NR 667-FNP WEEK 1 FULL LENGTH PRACTICE EXAM
FINAL CLASS LATEST REVISED EDITION 2026
Question 1
pts
Effective long-term treatment of systolic heart failure with reduced ejection fraction should include which
of the following?
Correct!
Prescribing valsartan/sacubitril (Entresto) unless contraindicated on discharge
Angiotensin Receptor and Neprilysin Inhibition is considered goal-directed therapy for patients with
reduced systolic heart function as evidence by the PARAGON-HF Trial. Auscultation is an assessment
item, not a treatment. Midazolam does not have any long term benefit for heart failure. Fluid bolus in a
patient with likely fluid overload from systolic heart failure only worsen their presenting symptoms.
Prescribing 500 ml fluid bolus for hypotension
Auscultating lung sounds for rhonchi
Prescribing midazolam to aid with air hunger
Question 2
pts
A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and shortness of
breath. His ECG shows ST-segment elevation. What is the initial management response?
Administer nitroglycerin sublingually
Start intravenous heparin
, Perform immediate coronary angiography
Correct!
Administer aspirin and call for emergency medical services
Question 3
pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset unilateral leg pain and
pallor. What is the most likely diagnosis?
You Answered
Deep vein thrombosis
Correct Answer
Acute arterial occlusion
Cellulitis
Peripheral artery disease
Question 4
pts
An older adult female presents for her annual examination. She has been on antihypertensive
medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse
practitioner is concerned about the patient’s cardiac health risks, due her to weight and her waist
circumference. According to the AHA guidelines, which of the following goals is expected for this patient?
Physical activity for 60 minutes daily, 7 days a week
Correct!
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 30 minutes daily, 7 days a week
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Question 5
pts
Recommendation for lipid check in adolescent with type 1 DM?
10 years
5 years
2 years
Correct!
1 year
,Remember than with pediatric patients with diabetes, the easiest way to remember the evaluation
schedule is to perform lipid checks is with annual physicals.
Question 6
pts
An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0. The patient
goes to a clinic for INR determination, and the result is 1.4. Which of the following would be likely to
decrease the effects of warfarin (Coumadin)?
Red Wine
Red meat
Correct!
Broccoli
Grapefruit
It’s important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist, and
therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K. Leafy green
vegetables such as broccoli and spinach are notorious for increasing vitamin K levels, and therefore
inhibiting the anticoagulation effect of warfarin. It’s also important to remember that with the direct oral
anticoagulants category, vitamin K is not affected, and therefore no dietary restrictions are required for
this class of medications such as apixaban, rivaroxaban, and edoxaban, which is a distinct benefit over
warfarin as noted above. Also, with warfarin it is important to remember that the effects are based on the
free drug, not the protein bound drug level, so patients who have considerable protein stores will require
more warfarin than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of lowering the
INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically causes warfarin levels
to rise through the CYP 450 system, and red wine causes the INR to increase by thinning the blood and
and red meat is not likely to have a considerable impact, although it might have some impact if the
protein stores are otherwise low prior to initiating the red meat in the diet. Broccoli is the only option that
has vitamin K and should be an obvious choice for this question.
Question 7
pts
A patient has been complaining of palpitations for the past week and presents to you at an urgent care
clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a hear rate of 122
beats per minute. What is your next order?
Administer 5mg of warfarin
, Correct!
Order a stat transthoracic (2D) echocardiogram and prepare the patient for transport to the closest appropriate hospital
for inpatient evaluation
A wearable monitor does not provide you with actionable information until it is read, and the patient is
already identified as being in atrial fibrillation. Warfarin without bridging will take several days to achieve
a therapeutic INR and without bridging (as it is not mentioned) would potentially increase prothrombotic
state for first few days due to inhibition of protein C and S. Amiodarone is a rhythm conversion
medication and should not be given unless first identifying any evidence of clot burden with an
echocardiogram.
Apply a Holter monitor
Administer 150mg of amiodarone IV bolus
Question 8
pts
As the nurse practitioner working in a primary care clinic, you have been notified from a hospitalist that
your long-term patient with a history of HFrEF (heart failure with reduced ejection fraction) with an
ejection fraction of 40% two years ago who is also not on optimal medical therapy has been diagnosed
with a myocardial infarction this admission and received emergent placement of a drug-eluting stent to
the left anterior descending artery. As the patient’s medical home who will manage this patient after
discharge, which of the following would you expect to be a priority in the patient’s care for their heart
failure after an acute MI?
Ordering a Holter monitor for 7 days post-discharge
Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than 45%
Ordering aspirin and clopidogrel for 3 months at discharge
Correct!
Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Dual anti-platelet therapy is required for 12 months minimum post-MI. A Holter monitor does not provide
any conceivable benefit for this patient as presented. The patient should have a protective mechanism
such as an implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than
35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not
eligible for 90 days for an AICD in this state, optimizing their medication regimen and repeating an echo
in 2-3 months to re-evaluate for improvement in their EF is required by most insurance companies. A
baseline echo is needed at discharge to provide a baseline for improvement vs their repeat echo in 2-3
months.
