FNP-BC 2026 Study Guide: Family Nurse
Practitioner Certification Practice Questions
Answer Explanations & Primary Care
Assessment, Diagnosis & Treatment Exam
Preparation
SECTION 1: CARDIOVASCULAR
Question 1
A 62-year-old male with diabetes and hypertension presents with chest pain at
rest lasting 20 minutes. ECG shows ST depression. What is the most appropriate
immediate action?
A) Prescribe nitroglycerin and discharge
B) Obtain troponin and admit for ACS rule-out
C) Schedule outpatient stress test
D) Start a beta-blocker and follow up in 1 week
Answer: B) Obtain troponin and admit for ACS rule-out
Rationale: Rest pain with ST depression suggests unstable angina/NSTEMI.
Immediate troponin and admission are required. Discharge or outpatient testing
is unsafe.
Question 2
A 55-year-old female has BP 158/96 mmHg on two visits. She has no
comorbidities. What is the first-line pharmacologic treatment?
A) Lisinopril
B) Atenolol
C) Furosemide
D) Clonidine
,Answer: A) Lisinopril
Rationale: ACC/AHA guidelines recommend ACE inhibitors, ARBs, CCBs, or
thiazides as first-line for hypertension. Beta-blockers and loop diuretics are not
first-line unless specific indications exist.
Question 3
A 70-year-old male with HFrEF (EF 30%) is on lisinopril and carvedilol. Which
additional medication improves mortality?
A) Amlodipine
B) Spironolactone
C) Furosemide
D) Digoxin
Answer: B) Spironolactone
Rationale: Mineralocorticoid receptor antagonists (spironolactone/eplerenone)
reduce mortality in HFrEF. Amlodipine and furosemide are symptomatic but not
mortality-reducing. Digoxin reduces hospitalizations but not mortality.
Question 4
A 68-year-old female with atrial fibrillation has CHA2DS2-VASc score of 4. What
is the most appropriate anticoagulation?
A) Aspirin 81 mg daily
B) Apixaban 5 mg BID
C) Clopidogrel 75 mg daily
D) No anticoagulation needed
Answer: B) Apixaban 5 mg BID
Rationale: CHA2DS2-VASc ≥2 in women warrants anticoagulation. DOACs
(apixaban, rivaroxaban) are preferred over warfarin. Aspirin and clopidogrel are
inadequate for stroke prevention in AF.
,Question 5
A 45-year-old male has LDL 190 mg/dL and no other risk factors. What is the
most appropriate treatment?
A) Lifestyle modification only
B) High-intensity statin
C) Moderate-intensity statin
D) Fibrate
Answer: B) High-intensity statin
Rationale: LDL ≥190 mg/dL warrants high-intensity statin (atorvastatin 40–80 mg
or rosuvastatin 20–40 mg) regardless of ASCVD risk. Fibrates are not first-line.
Question 6
A 30-year-old female presents with palpitations. ECG shows narrow-complex
tachycardia at 180 bpm. She is stable. What is the first-line treatment?
A) Adenosine 6 mg IV push
B) Amiodarone 150 mg IV
C) Synchronized cardioversion
D) Diltiazem 20 mg IV
Answer: A) Adenosine 6 mg IV push
Rationale: Stable narrow-complex tachycardia (SVT) is treated with adenosine.
Amiodarone is for ventricular arrhythmias. Cardioversion is for unstable patients.
Diltiazem is for rate control in AF.
Question 7
A 50-year-old male with chest pain has ECG showing ST elevation in leads II, III,
aVF. What is the diagnosis?
A) Anterior STEMI
B) Inferior STEMI
, C) Lateral STEMI
D) Posterior STEMI
Answer: B) Inferior STEMI
Rationale: Leads II, III, aVF represent the inferior wall. Anterior = V1–V4. Lateral =
I, aVL, V5–V6. Posterior = reciprocal changes in V1–V2.
Question 8
A 60-year-old female has BP 170/100 mmHg with headache and blurred vision.
What is the diagnosis?
A) Hypertensive urgency
B) Hypertensive emergency
C) White coat hypertension
D) Primary hypertension
Answer: B) Hypertensive emergency
Rationale: Hypertensive emergency = BP >180/120 with end-organ damage
(headache, visual changes). Urgency = severe BP without end-organ damage.
Question 9
A 72-year-old male has jugular venous distension, crackles, and S3 gallop. What
is the most likely diagnosis?
A) COPD exacerbation
B) Heart failure exacerbation
C) Pneumonia
D) Pulmonary embolism
Answer: B) Heart failure exacerbation
Rationale: JVD, crackles, and S3 gallop are classic for heart failure. COPD shows
wheezing and prolonged expiration. Pneumonia shows fever and consolidation.
