FNP Certification Review Mega Test Bank – 150
Questions with Answers And Rationales (A-Grade)
2025/2026
1. A 62-year-old man presents with exertional chest pain relieved by
rest. Which is the most appropriate initial diagnostic test?
A. Exercise ECG
B. Resting ECG
C. Cardiac MRI
D. Coronary angiography
Rationale: A resting ECG is the first-line initial test to evaluate
chest pain; exercise ECG is used if resting ECG is non-diagnostic
and patient can exercise.
2. Which medication is first-line for chronic stable angina
prevention?
A. Nifedipine
B. Hydralazine
C. Beta-blocker (e.g., metoprolol)
D. Verapamil
Rationale: Beta-blockers reduce myocardial oxygen demand and
are first-line for chronic stable angina unless contraindicated.
3. A 55-year-old with HTN has initial BP 150/92. Which lifestyle
change most likely reduces systolic BP the most?
A. Increased calcium intake
B. Moderate caffeine restriction
C. Weight loss of 10 kg
D. Vitamin D supplementation
Rationale: Weight loss has the largest effect on systolic BP per
unit change compared with other lifestyle modifications.
,4. First-line antihypertensive for a nonpregnant Black adult without
CKD?
A. ACE inhibitor
B. Thiazide diuretic or CCB
C. Beta-blocker
D. Aldosterone antagonist
Rationale: Guidelines recommend thiazide-type diuretics or CCBs
for Black adults as initial therapy for hypertension.
5. Which lab abnormality suggests primary hyperaldosteronism?
A. High potassium
B. Hypokalemia with metabolic alkalosis
C. Hyponatremia
D. Elevated TSH
Rationale: Excess aldosterone causes sodium retention and
potassium loss leading to hypokalemia and metabolic alkalosis.
6. A 45-year-old with new atrial fibrillation — what anticoagulation
is preferred for nonvalvular AF?
A. Aspirin only
B. Warfarin only
C. Direct oral anticoagulant (e.g., apixaban)
D. No anticoagulation if asymptomatic
Rationale: DOACs are preferred over warfarin for most patients
with nonvalvular AF due to similar or better efficacy and lower
bleeding risk.
7. Most appropriate treatment for acute otitis media in a 3-year-old
with fever and ear pain?
A. Observation only
B. Amoxicillin
C. Azithromycin
, D. Ceftriaxone IM routinely
Rationale: Amoxicillin is first-line for uncomplicated acute otitis
media unless recent antibiotics or allergy; observation may be
considered in select cases.
8. A 28-year-old female with dysmenorrhea and painful
intercourse—best next step?
A. Immediate hysterectomy
B. Evaluate for endometriosis (history, pelvic exam, consider
laparoscopy)
C. Start OCPs without evaluation
D. Start NSAIDs only
Rationale: Suspected endometriosis warrants focused
evaluation; empiric treatment with OCPs/NSAIDs can be used,
but diagnosis often requires further assessment.
9. Screening mammography should generally begin at what age for
average-risk women per common guidelines?
A. 30
B. 40
C. 40–50 depending on guideline; commonly begin at 40–50
D. 60
Rationale: Guidelines vary; many organizations recommend
starting at 40 or 50 with individualized decisions about earlier
screening.
10. A patient with type 2 diabetes and eGFR 45 mL/min/1.73m²
— which medication class is recommended for CV and renal
benefit?
A. DPP-4 inhibitors
B. Sulfonylureas
C. SGLT2 inhibitors (if eGFR adequate)
, D. Insulin only
Rationale: SGLT2 inhibitors provide cardiovascular and renal
protection; suitability depends on eGFR thresholds, but many are
recommended down to certain eGFR limits.
11. Best initial test to evaluate suspected hypothyroidism?
A. T3 level
B. TSH level
C. Free T4 only
D. Thyroid ultrasound
Rationale: TSH is the most sensitive initial test for primary
thyroid disease; reflex free T4 if TSH abnormal.
12. A patient with sudden unilateral leg swelling and pain —
most appropriate diagnostic test?
A. D-dimer only
B. Plain X-ray
C. Compression venous duplex ultrasound
D. MRI pelvis
Rationale: Duplex venous ultrasound is the preferred initial
imaging for suspected DVT.
13. For COPD maintenance therapy in a patient with moderate
symptoms and frequent exacerbations, which is recommended?
A. Short-acting beta agonist alone
B. Long-acting bronchodilator (LABA or LAMA), possibly
combined
C. Inhaled antibiotics
D. Oral steroids daily
Rationale: Long-acting bronchodilators are mainstay
maintenance therapy; inhaled corticosteroids considered for
specific phenotypes.
