AANP FNP Board Exam – Comprehensive Questions and
Answers with Detailed Rationales
Primary Care, Cardiology & Pulmonology
1.
A 58-year-old patient has a blood pressure of 168/96 mmHg at two
separate office visits. The patient has no symptoms and no evidence of
acute target-organ injury. What is the most appropriate next step?
A. Recheck the blood pressure in 6 months
B. Initiate antihypertensive therapy and lifestyle modification
C. Send the patient immediately to the emergency department
D. Start aspirin therapy only
Correct answer: B
Rationale: Persistent stage 2 hypertension generally warrants
pharmacologic treatment in addition to lifestyle modification.
Asymptomatic severe hypertension without acute target-organ injury
does not automatically require emergency hospitalization.
2.
A 67-year-old patient with hypertension and chronic kidney disease has
an elevated urine albumin-to-creatinine ratio. Which medication class is
particularly beneficial for renal protection?
A. ACE inhibitor
B. Short-acting calcium-channel blocker
C. Alpha blocker
D. Nitrate
Correct answer: A
,Rationale: ACE inhibitors reduce intraglomerular pressure and
albuminuria and provide renal and cardiovascular protection in
appropriate patients with hypertension and albuminuric chronic kidney
disease.
3.
A patient taking lisinopril develops persistent dry cough. Which
medication is the most appropriate alternative?
A. Losartan
B. Propranolol
C. Furosemide
D. Verapamil
Correct answer: A
Rationale: ACE inhibitors can cause a persistent dry cough due to
bradykinin accumulation. An angiotensin receptor blocker such as
losartan provides similar renin-angiotensin system blockade without
the same frequency of cough.
4.
A 72-year-old patient reports substernal chest pressure when walking
uphill that resolves after resting for several minutes. Which diagnosis is
most likely?
A. Stable angina
B. Acute pericarditis
C. Gastroesophageal reflux exclusively
D. Costochondritis
,Correct answer: A
Rationale: Predictable exertional chest pressure relieved by rest is
characteristic of stable angina caused by myocardial ischemia from
fixed coronary artery disease.
5.
A patient presents with crushing chest pain, diaphoresis, and nausea.
The ECG demonstrates ST-segment elevation in contiguous leads. What
is the priority?
A. Schedule an outpatient stress test
B. Treat as an acute STEMI and activate emergency reperfusion
management
C. Prescribe an antacid
D. Reassess in 24 hours
Correct answer: B
Rationale: ST-segment elevation with a compatible ischemic
presentation represents a medical emergency requiring immediate
emergency cardiovascular management and reperfusion evaluation.
6.
Which symptom is most characteristic of left-sided heart failure?
A. Peripheral edema only
B. Pulmonary crackles and orthopnea
C. Splenomegaly
D. Ascites without respiratory symptoms
Correct answer: B
, Rationale: Left-sided heart failure causes pulmonary venous
congestion, producing dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, and pulmonary crackles.
7.
A patient with heart failure develops worsening dyspnea, orthopnea,
and bilateral pulmonary crackles. Which finding would most strongly
support pulmonary congestion?
A. Elevated jugular venous pressure
B. Hyperactive bowel sounds
C. Unilateral calf bruising
D. Isolated ear pain
Correct answer: A
Rationale: Elevated jugular venous pressure reflects increased systemic
venous pressure and commonly accompanies volume overload in heart
failure.
8.
Which medication should generally be avoided in a patient with asthma
because it can provoke bronchospasm?
A. Nonselective beta blocker
B. Inhaled corticosteroid
C. Leukotriene receptor antagonist
D. Short-acting beta₂ agonist
Correct answer: A
Answers with Detailed Rationales
Primary Care, Cardiology & Pulmonology
1.
A 58-year-old patient has a blood pressure of 168/96 mmHg at two
separate office visits. The patient has no symptoms and no evidence of
acute target-organ injury. What is the most appropriate next step?
A. Recheck the blood pressure in 6 months
B. Initiate antihypertensive therapy and lifestyle modification
C. Send the patient immediately to the emergency department
D. Start aspirin therapy only
Correct answer: B
Rationale: Persistent stage 2 hypertension generally warrants
pharmacologic treatment in addition to lifestyle modification.
Asymptomatic severe hypertension without acute target-organ injury
does not automatically require emergency hospitalization.
2.
A 67-year-old patient with hypertension and chronic kidney disease has
an elevated urine albumin-to-creatinine ratio. Which medication class is
particularly beneficial for renal protection?
A. ACE inhibitor
B. Short-acting calcium-channel blocker
C. Alpha blocker
D. Nitrate
Correct answer: A
,Rationale: ACE inhibitors reduce intraglomerular pressure and
albuminuria and provide renal and cardiovascular protection in
appropriate patients with hypertension and albuminuric chronic kidney
disease.
3.
A patient taking lisinopril develops persistent dry cough. Which
medication is the most appropriate alternative?
A. Losartan
B. Propranolol
C. Furosemide
D. Verapamil
Correct answer: A
Rationale: ACE inhibitors can cause a persistent dry cough due to
bradykinin accumulation. An angiotensin receptor blocker such as
losartan provides similar renin-angiotensin system blockade without
the same frequency of cough.
4.
A 72-year-old patient reports substernal chest pressure when walking
uphill that resolves after resting for several minutes. Which diagnosis is
most likely?
A. Stable angina
B. Acute pericarditis
C. Gastroesophageal reflux exclusively
D. Costochondritis
,Correct answer: A
Rationale: Predictable exertional chest pressure relieved by rest is
characteristic of stable angina caused by myocardial ischemia from
fixed coronary artery disease.
5.
A patient presents with crushing chest pain, diaphoresis, and nausea.
The ECG demonstrates ST-segment elevation in contiguous leads. What
is the priority?
A. Schedule an outpatient stress test
B. Treat as an acute STEMI and activate emergency reperfusion
management
C. Prescribe an antacid
D. Reassess in 24 hours
Correct answer: B
Rationale: ST-segment elevation with a compatible ischemic
presentation represents a medical emergency requiring immediate
emergency cardiovascular management and reperfusion evaluation.
6.
Which symptom is most characteristic of left-sided heart failure?
A. Peripheral edema only
B. Pulmonary crackles and orthopnea
C. Splenomegaly
D. Ascites without respiratory symptoms
Correct answer: B
, Rationale: Left-sided heart failure causes pulmonary venous
congestion, producing dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, and pulmonary crackles.
7.
A patient with heart failure develops worsening dyspnea, orthopnea,
and bilateral pulmonary crackles. Which finding would most strongly
support pulmonary congestion?
A. Elevated jugular venous pressure
B. Hyperactive bowel sounds
C. Unilateral calf bruising
D. Isolated ear pain
Correct answer: A
Rationale: Elevated jugular venous pressure reflects increased systemic
venous pressure and commonly accompanies volume overload in heart
failure.
8.
Which medication should generally be avoided in a patient with asthma
because it can provoke bronchospasm?
A. Nonselective beta blocker
B. Inhaled corticosteroid
C. Leukotriene receptor antagonist
D. Short-acting beta₂ agonist
Correct answer: A
