1
Pass Your Maryland Nurse Practitioner Exam in
2026/2027 – Complete Accurate Practice Questions
with Well-Elaborated Answers & Rationales | 100%
Verified Solutions | Instant Download
Instructions: Read each question carefully, select the best answer, then review the detailed rationale.
1. The nurse practitioner is assessing a 63-year-old male who has a history of intravenous drug use as a
young adult. He presents with fatigue and nausea. Which screening will the nurse practitioner
recommend for this patient?
• A. Chest x-ray
• B. Urine specimen
• C. Hepatitis C
• D. Electroencephalogram
Correct Answer : C. Hepatitis C
Rationale: The CDC recommends one-time Hepatitis C screening for all adults born from 1945 through
1965, regardless of risk factors. Hepatitis C is transmitted through blood and sharing needles. Given the
patient's history of IV drug use, he is at high risk for chronic Hepatitis C infection, which can present with
vague symptoms like fatigue and nausea.
2. A 14-year-old, male patient has some general concerns about eczema, as his twin brother was
recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees
bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a
personal history of allergic rhinitis, and a history of:
• A. Asthma
• B. Bee allergy
• C. Otitis media
• D. Psoriasis
Correct Answer : A. Asthma
Rationale: The classic "atopic triad" consists of eczema (atopic dermatitis), allergic rhinitis (hay fever),
and asthma. A personal history of two of these conditions, along with a family history of atopy, places
the patient at high risk for developing eczema.
,2
3. A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse
practitioner assesses for ankle clonus by:
• A. Firmly applying a low-pitched tuning fork to the lateral malleolus.
• B. Flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the
percussion hammer.
• C. Sharply dorsiflexing the foot and maintaining this position while supporting the knee.
• D. Stroking the lateral aspect of the sole from the heel to the ball of the foot.
Correct Answer : C. Sharply dorsiflexing the foot and maintaining this position while supporting the
knee.
Rationale: Ankle clonus is a test for upper motor neuron lesions. The NP sharply dorsiflexes the patient's
foot and sustains the pressure. A positive test is the presence of rhythmic, involuntary beats of the foot.
Option B describes the test for the Achilles reflex, and option D describes the Babinski test.
4. The nurse practitioner is managing a stable 53-year-old patient with emphysema. In addition to
reinforcing smoking cessation and medication schedules, which annual intervention will the nurse
practitioner recommend?
• A. Pneumococcal polysaccharide vaccine (PPSV23)
• B. Live attenuated influenza vaccine (LAIV)
• C. Quadrivalent inactivated influenza vaccine (QIV)
• D. Pneumococcal conjugate vaccine (PCV13)
Correct Answer : C. Quadrivalent inactivated influenza vaccine (QIV)
Rationale: Adults with chronic respiratory diseases like emphysema should receive an annual
inactivated influenza vaccine (QIV). The live attenuated influenza vaccine (LAIV) is a nasal spray that is
contraindicated in patients with underlying lung disease. PPSV23 is indicated once for adults aged 19-64
who smoke, but it is not an annual vaccine. PCV13 is not routinely recommended for this age group
without specific risk factors.
5. During a sports participation exam of a 14-year-old high school athlete, the nurse practitioner notices
a split of the S2 component of the heart sound during deep inspiration. She notes that it disappears
upon expiration. The heart rate is regular, and no murmurs are auscultated. Which of the following is
correct?
• A. This is an abnormal finding, and the child should be referred to a cardiologist.
• B. The NP should order an echocardiogram to rule out a septal defect.
,3
• C. This is a physiological finding called a physiologic split of S2.
• D. This finding indicates pulmonic stenosis.
Correct Answer : C. This is a physiological finding called a physiologic split of S2.
Rationale: Physiologic splitting of the second heart sound (S2) is a normal finding. During inspiration,
increased venous return to the right side of the heart delays the closure of the pulmonic valve, causing
the split. During expiration, the split disappears. It is a benign finding in a healthy, asymptomatic child.
6. A 45-year-old male presents with a chief complaint of a new-onset, severe headache that started
abruptly 2 hours ago, described as a "thunderclap." The headache is the worst of his life. What is the
most appropriate first step?
• A. Prescribe sumatriptan (Imitrex) for a suspected migraine.
• B. Administer a non-steroidal anti-inflammatory drug (NSAID) and re-evaluate in 1 hour.
• C. Order a non-contrast head CT stat.
• D. Perform a thorough neurological exam and schedule an outpatient MRI.
Correct Answer : C. Order a non-contrast head CT stat.
Rationale: A "thunderclap headache" is a medical emergency until proven otherwise, as it is the classic
presentation for a subarachnoid hemorrhage (SAH). A non-contrast head CT is the initial imaging study
of choice to detect blood in the subarachnoid space.
7. The nurse practitioner is evaluating a 32-year-old female for a first-trimester pregnancy. She has a
history of two prior spontaneous abortions. What is the most appropriate initial screening for a
potential underlying cause?
