AANP Family Nurse Practitioner Review Study
Guide & Certification Preparation 2026/2027 | FNP
Exam Review
DOMAIN 1: ASSESSMENT & DIAGNOSIS
Cardiovascular System
1. A 65-year-old female presents with gradual onset of dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. Her blood pressure is 148/92
mmHg, heart rate 88 bpm, and respiratory rate 20/min. Jugular venous
distention is noted at 45 degrees. Which additional physical examination finding
is most consistent with heart failure?
A) Hyperactive bowel sounds
B) Tympanic abdomen
C) Jugular venous distention
D) Mydriasis
Correct Answer: C
Jugular venous distention reflects elevated central venous pressure and is a classic
sign of heart failure. Patients with heart failure typically present with JVD,
peripheral edema, pulmonary crackles, and an S3 gallop. Hyperactive bowel
sounds and tympanic abdomen are associated with gastrointestinal conditions,
while mydriasis suggests neurological or sympathetic stimulation.
2. A 62-year-old man with a 15-year history of type 2 diabetes mellitus presents
for routine follow-up. His blood pressure is 138/84 mmHg. Laboratory
evaluation reveals total cholesterol 240 mg/dL, HDL 30 mg/dL, and LDL 185
,mg/dL. He smokes 1 pack per day. His mother died from a myocardial infarction
at age 52. According to ACC/AHA guidelines, this patient should be started on:
A) Bile acid sequestrant
B) High-intensity statin therapy
C) Cholesterol absorption inhibitor
D) Low-dose aspirin only
Correct Answer: B
This patient meets multiple high-risk criteria for atherosclerotic cardiovascular
disease: diabetes mellitus, hypertension, smoking, family history of premature
CHD, and markedly elevated LDL ≥ 190 mg/dL. ACC/AHA guidelines recommend
high-intensity statin therapy as first-line pharmacologic treatment for patients
with LDL ≥ 190 mg/dL and those with clinical ASCVD or diabetes with risk factors.
Bile acid sequestrants and absorption inhibitors are adjunctive therapies, not first-
line.
3. A 58-year-old male presents to the emergency department with acute
substernal chest pain radiating to the left jaw, associated with diaphoresis and
nausea. ECG shows ST-segment elevation in leads V1-V4. What is the most
appropriate immediate intervention?
A) Administer oral aspirin and observe for 2 hours
B) Arrange for percutaneous coronary intervention within 90 minutes
C) Start high-dose oral beta-blocker therapy
D) Administer intravenous fibrinolytic therapy only
Correct Answer: B
Anterior STEMI presenting with ST elevation in V1-V4 requires immediate
reperfusion. PCI within 90 minutes of first medical contact is the gold standard per
AHA guidelines. Aspirin should be given immediately but is adjunctive, not
definitive treatment. Fibrinolytics are an alternative only if PCI cannot be
,performed within 120 minutes. Beta-blockers should be initiated after reperfusion,
not as primary therapy.
4. A 72-year-old woman with a history of hypertension and type 2 diabetes is
noted to have an irregularly irregular pulse during a routine examination. She
reports occasional palpitations but denies chest pain or shortness of breath.
Which diagnosis is most likely?
A) Atrial flutter
B) Atrial fibrillation
C) Ventricular tachycardia
D) Sinus arrhythmia
Correct Answer: B
Irregularly irregular rhythm is the hallmark of atrial fibrillation. This is the most
common sustained cardiac arrhythmia and prevalence increases with age. Risk
factors include hypertension, diabetes, and structural heart disease. Atrial flutter
typically presents with a regular or regularly irregular rhythm. Ventricular
tachycardia presents with a wide-complex tachycardia and is hemodynamically
unstable. Sinus arrhythmia is a normal variant, especially in young adults.
5. A patient with chronic heart failure who is taking lisinopril develops a
persistent, non-productive cough that is worse at night. What is the most likely
mechanism for this adverse effect?
A) Angiotensin II receptor blockade
B) Bradykinin accumulation
C) Increased prostaglandin synthesis
D) Beta-2 receptor stimulation
Correct Answer: B
, ACE inhibitors prevent the breakdown of bradykinin, leading to its accumulation in
the respiratory tract, which causes a characteristic dry cough. This occurs in
approximately 10-20% of patients. Switching to an angiotensin receptor blocker
(ARB) is appropriate when cough becomes intolerable, as ARBs do not affect
bradykinin metabolism.
6. A 55-year-old patient presents with a blood pressure of 142/90 mmHg on two
separate occasions one month apart. The patient has no known comorbidities
and reports no symptoms. Which of the following is the most appropriate next
step?
A) Recheck blood pressure in 6 months
B) Recommend therapeutic lifestyle changes and recheck in 3-6 months
C) Initiate antihypertensive medication immediately
D) Order echocardiogram to evaluate for end-organ damage
Correct Answer: B
Stage 1 hypertension (130-139/80-89 mmHg) in a patient without ASCVD risk
factors, target organ damage, or diabetes should initially be managed with
therapeutic lifestyle changes for 3-6 months before initiating pharmacologic
therapy. This patient has stage 1 hypertension and does not meet criteria for
immediate medication initiation. Rechecking in 6 months without intervention is
inadequate, and ordering echocardiogram at this stage is not evidence-based.
7. A 45-year-old female with no cardiac history presents with intermittent
palpitations, lightheadedness, and episodes of near-syncope. Holter monitor
reveals episodes of supraventricular tachycardia. Which initial pharmacologic
management is most appropriate?
