LEIK FNP Exam Practice Questions
(2026) – 600+ Questions, Answers &
Detailed Rationales for Family Nurse
Practitioner Board Exam Prep (PDF)
SECTION 1: ASSESSMENT & DIAGNOSIS – CARDIOLOGY
Question 1
A 72-year-old male presents for a routine physical. On cardiac auscultation, you hear a harsh, systolic
crescendo-decrescendo murmur best heard at the 2nd intercostal space, right sternal border, radiating
to the carotids. What is the most likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Pulmonic stenosis
D) Ventricular septal defect
Correct Answer: B) Aortic stenosis
Rationale: Aortic stenosis (AS) produces a harsh, systolic ejection murmur best heard at the right upper
sternal border (2nd ICS) that radiates to the carotids. This is a classic "Leik Pearl" for AS, often caused by
calcific degeneration in older adults. Aortic stenosis presents with the triad of syncope, angina, and heart
failure. Mitral regurgitation is best heard at the apex with radiation to the axilla; pulmonic stenosis is at
the left upper sternal border; VSD is at the left lower sternal border.
Question 2
A 68-year-old patient with hypertension is on hydrochlorothiazide 12.5 mg daily. At today's visit, BP is
168/96. The patient reports increased use of ibuprofen 800 mg TID for hip and knee pain. Which
statement best explains the effect of ibuprofen on her blood pressure?
A) Ibuprofen causes sodium and water retention, reducing the effectiveness of the thiazide diuretic
B) Ibuprofen directly stimulates the renin-angiotensin-aldosterone system
C) Ibuprofen increases cardiac output and heart rate
D) Ibuprofen has no effect on blood pressure when taken with a diuretic
Correct Answer: A) Ibuprofen causes sodium and water retention, reducing the effectiveness of the
thiazide diuretic
,Rationale: NSAIDs inhibit prostaglandin synthesis, leading to sodium and water retention. This blunts the
effectiveness of diuretics and antihypertensives. The patient's Stage II hypertension (≥140/90) is likely
exacerbated by NSAID use, which reduces the efficacy of the hydrochlorothiazide. NSAIDs should be
used with caution in patients with hypertension.
Question 3
An ECG shows absence of P-waves with irregularly irregular R-R intervals. What is the most likely
rhythm?
A) Atrial flutter
B) Atrial fibrillation
C) Sinus arrhythmia
D) Multifocal atrial tachycardia
Correct Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by the absence of discernible P-waves and an irregularly
irregular ventricular response. In Afib, the atria quiver rather than contract, leading to a lack of organized
atrial depolarization. Atrial flutter presents with "sawtooth" flutter waves (F-waves). Sinus arrhythmia
has normal P-waves with variation in R-R intervals; multifocal atrial tachycardia has at least three
different P-wave morphologies.
Question 4
Which heart sound is considered a normal finding in a pregnant woman or a well-trained athlete?
A) S1
B) S2
C) S3
D) S4
Correct Answer: C) S3
Rationale: An S3 (ventricular gallop) is often physiological in high-output states such as pregnancy, fever,
or in well-trained athletes due to increased venous return and rapid ventricular filling. However, an S3 is
pathological (fluid overload) in older adults and indicates heart failure. S4 is always pathological and
suggests a stiff, non-compliant ventricle.
Question 5
Which heart murmur is best heard at the apex with the patient in the left lateral decubitus position?
A) Aortic stenosis
B) Pulmonic stenosis
,C) Mitral stenosis
D) Tricuspid regurgitation
Correct Answer: C) Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble best heard at the apex. The left
lateral decubitus position brings the left atrium and ventricle closer to the chest wall, enhancing the
murmur. This is a classic exam pearl. Aortic stenosis is at RUSB; pulmonic stenosis is at LUSB; tricuspid
regurgitation is at the left lower sternal border.
Question 6
A 55-year-old patient with a 10-year history of hypertension presents with an elevated blood pressure.
Under current AHA/ACC guidelines, what BP range defines Stage 1 hypertension?
A) 120--89 mmHg
B) 130--89 mmHg
C) 140--99 mmHg
D) 160--109 mmHg
Correct Answer: B) 130--89 mmHg
Rationale: Under the 2017 AHA/ACC guidelines, Stage 1 hypertension is defined as systolic BP 130-139
mmHg or diastolic BP 80-89 mmHg. Normal BP is <120/80; Elevated is 120-129/<80; Stage 2 is ≥140/90.
This classification is important for risk stratification and initiating treatment in high-risk patients.
Question 7
What is the first-line antibiotic for a healthy adult with Community-Acquired Pneumonia (CAP) and no
comorbidities?
