1
FNP Exam Review: Comprehensive NP Study Guide for
AANP Boards (PASS YOUR FIRST TIME!)
Q1 of 150
Cardiovascular
A 58-year-old male with hypertension, diabetes, and dyslipidemia presents with exertional chest
pressure radiating to the left arm, relieved by rest. ECG is normal at rest. What is the MOST appropriate
next step?
A. Start aspirin and nitroglycerin PRN
B. Order coronary CT angiography
C. Order exercise stress test
D. Refer immediately to emergency department
Rationale: Correct: Exercise stress test. Classic stable angina symptoms with normal resting ECG warrant
exercise stress testing to evaluate for inducible ischemia. Emergency referral is not indicated with stable,
predictable, exertional symptoms. CT angiography is used when stress testing is inconclusive. Starting
medication alone without workup would be inadequate.
Q2 of 150
Cardiovascular
A patient on warfarin for atrial fibrillation has an INR of 6.2 but no active bleeding. What is the most
appropriate management?
A. Hold warfarin and administer vitamin K 10 mg IV
B. Hold warfarin; administer oral vitamin K 2.5 mg
C. Administer fresh frozen plasma immediately
D. Hold warfarin only and recheck INR in 24–48 hours
Rationale: Correct: Hold warfarin + oral vitamin K 2.5 mg. For supratherapeutic INR >5 with no
significant bleeding, guidelines recommend holding warfarin and administering low-dose oral vitamin K.
IV vitamin K is reserved for serious or life-threatening bleeding. FFP is only indicated for urgent reversal.
Q3 of 150
Cardiovascular
pg. 1
,2
Which of the following ECG findings is MOST characteristic of Wolff-Parkinson-White syndrome?
A. Right bundle branch block pattern
B. Prolonged QTc interval with T-wave inversions
C. Short PR interval with delta wave and wide QRS
D. Prolonged PR interval with delta wave
Rationale: Correct: Short PR + delta wave + wide QRS. WPW is characterized by a short PR interval (<120
ms), slurred upstroke of the QRS (delta wave), and widened QRS complex due to ventricular pre-
excitation via the accessory pathway (Bundle of Kent).
Q4 of 150
Cardiovascular
A 72-year-old woman with heart failure (EF 35%) is already on lisinopril. Which additional medication
class has shown to reduce mortality in HFrEF?
A. Beta-blockers (carvedilol, metoprolol succinate, bisoprolol)
B. Calcium channel blockers (amlodipine)
C. Loop diuretics (furosemide)
D. Nitrates
Rationale: Correct: Beta-blockers. Three beta-blockers — carvedilol, metoprolol succinate, and
bisoprolol — have demonstrated mortality reduction in HFrEF in randomized trials. ACEi/ARB + BB +
MRA + SGLT2i form the four pillars of HFrEF therapy. Loop diuretics relieve symptoms but do not reduce
mortality. CCBs with negative inotropy (verapamil, diltiazem) are contraindicated in HFrEF.
Q5 of 150
Cardiovascular
A patient's blood pressure is consistently 148/94 mmHg on three separate visits. They have CKD with
proteinuria. Which antihypertensive is PREFERRED as first-line?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
Rationale: Correct: Lisinopril (ACE inhibitor). ACE inhibitors (or ARBs) are preferred first-line agents for
hypertension in patients with CKD and proteinuria due to their renoprotective effects — they reduce
intraglomerular pressure and slow progression of proteinuric CKD. Thiazides are less effective when GFR
<30.
pg. 2
,3
Q6 of 150
Cardiovascular
Which finding on physical exam is MOST specific for cardiac tamponade?
A. Kussmaul sign
B. Pulsus paradoxus >10 mmHg
C. S3 gallop
D. Pulsus alternans
Rationale: Correct: Pulsus paradoxus >10 mmHg. Pulsus paradoxus (exaggerated decrease in systolic BP
>10 mmHg during inspiration) is the hallmark of cardiac tamponade. Beck's triad (hypotension, muffled
heart sounds, JVD) is also classic. Kussmaul sign is seen in constrictive pericarditis. Pulsus alternans is
associated with severe LV dysfunction.
Q7 of 150
Cardiovascular
A 65-year-old male presents with sudden onset tearing chest pain radiating to his back. He has a history
of Marfan syndrome. BP is 160/90 in the right arm and 130/70 in the left arm. What is the MOST likely
diagnosis?
A. Aortic dissection
B. Pulmonary embolism
C. Acute pericarditis
D. STEMI
Rationale: Correct: Aortic dissection. Classic presentation: sudden tearing/ripping pain radiating to back,
Marfan syndrome (risk factor for medial cystic necrosis), and BP differential between arms (>20 mmHg is
suggestive). Immediate CT angiography of the chest is the diagnostic test of choice.
