NSG 6998 FNP Predictor Exam Newest Questions with
Answers and Detailed Rationales 2026/2027 (APEA
Style Review) Instant Pdf Download
Question 1
A 62-year-old man with hypertension and type 2 diabetes has an office blood pressure of
154/96 mm Hg. Home readings average 150–155/92–95 mm Hg over the past month. He
is taking lisinopril 20 mg daily and reports good adherence.
What is the most appropriate next step?
A. Continue current therapy and recheck in 6 months
B. Increase antihypertensive therapy and reinforce lifestyle modifications
C. Stop lisinopril and begin a beta blocker
D. Recommend home monitoring only
Answer: B
Rationale: Persistent BP ≥130/80 mm Hg in a patient with diabetes generally warrants
intensification of therapy if lifestyle measures and adherence have been addressed. ACE
inhibitors are appropriate first-line agents, but additional medication is often needed to
achieve target blood pressure.
Question 2
A 25-year-old woman presents with dysuria, urinary frequency, and urgency for 2 days. She
is afebrile and denies flank pain. Urinalysis is positive for leukocyte esterase and nitrites.
Which diagnosis is most likely?
A. Pyelonephritis
B. Uncomplicated cystitis
C. Interstitial cystitis
D. Vaginitis
Answer: B
,Rationale: Dysuria, frequency, urgency, and positive nitrites/leukocyte esterase without
fever or flank pain are classic for uncomplicated cystitis.
Question 3
A patient with asthma uses an albuterol inhaler four times per week during the day and
awakens with symptoms twice each month.
Asthma severity is best classified as:
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Answer: B
Rationale: Symptoms occurring more than twice weekly (but not daily) are consistent with
mild persistent asthma. Current treatment recommendations favor inhaled corticosteroid-
containing therapy rather than SABA-only treatment for most patients.
Question 4
A 58-year-old man reports crushing substernal chest pain radiating to the left arm for 30
minutes.
The priority action is:
A. Prescribe a proton pump inhibitor
B. Obtain a 12-lead ECG immediately
C. Order an outpatient stress test
D. Schedule follow-up in one week
Answer: B
Rationale: Suspected acute coronary syndrome requires immediate ECG (ideally within 10
minutes in an emergency setting) and emergency evaluation.
Question 5
,A patient with type 2 diabetes has:
HbA1c: 9.2%
eGFR: 78 mL/min
No contraindications to metformin
The best initial medication is:
A. Metformin
B. Glyburide
C. Regular insulin only
D. Pioglitazone
Answer: A
Rationale: Unless contraindicated, metformin is the recommended first-line medication for
most adults with type 2 diabetes, along with lifestyle modification. Additional agents may be
added based on A1c, comorbidities, and individualized goals.
Question 6
Which murmur is most suggestive of aortic stenosis?
A. Holosystolic murmur at the apex radiating to the axilla
B. Mid-systolic crescendo-decrescendo murmur at the right upper sternal border radiating to
the carotids
C. Continuous machinery murmur
D. Early diastolic blowing murmur
Answer: B
Rationale: Aortic stenosis classically presents with a systolic crescendo-decrescendo
murmur heard best at the right upper sternal border with radiation to the carotid arteries.
Question 7
A 7-year-old presents with sore throat, fever, tonsillar exudates, and tender anterior cervical
lymph nodes.
The next step is:
, A. Treat empirically with antibiotics without testing
B. Perform a rapid antigen detection test for group A streptococcus
C. Diagnose viral pharyngitis
D. Order a chest X-ray
Answer: B
Rationale: Clinical findings suggest streptococcal pharyngitis, but testing is generally
recommended before treatment in children unless another diagnosis is clear.
Question 8
A patient taking warfarin develops black tarry stools.
The priority action is:
A. Reassure the patient
B. Continue warfarin and recheck next week
C. Urgently evaluate for gastrointestinal bleeding and check INR
D. Recommend an iron supplement
Answer: C
Rationale: Melena in a patient taking warfarin suggests possible gastrointestinal bleeding
and requires prompt evaluation.
Question 9
Which laboratory test best confirms hypothyroidism?
A. Elevated TSH with low free T4 (primary hypothyroidism)
B. Elevated free T4
C. Low TSH with elevated T3
D. Elevated cortisol
Answer: A
Rationale: Primary hypothyroidism is characterized by elevated TSH and low free T4 due to
decreased thyroid hormone production.