A) Azithromycin
B) Levofloxacin
C) High-dose Amoxicillin or Doxycycline
D) Cephalexin
Correct Answer: C) High-dose Amoxicillin (1g TID) or Doxycycline
Rationale: Per 2026 guidelines, for low-risk outpatients with no comorbidities, high-dose amoxicillin (1g
three times daily) or doxycycline are preferred monotherapies. Macrolides (azithromycin) are reserved
for patients with comorbidities or risk factors for drug-resistant pathogens. Levofloxacin is a
fluoroquinolone reserved for more severe cases.
Question 8
, A 75-year-old patient with heart failure presents with shortness of breath and lower extremity edema.
Which medication class provides significant cardio-renal protection and reduces heart failure
hospitalizations in patients with diabetes?
A) Metformin
B) GLP-1 receptor agonists
C) SGLT2 inhibitors
D) Thiazolidinediones
Correct Answer: C) SGLT2 inhibitors
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) provide significant cardio-renal protection and
reduce heart failure hospitalizations. They are preferred in patients with type 2 diabetes and heart
failure. Metformin is first-line for diabetes but does not have the same heart failure benefit; GLP-1
agonists are cardioprotective but SGLT2 inhibitors have stronger data for heart failure.
SECTION 2: ENDOCRINE & METABOLIC DISORDERS
Question 9
A patient with type 2 diabetes has the following labs: HbA1c 8.5%, eGFR 35 mL/min/1.73m². What is the
most appropriate change to the medication regimen?
A) Continue metformin and add insulin
B) Discontinue metformin and start an SGLT2 inhibitor
C) Discontinue metformin due to contraindication and start an alternative agent
D) Increase metformin dose
Correct Answer: C) Discontinue metformin due to contraindication and start an alternative agent
Rationale: Metformin is contraindicated when eGFR <30 mL/min/1.73m² and should be used with
caution when eGFR is 30-45. At eGFR 35, metformin should be reduced or discontinued due to risk of
lactic acidosis. An SGLT2 inhibitor or insulin may be appropriate alternatives, depending on the clinical
scenario. SGLT2 inhibitors are preferred in patients with heart failure or CKD.
Question 10
A patient presents with moon face, buffalo hump, purple abdominal striae, and hypertension. What is
the most likely diagnosis?
A) Cushing's syndrome
B) Addison's disease
C) Hyperthyroidism
D) Acromegaly
Correct Answer: A) Cushing's syndrome
(2026) – 600+ Questions, Answers &
Detailed Rationales for Family Nurse
Practitioner Board Exam Prep (PDF)
SECTION 1: ASSESSMENT & DIAGNOSIS – CARDIOLOGY
Question 1
A 72-year-old male presents for a routine physical. On cardiac auscultation, you hear a harsh, systolic
crescendo-decrescendo murmur best heard at the 2nd intercostal space, right sternal border, radiating
to the carotids. What is the most likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Pulmonic stenosis
D) Ventricular septal defect
Correct Answer: B) Aortic stenosis
Rationale: Aortic stenosis (AS) produces a harsh, systolic ejection murmur best heard at the right upper
sternal border (2nd ICS) that radiates to the carotids. This is a classic "Leik Pearl" for AS, often caused by
calcific degeneration in older adults. Aortic stenosis presents with the triad of syncope, angina, and heart
failure. Mitral regurgitation is best heard at the apex with radiation to the axilla; pulmonic stenosis is at
the left upper sternal border; VSD is at the left lower sternal border.
Question 2
A 68-year-old patient with hypertension is on hydrochlorothiazide 12.5 mg daily. At today's visit, BP is
168/96. The patient reports increased use of ibuprofen 800 mg TID for hip and knee pain. Which
statement best explains the effect of ibuprofen on her blood pressure?
A) Ibuprofen causes sodium and water retention, reducing the effectiveness of the thiazide diuretic
B) Ibuprofen directly stimulates the renin-angiotensin-aldosterone system
C) Ibuprofen increases cardiac output and heart rate
D) Ibuprofen has no effect on blood pressure when taken with a diuretic
Correct Answer: A) Ibuprofen causes sodium and water retention, reducing the effectiveness of the
thiazide diuretic
,Rationale: NSAIDs inhibit prostaglandin synthesis, leading to sodium and water retention. This blunts the
effectiveness of diuretics and antihypertensives. The patient's Stage II hypertension (≥140/90) is likely
exacerbated by NSAID use, which reduces the efficacy of the hydrochlorothiazide. NSAIDs should be
used with caution in patients with hypertension.
Question 3
An ECG shows absence of P-waves with irregularly irregular R-R intervals. What is the most likely
rhythm?
