Fitz Exit Exam 2025/2026 Edition ACTUAL
EXAM | NP Board Review Practice Test |
300 Questions | Verified Answers | A+
Graded | Verified Q&A | Pass Guaranteed -
A+ Graded
DOMAIN 1: CARDIOVASCULAR DISORDERS (40 Questions)
Q1: A 72-year-old patient with heart failure with reduced ejection fraction (HFrEF) is currently
taking carvedilol, lisinopril, and furosemide. Which medication addition would provide the greatest
mortality benefit according to current guidelines?
A. Digoxin
B. Spironolactone
C. Hydralazine/isosorbide dinitrate
D. Empagliflozin [CORRECT]
Correct Answer: D
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have been shown to reduce
cardiovascular death and heart failure hospitalizations in patients with HFrEF regardless of
diabetes status. Aldosterone antagonists (spironolactone) (B) also reduce mortality but are
typically added earlier. Digoxin (A) reduces symptoms but not mortality. Hydralazine/isosorbide
dinitrate (C) is indicated for African American patients or those intolerant to ACE inhibitors/ARBs.
,Fitz Note: The "Four Pillars" of HFrEF therapy now include: ACEi/ARB/ARNI, Beta-blocker, MRA,
and SGLT2 inhibitor. All four provide mortality benefit.
Q2: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4 and a HAS-BLED score of 3.
Which anticoagulation strategy is most appropriate?
A. Aspirin 81 mg daily
B. Warfarin with INR target 2-3 [CORRECT]
C. No anticoagulation due to bleeding risk
D. Dual antiplatelet therapy (aspirin + clopidogrel)
Correct Answer: B
Rationale: CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high stroke risk, and
anticoagulation is indicated regardless of bleeding risk. HAS-BLED score is used to identify
modifiable bleeding risk factors, not to withhold anticoagulation. Warfarin or DOACs are
appropriate. Aspirin (A) is not adequate for stroke prevention. No anticoagulation (C) is
inappropriate. DAPT (D) is not indicated for stroke prevention in atrial fibrillation.
Fitz Note: HAS-BLED helps manage risk (e.g., control BP, avoid NSAIDs) but never use it to deny
anticoagulation when CHA₂DS₂-VASc indicates high stroke risk.
Q3: A 68-year-old male presents with crushing chest pain radiating to the left arm, ST-elevation in
leads II, III, and aVF, and hypotension (BP 82/50 mmHg). Which intervention is the immediate
priority?
A. Administer sublingual nitroglycerin
B. Obtain emergent cardiac catheterization [CORRECT]
C. Administer IV beta-blocker
D. Perform immediate synchronized cardioversion
Correct Answer: B
,Rationale: This patient presents with an inferior STEMI complicated by cardiogenic shock
(hypotension). Emergent reperfusion therapy (PCI within 90 minutes or fibrinolysis within 30
minutes) is the priority. Nitroglycerin (A) is contraindicated in hypotension and right ventricular
infarcts. Beta-blockers (C) are contraindicated in cardiogenic shock. Cardioversion (D) is not
indicated without arrhythmia.
Fitz Note: Inferior STEMIs often involve the right ventricle. Always check right-sided leads (V4R)
and avoid nitrates/diuretics in RV infarcts due to preload dependence.
Q4: A 58-year-old patient with resistant hypertension is taking chlorthalidone, lisinopril, and
amlodipine. Laboratory evaluation shows hypokalemia (K+ 3.0 mEq/L) and metabolic alkalosis.
Which diagnostic test is most appropriate?
A. Plasma aldosterone-to-renin ratio [CORRECT]
B. 24-hour urine catecholamines
C. Renal artery CT angiography
D. Polysomnography
Correct Answer: A
Rationale: Resistant hypertension with hypokalemia and metabolic alkalosis suggests primary
hyperaldosteronism (Conn's syndrome). The screening test is plasma aldosterone-to-renin ratio
(>20-30 with aldosterone >15 ng/dL). Catecholamines (B) screen for pheochromocytoma (episodic
hypertension, headaches, sweating). Renal artery imaging (C) evaluates for renal artery stenosis
(flash pulmonary edema, abdominal bruit). Sleep study (D) evaluates for obstructive sleep apnea.
