Fitz, Dunphy, Leik; Exam 2 fnp 2- CARDIAC Exam with
Verified Rationales Practice Questions and Answers
2026 with complete solution
FNP EXAM 2 – CARDIAC
(Fitzgerald • Dunphy • Leik • Barkley Style)
A 62-year-old man presents with exertional chest pain relieved by rest. ECG is normal at rest. Best initial
diagnostic test?
A. Coronary angiography
B. Cardiac MRI
C. Exercise stress test
D. CT coronary calcium score
✅ Correct Answer: C
Explanation
Stable angina with interpretable ECG → exercise stress test is first-line.
• Angiography = invasive
• Calcium score = risk stratification, not diagnosis
• MRI = not first-line
Pearl:
If patient can exercise + normal baseline ECG → treadmill stress test
Which murmur increases with Valsalva maneuver?
,A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Ventricular septal defect
✅ Correct Answer: C
Explanation
Valsalva ↓ preload → worsens HCM obstruction, increasing murmur.
Trap:
Most murmurs decrease with Valsalva—HCM gets louder
A patient with atrial fibrillation and CHA₂DS₂-VASc score of 3 should receive:
A. Aspirin
B. No therapy
C. Anticoagulation
D. Dual antiplatelet therapy
✅ Correct Answer: C
Explanation
CHA₂DS₂-VASc ≥2 → oral anticoagulation required (DOAC or warfarin).
Pearl:
Aspirin is NOT adequate stroke prevention in AF.
Which medication is contraindicated in heart failure with reduced EF?
A. ACE inhibitor
B. Spironolactone
C. Metoprolol succinate
D. Diltiazem
✅ Correct Answer: D
Explanation
Non-dihydropyridine CCBs (verapamil, diltiazem) ↓ contractility.
Boards love this contraindication
Best initial treatment for acute pulmonary edema?
,A. IV fluids
B. Oral beta-blocker
C. IV furosemide
D. Digoxin
✅ Correct Answer: C
Explanation
Pulmonary edema = volume overload → IV loop diuretics
Clinical priority: Reduce preload FAST
Classic ECG finding of acute pericarditis?
A. ST elevation in one coronary territory
B. Diffuse ST elevation + PR depression
C. Q waves
D. T-wave inversion only
✅ Correct Answer: B
Explanation
Pericarditis → diffuse ST elevation, PR depression.
Key distinction from MI: ST changes are global
Which BP medication is preferred in diabetic patients?
A. Thiazide
B. ACE inhibitor
C. Beta-blocker
D. Alpha-blocker
✅ Correct Answer: B
Explanation
ACE inhibitors protect kidneys by reducing intraglomerular pressure.
Board favorite comorbidity pairing
Which finding confirms heart failure with preserved EF (HFpEF)?
A. EF < 40%
B. S3 gallop
, C. Diastolic dysfunction on echo
D. Dilated cardiomyopathy
✅ Correct Answer: C
Explanation
HFpEF = diastolic dysfunction with normal EF
Common in: elderly, women, HTN
First-line rate control for stable atrial fibrillation?
A. Amiodarone
B. Digoxin
C. Beta-blocker
D. Cardioversion
✅ Correct Answer: C
Explanation
Stable AF → rate control with beta-blocker or non-DHP CCB.
Which symptom is most specific for aortic stenosis?
A. Orthopnea
B. Syncope on exertion
C. Palpitations
D. Edema
✅ Correct Answer: B
Explanation
Classic AS triad:
• Syncope
• Angina
• Dyspnea
Mnemonic: SAD
A patient presents with tearing chest pain radiating to the back. Best next step?
Verified Rationales Practice Questions and Answers
2026 with complete solution
FNP EXAM 2 – CARDIAC
(Fitzgerald • Dunphy • Leik • Barkley Style)
A 62-year-old man presents with exertional chest pain relieved by rest. ECG is normal at rest. Best initial
diagnostic test?
A. Coronary angiography
B. Cardiac MRI
C. Exercise stress test
D. CT coronary calcium score
✅ Correct Answer: C
Explanation
Stable angina with interpretable ECG → exercise stress test is first-line.
• Angiography = invasive
• Calcium score = risk stratification, not diagnosis
• MRI = not first-line
Pearl:
If patient can exercise + normal baseline ECG → treadmill stress test
Which murmur increases with Valsalva maneuver?
,A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Ventricular septal defect
✅ Correct Answer: C
Explanation
Valsalva ↓ preload → worsens HCM obstruction, increasing murmur.
Trap:
Most murmurs decrease with Valsalva—HCM gets louder
A patient with atrial fibrillation and CHA₂DS₂-VASc score of 3 should receive:
A. Aspirin
B. No therapy
C. Anticoagulation
D. Dual antiplatelet therapy
✅ Correct Answer: C
Explanation
CHA₂DS₂-VASc ≥2 → oral anticoagulation required (DOAC or warfarin).
Pearl:
Aspirin is NOT adequate stroke prevention in AF.
Which medication is contraindicated in heart failure with reduced EF?
A. ACE inhibitor
B. Spironolactone
C. Metoprolol succinate
D. Diltiazem
✅ Correct Answer: D
Explanation
Non-dihydropyridine CCBs (verapamil, diltiazem) ↓ contractility.
Boards love this contraindication
Best initial treatment for acute pulmonary edema?
,A. IV fluids
B. Oral beta-blocker
C. IV furosemide
D. Digoxin
✅ Correct Answer: C
Explanation
Pulmonary edema = volume overload → IV loop diuretics
Clinical priority: Reduce preload FAST
Classic ECG finding of acute pericarditis?
A. ST elevation in one coronary territory
B. Diffuse ST elevation + PR depression
C. Q waves
D. T-wave inversion only
✅ Correct Answer: B
Explanation
Pericarditis → diffuse ST elevation, PR depression.
Key distinction from MI: ST changes are global
Which BP medication is preferred in diabetic patients?
A. Thiazide
B. ACE inhibitor
C. Beta-blocker
D. Alpha-blocker
✅ Correct Answer: B
Explanation
ACE inhibitors protect kidneys by reducing intraglomerular pressure.
Board favorite comorbidity pairing
Which finding confirms heart failure with preserved EF (HFpEF)?
A. EF < 40%
B. S3 gallop
, C. Diastolic dysfunction on echo
D. Dilated cardiomyopathy
✅ Correct Answer: C
Explanation
HFpEF = diastolic dysfunction with normal EF
Common in: elderly, women, HTN
First-line rate control for stable atrial fibrillation?
A. Amiodarone
B. Digoxin
C. Beta-blocker
D. Cardioversion
✅ Correct Answer: C
Explanation
Stable AF → rate control with beta-blocker or non-DHP CCB.
Which symptom is most specific for aortic stenosis?
A. Orthopnea
B. Syncope on exertion
C. Palpitations
D. Edema
✅ Correct Answer: B
Explanation
Classic AS triad:
• Syncope
• Angina
• Dyspnea
Mnemonic: SAD
A patient presents with tearing chest pain radiating to the back. Best next step?