A) Atrial flutter
B) Atrial fibrillation
C) Sinus arrhythmia
D) Multifocal atrial tachycardia
Correct Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by the absence of discernible P-waves and an irregularly
irregular ventricular response. In Afib, the atria quiver rather than contract, leading to a lack of organized
atrial depolarization. Atrial flutter presents with "sawtooth" flutter waves (F-waves). Sinus arrhythmia
has normal P-waves with variation in R-R intervals; multifocal atrial tachycardia has at least three
different P-wave morphologies.
Question 4
Which heart sound is considered a normal finding in a pregnant woman or a well-trained athlete?
A) S1
B) S2
C) S3
D) S4
Correct Answer: C) S3
Rationale: An S3 (ventricular gallop) is often physiological in high-output states such as pregnancy, fever,
or in well-trained athletes due to increased venous return and rapid ventricular filling. However, an S3 is
pathological (fluid overload) in older adults and indicates heart failure. S4 is always pathological and
suggests a stiff, non-compliant ventricle.
Question 5
Which heart murmur is best heard at the apex with the patient in the left lateral decubitus position?
A) Aortic stenosis
B) Pulmonic stenosis
,C) Mitral stenosis
D) Tricuspid regurgitation
Correct Answer: C) Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble best heard at the apex. The left
lateral decubitus position brings the left atrium and ventricle closer to the chest wall, enhancing the
murmur. This is a classic exam pearl. Aortic stenosis is at RUSB; pulmonic stenosis is at LUSB; tricuspid
regurgitation is at the left lower sternal border.
Question 6
A 55-year-old patient with a 10-year history of hypertension presents with an elevated blood pressure.
Under current AHA/ACC guidelines, what BP range defines Stage 1 hypertension?
A) 120--89 mmHg
B) 130--89 mmHg
C) 140--99 mmHg
D) 160--109 mmHg
Correct Answer: B) 130--89 mmHg
Rationale: Under the 2017 AHA/ACC guidelines, Stage 1 hypertension is defined as systolic BP 130-139
mmHg or diastolic BP 80-89 mmHg. Normal BP is <120/80; Elevated is 120-129/<80; Stage 2 is ≥140/90.
This classification is important for risk stratification and initiating treatment in high-risk patients.
Question 7
What is the first-line antibiotic for a healthy adult with Community-Acquired Pneumonia (CAP) and no
comorbidities?
A) Azithromycin
B) Levofloxacin
C) High-dose Amoxicillin or Doxycycline
D) Cephalexin
Correct Answer: C) High-dose Amoxicillin (1g TID) or Doxycycline
Rationale: Per 2026 guidelines, for low-risk outpatients with no comorbidities, high-dose amoxicillin (1g
three times daily) or doxycycline are preferred monotherapies. Macrolides (azithromycin) are reserved
for patients with comorbidities or risk factors for drug-resistant pathogens. Levofloxacin is a
fluoroquinolone reserved for more severe cases.
Question 8
, A 75-year-old patient with heart failure presents with shortness of breath and lower extremity edema.
Which medication class provides significant cardio-renal protection and reduces heart failure
hospitalizations in patients with diabetes?
A) Metformin
B) GLP-1 receptor agonists
C) SGLT2 inhibitors
D) Thiazolidinediones
Correct Answer: C) SGLT2 inhibitors
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) provide significant cardio-renal protection and
reduce heart failure hospitalizations. They are preferred in patients with type 2 diabetes and heart
failure. Metformin is first-line for diabetes but does not have the same heart failure benefit; GLP-1
agonists are cardioprotective but SGLT2 inhibitors have stronger data for heart failure.
SECTION 2: ENDOCRINE & METABOLIC DISORDERS
Question 9
A patient with type 2 diabetes has the following labs: HbA1c 8.5%, eGFR 35 mL/min/1.73m². What is the
most appropriate change to the medication regimen?
A) Continue metformin and add insulin
B) Discontinue metformin and start an SGLT2 inhibitor
C) Discontinue metformin due to contraindication and start an alternative agent
D) Increase metformin dose
Correct Answer: C) Discontinue metformin due to contraindication and start an alternative agent
Rationale: Metformin is contraindicated when eGFR <30 mL/min/1.73m² and should be used with
caution when eGFR is 30-45. At eGFR 35, metformin should be reduced or discontinued due to risk of
lactic acidosis. An SGLT2 inhibitor or insulin may be appropriate alternatives, depending on the clinical
scenario. SGLT2 inhibitors are preferred in patients with heart failure or CKD.
Question 10
A patient presents with moon face, buffalo hump, purple abdominal striae, and hypertension. What is
the most likely diagnosis?
A) Cushing's syndrome
B) Addison's disease
C) Hyperthyroidism
D) Acromegaly
Correct Answer: A) Cushing's syndrome
