SARAH MICHELLE’S AANP BOARD REVIEW
V2 NEWEST 2026 ACTUAL EXAM TEST
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COMPLETE 100 REAL EXAM QUESTIONS
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SARAH MICHELLE-STYLE AANP PRACTICE QUESTIONS
(ORIGINAL)
Question 1
A 68-year-old male with a 40-pack-year history presents with a 3-month history of
progressive hoarseness and a sensation of a "lump" in his throat. He denies fever or
odynophagia. Direct laryngoscopy reveals a leukoplakic lesion on the left vocal cord.
What is the most appropriate next step?
A) Observation and repeat laryngoscopy in 6 months
B) Empiric trial of proton pump inhibitor (PPI) therapy
C) Referral for vocal cord biopsy
D) Voice rest and speech therapy
Answer: C) Referral for vocal cord biopsy
Rationale: Leukoplakia on the vocal cord in a heavy smoker is a premalignant lesion
(squamous cell dysplasia) until proven otherwise. Biopsy is mandatory to rule out
carcinoma.
,Question 2
A 45-year-old female with known systemic lupus erythematosus (SLE) complains of
sudden, sharp left-sided chest pain that worsens with inspiration and improves when
leaning forward. On exam, you appreciate a scratchy, high-pitched sound over the left
sternal border. What is the most likely diagnosis?
A) Pulmonary embolism
B) Acute myocardial infarction
C) Pericarditis
D) Pleuritis
Answer: C) Pericarditis
Rationale: Pericarditis is common in SLE. The hallmark is sharp pleuritic chest pain that
improves with sitting forward and a pericardial friction rub (scratchy sound).
Question 3
A 72-year-old male with hypertension and diabetes presents for a routine visit. His
blood pressure is 148/86 mmHg. His home medication is lisinopril 10 mg daily. His latest
labs show a serum creatinine of 1.4 mg/dL (eGFR 52) and potassium 4.9 mEq/L. What is
the best adjustment to his antihypertensive regimen?
A) Add hydrochlorothiazide 12.5 mg
B) Increase lisinopril to 20 mg
C) Add amlodipine 5 mg
D) Switch lisinopril to losartan
Answer: C) Add amlodipine 5 mg
Rationale: In CKD (eGFR <60), ACE inhibitors are first-line, but you should not max out
an ACEi if the patient is nearing hyperkalemia (K+ 4.9). Adding a CCB (amlodipine) is the
,safest next step to achieve BP goal without risking further renal dysfunction or
hyperkalemia.
Question 4
A 28-year-old G1P0 at 28 weeks gestation presents with a blood pressure of 155/100
mmHg. She has a headache and blurred vision. Urinalysis shows 3+ protein. Which
medication is contraindicated in this patient?
A) Labetalol
B) Nifedipine
C) Methyldopa
D) Enalapril
Answer: D) Enalapril
Rationale: ACE inhibitors (enalapril, lisinopril) and ARBs are contraindicated in the
second and third trimesters due to the risk of fetal renal agenesis, oligohydramnios, and
fetal death. Labetalol, nifedipine, and methyldopa are safe for acute and chronic
management of pre-eclampsia.
Question 5
A 55-year-old male presents with acute onset of severe, tearing chest pain radiating to
his back. His blood pressure is 180/110 in the right arm and 130/80 in the left arm. What
is the most critical initial diagnostic test?
A) ECG
B) Chest X-ray
C) CT angiography of the chest
D) Transthoracic echocardiogram
, Answer: C) CT angiography of the chest
Rationale: This is an aortic dissection (blood pressure differential). CT angiography is
the gold standard for rapid diagnosis. While ECG is done to rule out MI, it won't rule out
dissection; CTA is the definitive test here.
Question 6
A 62-year-old female with type 2 diabetes reports a 2-week history of severe pain and
redness in her right great toe. She denies injury. On exam, the toe is warm,
erythematous, and exquisitely tender to light touch. She has no fever. Which medication
is first-line for the acute management of this condition?
A) Allopurinol
B) Colchicine
C) Febuxostat
D) Prednisone
Answer: B) Colchicine
Rationale: This is acute gout. For acute flares, first-line options are NSAIDs, colchicine,
or corticosteroids. Colchicine is highly effective if started within 24-48 hours. Allopurinol
and febuxostat are for chronic urate-lowering, not acute flares (and can worsen the flare
if started acutely).
Question 7
A 48-year-old patient with a history of generalized anxiety disorder (GAD) is on
sertraline 100 mg daily. She reports she is going on vacation and forgot to refill her
prescription. She is now without medication for 3 days and reports feeling dizzy,
nauseous, and "electric shock" sensations in her head. What is the most likely cause?
