1
FNP Exam Review: Comprehensive NP Study Guide for
AANP Boards (PASS YOUR FIRST TIME!)
CGSC C300 EXAM QUESTIONS AND ANSWERS GRADED A+ 2026
1. A 55-year-old black man has a blood pressure of 148/92 mmHg on two
separate visits. He has no other medical conditions. According to JNC 8
guidelines, which class of medication should be initiated as first-line therapy?
A. ACE inhibitor
B. Beta-blocker
C. Calcium channel blocker or thiazide diuretic
D. Alpha-blocker
Correct Answer: C. Calcium channel blocker or thiazide diuretic.
Rationale: In black patients, thiazide-type diuretics and calcium channel blockers
are more effective as initial monotherapy for hypertension than ACE inhibitors or
ARBs. This is based on evidence showing better blood pressure reduction and
cardiovascular outcomes in this population. A beta-blocker is not first-line for
uncomplicated hypertension. Alpha-blockers are reserved for resistant cases or
benign prostatic hyperplasia.
2. A 62-year-old woman with hypertension and diabetes has an LDL cholesterol
of 145 mg/dL. She is currently on atorvastatin 20 mg daily. Her 10-year ASCVD
risk is 18%. What is the most appropriate next step?
A. Continue current therapy
B. Increase atorvastatin to a high-intensity dose
C. Add ezetimibe
D. Switch to a fibrate
Correct Answer: B. Increase atorvastatin to a high-intensity dose (40–80 mg).
Rationale: For patients with clinical ASCVD or high 10-year risk (>7.5%), a high-
intensity statin is recommended to achieve at least a 50% reduction in LDL-C.
,2
Atorvastatin 40–80 mg or rosuvastatin 20–40 mg are considered high-intensity.
Ezetimibe is an add-on if LDL remains above goal on maximum tolerated statin.
Fibrates are primarily for triglycerides.
3. A 70-year-old man with HFrEF (EF 35%) is on lisinopril and carvedilol. He has
NYHA class II symptoms and no kidney disease. Which additional medication
has been shown to reduce mortality?
A. Digoxin
B. Spironolactone
C. Furosemide
D. Amlodipine
Correct Answer: B. Spironolactone.
Rationale: Mineralocorticoid receptor antagonists (MRA) like spironolactone and
eplerenone reduce mortality and heart failure hospitalizations in patients with
HFrEF (EF ≤35%) when added to standard therapy. Digoxin reduces
hospitalizations but not mortality. Furosemide is for symptom relief. Amlodipine
is a CCB that has no proven mortality benefit in HFrEF.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3 (age 70,
hypertension, diabetes). What is the recommended antithrombotic therapy?
A. Aspirin 325 mg daily
B. Warfarin (target INR 2–3) or a direct oral anticoagulant (DOAC)
C. Clopidogrel alone
D. No antithrombotic therapy
Correct Answer: B. Warfarin or a DOAC.
Rationale: For nonvalvular atrial fibrillation, a CHA₂DS₂-VASc score of ≥2 in men
(≥3 in women) warrants oral anticoagulation. DOACs (apixaban, rivaroxaban,
dabigatran, edoxaban) are preferred over warfarin for most patients due to
superior safety and convenience. Aspirin is no longer recommended for stroke
prevention in AF.
,3
5. A 45-year-old woman presents with sudden onset of tearing chest pain
radiating to the back. She has a history of uncontrolled hypertension. Blood
pressure is 190/100 mmHg in the right arm and 140/80 mmHg in the left arm.
What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B. Aortic dissection.
Rationale: The classic presentation is severe "tearing" or "ripping" pain, often
radiating to the back. Hypertension is a major risk factor. Unequal blood
pressures between arms suggest dissection involving the aortic arch branches.
Immediate imaging (CT angiography or TEE) is required. MI pain is usually
substernal pressure; pericarditis is sharp, positional. PE causes acute dyspnea.
6. A 60-year-old man with known coronary artery disease reports substernal
chest pressure that occurs with exertion and is relieved by rest. This pattern is
consistent with:
A. Unstable angina
B. Stable angina
C. Prinzmetal angina
D. Non-cardiac chest pain
Correct Answer: B. Stable angina.