• A. Thyroid function tests
• B. Antiphospholipid antibody panel
• C. Progesterone level
• D. Karyotype of both parents
Correct Answer : B. Antiphospholipid antibody panel
Rationale: Recurrent pregnancy loss (two or more consecutive miscarriages) warrants an evaluation for
an underlying cause. Antiphospholipid syndrome (APS) is an acquired thrombophilia and a treatable
cause of recurrent miscarriage. Screening for antiphospholipid antibodies is a standard part of the
workup.
, 4
8. A 78-year-old male is brought in by his daughter for a "check-up." She reports that over the past year,
her father has become more withdrawn, has trouble finding his words, and has difficulty remembering
recent conversations. A Mini-Cog test is abnormal. In addition to a neurological exam, what is the most
appropriate next step?
• A. Refer to a neurologist for an EEG.
• B. Order a TSH, B12, and a basic metabolic panel.
• C. Start a trial of donepezil (Aricept).
• D. Schedule a PET scan of the brain.
Correct Answer : B. Order a TSH, B12, and a basic metabolic panel.
Rationale: Before diagnosing Alzheimer's disease or another dementia, it is crucial to rule out reversible
causes of cognitive impairment. Common reversible causes include hypothyroidism (TSH) and vitamin
B12 deficiency.
9. An 8-year-old child is brought to the clinic for a school physical. The parent reports the child has had
three documented episodes of streptococcal pharyngitis in the past year. The NP hears a new, faint,
low-pitched, rumbling diastolic murmur at the apex. What is the most likely diagnosis?
• A. Atrial septal defect
• B. Acute rheumatic fever
• C. Mitral valve prolapse
• D. Aortic stenosis
Correct Answer : B. Acute rheumatic fever
Rationale: Acute rheumatic fever is an inflammatory disease that can occur 2-4 weeks after an
untreated or inadequately treated group A streptococcal pharyngitis. Carditis is a major Jones criterion
and often presents as a new heart murmur, such as mitral regurgitation or a Carey Coombs murmur (a
mid-diastolic murmur at the apex).
10. A 67-year-old patient with a history of heart failure presents to the clinic with progressive dyspnea
on exertion, orthopnea, and a 4-lb weight gain over the past week. His blood pressure is 155/95 mmHg,
and heart rate is 92 bpm. Lung auscultation reveals crackles in the lower lobes bilaterally. He is currently
on lisinopril, metoprolol, and furosemide. What is the most appropriate initial medication adjustment?
• A. Increase the lisinopril dose.
• B. Increase the metoprolol dose.
• C. Increase the furosemide dose.
Pass Your Maryland Nurse Practitioner Exam in
2026/2027 – Complete Accurate Practice Questions
with Well-Elaborated Answers & Rationales | 100%
Verified Solutions | Instant Download
Instructions: Read each question carefully, select the best answer, then review the detailed rationale.
1. The nurse practitioner is assessing a 63-year-old male who has a history of intravenous drug use as a
young adult. He presents with fatigue and nausea. Which screening will the nurse practitioner
recommend for this patient?
• A. Chest x-ray
• B. Urine specimen
• C. Hepatitis C
• D. Electroencephalogram
Correct Answer : C. Hepatitis C
Rationale: The CDC recommends one-time Hepatitis C screening for all adults born from 1945 through
1965, regardless of risk factors. Hepatitis C is transmitted through blood and sharing needles. Given the
patient's history of IV drug use, he is at high risk for chronic Hepatitis C infection, which can present with
vague symptoms like fatigue and nausea.
2. A 14-year-old, male patient has some general concerns about eczema, as his twin brother was
recently diagnosed with this condition. The patient reports urticaria and a rash on his posterior knees
bilaterally. The three factors that put the patient at risk for eczema are a family history of eczema, a
personal history of allergic rhinitis, and a history of:
• A. Asthma
• B. Bee allergy
• C. Otitis media
• D. Psoriasis
Correct Answer : A. Asthma
Rationale: The classic "atopic triad" consists of eczema (atopic dermatitis), allergic rhinitis (hay fever),
and asthma. A personal history of two of these conditions, along with a family history of atopy, places
the patient at high risk for developing eczema.
,2
3. A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse
practitioner assesses for ankle clonus by:
• A. Firmly applying a low-pitched tuning fork to the lateral malleolus.
• B. Flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the
percussion hammer.
• C. Sharply dorsiflexing the foot and maintaining this position while supporting the knee.
• D. Stroking the lateral aspect of the sole from the heel to the ball of the foot.
Correct Answer : C. Sharply dorsiflexing the foot and maintaining this position while supporting the
knee.
Rationale: Ankle clonus is a test for upper motor neuron lesions. The NP sharply dorsiflexes the patient's
foot and sustains the pressure. A positive test is the presence of rhythmic, involuntary beats of the foot.
Option B describes the test for the Achilles reflex, and option D describes the Babinski test.
4. The nurse practitioner is managing a stable 53-year-old patient with emphysema. In addition to
reinforcing smoking cessation and medication schedules, which annual intervention will the nurse
practitioner recommend?