A) Amiodarone
B) Metoprolol
Guide & Certification Preparation 2026/2027 | FNP
Exam Review
DOMAIN 1: ASSESSMENT & DIAGNOSIS
Cardiovascular System
1. A 65-year-old female presents with gradual onset of dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. Her blood pressure is 148/92
mmHg, heart rate 88 bpm, and respiratory rate 20/min. Jugular venous
distention is noted at 45 degrees. Which additional physical examination finding
is most consistent with heart failure?
A) Hyperactive bowel sounds
B) Tympanic abdomen
C) Jugular venous distention
D) Mydriasis
Correct Answer: C
Jugular venous distention reflects elevated central venous pressure and is a classic
sign of heart failure. Patients with heart failure typically present with JVD,
peripheral edema, pulmonary crackles, and an S3 gallop. Hyperactive bowel
sounds and tympanic abdomen are associated with gastrointestinal conditions,
while mydriasis suggests neurological or sympathetic stimulation.
2. A 62-year-old man with a 15-year history of type 2 diabetes mellitus presents
for routine follow-up. His blood pressure is 138/84 mmHg. Laboratory
evaluation reveals total cholesterol 240 mg/dL, HDL 30 mg/dL, and LDL 185
,mg/dL. He smokes 1 pack per day. His mother died from a myocardial infarction
at age 52. According to ACC/AHA guidelines, this patient should be started on:
A) Bile acid sequestrant
B) High-intensity statin therapy
C) Cholesterol absorption inhibitor
D) Low-dose aspirin only
Correct Answer: B
This patient meets multiple high-risk criteria for atherosclerotic cardiovascular
disease: diabetes mellitus, hypertension, smoking, family history of premature
CHD, and markedly elevated LDL ≥ 190 mg/dL. ACC/AHA guidelines recommend
high-intensity statin therapy as first-line pharmacologic treatment for patients
with LDL ≥ 190 mg/dL and those with clinical ASCVD or diabetes with risk factors.
Bile acid sequestrants and absorption inhibitors are adjunctive therapies, not first-
line.
3. A 58-year-old male presents to the emergency department with acute
substernal chest pain radiating to the left jaw, associated with diaphoresis and
nausea. ECG shows ST-segment elevation in leads V1-V4. What is the most
appropriate immediate intervention?
A) Administer oral aspirin and observe for 2 hours
B) Arrange for percutaneous coronary intervention within 90 minutes
C) Start high-dose oral beta-blocker therapy
D) Administer intravenous fibrinolytic therapy only
Correct Answer: B
Anterior STEMI presenting with ST elevation in V1-V4 requires immediate
reperfusion. PCI within 90 minutes of first medical contact is the gold standard per
AHA guidelines. Aspirin should be given immediately but is adjunctive, not
definitive treatment. Fibrinolytics are an alternative only if PCI cannot be
,performed within 120 minutes. Beta-blockers should be initiated after reperfusion,
not as primary therapy.
4. A 72-year-old woman with a history of hypertension and type 2 diabetes is
noted to have an irregularly irregular pulse during a routine examination. She
reports occasional palpitations but denies chest pain or shortness of breath.
Which diagnosis is most likely?
A) Atrial flutter
B) Atrial fibrillation
C) Ventricular tachycardia
D) Sinus arrhythmia
Correct Answer: B
Irregularly irregular rhythm is the hallmark of atrial fibrillation. This is the most
common sustained cardiac arrhythmia and prevalence increases with age. Risk
factors include hypertension, diabetes, and structural heart disease. Atrial flutter
typically presents with a regular or regularly irregular rhythm. Ventricular
tachycardia presents with a wide-complex tachycardia and is hemodynamically
unstable. Sinus arrhythmia is a normal variant, especially in young adults.
5. A patient with chronic heart failure who is taking lisinopril develops a
persistent, non-productive cough that is worse at night. What is the most likely
mechanism for this adverse effect?
A) Angiotensin II receptor blockade
B) Bradykinin accumulation
C) Increased prostaglandin synthesis
D) Beta-2 receptor stimulation
Correct Answer: B
, ACE inhibitors prevent the breakdown of bradykinin, leading to its accumulation in
the respiratory tract, which causes a characteristic dry cough. This occurs in
approximately 10-20% of patients. Switching to an angiotensin receptor blocker
(ARB) is appropriate when cough becomes intolerable, as ARBs do not affect
bradykinin metabolism.
6. A 55-year-old patient presents with a blood pressure of 142/90 mmHg on two
separate occasions one month apart. The patient has no known comorbidities
and reports no symptoms. Which of the following is the most appropriate next
step?
A) Recheck blood pressure in 6 months
B) Recommend therapeutic lifestyle changes and recheck in 3-6 months
C) Initiate antihypertensive medication immediately
D) Order echocardiogram to evaluate for end-organ damage
Correct Answer: B
Stage 1 hypertension (130-139/80-89 mmHg) in a patient without ASCVD risk
factors, target organ damage, or diabetes should initially be managed with
therapeutic lifestyle changes for 3-6 months before initiating pharmacologic
therapy. This patient has stage 1 hypertension and does not meet criteria for
immediate medication initiation. Rechecking in 6 months without intervention is
inadequate, and ordering echocardiogram at this stage is not evidence-based.
7. A 45-year-old female with no cardiac history presents with intermittent
palpitations, lightheadedness, and episodes of near-syncope. Holter monitor
reveals episodes of supraventricular tachycardia. Which initial pharmacologic
management is most appropriate?
A) Amiodarone
B) Metoprolol