Rationale: Stable angina is characterized by predictable chest discomfort
triggered by exertion or stress and relieved by rest or nitroglycerin within
minutes. Unstable angina occurs at rest, is new-onset, or is worsening in pattern.
Prinzmetal angina is vasospastic, often occurring at rest.
7. A 50-year-old man with hypertension and hyperlipidemia has a 10-year
ASCVD risk of 12%. What is the recommended statin intensity for primary
prevention?
A. No statin needed
, 4
B. Low-intensity statin
C. Moderate- to high-intensity statin
D. Only lifestyle modifications
Correct Answer: C. Moderate- to high-intensity statin.
Rationale: For primary prevention in adults aged 40–75 with an LDL 70–189
mg/dL and a 10-year ASCVD risk ≥7.5% to <20%, a moderate-intensity statin is
reasonable; a high-intensity statin can be considered. For risk ≥20%, high-intensity
is recommended.
8. A patient with systolic heart failure develops a dry, hacking cough after
starting lisinopril. Which medication is the best alternative?
A. Enalapril
B. Losartan
C. Metoprolol
D. Amlodipine
Correct Answer: B. Losartan (an ARB).
Rationale: ACE inhibitors cause cough in 5–20% of patients due to bradykinin
accumulation. ARBs block angiotensin II receptors without affecting bradykinin, so
they rarely cause cough. They provide similar mortality benefits in heart failure.
Switching to another ACE inhibitor will likely cause the same effect.
9. A 65-year-old patient with atrial fibrillation is started on warfarin. Which
dietary instruction is most important?
A. Avoid all leafy green vegetables
B. Consume a consistent amount of vitamin K-containing foods
C. Increase intake of vitamin K-rich foods
D. Restrict fluid intake
Correct Answer: B. Consume a consistent amount of vitamin K.
Rationale: Warfarin inhibits vitamin K-dependent clotting factors. Large
fluctuations in vitamin K intake can destabilize the INR. Patients should maintain a
consistent diet, not eliminate leafy greens. Sudden increases can lower INR;
decreases can raise INR.
FNP Exam Review: Comprehensive NP Study Guide for
AANP Boards (PASS YOUR FIRST TIME!)
CGSC C300 EXAM QUESTIONS AND ANSWERS GRADED A+ 2026
1. A 55-year-old black man has a blood pressure of 148/92 mmHg on two
separate visits. He has no other medical conditions. According to JNC 8
guidelines, which class of medication should be initiated as first-line therapy?
A. ACE inhibitor
B. Beta-blocker
C. Calcium channel blocker or thiazide diuretic
D. Alpha-blocker
Correct Answer: C. Calcium channel blocker or thiazide diuretic.
Rationale: In black patients, thiazide-type diuretics and calcium channel blockers
are more effective as initial monotherapy for hypertension than ACE inhibitors or
ARBs. This is based on evidence showing better blood pressure reduction and
cardiovascular outcomes in this population. A beta-blocker is not first-line for
uncomplicated hypertension. Alpha-blockers are reserved for resistant cases or
benign prostatic hyperplasia.
2. A 62-year-old woman with hypertension and diabetes has an LDL cholesterol
of 145 mg/dL. She is currently on atorvastatin 20 mg daily. Her 10-year ASCVD
risk is 18%. What is the most appropriate next step?
A. Continue current therapy
B. Increase atorvastatin to a high-intensity dose
C. Add ezetimibe
D. Switch to a fibrate
Correct Answer: B. Increase atorvastatin to a high-intensity dose (40–80 mg).
Rationale: For patients with clinical ASCVD or high 10-year risk (>7.5%), a high-
intensity statin is recommended to achieve at least a 50% reduction in LDL-C.
,2
Atorvastatin 40–80 mg or rosuvastatin 20–40 mg are considered high-intensity.
Ezetimibe is an add-on if LDL remains above goal on maximum tolerated statin.
Fibrates are primarily for triglycerides.
3. A 70-year-old man with HFrEF (EF 35%) is on lisinopril and carvedilol. He has
NYHA class II symptoms and no kidney disease. Which additional medication
has been shown to reduce mortality?
