AANP FNP Certification Exam:
100 Practice Questions and
Answer Explanations
Part One: Cardiovascular (1–15)
1. A 58-year-old male presents with new-onset substernal chest pain radiating to the left
arm, diaphoresis, and dyspnea. Troponin is elevated at 2.5 ng/mL, and ECG shows ST
elevation in the anterior leads. What is the most appropriate immediate management?
A. Administer aspirin 325 mg, clopidogrel 600 mg loading dose, and refer for percutaneous
coronary intervention (PCI)
B. Start intravenous nitroglycerin and schedule a stress test in 2 days
C. Discharge with sublingual nitroglycerin and schedule office follow-up in one week
D. Obtain CT angiography to rule out pulmonary embolism before treatment
Answer: A
Explanation: The patient presents with classic STEMI. Per ACLS and ACC/AHA standards,
STEMI requires emergent reperfusion via PCI combined with dual antiplatelet therapy
(aspirin and a P2Y12 inhibitor). Time to treatment is critical, with door-to-balloon time goals
of less than 90 minutes .
2. A 72-year-old woman with hypertension and atrial fibrillation presents with a new
systolic murmur heard best at the right upper sternal border that radiates to the carotid
arteries. She reports progressive dyspnea and fatigue. What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary stenosis
Answer: B
Explanation: Aortic stenosis produces a systolic ejection murmur at the right upper sternal
border with radiation to the carotids. Dyspnea and fatigue reflect the hemodynamic burden
of left ventricular outflow obstruction. It is common in older adults due to valve calcification
.
3. A 45-year-old man with uncontrolled hypertension (BP 160/100) is prescribed lisinopril
as monotherapy. He also takes metformin for type 2 diabetes. After 2 weeks, he reports a
persistent dry cough. What is the most appropriate management?
A. Continue lisinopril and add dextromethorphan for cough suppression
B. Discontinue lisinopril and switch to an angiotensin II receptor blocker (ARB)
,C. Reduce the lisinopril dose by half to minimize side effects
D. Add diphenhydramine to manage the cough while continuing lisinopril
Answer: B
Explanation: ACE inhibitor–induced dry cough occurs in approximately 5–20% of patients.
The most appropriate management is discontinuation of the ACE inhibitor and switching to
an ARB, which does not cause bradykinin-mediated cough .
4. A patient with heart failure has a potassium level of 3.1 mEq/L and is taking digoxin.
What is the priority action?
A. Administer digoxin as ordered
B. Hold digoxin and notify the provider
C. Administer potassium without holding digoxin
D. Increase the digoxin dose
Answer: B
Explanation: Hypokalemia increases the risk of digoxin toxicity and cardiac dysrhythmias.
The provider should be notified before administering digoxin.
5. A 72-year-old woman on hydrochlorothiazide for hypertension complains of hip and
knee pain. She has increased ibuprofen from 400 mg TID to 800 mg TID. What is the
concern?
A. Increased risk of GI bleeding and renal impairment
B. Improved pain control with no risks
C. Decreased antihypertensive effect
D. Increased potassium levels
Answer: A
Explanation: NSAIDs at high doses increase the risk of gastrointestinal bleeding and acute
kidney injury, especially in older adults.
6. Which of the following is a modifiable risk factor for coronary artery disease?
A. Family history
B. Age
C. Smoking
D. Male gender
Answer: C
Explanation: Smoking is a modifiable risk factor. Family history, age, and male gender are
non-modifiable.
7. A 65-year-old woman with a history of smoking and a mother who died of a heart attack
at age 40 has an LDL of 200 mg/dL. In addition to therapeutic lifestyle changes, what
should be initiated?
A. Bile acid sequestrant
B. Statin drug
C. Cholesterol absorption inhibitor
, D. Low-dose aspirin only
Answer: B
Explanation: The patient meets criteria for high-risk primary prevention. LDL ≥190 mg/dL
warrants high-intensity statin therapy per ACC/AHA guidelines. Statins are first-line
pharmacologic therapy for LDL reduction .
8. A patient presents with crushing chest pain and ST-elevation in leads II, III, and aVF.
What is the most likely diagnosis?
A. Anterior STEMI
B. Inferior STEMI
C. NSTEMI
D. Pericarditis
Answer: B
Explanation: ST-elevation in leads II, III, and aVF corresponds to the inferior myocardial wall.
9. A 68-year-old female presents with sudden-onset confusion and right-sided weakness.
CT shows ischemic stroke. Which therapy should be considered within the first 3 hours of
symptom onset?
A. Aspirin
B. Intravenous thrombolysis
C. Heparin
D. Statin therapy
Answer: B
Explanation: IV tPA is indicated for ischemic stroke within 3–4.5 hours of symptom onset if
no contraindications exist.
10. Which of the following is a risk factor for developing infective endocarditis?
A. Mitral valve prolapse with regurgitation
B. Hypertension
C. Asthma
D. Type 2 diabetes
Answer: A
Explanation: Valvular abnormalities, including MVP with regurgitation, predispose patients
to infective endocarditis.
11. A 24-year-old woman is found to have mitral valve prolapse (MVP). Which physical
exam finding is expected?
A. Pectus excavatum
B. Obesity
C. Petite stature
D. Hyperextensible joints
Answer: D
Explanation: MVP is associated with hyperextensible joints and scoliosis.
