SARAH MICHELLE FNP PRACTICE TEST 2026/2027 |
Graded A Q&A | Comprehensive Board Certification
Practice Exam | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (22 Questions)
Q1: A 58-year-old African American male presents for a follow-up visit. His BP readings
over the past three visits have been 148/92, 152/88, and 146/90 mmHg. He has a 20
pack-year smoking history and BMI of 31. Current medications include lisinopril 10 mg
daily. His home BP log shows consistent readings in the 140s/90s. According to the
2017 ACC/AHA hypertension guidelines, what is the most appropriate next step in
management?
A. Increase lisinopril to 20 mg daily and recheck in 4 weeks
B. Add hydrochlorothiazide 12.5 mg daily to lisinopril 10 mg
C. Add amlodipine 5 mg daily to lisinopril 10 mg
D. Switch lisinopril to losartan 50 mg daily
C. Add amlodipine 5 mg daily to lisinopril 10 mg [CORRECT]
Correct Answer: C
Rationale: This patient has Stage 2 hypertension (BP ≥140/90 mmHg on multiple
occasions) and is already on ACE-I monotherapy. The 2017 ACC/AHA guidelines
recommend initiating two agents of different classes for Stage 2 HTN. A thiazide
diuretic or CCB are appropriate choices; however, in African American patients, CCBs or
thiazide diuretics are often more effective than ACE-I/ARB monotherapy. Adding
amlodipine (CCB) provides complementary mechanisms and improved BP control.
Option A is insufficient for Stage 2 HTN. Option B is reasonable but less optimal as
,initial dual therapy in this demographic without compelling indication for diuretic. Option
D is inappropriate as switching to ARB monotherapy does not address the need for dual
therapy.
Q2: A 72-year-old female with a history of atrial fibrillation on warfarin (INR 2.5-3.0)
presents with acute onset right-sided weakness and aphasia. CT head shows no
hemorrhage. Her last known well time was 2 hours ago. Vital signs: BP 185/110, HR 88
irregularly irregular, RR 18, SpO2 95% RA. What is the priority intervention?
A. Immediate IV tPA administration
B. BP reduction to <140/90 before any intervention
C. Urgent CT angiography to evaluate for large vessel occlusion
D. Administration of IV labetalol to achieve SBP <185
D. Administration of IV labetalol to achieve SBP <185 [CORRECT]
Correct Answer: D
Rationale: For acute ischemic stroke, current AHA/ASA guidelines indicate that IV tPA
can be administered if SBP <185 and DBP <110 mmHg at time of treatment. This
patient's BP of 185/110 meets the threshold requiring acute BP reduction before tPA
eligibility. Labetalol is the recommended first-line agent for this purpose. Option A is
contraindicated at this BP. Option C may be considered but BP must be controlled first.
Option B is too aggressive; rapid over-correction can worsen cerebral perfusion.
Q3: A 65-year-old male with HFrEF (EF 30%) on lisinopril 20 mg, metoprolol succinate
100 mg, and furosemide 40 mg presents with worsening dyspnea and 3-pound weight
gain over 3 days. Physical exam reveals bibasilar crackles, JVP 8 cm, and 2+ bilateral
lower extremity edema. Which medication adjustment is most appropriate?
,A. Increase furosemide to 80 mg daily and monitor electrolytes
B. Add digoxin 0.125 mg daily for inotropic support
C. Switch metoprolol to carvedilol 25 mg BID
D. Add spironolactone 25 mg daily
A. Increase furosemide to 80 mg daily and monitor electrolytes [CORRECT]
Correct Answer: A
Rationale: This patient presents with acute decompensated heart failure with volume
overload. The cornerstone of acute management is diuretic optimization to achieve
euvolemia. Increasing the loop diuretic dose addresses the immediate pathophysiology.
Option B (digoxin) is not first-line for decompensation and has narrow therapeutic index.
Option C (beta-blocker switch) is inappropriate during acute decompensation and may
worsen symptoms. Option D (spironolactone) is guideline-directed medical therapy for
HFrEF but does not address acute volume overload.