FINAL CLASS LATEST REVISED EDITION 2026
Question 1
pts
Effective long-term treatment of systolic heart failure with reduced ejection fraction should include which
of the following?
Correct!
Prescribing valsartan/sacubitril (Entresto) unless contraindicated on discharge
Angiotensin Receptor and Neprilysin Inhibition is considered goal-directed therapy for patients with
reduced systolic heart function as evidence by the PARAGON-HF Trial. Auscultation is an assessment
item, not a treatment. Midazolam does not have any long term benefit for heart failure. Fluid bolus in a
patient with likely fluid overload from systolic heart failure only worsen their presenting symptoms.
Prescribing 500 ml fluid bolus for hypotension
Auscultating lung sounds for rhonchi
Prescribing midazolam to aid with air hunger
Question 2
pts
A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and shortness of
breath. His ECG shows ST-segment elevation. What is the initial management response?
Administer nitroglycerin sublingually
Start intravenous heparin
, Perform immediate coronary angiography
Correct!
Administer aspirin and call for emergency medical services
Question 3
pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-onset unilateral leg pain and
pallor. What is the most likely diagnosis?
You Answered
Deep vein thrombosis
Correct Answer
Acute arterial occlusion
Cellulitis
Peripheral artery disease
Question 4
pts
An older adult female presents for her annual examination. She has been on antihypertensive
medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse
practitioner is concerned about the patient’s cardiac health risks, due her to weight and her waist
circumference. According to the AHA guidelines, which of the following goals is expected for this patient?
Physical activity for 60 minutes daily, 7 days a week
Correct!
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 30 minutes daily, 7 days a week
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Question 5
pts
Recommendation for lipid check in adolescent with type 1 DM?
10 years
5 years
2 years
Correct!
1 year
,Remember than with pediatric patients with diabetes, the easiest way to remember the evaluation
schedule is to perform lipid checks is with annual physicals.
Question 6
pts
An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0. The patient
goes to a clinic for INR determination, and the result is 1.4. Which of the following would be likely to
decrease the effects of warfarin (Coumadin)?
Red Wine
Red meat
Correct!
Broccoli
Grapefruit
It’s important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist, and
therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K. Leafy green
vegetables such as broccoli and spinach are notorious for increasing vitamin K levels, and therefore
inhibiting the anticoagulation effect of warfarin. It’s also important to remember that with the direct oral
anticoagulants category, vitamin K is not affected, and therefore no dietary restrictions are required for
this class of medications such as apixaban, rivaroxaban, and edoxaban, which is a distinct benefit over
warfarin as noted above. Also, with warfarin it is important to remember that the effects are based on the
free drug, not the protein bound drug level, so patients who have considerable protein stores will require
more warfarin than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of lowering the
INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically causes warfarin levels
to rise through the CYP 450 system, and red wine causes the INR to increase by thinning the blood and
and red meat is not likely to have a considerable impact, although it might have some impact if the
protein stores are otherwise low prior to initiating the red meat in the diet. Broccoli is the only option that
has vitamin K and should be an obvious choice for this question.
Question 7
pts
A patient has been complaining of palpitations for the past week and presents to you at an urgent care
clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a hear rate of 122
beats per minute. What is your next order?
Administer 5mg of warfarin
, Correct!
Order a stat transthoracic (2D) echocardiogram and prepare the patient for transport to the closest appropriate hospital
for inpatient evaluation
A wearable monitor does not provide you with actionable information until it is read, and the patient is
already identified as being in atrial fibrillation. Warfarin without bridging will take several days to achieve
a therapeutic INR and without bridging (as it is not mentioned) would potentially increase prothrombotic
state for first few days due to inhibition of protein C and S. Amiodarone is a rhythm conversion
medication and should not be given unless first identifying any evidence of clot burden with an
echocardiogram.
Apply a Holter monitor
Administer 150mg of amiodarone IV bolus
Question 8
pts
As the nurse practitioner working in a primary care clinic, you have been notified from a hospitalist that
your long-term patient with a history of HFrEF (heart failure with reduced ejection fraction) with an
ejection fraction of 40% two years ago who is also not on optimal medical therapy has been diagnosed
with a myocardial infarction this admission and received emergent placement of a drug-eluting stent to
the left anterior descending artery. As the patient’s medical home who will manage this patient after
discharge, which of the following would you expect to be a priority in the patient’s care for their heart
failure after an acute MI?
Ordering a Holter monitor for 7 days post-discharge
Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than 45%
Ordering aspirin and clopidogrel for 3 months at discharge
Correct!
Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Dual anti-platelet therapy is required for 12 months minimum post-MI. A Holter monitor does not provide
any conceivable benefit for this patient as presented. The patient should have a protective mechanism
such as an implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than
35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not
eligible for 90 days for an AICD in this state, optimizing their medication regimen and repeating an echo
in 2-3 months to re-evaluate for improvement in their EF is required by most insurance companies. A
baseline echo is needed at discharge to provide a baseline for improvement vs their repeat echo in 2-3
months.
