SARAH MICHELLE LIVE REVIEW NP
EXAM PRACTICE QUESTIONS AND
ANSWERS 2026/2027
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril 20mg daily and Metoprolol Succinate
50mg daily. His blood pressure is 138/84 mmHg and heart rate is 62 bpm. Which of the
following is the most appropriate next step in managing his guideline-directed medical
therapy (GDMT)?
A. Switch Lisinopril to Sacubitril/Valsartan (Entresto).
B. Increase the dose of Metoprolol Succinate.
C. Add Amlodipine to achieve a blood pressure goal of <130/80.
D. Replace Lisinopril with Losartan.
Answer: A
Conceptual Explanation: For patients with HFrEF (NYHA Class II-III), current guidelines
recommend replacing an ACE inhibitor or ARB with an Angiotensin Receptor-Neprilysin
Inhibitor (ARNI) like Sacubitril/Valsartan to further reduce morbidity and mortality.
,2. Which heart murmur is typically characterized by a mid-systolic click followed by a late
systolic murmur, best heard at the apex?
A. Aortic Stenosis
B. Mitral Valve Prolapse
C. Mitral Regurgitation
D. Aortic Regurgitation
Answer: B
Conceptual Explanation: Mitral Valve Prolapse (MVP) is classically associated with a mid-
systolic click and a late systolic murmur at the apex. The click is due to the sudden tensing
of the chordae tendineae as the valve leaflets prolapse into the left atrium.
3. A 45-year-old female presents with a TSH of 0.1 mIU/L and a high Free T4. She has a visible
goiter and exophthalmos. Which medication is the preferred initial treatment for this patient
in her first trimester of pregnancy?
A. Methimazole
B. Radioactive Iodine
C. Propylthiouracil (PTU)
D. Levothyroxine
Answer: C
, Conceptual Explanation: In the first trimester of pregnancy, Propylthiouracil (PTU) is
preferred over Methimazole due to the risk of Methimazole-associated embryopathy
(aplasia cutis). Methimazole is typically used in the second and third trimesters.
4. An 82-year-old patient is diagnosed with community-acquired pneumonia. Which of the
following medications should be avoided according to the Beers Criteria?
A. Azithromycin
B. Clarithromycin
C. Levofloxacin
D. Nitrofurantoin
Answer: C
Conceptual Explanation: Fluoroquinolones like Levofloxacin are included in the Beers
Criteria to be used with caution in older adults due to risks of tendon rupture, C. diff
infection, and CNS effects (confusion), although they aren’t strictly contraindicated if
necessary.
5. A 24-year-old female presents with a ‘strawberry cervix’ and a profuse, malodorous, thin,
green-yellow discharge. Which of the following is the gold standard for diagnosis?
A. Wet mount microscopy
B. Nucleic acid amplification test (NAAT)
C. Whiff test
EXAM PRACTICE QUESTIONS AND
ANSWERS 2026/2027
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril 20mg daily and Metoprolol Succinate
50mg daily. His blood pressure is 138/84 mmHg and heart rate is 62 bpm. Which of the
following is the most appropriate next step in managing his guideline-directed medical
therapy (GDMT)?
A. Switch Lisinopril to Sacubitril/Valsartan (Entresto).
B. Increase the dose of Metoprolol Succinate.
C. Add Amlodipine to achieve a blood pressure goal of <130/80.
D. Replace Lisinopril with Losartan.
Answer: A
Conceptual Explanation: For patients with HFrEF (NYHA Class II-III), current guidelines
recommend replacing an ACE inhibitor or ARB with an Angiotensin Receptor-Neprilysin
Inhibitor (ARNI) like Sacubitril/Valsartan to further reduce morbidity and mortality.
,2. Which heart murmur is typically characterized by a mid-systolic click followed by a late
systolic murmur, best heard at the apex?
A. Aortic Stenosis
B. Mitral Valve Prolapse
C. Mitral Regurgitation
D. Aortic Regurgitation
Answer: B
Conceptual Explanation: Mitral Valve Prolapse (MVP) is classically associated with a mid-
systolic click and a late systolic murmur at the apex. The click is due to the sudden tensing
of the chordae tendineae as the valve leaflets prolapse into the left atrium.
3. A 45-year-old female presents with a TSH of 0.1 mIU/L and a high Free T4. She has a visible
goiter and exophthalmos. Which medication is the preferred initial treatment for this patient
in her first trimester of pregnancy?
A. Methimazole
B. Radioactive Iodine
C. Propylthiouracil (PTU)
D. Levothyroxine
Answer: C
, Conceptual Explanation: In the first trimester of pregnancy, Propylthiouracil (PTU) is
preferred over Methimazole due to the risk of Methimazole-associated embryopathy
(aplasia cutis). Methimazole is typically used in the second and third trimesters.
4. An 82-year-old patient is diagnosed with community-acquired pneumonia. Which of the
following medications should be avoided according to the Beers Criteria?
A. Azithromycin
B. Clarithromycin
C. Levofloxacin
D. Nitrofurantoin
Answer: C
Conceptual Explanation: Fluoroquinolones like Levofloxacin are included in the Beers
Criteria to be used with caution in older adults due to risks of tendon rupture, C. diff
infection, and CNS effects (confusion), although they aren’t strictly contraindicated if
necessary.
5. A 24-year-old female presents with a ‘strawberry cervix’ and a profuse, malodorous, thin,
green-yellow discharge. Which of the following is the gold standard for diagnosis?
A. Wet mount microscopy
B. Nucleic acid amplification test (NAAT)
C. Whiff test