Q4: A 55-year-old female with type 2 diabetes presents for routine follow-up. She reports
occasional chest pressure with exertion that resolves with rest. Her HbA1c is 7.2%. She
takes metformin 1000 mg BID. ECG shows nonspecific ST-T wave changes. What is the
most appropriate next diagnostic step?
A. Exercise stress testing without imaging
B. Coronary CT angiography
C. Pharmacologic stress testing with imaging
D. Immediate cardiac catheterization
A. Exercise stress testing without imaging [CORRECT]
Correct Answer: A
, Rationale: This patient has stable angina equivalent symptoms in the setting of
diabetes. According to ACC/AHA guidelines, patients with intermediate pre-test
probability and ability to exercise should undergo exercise treadmill testing as the initial
evaluation. Option B is reserved for low-risk patients or when anatomy needs
clarification. Option C is indicated if the patient cannot exercise or has baseline ECG
abnormalities that preclude interpretation. Option D is invasive and reserved for
high-risk features or failed medical therapy.
Q5: A 68-year-old male with hypertension and hyperlipidemia presents with sudden
onset tearing chest pain radiating to the back. BP is 185/105 in the right arm and
140/85 in the left arm. Pulse deficit is noted. What is the priority diagnostic study?
A. CT angiography of the chest, abdomen, and pelvis
B. Transthoracic echocardiogram
C. Chest X-ray
D. Cardiac catheterization
A. CT angiography of the chest, abdomen, and pelvis [CORRECT]
Correct Answer: A
Rationale: The presentation is classic for aortic dissection: tearing chest pain, blood
pressure differential between arms (>20 mmHg), and pulse deficit. CT angiography is
the gold standard diagnostic study with high sensitivity and specificity. Option B may
show aortic root involvement but lacks sensitivity for the entire aorta. Option C may
show mediastinal widening but is insufficient for diagnosis. Option D is contraindicated
and does not evaluate the aortic pathology.
Graded A Q&A | Comprehensive Board Certification
Practice Exam | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (22 Questions)
Q1: A 58-year-old African American male presents for a follow-up visit. His BP readings
over the past three visits have been 148/92, 152/88, and 146/90 mmHg. He has a 20
pack-year smoking history and BMI of 31. Current medications include lisinopril 10 mg
daily. His home BP log shows consistent readings in the 140s/90s. According to the
2017 ACC/AHA hypertension guidelines, what is the most appropriate next step in
management?
A. Increase lisinopril to 20 mg daily and recheck in 4 weeks
B. Add hydrochlorothiazide 12.5 mg daily to lisinopril 10 mg
C. Add amlodipine 5 mg daily to lisinopril 10 mg
D. Switch lisinopril to losartan 50 mg daily
C. Add amlodipine 5 mg daily to lisinopril 10 mg [CORRECT]
Correct Answer: C
Rationale: This patient has Stage 2 hypertension (BP ≥140/90 mmHg on multiple
occasions) and is already on ACE-I monotherapy. The 2017 ACC/AHA guidelines
recommend initiating two agents of different classes for Stage 2 HTN. A thiazide
diuretic or CCB are appropriate choices; however, in African American patients, CCBs or
thiazide diuretics are often more effective than ACE-I/ARB monotherapy. Adding
amlodipine (CCB) provides complementary mechanisms and improved BP control.
Option A is insufficient for Stage 2 HTN. Option B is reasonable but less optimal as
,initial dual therapy in this demographic without compelling indication for diuretic. Option
D is inappropriate as switching to ARB monotherapy does not address the need for dual
therapy.
Q2: A 72-year-old female with a history of atrial fibrillation on warfarin (INR 2.5-3.0)
presents with acute onset right-sided weakness and aphasia. CT head shows no
hemorrhage. Her last known well time was 2 hours ago. Vital signs: BP 185/110, HR 88
irregularly irregular, RR 18, SpO2 95% RA. What is the priority intervention?
