AANP FNP ACTUAL EXAM – QUESTIONS
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DETAILED ANSWERS | PLUS RATIONALES
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UPDATE 2026/2027
1. A 58-year-old male presents with BP readings averaging 148/92 mmHg on three
separate occasions. He has no comorbidities. What is the most appropriate initial
management?
A. Start ACE inhibitor
B. Lifestyle modification only
C. Start beta-blocker
D. Start thiazide diuretic
Answer: D
Rationale: According to JNC 8 and current AANP guidelines, initial pharmacologic
treatment for stage 1 hypertension (140-159/90-99 mmHg) in the general non-black
population includes a thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker.
Thiazide diuretics are recommended as first-line therapy for most patients. Lifestyle
modifications should be recommended concurrently, but pharmacotherapy is indicated
for persistent BP ≥140/90 mmHg . Key Tip: Remember "ABCD" for hypertension
treatment: ACE inhibitors/ARBs for diabetes/renal disease, Beta-blockers for post-MI,
CCB for elderly/isolated systolic HTN, Diuretics as first-line for most.
2. A 72-year-old male presents with syncope. Cardiac auscultation reveals a harsh
crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to carotids. Carotid upstroke is delayed. Most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
,C. Hypertrophic cardiomyopathy
D. Pulmonic stenosis
Answer: B
Rationale: This presentation is classic for aortic stenosis: harsh systolic ejection murmur
at right upper sternal border (aortic area), radiating to carotids, with delayed carotid
upstroke (pulsus parvus et tardus). Syncope is a concerning symptom suggesting severe
AS requiring evaluation for valve replacement . Key Tip: AS murmur = "Systolic at RUSB,
radiates to neck." Symptoms = "SAD": Syncope, Angina, Dyspnea.
3. Which antihypertensive is contraindicated in pregnancy?
A. Labetalol
B. Methyldopa
C. ACE inhibitors
D. Nifedipine
Answer: C
Rationale: ACE inhibitors and ARBs are contraindicated in pregnancy due to risks of
fetal renal dysgenesis, oligohydramnios, and neonatal anuria. Safe options in pregnancy
include labetalol, methyldopa, and nifedipine. Methyldopa has the longest safety track
record .
4. Crackles heard at lung bases most commonly indicate which condition?
A. Asthma
B. Pneumothorax
C. Pulmonary edema
D. Bronchitis
Answer: C
Rationale: Fine, late-inspiratory crackles (rales) at lung bases are characteristic of
pulmonary edema due to left heart failure. They result from fluid-filled alveoli opening
during inspiration. Asthma and bronchitis produce wheezing; pneumothorax causes
absent breath sounds .
,5. Which lipid abnormality MOST increases cardiovascular risk?
A. Low HDL
B. High triglycerides
C. Elevated LDL
D. High total cholesterol
Answer: C
Rationale: Elevated LDL cholesterol is the primary atherogenic lipoprotein and the main
target of lipid-lowering therapy. While low HDL and high triglycerides contribute to risk,
LDL reduction has the strongest evidence for cardiovascular event reduction. The 2018
ACC/AHA guidelines emphasize LDL as the primary treatment target .
6. First-line therapy for stable angina includes which medication class?
A. Short-acting nitroglycerin
B. Beta-blockers
C. Calcium channel blockers
D. Ranolazine
Answer: B
Rationale: Beta-blockers are first-line antianginal therapy for stable angina because
they reduce myocardial oxygen demand by decreasing heart rate, contractility, and BP.
Short-acting nitroglycerin is used for acute symptom relief but is not preventive.
Calcium channel blockers and ranolazine are alternatives or add-on therapy .
7. Which ECG finding is most characteristic of acute pericarditis?
A. ST-segment elevation with reciprocal depression
B. Diffuse ST-segment elevation with PR depression
C. Pathologic Q waves
D. T wave inversions in anterior leads
Answer: B
Rationale: Acute pericarditis typically shows diffuse ST-segment elevation (concave up)
, and PR segment depression. Unlike STEMI, there are no reciprocal changes, and Q
waves are absent. PR depression is a distinguishing early finding .
8. A 65-year-old diabetic patient has an ABI of 0.6 with a venous leg ulcer. What is
the MOST appropriate compression intervention?
A. Full compression therapy
B. No compression
C. Modified/light compression
D. Immediate surgical debridement
Answer: C
Rationale: ABI 0.5-0.8 indicates moderate arterial disease. Full compression is
contraindicated as it could further compromise arterial flow. Modified/light compression
is appropriate; patients should be referred to vascular specialist .
9. A patient presents with acute onset of tearing chest pain radiating to the back.
BP is 160/50 mmHg in right arm and 110/60 mmHg in left arm. A diastolic
murmur is heard at right sternal border. Most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Aortic dissection presents with sudden severe tearing chest pain radiating to
back. Differential BP between arms (>20 mmHg) and murmur of aortic regurgitation
suggest ascending aorta involvement. This is a medical emergency requiring immediate
CT angiography or TEE .
10. A patient with known heart failure presents with worsening dyspnea,
orthopnea, and 3+ pitting edema. Which medication class has been shown to
reduce mortality in heart failure with reduced ejection fraction (HFrEF)?
AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES
| DOWNLOAD AND PASS | LATEST EXAM
UPDATE 2026/2027
1. A 58-year-old male presents with BP readings averaging 148/92 mmHg on three
separate occasions. He has no comorbidities. What is the most appropriate initial
management?
A. Start ACE inhibitor
B. Lifestyle modification only
C. Start beta-blocker
D. Start thiazide diuretic
Answer: D
Rationale: According to JNC 8 and current AANP guidelines, initial pharmacologic
treatment for stage 1 hypertension (140-159/90-99 mmHg) in the general non-black
population includes a thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker.
Thiazide diuretics are recommended as first-line therapy for most patients. Lifestyle
modifications should be recommended concurrently, but pharmacotherapy is indicated
for persistent BP ≥140/90 mmHg . Key Tip: Remember "ABCD" for hypertension
treatment: ACE inhibitors/ARBs for diabetes/renal disease, Beta-blockers for post-MI,
CCB for elderly/isolated systolic HTN, Diuretics as first-line for most.
2. A 72-year-old male presents with syncope. Cardiac auscultation reveals a harsh
crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to carotids. Carotid upstroke is delayed. Most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
,C. Hypertrophic cardiomyopathy
D. Pulmonic stenosis
Answer: B
Rationale: This presentation is classic for aortic stenosis: harsh systolic ejection murmur
at right upper sternal border (aortic area), radiating to carotids, with delayed carotid
upstroke (pulsus parvus et tardus). Syncope is a concerning symptom suggesting severe
AS requiring evaluation for valve replacement . Key Tip: AS murmur = "Systolic at RUSB,
radiates to neck." Symptoms = "SAD": Syncope, Angina, Dyspnea.
3. Which antihypertensive is contraindicated in pregnancy?
A. Labetalol
B. Methyldopa
C. ACE inhibitors
D. Nifedipine
Answer: C
Rationale: ACE inhibitors and ARBs are contraindicated in pregnancy due to risks of
fetal renal dysgenesis, oligohydramnios, and neonatal anuria. Safe options in pregnancy
include labetalol, methyldopa, and nifedipine. Methyldopa has the longest safety track
record .
4. Crackles heard at lung bases most commonly indicate which condition?
A. Asthma
B. Pneumothorax
C. Pulmonary edema
D. Bronchitis
Answer: C
Rationale: Fine, late-inspiratory crackles (rales) at lung bases are characteristic of
pulmonary edema due to left heart failure. They result from fluid-filled alveoli opening
during inspiration. Asthma and bronchitis produce wheezing; pneumothorax causes
absent breath sounds .
,5. Which lipid abnormality MOST increases cardiovascular risk?
A. Low HDL
B. High triglycerides
C. Elevated LDL
D. High total cholesterol
Answer: C
Rationale: Elevated LDL cholesterol is the primary atherogenic lipoprotein and the main
target of lipid-lowering therapy. While low HDL and high triglycerides contribute to risk,
LDL reduction has the strongest evidence for cardiovascular event reduction. The 2018
ACC/AHA guidelines emphasize LDL as the primary treatment target .
6. First-line therapy for stable angina includes which medication class?
A. Short-acting nitroglycerin
B. Beta-blockers
C. Calcium channel blockers
D. Ranolazine
Answer: B
Rationale: Beta-blockers are first-line antianginal therapy for stable angina because
they reduce myocardial oxygen demand by decreasing heart rate, contractility, and BP.
Short-acting nitroglycerin is used for acute symptom relief but is not preventive.
Calcium channel blockers and ranolazine are alternatives or add-on therapy .
7. Which ECG finding is most characteristic of acute pericarditis?
A. ST-segment elevation with reciprocal depression
B. Diffuse ST-segment elevation with PR depression
C. Pathologic Q waves
D. T wave inversions in anterior leads
Answer: B
Rationale: Acute pericarditis typically shows diffuse ST-segment elevation (concave up)
, and PR segment depression. Unlike STEMI, there are no reciprocal changes, and Q
waves are absent. PR depression is a distinguishing early finding .
8. A 65-year-old diabetic patient has an ABI of 0.6 with a venous leg ulcer. What is
the MOST appropriate compression intervention?
A. Full compression therapy
B. No compression
C. Modified/light compression
D. Immediate surgical debridement
Answer: C
Rationale: ABI 0.5-0.8 indicates moderate arterial disease. Full compression is
contraindicated as it could further compromise arterial flow. Modified/light compression
is appropriate; patients should be referred to vascular specialist .
9. A patient presents with acute onset of tearing chest pain radiating to the back.
BP is 160/50 mmHg in right arm and 110/60 mmHg in left arm. A diastolic
murmur is heard at right sternal border. Most likely diagnosis?
A. Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Aortic dissection presents with sudden severe tearing chest pain radiating to
back. Differential BP between arms (>20 mmHg) and murmur of aortic regurgitation
suggest ascending aorta involvement. This is a medical emergency requiring immediate
CT angiography or TEE .
10. A patient with known heart failure presents with worsening dyspnea,
orthopnea, and 3+ pitting edema. Which medication class has been shown to
reduce mortality in heart failure with reduced ejection fraction (HFrEF)?
