NR667 FNP Exam 5 — Comprehensive Practice
Question Bank (Verified Update)
Format: Question → Answer → Detailed Rationale | Complete
Verified Questions | Graded A+
SECTION 1: CARDIOVASCULAR (Questions)
1. A 62-year-old African American male, BP 156/96 x2 visits,
no CKD/DM, BMI 31, 10-year ASCVD 12%. What is the FNP's
first-line antihypertensive choice?
A) Lisinopril alone
B) Thiazide-type diuretic or dihydropyridine CCB
(chlorthalidone/amlodipine)
C) Beta-blocker atenolol
D) Clonidine
Correct Answer: B
Rationale: For Black adults with hypertension without CKD or
HF, thiazide diuretics or CCBs are first-line per JNC-8/AHA, with
superior stroke reduction. ACE inhibitors/ARBs are less effective
as monotherapy in this population.
2. A 60-year-old man with hypertension and diabetes presents
with sudden severe headache, blurred vision, and BP 200/110
,mmHg. The FNP should:
A) Start an oral ACE inhibitor and schedule follow-up in one
week
B) Refer the patient immediately to the emergency department
C) Order a stat CT scan and manage as outpatient
D) Recommend lifestyle modifications and recheck in 48 hours
Correct Answer: B
Rationale: This is a hypertensive emergency (BP ≥180/120
mmHg with acute target organ damage). Immediate IV
antihypertensive therapy in a controlled setting is required to
prevent stroke or renal failure.
3. A 58-year-old patient presents with a new onset of atrial
fibrillation. Which medication is considered first-line for rate
control?
A) Amiodarone
B) Metoprolol succinate
C) Flecainide
D) Digoxin
Correct Answer: B
Rationale: Beta-blockers such as metoprolol succinate are first-
line for rate control in atrial fibrillation.
4. A patient with a new onset rapid heart rate that is
irregularly irregular, HR 100, BP 120/74, respirations 16, SpO2
99%. This has been going on intermittently for a week, but for
,the past four days straight it hasn't stopped. First priority
intervention:
A) Immediate synchronized cardioversion
B) Maintain rate control and anticoagulation prior to rhythm
conversion
C) Administer adenosine 6 mg IV push
D) Start amiodarone infusion
Correct Answer: B
Rationale: For atrial fibrillation lasting >48 hours, rate control
and anticoagulation are priorities prior to rhythm conversion to
prevent thromboembolic events.
5. A 65-year-old alcoholic patient presents with new onset of
persistent palpitations and anxiety for the past 3 days.
Monitor shows irregularly irregular rhythm. Which
intervention should be performed first?
A) Ordering a BNP and Vitamin D level
B) Prescribing amiodarone 150mg IV bolus
C) Ordering a transthoracic echocardiogram
D) Palpating pulses bilaterally to identify unilateral pulse deficit
Correct Answer: D
Rationale: Palpating pulses bilaterally to identify a pulse deficit
is the first priority in assessing a patient with an irregularly
irregular rhythm to evaluate for hemodynamic compromise.
, 6. A "code blue" is called. Cardiac monitoring shows normal
sinus rhythm at 80, but no carotid pulse is palpable. What is
this rhythm called?
A) Idioventricular rhythm
B) Junctional tachycardia
C) Wandering atrial pacemaker
D) Pulseless electrical activity (PEA)
Correct Answer: D
Rationale: PEA appears as an organized rhythm without a
palpable pulse.
7. A 72-year-old with sudden severe tearing chest pain
radiating to the back. Diagnosis?
A) Acute MI
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: B
Rationale: Sudden severe tearing chest pain radiating to the
back is classic for aortic dissection. Emergency CT angiography
is required.
8. A 55-year-old with palpitations and irregularly irregular
pulse. ECG shows no P waves. Diagnosis?
A) Atrial flutter
B) Atrial fibrillation
Question Bank (Verified Update)
Format: Question → Answer → Detailed Rationale | Complete
Verified Questions | Graded A+
SECTION 1: CARDIOVASCULAR (Questions)
1. A 62-year-old African American male, BP 156/96 x2 visits,
no CKD/DM, BMI 31, 10-year ASCVD 12%. What is the FNP's
first-line antihypertensive choice?
A) Lisinopril alone
B) Thiazide-type diuretic or dihydropyridine CCB
(chlorthalidone/amlodipine)
C) Beta-blocker atenolol
D) Clonidine
Correct Answer: B
Rationale: For Black adults with hypertension without CKD or
HF, thiazide diuretics or CCBs are first-line per JNC-8/AHA, with
superior stroke reduction. ACE inhibitors/ARBs are less effective
as monotherapy in this population.
2. A 60-year-old man with hypertension and diabetes presents
with sudden severe headache, blurred vision, and BP 200/110
,mmHg. The FNP should:
A) Start an oral ACE inhibitor and schedule follow-up in one
week
B) Refer the patient immediately to the emergency department
C) Order a stat CT scan and manage as outpatient
D) Recommend lifestyle modifications and recheck in 48 hours
Correct Answer: B
Rationale: This is a hypertensive emergency (BP ≥180/120
mmHg with acute target organ damage). Immediate IV
antihypertensive therapy in a controlled setting is required to
prevent stroke or renal failure.
3. A 58-year-old patient presents with a new onset of atrial
fibrillation. Which medication is considered first-line for rate
control?
A) Amiodarone
B) Metoprolol succinate
C) Flecainide
D) Digoxin
Correct Answer: B
Rationale: Beta-blockers such as metoprolol succinate are first-
line for rate control in atrial fibrillation.
4. A patient with a new onset rapid heart rate that is
irregularly irregular, HR 100, BP 120/74, respirations 16, SpO2
99%. This has been going on intermittently for a week, but for
,the past four days straight it hasn't stopped. First priority
intervention:
A) Immediate synchronized cardioversion
B) Maintain rate control and anticoagulation prior to rhythm
conversion
C) Administer adenosine 6 mg IV push
D) Start amiodarone infusion
Correct Answer: B
Rationale: For atrial fibrillation lasting >48 hours, rate control
and anticoagulation are priorities prior to rhythm conversion to
prevent thromboembolic events.
5. A 65-year-old alcoholic patient presents with new onset of
persistent palpitations and anxiety for the past 3 days.
Monitor shows irregularly irregular rhythm. Which
intervention should be performed first?
A) Ordering a BNP and Vitamin D level
B) Prescribing amiodarone 150mg IV bolus
C) Ordering a transthoracic echocardiogram
D) Palpating pulses bilaterally to identify unilateral pulse deficit
Correct Answer: D
Rationale: Palpating pulses bilaterally to identify a pulse deficit
is the first priority in assessing a patient with an irregularly
irregular rhythm to evaluate for hemodynamic compromise.
, 6. A "code blue" is called. Cardiac monitoring shows normal
sinus rhythm at 80, but no carotid pulse is palpable. What is
this rhythm called?
A) Idioventricular rhythm
B) Junctional tachycardia
C) Wandering atrial pacemaker
D) Pulseless electrical activity (PEA)
Correct Answer: D
Rationale: PEA appears as an organized rhythm without a
palpable pulse.
7. A 72-year-old with sudden severe tearing chest pain
radiating to the back. Diagnosis?
A) Acute MI
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: B
Rationale: Sudden severe tearing chest pain radiating to the
back is classic for aortic dissection. Emergency CT angiography
is required.
8. A 55-year-old with palpitations and irregularly irregular
pulse. ECG shows no P waves. Diagnosis?
A) Atrial flutter
B) Atrial fibrillation