V2 NEWEST 2026 ACTUAL EXAM TEST
BANK| NP CERTIFICATION EXAM PREP WITH
COMPLETE 100 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+
(MOST RECENT!!)
SARAH MICHELLE-STYLE AANP PRACTICE QUESTIONS
(ORIGINAL)
Question 1
A 68-year-old male with a 40-pack-year history presents with a 3-month history of
progressive hoarseness and a sensation of a "lump" in his throat. He denies fever or
odynophagia. Direct laryngoscopy reveals a leukoplakic lesion on the left vocal cord.
What is the most appropriate next step?
A) Observation and repeat laryngoscopy in 6 months
B) Empiric trial of proton pump inhibitor (PPI) therapy
C) Referral for vocal cord biopsy
D) Voice rest and speech therapy
Answer: C) Referral for vocal cord biopsy
Rationale: Leukoplakia on the vocal cord in a heavy smoker is a premalignant lesion
(squamous cell dysplasia) until proven otherwise. Biopsy is mandatory to rule out
carcinoma.
,Question 2
A 45-year-old female with known systemic lupus erythematosus (SLE) complains of
sudden, sharp left-sided chest pain that worsens with inspiration and improves when
leaning forward. On exam, you appreciate a scratchy, high-pitched sound over the left
sternal border. What is the most likely diagnosis?
A) Pulmonary embolism
B) Acute myocardial infarction
C) Pericarditis
D) Pleuritis
Answer: C) Pericarditis
Rationale: Pericarditis is common in SLE. The hallmark is sharp pleuritic chest pain that
improves with sitting forward and a pericardial friction rub (scratchy sound).
Question 3
A 72-year-old male with hypertension and diabetes presents for a routine visit. His
blood pressure is 148/86 mmHg. His home medication is lisinopril 10 mg daily. His latest
labs show a serum creatinine of 1.4 mg/dL (eGFR 52) and potassium 4.9 mEq/L. What is
the best adjustment to his antihypertensive regimen?
A) Add hydrochlorothiazide 12.5 mg
B) Increase lisinopril to 20 mg
C) Add amlodipine 5 mg
D) Switch lisinopril to losartan
Answer: C) Add amlodipine 5 mg
Rationale: In CKD (eGFR <60), ACE inhibitors are first-line, but you should not max out
an ACEi if the patient is nearing hyperkalemia (K+ 4.9). Adding a CCB (amlodipine) is the
,safest next step to achieve BP goal without risking further renal dysfunction or
hyperkalemia.
Question 4
A 28-year-old G1P0 at 28 weeks gestation presents with a blood pressure of 155/100
mmHg. She has a headache and blurred vision. Urinalysis shows 3+ protein. Which
medication is contraindicated in this patient?
A) Labetalol
B) Nifedipine
C) Methyldopa
D) Enalapril
Answer: D) Enalapril
Rationale: ACE inhibitors (enalapril, lisinopril) and ARBs are contraindicated in the
second and third trimesters due to the risk of fetal renal agenesis, oligohydramnios, and
fetal death. Labetalol, nifedipine, and methyldopa are safe for acute and chronic
management of pre-eclampsia.
Question 5
A 55-year-old male presents with acute onset of severe, tearing chest pain radiating to
his back. His blood pressure is 180/110 in the right arm and 130/80 in the left arm. What
is the most critical initial diagnostic test?
A) ECG
B) Chest X-ray
C) CT angiography of the chest
D) Transthoracic echocardiogram
, Answer: C) CT angiography of the chest
Rationale: This is an aortic dissection (blood pressure differential). CT angiography is
the gold standard for rapid diagnosis. While ECG is done to rule out MI, it won't rule out
dissection; CTA is the definitive test here.
Question 6
A 62-year-old female with type 2 diabetes reports a 2-week history of severe pain and
redness in her right great toe. She denies injury. On exam, the toe is warm,
erythematous, and exquisitely tender to light touch. She has no fever. Which medication
is first-line for the acute management of this condition?
A) Allopurinol
B) Colchicine
C) Febuxostat
D) Prednisone
Answer: B) Colchicine
Rationale: This is acute gout. For acute flares, first-line options are NSAIDs, colchicine,
or corticosteroids. Colchicine is highly effective if started within 24-48 hours. Allopurinol
and febuxostat are for chronic urate-lowering, not acute flares (and can worsen the flare
if started acutely).
Question 7
A 48-year-old patient with a history of generalized anxiety disorder (GAD) is on
sertraline 100 mg daily. She reports she is going on vacation and forgot to refill her
prescription. She is now without medication for 3 days and reports feeling dizzy,
nauseous, and "electric shock" sensations in her head. What is the most likely cause?