100 Practice Questions and
Answer Explanations
Part One: Cardiovascular (1–15)
1. A 58-year-old male presents with new-onset substernal chest pain radiating to the left
arm, diaphoresis, and dyspnea. Troponin is elevated at 2.5 ng/mL, and ECG shows ST
elevation in the anterior leads. What is the most appropriate immediate management?
A. Administer aspirin 325 mg, clopidogrel 600 mg loading dose, and refer for percutaneous
coronary intervention (PCI)
B. Start intravenous nitroglycerin and schedule a stress test in 2 days
C. Discharge with sublingual nitroglycerin and schedule office follow-up in one week
D. Obtain CT angiography to rule out pulmonary embolism before treatment
Answer: A
Explanation: The patient presents with classic STEMI. Per ACLS and ACC/AHA standards,
STEMI requires emergent reperfusion via PCI combined with dual antiplatelet therapy
(aspirin and a P2Y12 inhibitor). Time to treatment is critical, with door-to-balloon time goals
of less than 90 minutes .
2. A 72-year-old woman with hypertension and atrial fibrillation presents with a new
systolic murmur heard best at the right upper sternal border that radiates to the carotid
arteries. She reports progressive dyspnea and fatigue. What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary stenosis
Answer: B
Explanation: Aortic stenosis produces a systolic ejection murmur at the right upper sternal
border with radiation to the carotids. Dyspnea and fatigue reflect the hemodynamic burden
of left ventricular outflow obstruction. It is common in older adults due to valve calcification
.
3. A 45-year-old man with uncontrolled hypertension (BP 160/100) is prescribed lisinopril
as monotherapy. He also takes metformin for type 2 diabetes. After 2 weeks, he reports a
persistent dry cough. What is the most appropriate management?
A. Continue lisinopril and add dextromethorphan for cough suppression
B. Discontinue lisinopril and switch to an angiotensin II receptor blocker (ARB)
,C. Reduce the lisinopril dose by half to minimize side effects
D. Add diphenhydramine to manage the cough while continuing lisinopril
Answer: B
Explanation: ACE inhibitor–induced dry cough occurs in approximately 5–20% of patients.
The most appropriate management is discontinuation of the ACE inhibitor and switching to
an ARB, which does not cause bradykinin-mediated cough .
4. A patient with heart failure has a potassium level of 3.1 mEq/L and is taking digoxin.
What is the priority action?
A. Administer digoxin as ordered
B. Hold digoxin and notify the provider
C. Administer potassium without holding digoxin
D. Increase the digoxin dose
Answer: B
Explanation: Hypokalemia increases the risk of digoxin toxicity and cardiac dysrhythmias.
The provider should be notified before administering digoxin.
5. A 72-year-old woman on hydrochlorothiazide for hypertension complains of hip and
knee pain. She has increased ibuprofen from 400 mg TID to 800 mg TID. What is the
concern?
A. Increased risk of GI bleeding and renal impairment
B. Improved pain control with no risks
C. Decreased antihypertensive effect
D. Increased potassium levels
Answer: A
Explanation: NSAIDs at high doses increase the risk of gastrointestinal bleeding and acute
kidney injury, especially in older adults.
6. Which of the following is a modifiable risk factor for coronary artery disease?
A. Family history
B. Age
C. Smoking
D. Male gender
Answer: C
Explanation: Smoking is a modifiable risk factor. Family history, age, and male gender are
non-modifiable.
7. A 65-year-old woman with a history of smoking and a mother who died of a heart attack
at age 40 has an LDL of 200 mg/dL. In addition to therapeutic lifestyle changes, what
should be initiated?
A. Bile acid sequestrant
B. Statin drug
C. Cholesterol absorption inhibitor
, D. Low-dose aspirin only
Answer: B
Explanation: The patient meets criteria for high-risk primary prevention. LDL ≥190 mg/dL
warrants high-intensity statin therapy per ACC/AHA guidelines. Statins are first-line
pharmacologic therapy for LDL reduction .
8. A patient presents with crushing chest pain and ST-elevation in leads II, III, and aVF.
What is the most likely diagnosis?
A. Anterior STEMI
B. Inferior STEMI
C. NSTEMI
D. Pericarditis
Answer: B
Explanation: ST-elevation in leads II, III, and aVF corresponds to the inferior myocardial wall.
9. A 68-year-old female presents with sudden-onset confusion and right-sided weakness.
CT shows ischemic stroke. Which therapy should be considered within the first 3 hours of
symptom onset?
A. Aspirin
B. Intravenous thrombolysis
C. Heparin
D. Statin therapy
Answer: B
Explanation: IV tPA is indicated for ischemic stroke within 3–4.5 hours of symptom onset if
no contraindications exist.
10. Which of the following is a risk factor for developing infective endocarditis?
A. Mitral valve prolapse with regurgitation
B. Hypertension
C. Asthma
D. Type 2 diabetes
Answer: A
Explanation: Valvular abnormalities, including MVP with regurgitation, predispose patients
to infective endocarditis.
11. A 24-year-old woman is found to have mitral valve prolapse (MVP). Which physical
exam finding is expected?
A. Pectus excavatum
B. Obesity
C. Petite stature
D. Hyperextensible joints
Answer: D
Explanation: MVP is associated with hyperextensible joints and scoliosis.