Answers and Detailed Rationales 2026/2027 (APEA
Style Review) Instant Pdf Download
Question 1
A 62-year-old man with hypertension and type 2 diabetes has an office blood pressure of
154/96 mm Hg. Home readings average 150–155/92–95 mm Hg over the past month. He
is taking lisinopril 20 mg daily and reports good adherence.
What is the most appropriate next step?
A. Continue current therapy and recheck in 6 months
B. Increase antihypertensive therapy and reinforce lifestyle modifications
C. Stop lisinopril and begin a beta blocker
D. Recommend home monitoring only
Answer: B
Rationale: Persistent BP ≥130/80 mm Hg in a patient with diabetes generally warrants
intensification of therapy if lifestyle measures and adherence have been addressed. ACE
inhibitors are appropriate first-line agents, but additional medication is often needed to
achieve target blood pressure.
Question 2
A 25-year-old woman presents with dysuria, urinary frequency, and urgency for 2 days. She
is afebrile and denies flank pain. Urinalysis is positive for leukocyte esterase and nitrites.
Which diagnosis is most likely?
A. Pyelonephritis
B. Uncomplicated cystitis
C. Interstitial cystitis
D. Vaginitis
Answer: B
,Rationale: Dysuria, frequency, urgency, and positive nitrites/leukocyte esterase without
fever or flank pain are classic for uncomplicated cystitis.
Question 3
A patient with asthma uses an albuterol inhaler four times per week during the day and
awakens with symptoms twice each month.
Asthma severity is best classified as:
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Answer: B
Rationale: Symptoms occurring more than twice weekly (but not daily) are consistent with
mild persistent asthma. Current treatment recommendations favor inhaled corticosteroid-
containing therapy rather than SABA-only treatment for most patients.
Question 4
A 58-year-old man reports crushing substernal chest pain radiating to the left arm for 30
minutes.
The priority action is:
A. Prescribe a proton pump inhibitor
B. Obtain a 12-lead ECG immediately
C. Order an outpatient stress test
D. Schedule follow-up in one week
Answer: B
Rationale: Suspected acute coronary syndrome requires immediate ECG (ideally within 10
minutes in an emergency setting) and emergency evaluation.
Question 5
,A patient with type 2 diabetes has:
HbA1c: 9.2%
eGFR: 78 mL/min
No contraindications to metformin
The best initial medication is:
A. Metformin
B. Glyburide
C. Regular insulin only
D. Pioglitazone
Answer: A
Rationale: Unless contraindicated, metformin is the recommended first-line medication for
most adults with type 2 diabetes, along with lifestyle modification. Additional agents may be
added based on A1c, comorbidities, and individualized goals.
Question 6
Which murmur is most suggestive of aortic stenosis?
A. Holosystolic murmur at the apex radiating to the axilla
B. Mid-systolic crescendo-decrescendo murmur at the right upper sternal border radiating to
the carotids
C. Continuous machinery murmur
D. Early diastolic blowing murmur
Answer: B
Rationale: Aortic stenosis classically presents with a systolic crescendo-decrescendo
murmur heard best at the right upper sternal border with radiation to the carotid arteries.
Question 7
A 7-year-old presents with sore throat, fever, tonsillar exudates, and tender anterior cervical
lymph nodes.
The next step is:
, A. Treat empirically with antibiotics without testing
B. Perform a rapid antigen detection test for group A streptococcus
C. Diagnose viral pharyngitis
D. Order a chest X-ray
Answer: B
Rationale: Clinical findings suggest streptococcal pharyngitis, but testing is generally
recommended before treatment in children unless another diagnosis is clear.
Question 8
A patient taking warfarin develops black tarry stools.
The priority action is:
A. Reassure the patient
B. Continue warfarin and recheck next week
C. Urgently evaluate for gastrointestinal bleeding and check INR
D. Recommend an iron supplement
Answer: C
Rationale: Melena in a patient taking warfarin suggests possible gastrointestinal bleeding
and requires prompt evaluation.
Question 9
Which laboratory test best confirms hypothyroidism?
A. Elevated TSH with low free T4 (primary hypothyroidism)
B. Elevated free T4
C. Low TSH with elevated T3
D. Elevated cortisol
Answer: A
Rationale: Primary hypothyroidism is characterized by elevated TSH and low free T4 due to
decreased thyroid hormone production.
