc ≥2 → anticoagulation required
Aspirin is not adequate stroke prevention
4.
Which murmur increases with Valsalva maneuver?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Tricuspid regurgitation
✅ Correct Answer: C
Explanation
Valsalva ↓ preload → worsens LV outflow obstruction in HCM
5.
Most specific ECG finding for acute pericarditis?
A. ST elevation in one lead group
B. PR depression and diffuse ST elevation
C. Q waves
D. T-wave inversion only
,✅ Correct Answer: B
6.
Which antihypertensive is preferred in diabetic nephropathy?
A. Thiazide diuretic
B. Beta-blocker
C. ACE inhibitor
D. Alpha-blocker
✅ Correct Answer: C
Renal-protective effect tested heavily
7.
Which condition defines HFpEF?
A. EF <40%
B. Systolic dysfunction
C. Diastolic dysfunction with normal EF
D. Dilated cardiomyopathy
✅ Correct Answer: C
8.
Best initial therapy for acute pulmonary edema?
A. IV fluids
B. Oral beta-blocker
C. IV furosemide
D. Digoxin
✅ Correct Answer: C
9.
A 64-year-old smoker has sudden tearing chest pain radiating to the back. Next step?
A. Troponin
B. ECG
C. CT angiography
D. Stress test
, ✅ Correct Answer: C
Suspected aortic dissection = immediate CT
10.
Which lab is most helpful to confirm heart failure?
A. Troponin
B. BNP
C. CK-MB
D. ESR
✅ Correct Answer: B
11.
Which rhythm requires immediate defibrillation?
A. Ventricular fibrillation
B. Atrial flutter
C. Sinus tachycardia
D. First-degree AV block
✅ Correct Answer: A
12.
Which medication improves survival in HFrEF?
A. Loop diuretics
B. Digoxin
C. ACE inhibitors
D. Nitrates
✅ Correct Answer: C
Diuretics = symptoms, not mortality
13.
Classic triad of aortic stenosis?
A. Edema, dyspnea, cough
B. Syncope, angina, dyspnea