Q8 of 150
Cardiovascular
Lisinopril is discontinued in a patient who develops angioedema. Which antihypertensive class is
CONTRAINDICATED as a substitute?
A. ARBs (valsartan, losartan)
B. Calcium channel blockers
C. Beta-blockers
D. Thiazide diuretics
pg. 3
, 4
Rationale: Correct: ARBs are relatively contraindicated. ACE inhibitor-induced angioedema is bradykinin-
mediated. ARBs do not inhibit bradykinin degradation but ~10–15% cross-reactivity risk exists. Most
guidelines state ARBs can be used cautiously with informed consent in patients who absolutely need
RAAS blockade, but they are generally avoided. Calcium channel blockers are the safest switch.
Q9 of 150
Pulmonary
A 45-year-old non-smoker presents with progressive dyspnea and wheezing. Spirometry shows
FEV1/FVC of 0.62, with 15% improvement after bronchodilator. Which diagnosis is MOST likely?
A. COPD
B. Pulmonary fibrosis
C. Restrictive lung disease
D. Asthma
Rationale: Correct: Asthma. The bronchodilator response ≥12% AND ≥200 mL is diagnostic of asthma.
Young non-smoker with reversible obstruction = asthma. COPD typically has fixed obstruction (<12%
reversibility), occurs in older smokers. Restrictive disease shows reduced FVC with normal FEV1/FVC
ratio.
Q10 of 150
Pulmonary
A COPD patient on maximal LABA/LAMA therapy continues to have frequent exacerbations. Which add-
on therapy is MOST appropriate?
A. Add roflumilast (PDE4 inhibitor) if chronic bronchitis phenotype
B. Add azithromycin 250 mg daily
C. Add inhaled corticosteroid (ICS)
D. Add oral theophylline
Rationale: Correct: Roflumilast. Roflumilast is a selective PDE4 inhibitor approved for COPD patients with
severe airflow limitation, chronic bronchitis phenotype, and frequent exacerbations despite
LABA/LAMA. It reduces exacerbation frequency. Azithromycin prophylaxis is also an option but carries
risks of antibiotic resistance and QTc prolongation.
Q11 of 150
Pulmonary
A 32-year-old woman presents with pleuritic chest pain, dyspnea, and tachycardia 1 week postpartum.
D-dimer is markedly elevated. What is the NEXT best step?
A. V/Q scan only
pg. 4
FNP Exam Review: Comprehensive NP Study Guide for
AANP Boards (PASS YOUR FIRST TIME!)
Q1 of 150
Cardiovascular
A 58-year-old male with hypertension, diabetes, and dyslipidemia presents with exertional chest
pressure radiating to the left arm, relieved by rest. ECG is normal at rest. What is the MOST appropriate
next step?
A. Start aspirin and nitroglycerin PRN
B. Order coronary CT angiography
C. Order exercise stress test
D. Refer immediately to emergency department
Rationale: Correct: Exercise stress test. Classic stable angina symptoms with normal resting ECG warrant
exercise stress testing to evaluate for inducible ischemia. Emergency referral is not indicated with stable,
predictable, exertional symptoms. CT angiography is used when stress testing is inconclusive. Starting
medication alone without workup would be inadequate.
Q2 of 150
Cardiovascular
A patient on warfarin for atrial fibrillation has an INR of 6.2 but no active bleeding. What is the most
appropriate management?
A. Hold warfarin and administer vitamin K 10 mg IV
B. Hold warfarin; administer oral vitamin K 2.5 mg
C. Administer fresh frozen plasma immediately
D. Hold warfarin only and recheck INR in 24–48 hours
Rationale: Correct: Hold warfarin + oral vitamin K 2.5 mg. For supratherapeutic INR >5 with no
significant bleeding, guidelines recommend holding warfarin and administering low-dose oral vitamin K.
IV vitamin K is reserved for serious or life-threatening bleeding. FFP is only indicated for urgent reversal.
Q3 of 150
Cardiovascular
pg. 1
,2
Which of the following ECG findings is MOST characteristic of Wolff-Parkinson-White syndrome?
A. Right bundle branch block pattern
B. Prolonged QTc interval with T-wave inversions
C. Short PR interval with delta wave and wide QRS
D. Prolonged PR interval with delta wave
Rationale: Correct: Short PR + delta wave + wide QRS. WPW is characterized by a short PR interval (<120
ms), slurred upstroke of the QRS (delta wave), and widened QRS complex due to ventricular pre-
excitation via the accessory pathway (Bundle of Kent).
Q4 of 150
Cardiovascular
A 72-year-old woman with heart failure (EF 35%) is already on lisinopril. Which additional medication
class has shown to reduce mortality in HFrEF?
