FITZGERALD HEALTH EDUCATION ASSOCIATES| NURSE PRACTITIONER
EXIT EXAM COMPLETE QUESTIONS WITH DETAILED ANSWERS AND
RATIONALES|FITZ EXAM PREP LATEST UPDATE
2026/2027
DOMAIN 1: ADVANCED HEALTH ASSESSMENT (50 Questions)
QUESTION 1
A 55-year-old male presents with a history of hypertension and reports
intermittent chest discomfort. On examination, you note a laterally displaced
PMI, an S4 gallop, and a II/VI systolic ejection murmur at the right upper sternal
border that radiates to the carotids. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonary hypertension
Correct Answer: A
Rationale: Aortic stenosis typically presents with a systolic ejection murmur at
the right upper sternal border, radiating to the carotids. An S4 gallop is common
due to decreased left ventricular compliance. The laterally displaced PMI suggests
left ventricular hypertrophy from pressure overload.
QUESTION 2
A 42-year-old woman presents with fatigue, weight gain, and cold intolerance.
Physical exam reveals dry skin, coarse hair, and a delayed relaxation phase of
deep tendon reflexes. Which laboratory finding would confirm the diagnosis?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Elevated TSH, elevated free T4
D. Normal TSH, low free T4
1
,Correct Answer: A
Rationale: Primary hypothyroidism is confirmed by an elevated TSH (pituitary
attempting to stimulate the thyroid) and a low free T4. The clinical presentation
(signs of hypometabolism) supports the diagnosis.
QUESTION 3
During a cardiac examination, you auscultate a high-pitched, blowing, pansystolic
murmur at the apex that radiates to the axilla. The murmur does not change with
respiration. What is the most likely valvular lesion?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Tricuspid regurgitation
Correct Answer: B
Rationale: Mitral regurgitation produces a high-pitched, blowing, pansystolic
murmur best heard at the apex with radiation to the axilla. It does not vary with
respiration (left-sided lesion). Mitral stenosis is diastolic, aortic regurgitation
is diastolic, and tricuspid regurgitation varies with inspiration.
QUESTION 4
A 68-year-old male presents with a 3-month history of lower back pain that is
worse at night and relieved by activity. He also reports unintentional weight loss
and fatigue. What is the most concerning diagnosis to rule out?
A. Osteoarthritis
B. Spinal stenosis
C. Multiple myeloma
D. Lumbar strain
2
,Correct Answer: C
Rationale: Back pain that is worse at night, accompanied by constitutional
symptoms (weight loss, fatigue), and not relieved by rest is concerning for
malignancy, particularly multiple myeloma. Osteoarthritis is worse with activity
and relieved by rest.
QUESTION 5
A 28-year-old pregnant woman at 32 weeks gestation presents with headache,
blurred vision, and right upper quadrant pain. Her blood pressure is 168/102
mmHg. Urine dipstick shows 3+ protein. What is the most likely diagnosis?
A. Gestational hypertension
B. Preeclampsia with severe features
C. Chronic hypertension
D. HELLP syndrome
Correct Answer: B
Rationale: This patient has severe preeclampsia: BP ≥160/110, with headache,
visual disturbances, and epigastric/RUQ pain indicating severe features. HELLP
syndrome is a variant of severe preeclampsia with hemolysis, elevated liver
enzymes, and low platelets.
QUESTION 6
A 7-year-old child presents with a sore throat, fever, and "strawberry tongue."
On examination, you note palatal petechiae and a fine maculopapular rash. What
is the most likely diagnosis?
A. Measles
B. Scarlet fever (Group A Streptococcus)
C. Kawasaki disease
3
, D. Hand-foot-and-mouth disease
Correct Answer: B
Rationale: Scarlet fever presents with pharyngitis, fever, strawberry tongue,
palatal petechiae, and a fine sandpaper-like rash. Kawasaki disease also has
strawberry tongue and rash but is associated with conjunctival injection, cervical
lymphadenopathy, and coronary artery aneurysms.
QUESTION 7
A 65-year-old diabetic male with a history of peripheral neuropathy presents with
a painless ulcer on the plantar surface of his foot. The ulcer is surrounded by
callus and has a punched-out appearance. What is the most appropriate initial
management?
A. Debridement and offloading
B. Systemic antibiotics
C. Vascular surgery referral
D. Hyperbaric oxygen therapy
Correct Answer: A
Rationale: The priority is mechanical offloading (to remove pressure from the
ulcer) and debridement of callus and necrotic tissue. Antibiotics are used if there
is infection, but the first step is wound care and offloading. Vascular assessment
is important but not the first step unless ischemia is suspected.
QUESTION 8
A 52-year-old woman presents with a 6-month history of progressive weakness in
her proximal muscles, difficulty rising from a chair, and a heliotrope rash on her
eyelids. Which enzyme is most likely elevated?