• A. Pneumococcal polysaccharide vaccine (PPSV23)
• B. Live attenuated influenza vaccine (LAIV)
• C. Quadrivalent inactivated influenza vaccine (QIV)
• D. Pneumococcal conjugate vaccine (PCV13)
Correct Answer : C. Quadrivalent inactivated influenza vaccine (QIV)
Rationale: Adults with chronic respiratory diseases like emphysema should receive an annual
inactivated influenza vaccine (QIV). The live attenuated influenza vaccine (LAIV) is a nasal spray that is
contraindicated in patients with underlying lung disease. PPSV23 is indicated once for adults aged 19-64
who smoke, but it is not an annual vaccine. PCV13 is not routinely recommended for this age group
without specific risk factors.
5. During a sports participation exam of a 14-year-old high school athlete, the nurse practitioner notices
a split of the S2 component of the heart sound during deep inspiration. She notes that it disappears
upon expiration. The heart rate is regular, and no murmurs are auscultated. Which of the following is
correct?
• A. This is an abnormal finding, and the child should be referred to a cardiologist.
• B. The NP should order an echocardiogram to rule out a septal defect.
,3
• C. This is a physiological finding called a physiologic split of S2.
• D. This finding indicates pulmonic stenosis.
Correct Answer : C. This is a physiological finding called a physiologic split of S2.
Rationale: Physiologic splitting of the second heart sound (S2) is a normal finding. During inspiration,
increased venous return to the right side of the heart delays the closure of the pulmonic valve, causing
the split. During expiration, the split disappears. It is a benign finding in a healthy, asymptomatic child.
6. A 45-year-old male presents with a chief complaint of a new-onset, severe headache that started
abruptly 2 hours ago, described as a "thunderclap." The headache is the worst of his life. What is the
most appropriate first step?
• A. Prescribe sumatriptan (Imitrex) for a suspected migraine.
• B. Administer a non-steroidal anti-inflammatory drug (NSAID) and re-evaluate in 1 hour.
• C. Order a non-contrast head CT stat.
• D. Perform a thorough neurological exam and schedule an outpatient MRI.
Correct Answer : C. Order a non-contrast head CT stat.
Rationale: A "thunderclap headache" is a medical emergency until proven otherwise, as it is the classic
presentation for a subarachnoid hemorrhage (SAH). A non-contrast head CT is the initial imaging study
of choice to detect blood in the subarachnoid space.
7. The nurse practitioner is evaluating a 32-year-old female for a first-trimester pregnancy. She has a
history of two prior spontaneous abortions. What is the most appropriate initial screening for a
potential underlying cause?
• A. Thyroid function tests
• B. Antiphospholipid antibody panel
• C. Progesterone level
• D. Karyotype of both parents
Correct Answer : B. Antiphospholipid antibody panel
Rationale: Recurrent pregnancy loss (two or more consecutive miscarriages) warrants an evaluation for
an underlying cause. Antiphospholipid syndrome (APS) is an acquired thrombophilia and a treatable
cause of recurrent miscarriage. Screening for antiphospholipid antibodies is a standard part of the
workup.
, 4
8. A 78-year-old male is brought in by his daughter for a "check-up." She reports that over the past year,
her father has become more withdrawn, has trouble finding his words, and has difficulty remembering
recent conversations. A Mini-Cog test is abnormal. In addition to a neurological exam, what is the most
appropriate next step?
• A. Refer to a neurologist for an EEG.
• B. Order a TSH, B12, and a basic metabolic panel.
• C. Start a trial of donepezil (Aricept).
• D. Schedule a PET scan of the brain.
Correct Answer : B. Order a TSH, B12, and a basic metabolic panel.
Rationale: Before diagnosing Alzheimer's disease or another dementia, it is crucial to rule out reversible
causes of cognitive impairment. Common reversible causes include hypothyroidism (TSH) and vitamin
B12 deficiency.
9. An 8-year-old child is brought to the clinic for a school physical. The parent reports the child has had
three documented episodes of streptococcal pharyngitis in the past year. The NP hears a new, faint,
low-pitched, rumbling diastolic murmur at the apex. What is the most likely diagnosis?
• A. Atrial septal defect
• B. Acute rheumatic fever
• C. Mitral valve prolapse
• D. Aortic stenosis
Correct Answer : B. Acute rheumatic fever
Rationale: Acute rheumatic fever is an inflammatory disease that can occur 2-4 weeks after an
untreated or inadequately treated group A streptococcal pharyngitis. Carditis is a major Jones criterion
and often presents as a new heart murmur, such as mitral regurgitation or a Carey Coombs murmur (a
mid-diastolic murmur at the apex).
10. A 67-year-old patient with a history of heart failure presents to the clinic with progressive dyspnea
on exertion, orthopnea, and a 4-lb weight gain over the past week. His blood pressure is 155/95 mmHg,
and heart rate is 92 bpm. Lung auscultation reveals crackles in the lower lobes bilaterally. He is currently
on lisinopril, metoprolol, and furosemide. What is the most appropriate initial medication adjustment?
• A. Increase the lisinopril dose.
• B. Increase the metoprolol dose.
• C. Increase the furosemide dose.
