AANP FNP Certification Exam Bank
(2026/2027) | Accurate Real Exam
Questions | Expert Verified Answers &
Rationales
Question 1: All diastolic murmurs are:
A) Innocent findings in athletes
B) Pathological and require evaluation
C) Normal in elderly patients
D) Always associated with fever
Correct Answer: B) Pathological and require evaluation
Rationale: All diastolic murmurs are pathological and require further evaluation. Systolic
murmurs can be innocent or physiological, but diastolic murmurs always indicate
underlying cardiac pathology such as aortic regurgitation or mitral stenosis .
Key Tip: Remember: "Diastolic = Dangerous." Any murmur occurring during diastole
warrants an echocardiogram and cardiology referral.
Question 2: A heart murmur that radiates to the axilla is most likely:
A) Aortic stenosis
B) Mitral regurgitation (MR)
C) Pulmonic stenosis
D) Tricuspid regurgitation
Correct Answer: B) Mitral regurgitation (MR)
Rationale: Mitral regurgitation (MR) is a holosystolic or pansystolic murmur that
radiates to the axilla and is best heard at the 5th intercostal space, midclavicular line
(apex). Use the mnemonic "MR ASSH" - MR radiates to Axilla, AS (Aortic Stenosis)
radiates to the neck .
,Key Tip: Aortic stenosis radiates to the carotids; mitral regurgitation radiates to the
axilla. Think "Mitral goes to the armpit."
Question 3: A patient with hypertension and coronary artery disease has palpable
femoral pulses but absent pedal pulses. This finding is most consistent with:
A) Chronic venous insufficiency
B) Peripheral arterial disease (PAD)
C) Deep vein thrombosis
D) Neurogenic claudication
Correct Answer: B) Peripheral arterial disease (PAD)
Rationale: Peripheral arterial disease (PAD) presents with diminished or absent pulses
distal to the blockage, intermittent claudication (pain with walking), nocturnal pain
relieved by dangling legs, dependent rubor, and shiny, hairless skin. Diagnosis is
confirmed with Doppler and ABI <0.9 .
Key Tip: PAD = "Pulse Deficit." Check ABI (Ankle-Brachial Index); values <0.9 indicate
PAD, values <0.5 indicate severe disease.
Question 4: A bounding radial pulse with a weak femoral pulse suggests:
A) Aortic stenosis
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosus
D) Mitral valve prolapse
Correct Answer: B) Coarctation of the aorta (COA)
Rationale: Coarctation of the aorta presents with hypertension in the upper extremities
and weak/absent femoral pulses (delayed or diminished). Upper extremity BP is
elevated; lower extremity BP is low. This is a congenital condition that presents with a
pulse deficit .
Key Tip: "Upper extremity hypertension + weak femoral pulses = Coarctation until
proven otherwise."
,Question 5: A 65-year-old male presents with intermittent chest pressure brought on
by exertion and relieved by rest. This is most consistent with:
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Correct Answer: A) Stable angina
Rationale: Stable angina is characterized by chest discomfort precipitated by exertion or
stress and relieved by rest or nitroglycerin. Unstable angina is new-onset, increasing in
frequency, or occurring at rest. MI presents with prolonged pain not relieved by rest .
Key Tip: "Stable = Predictable." Same activity, same pain, same relief pattern.
Question 6: A patient presents with sudden, severe "tearing" chest pain radiating to the
back, with a blood pressure difference of 30 mmHg between arms. You suspect:
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain that often
radiates to the back. BP differential between arms (>20 mmHg) is a key finding. Risk
factors include hypertension, connective tissue disorders (Marfan), and bicuspid aortic
valve .
Key Tip: "Tearing pain + BP differential = Dissection until proven otherwise." Immediate
CT angiography is required.
Question 7: In monitoring a patient on amiodarone, which laboratory test is most
important to check regularly?
A) Complete blood count
B) Liver function tests
, C) Thyroid function tests
D) Serum electrolytes
Correct Answer: C) Thyroid function tests
Rationale: Amiodarone is iodine-rich and can cause both hyperthyroidism and
hypothyroidism. Thyroid function tests should be checked every 6 months. Also monitor
pulmonary function (for fibrosis), liver enzymes, and corneal exams .
Key Tip: "Amiodarone affects the thyroid, lungs, liver, and eyes." TFTs are the most
common lab to trend.
Question 8: JNC-8 guidelines recommend a blood pressure target of <140/90 for which
of the following populations?
A) All adults regardless of age
B) Adults <60 years and those with CKD or diabetes
C) Adults >60 years only
D) Only those with established cardiovascular disease
Correct Answer: B) Adults <60 years and those with CKD or diabetes
Rationale: JNC-8 recommends <140/90 for adults <60 years and all adults with CKD or
diabetes. For adults ≥60 years without these conditions, the target is <150/90. More
recent guidelines (ACC/AHA 2017) recommend <130/80 for most adults .
Key Tip: Know the difference between JNC-8 and ACC/AHA guidelines. JNC-8 is older
but still tested; ACC/AHA 2017 is stricter (<130/80 for most).
Question 9: A patient with heart failure and reduced ejection fraction (HFrEF) should be
started on which two medications first?