Fitz Note: Primary hyperaldosteronism is the most common cause of secondary hypertension and
often presents with "resistant" HTN and spontaneous hypokalemia.
Q5: A patient with severe aortic stenosis (valve area 0.7 cm², mean gradient 48 mmHg) reports
exertional syncope. Which statement regarding management is correct?
A. Medical therapy with vasodilators is preferred over surgery
B. Observation is appropriate until dyspnea develops
, C. Surgical valve replacement or TAVR is indicated [CORRECT]
D. Balloon valvuloplasty is definitive therapy
Correct Answer: C
Rationale: Severe AS with symptoms (angina, syncope, dyspnea - the classic triad) indicates
surgical or transcatheter valve replacement. Medical therapy (A) does not improve survival.
Observation (B) is dangerous as symptomatic AS carries 50% 2-year mortality without intervention.
Balloon valvuloplasty (D) is a bridge to surgery in hemodynamically unstable patients, not definitive
therapy.
Fitz Note: The classic triad of aortic stenosis symptoms: Angina, Syncope, Dyspnea. Once
symptomatic, mortality is high without valve replacement.
Q6: A 45-year-old patient started on atorvastatin 80 mg for secondary prevention after MI develops
muscle aches and weakness. CK is elevated at 2500 U/L. Which action is most appropriate?
A. Switch to rosuvastatin 40 mg
B. Discontinue statin immediately [CORRECT]
C. Add coenzyme Q10 and continue statin
D. Reduce atorvastatin to 40 mg
Correct Answer: B
Rationale: CK >10x ULN (or >1000 U/L) with symptoms indicates rhabdomyolysis. The statin must
be discontinued immediately to prevent renal failure. Switching to another statin (A) or continuing at
lower dose (D) is inappropriate with significant muscle injury. CoQ10 (C) has limited evidence and
does not address acute rhabdomyolysis.
Fitz Note: Statin myopathy: CK >3x ULN + symptoms = stop drug. CK >10x ULN or myoglobinuria =
rhabdomyolysis, discontinue immediately and hydrate.
EXAM | NP Board Review Practice Test |
300 Questions | Verified Answers | A+
Graded | Verified Q&A | Pass Guaranteed -
A+ Graded
DOMAIN 1: CARDIOVASCULAR DISORDERS (40 Questions)
Q1: A 72-year-old patient with heart failure with reduced ejection fraction (HFrEF) is currently
taking carvedilol, lisinopril, and furosemide. Which medication addition would provide the greatest
mortality benefit according to current guidelines?
A. Digoxin
B. Spironolactone
C. Hydralazine/isosorbide dinitrate
D. Empagliflozin [CORRECT]
Correct Answer: D
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have been shown to reduce
cardiovascular death and heart failure hospitalizations in patients with HFrEF regardless of
diabetes status. Aldosterone antagonists (spironolactone) (B) also reduce mortality but are
typically added earlier. Digoxin (A) reduces symptoms but not mortality. Hydralazine/isosorbide
dinitrate (C) is indicated for African American patients or those intolerant to ACE inhibitors/ARBs.
,Fitz Note: The "Four Pillars" of HFrEF therapy now include: ACEi/ARB/ARNI, Beta-blocker, MRA,
and SGLT2 inhibitor. All four provide mortality benefit.
Q2: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4 and a HAS-BLED score of 3.
Which anticoagulation strategy is most appropriate?
A. Aspirin 81 mg daily
B. Warfarin with INR target 2-3 [CORRECT]
C. No anticoagulation due to bleeding risk
D. Dual antiplatelet therapy (aspirin + clopidogrel)
Correct Answer: B
Rationale: CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high stroke risk, and
anticoagulation is indicated regardless of bleeding risk. HAS-BLED score is used to identify
modifiable bleeding risk factors, not to withhold anticoagulation. Warfarin or DOACs are
appropriate. Aspirin (A) is not adequate for stroke prevention. No anticoagulation (C) is
inappropriate. DAPT (D) is not indicated for stroke prevention in atrial fibrillation.