PE shows sudden dyspnea and tachycardia.
Practitioner Certification Practice Questions
Answer Explanations & Primary Care
Assessment, Diagnosis & Treatment Exam
Preparation
SECTION 1: CARDIOVASCULAR
Question 1
A 62-year-old male with diabetes and hypertension presents with chest pain at
rest lasting 20 minutes. ECG shows ST depression. What is the most appropriate
immediate action?
A) Prescribe nitroglycerin and discharge
B) Obtain troponin and admit for ACS rule-out
C) Schedule outpatient stress test
D) Start a beta-blocker and follow up in 1 week
Answer: B) Obtain troponin and admit for ACS rule-out
Rationale: Rest pain with ST depression suggests unstable angina/NSTEMI.
Immediate troponin and admission are required. Discharge or outpatient testing
is unsafe.
Question 2
A 55-year-old female has BP 158/96 mmHg on two visits. She has no
comorbidities. What is the first-line pharmacologic treatment?
A) Lisinopril
B) Atenolol
C) Furosemide
D) Clonidine
,Answer: A) Lisinopril
Rationale: ACC/AHA guidelines recommend ACE inhibitors, ARBs, CCBs, or
thiazides as first-line for hypertension. Beta-blockers and loop diuretics are not
first-line unless specific indications exist.
Question 3
A 70-year-old male with HFrEF (EF 30%) is on lisinopril and carvedilol. Which
additional medication improves mortality?
A) Amlodipine
B) Spironolactone
C) Furosemide
D) Digoxin
Answer: B) Spironolactone
Rationale: Mineralocorticoid receptor antagonists (spironolactone/eplerenone)
reduce mortality in HFrEF. Amlodipine and furosemide are symptomatic but not
mortality-reducing. Digoxin reduces hospitalizations but not mortality.
Question 4
A 68-year-old female with atrial fibrillation has CHA2DS2-VASc score of 4. What
is the most appropriate anticoagulation?
A) Aspirin 81 mg daily
B) Apixaban 5 mg BID
C) Clopidogrel 75 mg daily
D) No anticoagulation needed
Answer: B) Apixaban 5 mg BID
Rationale: CHA2DS2-VASc ≥2 in women warrants anticoagulation. DOACs
(apixaban, rivaroxaban) are preferred over warfarin. Aspirin and clopidogrel are
inadequate for stroke prevention in AF.
,Question 5
A 45-year-old male has LDL 190 mg/dL and no other risk factors. What is the
most appropriate treatment?
A) Lifestyle modification only
B) High-intensity statin
C) Moderate-intensity statin
D) Fibrate
Answer: B) High-intensity statin
Rationale: LDL ≥190 mg/dL warrants high-intensity statin (atorvastatin 40–80 mg
or rosuvastatin 20–40 mg) regardless of ASCVD risk. Fibrates are not first-line.
Question 6
A 30-year-old female presents with palpitations. ECG shows narrow-complex
tachycardia at 180 bpm. She is stable. What is the first-line treatment?
A) Adenosine 6 mg IV push
B) Amiodarone 150 mg IV
C) Synchronized cardioversion
D) Diltiazem 20 mg IV
Answer: A) Adenosine 6 mg IV push
Rationale: Stable narrow-complex tachycardia (SVT) is treated with adenosine.
Amiodarone is for ventricular arrhythmias. Cardioversion is for unstable patients.
Diltiazem is for rate control in AF.
Question 7
A 50-year-old male with chest pain has ECG showing ST elevation in leads II, III,
aVF. What is the diagnosis?
A) Anterior STEMI
B) Inferior STEMI
, C) Lateral STEMI
D) Posterior STEMI
Answer: B) Inferior STEMI
Rationale: Leads II, III, aVF represent the inferior wall. Anterior = V1–V4. Lateral =
I, aVL, V5–V6. Posterior = reciprocal changes in V1–V2.
Question 8
A 60-year-old female has BP 170/100 mmHg with headache and blurred vision.
What is the diagnosis?
A) Hypertensive urgency
B) Hypertensive emergency
C) White coat hypertension
D) Primary hypertension
Answer: B) Hypertensive emergency
Rationale: Hypertensive emergency = BP >180/120 with end-organ damage
(headache, visual changes). Urgency = severe BP without end-organ damage.
Question 9
A 72-year-old male has jugular venous distension, crackles, and S3 gallop. What
is the most likely diagnosis?
A) COPD exacerbation
B) Heart failure exacerbation
C) Pneumonia
D) Pulmonary embolism
Answer: B) Heart failure exacerbation
Rationale: JVD, crackles, and S3 gallop are classic for heart failure. COPD shows
wheezing and prolonged expiration. Pneumonia shows fever and consolidation.
PE shows sudden dyspnea and tachycardia.