A) Digoxin and furosemide
B) Beta-blocker and ACE inhibitor
C) Calcium channel blocker and nitrate
D) Spironolactone and hydralazine
Correct Answer: B) Beta-blocker and ACE inhibitor
(2026/2027) | Accurate Real Exam
Questions | Expert Verified Answers &
Rationales
Question 1: All diastolic murmurs are:
A) Innocent findings in athletes
B) Pathological and require evaluation
C) Normal in elderly patients
D) Always associated with fever
Correct Answer: B) Pathological and require evaluation
Rationale: All diastolic murmurs are pathological and require further evaluation. Systolic
murmurs can be innocent or physiological, but diastolic murmurs always indicate
underlying cardiac pathology such as aortic regurgitation or mitral stenosis .
Key Tip: Remember: "Diastolic = Dangerous." Any murmur occurring during diastole
warrants an echocardiogram and cardiology referral.
Question 2: A heart murmur that radiates to the axilla is most likely:
A) Aortic stenosis
B) Mitral regurgitation (MR)
C) Pulmonic stenosis
D) Tricuspid regurgitation
Correct Answer: B) Mitral regurgitation (MR)
Rationale: Mitral regurgitation (MR) is a holosystolic or pansystolic murmur that
radiates to the axilla and is best heard at the 5th intercostal space, midclavicular line
(apex). Use the mnemonic "MR ASSH" - MR radiates to Axilla, AS (Aortic Stenosis)
radiates to the neck .
,Key Tip: Aortic stenosis radiates to the carotids; mitral regurgitation radiates to the
axilla. Think "Mitral goes to the armpit."
Question 3: A patient with hypertension and coronary artery disease has palpable
femoral pulses but absent pedal pulses. This finding is most consistent with:
A) Chronic venous insufficiency
B) Peripheral arterial disease (PAD)
C) Deep vein thrombosis
D) Neurogenic claudication
Correct Answer: B) Peripheral arterial disease (PAD)
Rationale: Peripheral arterial disease (PAD) presents with diminished or absent pulses
distal to the blockage, intermittent claudication (pain with walking), nocturnal pain
relieved by dangling legs, dependent rubor, and shiny, hairless skin. Diagnosis is
confirmed with Doppler and ABI <0.9 .
Key Tip: PAD = "Pulse Deficit." Check ABI (Ankle-Brachial Index); values <0.9 indicate
PAD, values <0.5 indicate severe disease.
Question 4: A bounding radial pulse with a weak femoral pulse suggests:
A) Aortic stenosis
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosus
D) Mitral valve prolapse
Correct Answer: B) Coarctation of the aorta (COA)
Rationale: Coarctation of the aorta presents with hypertension in the upper extremities
and weak/absent femoral pulses (delayed or diminished). Upper extremity BP is
elevated; lower extremity BP is low. This is a congenital condition that presents with a
pulse deficit .
Key Tip: "Upper extremity hypertension + weak femoral pulses = Coarctation until
proven otherwise."
,Question 5: A 65-year-old male presents with intermittent chest pressure brought on
by exertion and relieved by rest. This is most consistent with:
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
Correct Answer: A) Stable angina
Rationale: Stable angina is characterized by chest discomfort precipitated by exertion or
stress and relieved by rest or nitroglycerin. Unstable angina is new-onset, increasing in
frequency, or occurring at rest. MI presents with prolonged pain not relieved by rest .
Key Tip: "Stable = Predictable." Same activity, same pain, same relief pattern.
Question 6: A patient presents with sudden, severe "tearing" chest pain radiating to the
back, with a blood pressure difference of 30 mmHg between arms. You suspect:
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Aortic dissection presents with sudden, severe, tearing chest pain that often
radiates to the back. BP differential between arms (>20 mmHg) is a key finding. Risk
factors include hypertension, connective tissue disorders (Marfan), and bicuspid aortic
valve .
Key Tip: "Tearing pain + BP differential = Dissection until proven otherwise." Immediate
CT angiography is required.
Question 7: In monitoring a patient on amiodarone, which laboratory test is most
important to check regularly?
A) Complete blood count
B) Liver function tests
, C) Thyroid function tests
D) Serum electrolytes
Correct Answer: C) Thyroid function tests
Rationale: Amiodarone is iodine-rich and can cause both hyperthyroidism and
hypothyroidism. Thyroid function tests should be checked every 6 months. Also monitor
pulmonary function (for fibrosis), liver enzymes, and corneal exams .
Key Tip: "Amiodarone affects the thyroid, lungs, liver, and eyes." TFTs are the most
common lab to trend.
Question 8: JNC-8 guidelines recommend a blood pressure target of <140/90 for which
of the following populations?
A) All adults regardless of age
B) Adults <60 years and those with CKD or diabetes
C) Adults >60 years only
D) Only those with established cardiovascular disease
Correct Answer: B) Adults <60 years and those with CKD or diabetes
Rationale: JNC-8 recommends <140/90 for adults <60 years and all adults with CKD or
diabetes. For adults ≥60 years without these conditions, the target is <150/90. More
recent guidelines (ACC/AHA 2017) recommend <130/80 for most adults .
Key Tip: Know the difference between JNC-8 and ACC/AHA guidelines. JNC-8 is older
but still tested; ACC/AHA 2017 is stricter (<130/80 for most).
Question 9: A patient with heart failure and reduced ejection fraction (HFrEF) should be
started on which two medications first?
A) Digoxin and furosemide
B) Beta-blocker and ACE inhibitor
C) Calcium channel blocker and nitrate
D) Spironolactone and hydralazine
Correct Answer: B) Beta-blocker and ACE inhibitor