Fitz Note: HAS-BLED helps manage risk (e.g., control BP, avoid NSAIDs) but never use it to deny
anticoagulation when CHA₂DS₂-VASc indicates high stroke risk.
Q3: A 68-year-old male presents with crushing chest pain radiating to the left arm, ST-elevation in
leads II, III, and aVF, and hypotension (BP 82/50 mmHg). Which intervention is the immediate
priority?
A. Administer sublingual nitroglycerin
B. Obtain emergent cardiac catheterization [CORRECT]
C. Administer IV beta-blocker
D. Perform immediate synchronized cardioversion
Correct Answer: B
,Rationale: This patient presents with an inferior STEMI complicated by cardiogenic shock
(hypotension). Emergent reperfusion therapy (PCI within 90 minutes or fibrinolysis within 30
minutes) is the priority. Nitroglycerin (A) is contraindicated in hypotension and right ventricular
infarcts. Beta-blockers (C) are contraindicated in cardiogenic shock. Cardioversion (D) is not
indicated without arrhythmia.
Fitz Note: Inferior STEMIs often involve the right ventricle. Always check right-sided leads (V4R)
and avoid nitrates/diuretics in RV infarcts due to preload dependence.
Q4: A 58-year-old patient with resistant hypertension is taking chlorthalidone, lisinopril, and
amlodipine. Laboratory evaluation shows hypokalemia (K+ 3.0 mEq/L) and metabolic alkalosis.
Which diagnostic test is most appropriate?
A. Plasma aldosterone-to-renin ratio [CORRECT]
B. 24-hour urine catecholamines
C. Renal artery CT angiography
D. Polysomnography
Correct Answer: A
Rationale: Resistant hypertension with hypokalemia and metabolic alkalosis suggests primary
hyperaldosteronism (Conn's syndrome). The screening test is plasma aldosterone-to-renin ratio
(>20-30 with aldosterone >15 ng/dL). Catecholamines (B) screen for pheochromocytoma (episodic
hypertension, headaches, sweating). Renal artery imaging (C) evaluates for renal artery stenosis
(flash pulmonary edema, abdominal bruit). Sleep study (D) evaluates for obstructive sleep apnea.
Fitz Note: Primary hyperaldosteronism is the most common cause of secondary hypertension and
often presents with "resistant" HTN and spontaneous hypokalemia.
Q5: A patient with severe aortic stenosis (valve area 0.7 cm², mean gradient 48 mmHg) reports
exertional syncope. Which statement regarding management is correct?
A. Medical therapy with vasodilators is preferred over surgery
B. Observation is appropriate until dyspnea develops
, C. Surgical valve replacement or TAVR is indicated [CORRECT]
D. Balloon valvuloplasty is definitive therapy
Correct Answer: C
Rationale: Severe AS with symptoms (angina, syncope, dyspnea - the classic triad) indicates
surgical or transcatheter valve replacement. Medical therapy (A) does not improve survival.
Observation (B) is dangerous as symptomatic AS carries 50% 2-year mortality without intervention.
Balloon valvuloplasty (D) is a bridge to surgery in hemodynamically unstable patients, not definitive
therapy.
Fitz Note: The classic triad of aortic stenosis symptoms: Angina, Syncope, Dyspnea. Once
symptomatic, mortality is high without valve replacement.
Q6: A 45-year-old patient started on atorvastatin 80 mg for secondary prevention after MI develops
muscle aches and weakness. CK is elevated at 2500 U/L. Which action is most appropriate?
A. Switch to rosuvastatin 40 mg
B. Discontinue statin immediately [CORRECT]
C. Add coenzyme Q10 and continue statin
D. Reduce atorvastatin to 40 mg
Correct Answer: B
Rationale: CK >10x ULN (or >1000 U/L) with symptoms indicates rhabdomyolysis. The statin must
be discontinued immediately to prevent renal failure. Switching to another statin (A) or continuing at
lower dose (D) is inappropriate with significant muscle injury. CoQ10 (C) has limited evidence and
does not address acute rhabdomyolysis.
Fitz Note: Statin myopathy: CK >3x ULN + symptoms = stop drug. CK >10x ULN or myoglobinuria =
rhabdomyolysis, discontinue immediately and hydrate.