A. Beta-blockers (carvedilol, metoprolol succinate, bisoprolol)
B. Calcium channel blockers (amlodipine)
C. Loop diuretics (furosemide)
D. Nitrates
Rationale: Correct: Beta-blockers. Three beta-blockers — carvedilol, metoprolol succinate, and
bisoprolol — have demonstrated mortality reduction in HFrEF in randomized trials. ACEi/ARB + BB +
MRA + SGLT2i form the four pillars of HFrEF therapy. Loop diuretics relieve symptoms but do not reduce
mortality. CCBs with negative inotropy (verapamil, diltiazem) are contraindicated in HFrEF.
Q5 of 150
Cardiovascular
A patient's blood pressure is consistently 148/94 mmHg on three separate visits. They have CKD with
proteinuria. Which antihypertensive is PREFERRED as first-line?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
Rationale: Correct: Lisinopril (ACE inhibitor). ACE inhibitors (or ARBs) are preferred first-line agents for
hypertension in patients with CKD and proteinuria due to their renoprotective effects — they reduce
intraglomerular pressure and slow progression of proteinuric CKD. Thiazides are less effective when GFR
<30.
pg. 2
,3
Q6 of 150
Cardiovascular
Which finding on physical exam is MOST specific for cardiac tamponade?
A. Kussmaul sign
B. Pulsus paradoxus >10 mmHg
C. S3 gallop
D. Pulsus alternans
Rationale: Correct: Pulsus paradoxus >10 mmHg. Pulsus paradoxus (exaggerated decrease in systolic BP
>10 mmHg during inspiration) is the hallmark of cardiac tamponade. Beck's triad (hypotension, muffled
heart sounds, JVD) is also classic. Kussmaul sign is seen in constrictive pericarditis. Pulsus alternans is
associated with severe LV dysfunction.
Q7 of 150
Cardiovascular
A 65-year-old male presents with sudden onset tearing chest pain radiating to his back. He has a history
of Marfan syndrome. BP is 160/90 in the right arm and 130/70 in the left arm. What is the MOST likely
diagnosis?
A. Aortic dissection
B. Pulmonary embolism
C. Acute pericarditis
D. STEMI
Rationale: Correct: Aortic dissection. Classic presentation: sudden tearing/ripping pain radiating to back,
Marfan syndrome (risk factor for medial cystic necrosis), and BP differential between arms (>20 mmHg is
suggestive). Immediate CT angiography of the chest is the diagnostic test of choice.
Q8 of 150
Cardiovascular
Lisinopril is discontinued in a patient who develops angioedema. Which antihypertensive class is
CONTRAINDICATED as a substitute?
A. ARBs (valsartan, losartan)
B. Calcium channel blockers
C. Beta-blockers
D. Thiazide diuretics
pg. 3
, 4
Rationale: Correct: ARBs are relatively contraindicated. ACE inhibitor-induced angioedema is bradykinin-
mediated. ARBs do not inhibit bradykinin degradation but ~10–15% cross-reactivity risk exists. Most
guidelines state ARBs can be used cautiously with informed consent in patients who absolutely need
RAAS blockade, but they are generally avoided. Calcium channel blockers are the safest switch.
Q9 of 150
Pulmonary
A 45-year-old non-smoker presents with progressive dyspnea and wheezing. Spirometry shows
FEV1/FVC of 0.62, with 15% improvement after bronchodilator. Which diagnosis is MOST likely?
A. COPD
B. Pulmonary fibrosis
C. Restrictive lung disease
D. Asthma
Rationale: Correct: Asthma. The bronchodilator response ≥12% AND ≥200 mL is diagnostic of asthma.
Young non-smoker with reversible obstruction = asthma. COPD typically has fixed obstruction (<12%
reversibility), occurs in older smokers. Restrictive disease shows reduced FVC with normal FEV1/FVC
ratio.
Q10 of 150
Pulmonary
A COPD patient on maximal LABA/LAMA therapy continues to have frequent exacerbations. Which add-
on therapy is MOST appropriate?
A. Add roflumilast (PDE4 inhibitor) if chronic bronchitis phenotype
B. Add azithromycin 250 mg daily
C. Add inhaled corticosteroid (ICS)
D. Add oral theophylline
Rationale: Correct: Roflumilast. Roflumilast is a selective PDE4 inhibitor approved for COPD patients with
severe airflow limitation, chronic bronchitis phenotype, and frequent exacerbations despite
LABA/LAMA. It reduces exacerbation frequency. Azithromycin prophylaxis is also an option but carries
risks of antibiotic resistance and QTc prolongation.
Q11 of 150
Pulmonary
A 32-year-old woman presents with pleuritic chest pain, dyspnea, and tachycardia 1 week postpartum.
D-dimer is markedly elevated. What is the NEXT best step?
A. V/Q scan only
pg. 4