Questions with Answers And Rationales (A-Grade)
2025/2026
1. A 62-year-old man presents with exertional chest pain relieved by
rest. Which is the most appropriate initial diagnostic test?
A. Exercise ECG
B. Resting ECG
C. Cardiac MRI
D. Coronary angiography
Rationale: A resting ECG is the first-line initial test to evaluate
chest pain; exercise ECG is used if resting ECG is non-diagnostic
and patient can exercise.
2. Which medication is first-line for chronic stable angina
prevention?
A. Nifedipine
B. Hydralazine
C. Beta-blocker (e.g., metoprolol)
D. Verapamil
Rationale: Beta-blockers reduce myocardial oxygen demand and
are first-line for chronic stable angina unless contraindicated.
3. A 55-year-old with HTN has initial BP 150/92. Which lifestyle
change most likely reduces systolic BP the most?
A. Increased calcium intake
B. Moderate caffeine restriction
C. Weight loss of 10 kg
D. Vitamin D supplementation
Rationale: Weight loss has the largest effect on systolic BP per
unit change compared with other lifestyle modifications.
,4. First-line antihypertensive for a nonpregnant Black adult without
CKD?
A. ACE inhibitor
B. Thiazide diuretic or CCB
C. Beta-blocker
D. Aldosterone antagonist
Rationale: Guidelines recommend thiazide-type diuretics or CCBs
for Black adults as initial therapy for hypertension.
5. Which lab abnormality suggests primary hyperaldosteronism?
A. High potassium
B. Hypokalemia with metabolic alkalosis
C. Hyponatremia
D. Elevated TSH
Rationale: Excess aldosterone causes sodium retention and
potassium loss leading to hypokalemia and metabolic alkalosis.
6. A 45-year-old with new atrial fibrillation — what anticoagulation
is preferred for nonvalvular AF?
A. Aspirin only
B. Warfarin only
C. Direct oral anticoagulant (e.g., apixaban)
D. No anticoagulation if asymptomatic
Rationale: DOACs are preferred over warfarin for most patients
with nonvalvular AF due to similar or better efficacy and lower
bleeding risk.
7. Most appropriate treatment for acute otitis media in a 3-year-old
with fever and ear pain?
A. Observation only
B. Amoxicillin
C. Azithromycin
, D. Ceftriaxone IM routinely
Rationale: Amoxicillin is first-line for uncomplicated acute otitis
media unless recent antibiotics or allergy; observation may be
considered in select cases.
8. A 28-year-old female with dysmenorrhea and painful
intercourse—best next step?
A. Immediate hysterectomy
B. Evaluate for endometriosis (history, pelvic exam, consider
laparoscopy)
C. Start OCPs without evaluation
D. Start NSAIDs only
Rationale: Suspected endometriosis warrants focused
evaluation; empiric treatment with OCPs/NSAIDs can be used,
but diagnosis often requires further assessment.
9. Screening mammography should generally begin at what age for
average-risk women per common guidelines?
A. 30
B. 40
C. 40–50 depending on guideline; commonly begin at 40–50
D. 60
Rationale: Guidelines vary; many organizations recommend
starting at 40 or 50 with individualized decisions about earlier
screening.
10. A patient with type 2 diabetes and eGFR 45 mL/min/1.73m²
— which medication class is recommended for CV and renal
benefit?
A. DPP-4 inhibitors
B. Sulfonylureas
C. SGLT2 inhibitors (if eGFR adequate)
, D. Insulin only
Rationale: SGLT2 inhibitors provide cardiovascular and renal
protection; suitability depends on eGFR thresholds, but many are
recommended down to certain eGFR limits.
11. Best initial test to evaluate suspected hypothyroidism?
A. T3 level
B. TSH level
C. Free T4 only
D. Thyroid ultrasound
Rationale: TSH is the most sensitive initial test for primary
thyroid disease; reflex free T4 if TSH abnormal.
12. A patient with sudden unilateral leg swelling and pain —
most appropriate diagnostic test?
A. D-dimer only
B. Plain X-ray
C. Compression venous duplex ultrasound
D. MRI pelvis
Rationale: Duplex venous ultrasound is the preferred initial
imaging for suspected DVT.
13. For COPD maintenance therapy in a patient with moderate
symptoms and frequent exacerbations, which is recommended?
A. Short-acting beta agonist alone
B. Long-acting bronchodilator (LABA or LAMA), possibly
combined
C. Inhaled antibiotics
D. Oral steroids daily
Rationale: Long-acting bronchodilators are mainstay
maintenance therapy; inhaled corticosteroids considered for
specific phenotypes.