A. Digoxin
B. Spironolactone
C. Furosemide
D. Amlodipine
Correct Answer: B. Spironolactone.
Rationale: Mineralocorticoid receptor antagonists (MRA) like spironolactone and
eplerenone reduce mortality and heart failure hospitalizations in patients with
HFrEF (EF ≤35%) when added to standard therapy. Digoxin reduces
hospitalizations but not mortality. Furosemide is for symptom relief. Amlodipine
is a CCB that has no proven mortality benefit in HFrEF.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3 (age 70,
hypertension, diabetes). What is the recommended antithrombotic therapy?
A. Aspirin 325 mg daily
B. Warfarin (target INR 2–3) or a direct oral anticoagulant (DOAC)
C. Clopidogrel alone
D. No antithrombotic therapy
Correct Answer: B. Warfarin or a DOAC.
Rationale: For nonvalvular atrial fibrillation, a CHA₂DS₂-VASc score of ≥2 in men
(≥3 in women) warrants oral anticoagulation. DOACs (apixaban, rivaroxaban,
dabigatran, edoxaban) are preferred over warfarin for most patients due to
superior safety and convenience. Aspirin is no longer recommended for stroke
prevention in AF.
,3
5. A 45-year-old woman presents with sudden onset of tearing chest pain
radiating to the back. She has a history of uncontrolled hypertension. Blood
pressure is 190/100 mmHg in the right arm and 140/80 mmHg in the left arm.
What is the most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B. Aortic dissection.
Rationale: The classic presentation is severe "tearing" or "ripping" pain, often
radiating to the back. Hypertension is a major risk factor. Unequal blood
pressures between arms suggest dissection involving the aortic arch branches.
Immediate imaging (CT angiography or TEE) is required. MI pain is usually
substernal pressure; pericarditis is sharp, positional. PE causes acute dyspnea.
6. A 60-year-old man with known coronary artery disease reports substernal
chest pressure that occurs with exertion and is relieved by rest. This pattern is
consistent with:
A. Unstable angina
B. Stable angina
C. Prinzmetal angina
D. Non-cardiac chest pain
Correct Answer: B. Stable angina.
Rationale: Stable angina is characterized by predictable chest discomfort
triggered by exertion or stress and relieved by rest or nitroglycerin within
minutes. Unstable angina occurs at rest, is new-onset, or is worsening in pattern.
Prinzmetal angina is vasospastic, often occurring at rest.
7. A 50-year-old man with hypertension and hyperlipidemia has a 10-year
ASCVD risk of 12%. What is the recommended statin intensity for primary
prevention?
A. No statin needed
, 4
B. Low-intensity statin
C. Moderate- to high-intensity statin
D. Only lifestyle modifications
Correct Answer: C. Moderate- to high-intensity statin.
Rationale: For primary prevention in adults aged 40–75 with an LDL 70–189
mg/dL and a 10-year ASCVD risk ≥7.5% to <20%, a moderate-intensity statin is
reasonable; a high-intensity statin can be considered. For risk ≥20%, high-intensity
is recommended.
8. A patient with systolic heart failure develops a dry, hacking cough after
starting lisinopril. Which medication is the best alternative?
A. Enalapril
B. Losartan
C. Metoprolol
D. Amlodipine
Correct Answer: B. Losartan (an ARB).
Rationale: ACE inhibitors cause cough in 5–20% of patients due to bradykinin
accumulation. ARBs block angiotensin II receptors without affecting bradykinin, so
they rarely cause cough. They provide similar mortality benefits in heart failure.
Switching to another ACE inhibitor will likely cause the same effect.
9. A 65-year-old patient with atrial fibrillation is started on warfarin. Which
dietary instruction is most important?
A. Avoid all leafy green vegetables
B. Consume a consistent amount of vitamin K-containing foods
C. Increase intake of vitamin K-rich foods
D. Restrict fluid intake
Correct Answer: B. Consume a consistent amount of vitamin K.
Rationale: Warfarin inhibits vitamin K-dependent clotting factors. Large
fluctuations in vitamin K intake can destabilize the INR. Patients should maintain a
consistent diet, not eliminate leafy greens. Sudden increases can lower INR;
decreases can raise INR.