A. Creatine kinase (CK)
4
EXIT EXAM COMPLETE QUESTIONS WITH DETAILED ANSWERS AND
RATIONALES|FITZ EXAM PREP LATEST UPDATE
2026/2027
DOMAIN 1: ADVANCED HEALTH ASSESSMENT (50 Questions)
QUESTION 1
A 55-year-old male presents with a history of hypertension and reports
intermittent chest discomfort. On examination, you note a laterally displaced
PMI, an S4 gallop, and a II/VI systolic ejection murmur at the right upper sternal
border that radiates to the carotids. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonary hypertension
Correct Answer: A
Rationale: Aortic stenosis typically presents with a systolic ejection murmur at
the right upper sternal border, radiating to the carotids. An S4 gallop is common
due to decreased left ventricular compliance. The laterally displaced PMI suggests
left ventricular hypertrophy from pressure overload.
QUESTION 2
A 42-year-old woman presents with fatigue, weight gain, and cold intolerance.
Physical exam reveals dry skin, coarse hair, and a delayed relaxation phase of
deep tendon reflexes. Which laboratory finding would confirm the diagnosis?
A. Elevated TSH, low free T4
B. Low TSH, elevated free T4
C. Elevated TSH, elevated free T4
D. Normal TSH, low free T4
1
,Correct Answer: A
Rationale: Primary hypothyroidism is confirmed by an elevated TSH (pituitary
attempting to stimulate the thyroid) and a low free T4. The clinical presentation
(signs of hypometabolism) supports the diagnosis.
QUESTION 3
During a cardiac examination, you auscultate a high-pitched, blowing, pansystolic
murmur at the apex that radiates to the axilla. The murmur does not change with
respiration. What is the most likely valvular lesion?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Tricuspid regurgitation
Correct Answer: B
Rationale: Mitral regurgitation produces a high-pitched, blowing, pansystolic
murmur best heard at the apex with radiation to the axilla. It does not vary with
respiration (left-sided lesion). Mitral stenosis is diastolic, aortic regurgitation
is diastolic, and tricuspid regurgitation varies with inspiration.
QUESTION 4
A 68-year-old male presents with a 3-month history of lower back pain that is
worse at night and relieved by activity. He also reports unintentional weight loss
and fatigue. What is the most concerning diagnosis to rule out?
A. Osteoarthritis
B. Spinal stenosis
C. Multiple myeloma
D. Lumbar strain
2
,Correct Answer: C
Rationale: Back pain that is worse at night, accompanied by constitutional
symptoms (weight loss, fatigue), and not relieved by rest is concerning for
malignancy, particularly multiple myeloma. Osteoarthritis is worse with activity
and relieved by rest.
QUESTION 5
A 28-year-old pregnant woman at 32 weeks gestation presents with headache,
blurred vision, and right upper quadrant pain. Her blood pressure is 168/102
mmHg. Urine dipstick shows 3+ protein. What is the most likely diagnosis?
A. Gestational hypertension
B. Preeclampsia with severe features
C. Chronic hypertension
D. HELLP syndrome
Correct Answer: B
Rationale: This patient has severe preeclampsia: BP ≥160/110, with headache,
visual disturbances, and epigastric/RUQ pain indicating severe features. HELLP
syndrome is a variant of severe preeclampsia with hemolysis, elevated liver
enzymes, and low platelets.
QUESTION 6
A 7-year-old child presents with a sore throat, fever, and "strawberry tongue."
On examination, you note palatal petechiae and a fine maculopapular rash. What
is the most likely diagnosis?
A. Measles
B. Scarlet fever (Group A Streptococcus)
C. Kawasaki disease
3
, D. Hand-foot-and-mouth disease
Correct Answer: B
Rationale: Scarlet fever presents with pharyngitis, fever, strawberry tongue,
palatal petechiae, and a fine sandpaper-like rash. Kawasaki disease also has
strawberry tongue and rash but is associated with conjunctival injection, cervical
lymphadenopathy, and coronary artery aneurysms.
QUESTION 7
A 65-year-old diabetic male with a history of peripheral neuropathy presents with
a painless ulcer on the plantar surface of his foot. The ulcer is surrounded by
callus and has a punched-out appearance. What is the most appropriate initial
management?
A. Debridement and offloading
B. Systemic antibiotics
C. Vascular surgery referral
D. Hyperbaric oxygen therapy
Correct Answer: A
Rationale: The priority is mechanical offloading (to remove pressure from the
ulcer) and debridement of callus and necrotic tissue. Antibiotics are used if there
is infection, but the first step is wound care and offloading. Vascular assessment
is important but not the first step unless ischemia is suspected.
QUESTION 8
A 52-year-old woman presents with a 6-month history of progressive weakness in
her proximal muscles, difficulty rising from a chair, and a heliotrope rash on her
eyelids. Which enzyme is most likely elevated?
A. Creatine kinase (CK)
4