A. Immediate IV tPA administration
B. BP reduction to <140/90 before any intervention
C. Urgent CT angiography to evaluate for large vessel occlusion
D. Administration of IV labetalol to achieve SBP <185
D. Administration of IV labetalol to achieve SBP <185 [CORRECT]
Correct Answer: D
Rationale: For acute ischemic stroke, current AHA/ASA guidelines indicate that IV tPA
can be administered if SBP <185 and DBP <110 mmHg at time of treatment. This
patient's BP of 185/110 meets the threshold requiring acute BP reduction before tPA
eligibility. Labetalol is the recommended first-line agent for this purpose. Option A is
contraindicated at this BP. Option C may be considered but BP must be controlled first.
Option B is too aggressive; rapid over-correction can worsen cerebral perfusion.
Q3: A 65-year-old male with HFrEF (EF 30%) on lisinopril 20 mg, metoprolol succinate
100 mg, and furosemide 40 mg presents with worsening dyspnea and 3-pound weight
gain over 3 days. Physical exam reveals bibasilar crackles, JVP 8 cm, and 2+ bilateral
lower extremity edema. Which medication adjustment is most appropriate?
,A. Increase furosemide to 80 mg daily and monitor electrolytes
B. Add digoxin 0.125 mg daily for inotropic support
C. Switch metoprolol to carvedilol 25 mg BID
D. Add spironolactone 25 mg daily
A. Increase furosemide to 80 mg daily and monitor electrolytes [CORRECT]
Correct Answer: A
Rationale: This patient presents with acute decompensated heart failure with volume
overload. The cornerstone of acute management is diuretic optimization to achieve
euvolemia. Increasing the loop diuretic dose addresses the immediate pathophysiology.
Option B (digoxin) is not first-line for decompensation and has narrow therapeutic index.
Option C (beta-blocker switch) is inappropriate during acute decompensation and may
worsen symptoms. Option D (spironolactone) is guideline-directed medical therapy for
HFrEF but does not address acute volume overload.
Q4: A 55-year-old female with type 2 diabetes presents for routine follow-up. She reports
occasional chest pressure with exertion that resolves with rest. Her HbA1c is 7.2%. She
takes metformin 1000 mg BID. ECG shows nonspecific ST-T wave changes. What is the
most appropriate next diagnostic step?
A. Exercise stress testing without imaging
B. Coronary CT angiography
C. Pharmacologic stress testing with imaging
D. Immediate cardiac catheterization
A. Exercise stress testing without imaging [CORRECT]
Correct Answer: A
, Rationale: This patient has stable angina equivalent symptoms in the setting of
diabetes. According to ACC/AHA guidelines, patients with intermediate pre-test
probability and ability to exercise should undergo exercise treadmill testing as the initial
evaluation. Option B is reserved for low-risk patients or when anatomy needs
clarification. Option C is indicated if the patient cannot exercise or has baseline ECG
abnormalities that preclude interpretation. Option D is invasive and reserved for
high-risk features or failed medical therapy.
Q5: A 68-year-old male with hypertension and hyperlipidemia presents with sudden
onset tearing chest pain radiating to the back. BP is 185/105 in the right arm and
140/85 in the left arm. Pulse deficit is noted. What is the priority diagnostic study?
A. CT angiography of the chest, abdomen, and pelvis
B. Transthoracic echocardiogram
C. Chest X-ray
D. Cardiac catheterization
A. CT angiography of the chest, abdomen, and pelvis [CORRECT]
Correct Answer: A
Rationale: The presentation is classic for aortic dissection: tearing chest pain, blood
pressure differential between arms (>20 mmHg), and pulse deficit. CT angiography is
the gold standard diagnostic study with high sensitivity and specificity. Option B may
show aortic root involvement but lacks sensitivity for the entire aorta. Option C may
show mediastinal widening but is insufficient for diagnosis. Option D is contraindicated
and does not evaluate the aortic pathology.
