PASS YOUR MARYLAND NURSE PRACTITIONER EXAM IN
2026/2027 – COMPLETE ACCURATE PRACTICE QUESTIONS
1. A nurse practitioner is preparing to practice in Maryland and has completed
a graduate-level nurse practitioner program but has not yet obtained the
required Maryland nurse practitioner certification. The NP has a current RN
license and national certification. Which action is most appropriate before
beginning independent practice as a nurse practitioner in Maryland?
A. Begin practicing independently because national certification
automatically grants Maryland NP authority
B. Practice independently for up to 90 days while the Maryland application
is processed
C. Obtain Maryland nurse practitioner certification before commencing
practice unless a specific regulatory pathway for practice before
certification applies
D. Practice independently if a supervising physician signs a general
employment agreement
Answer: C
2. A 58-year-old patient presents to a primary care clinic with progressive
fatigue, exertional dyspnea, and intermittent palpitations. The patient
reports heavy menstrual bleeding and follows a diet low in iron-containing
foods. Laboratory studies show hemoglobin 9.2 g/dL, hematocrit 29%, MCV
72 fL, and elevated RDW. Which diagnosis should the nurse practitioner
consider most likely based on the clinical presentation and laboratory
pattern?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency anemia
C. Hemolytic anemia
D. Aplastic anemia
Answer: A
pg. 1
, 3. A 67-year-old patient with hypertension, type 2 diabetes, and chronic
kidney disease presents for routine follow-up. The patient reports taking
the prescribed antihypertensive medication but has not been checking
blood pressure at home. The clinic blood pressure is 168/94 mm Hg. Which
assessment should the nurse practitioner prioritize before modifying long-
term therapy?
A. Determine whether the patient has consumed carbohydrates that
morning
B. Confirm medication adherence, dosing, technique of blood-pressure
measurement, and possible contributing factors
C. Immediately prescribe three additional antihypertensive medications
D. Discontinue the current antihypertensive because it has failed
Answer: B
4. A 45-year-old patient presents with episodic unilateral throbbing headaches
associated with nausea, photophobia, and worsening symptoms with
routine activity. The patient reports experiencing similar episodes for
several years and denies focal neurologic deficits, fever, or recent trauma.
Which diagnosis is most consistent with this presentation?
A. Tension-type headache
B. Cluster headache
C. Migraine without an identified secondary cause
D. Bacterial meningitis
Answer: C
5. A 29-year-old patient presents with dysuria and urinary frequency for two
days. The patient denies flank pain, fever, vomiting, pregnancy, or vaginal
discharge. Urinalysis demonstrates leukocyte esterase and nitrites. Which
diagnosis is most consistent with these findings?
A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Vaginitis
pg. 2
,Answer: A
6. A 72-year-old patient with atrial fibrillation is taking an oral anticoagulant
and reports several episodes of black, tarry stools accompanied by
increasing fatigue. Vital signs reveal tachycardia and mild hypotension.
Which action should the nurse practitioner prioritize?
A. Reassure the patient that dark stools are expected with anticoagulant
therapy
B. Recommend increasing dietary iron and reassessing in one month
C. Evaluate urgently for gastrointestinal bleeding and hemodynamic
compromise
D. Tell the patient to take the anticoagulant with food and continue the
current regimen
Answer: C
7. A 34-year-old patient presents with recurrent episodes of wheezing, chest
tightness, and cough that occur primarily at night and after exposure to cat
dander. Between episodes, the patient reports normal exercise tolerance
and no daily symptoms. Which diagnostic approach is most appropriate for
evaluating suspected asthma?
A. Confirm variable airflow limitation using spirometry or an appropriate
objective pulmonary assessment
B. Diagnose asthma solely from the presence of nighttime cough
C. Diagnose chronic obstructive pulmonary disease based on intermittent
wheezing
D. Begin long-term oxygen therapy before pulmonary testing
Answer: A
8. A 61-year-old patient with a 40-pack-year smoking history presents with
chronic productive cough and progressive exertional dyspnea. Spirometry
demonstrates persistent airflow limitation that does not completely
normalize after bronchodilator administration. Which condition should the
nurse practitioner consider?
pg. 3
, A. Acute bacterial sinusitis
B. Chronic obstructive pulmonary disease
C. Restrictive pleural disease
D. Acute pulmonary embolism
Answer: B
9. A 26-year-old patient presents with sore throat, fever, tender anterior
cervical lymph nodes, and tonsillar exudates. The patient has no cough.
Which diagnostic strategy is most appropriate when streptococcal
pharyngitis is suspected?
A. Treat every patient empirically without testing
B. Use an appropriate rapid antigen test and/or throat culture according to
age and clinical circumstances
C. Obtain a chest CT scan
D. Diagnose infectious mononucleosis solely from the presence of tonsillar
exudates
Answer: B
10. A 38-year-old patient presents with fever, facial pain, purulent nasal
discharge, and worsening symptoms after initially improving from an upper
respiratory infection. Symptoms have persisted for more than a week.
Which diagnosis should be considered?
A. Acute bacterial rhinosinusitis
B. Allergic rhinitis
C. Migraine without sinus involvement
D. Viral gastroenteritis
Answer: A
11. A 50-year-old patient reports burning epigastric discomfort that occurs after
large meals and when lying down at night. The patient frequently uses
NSAIDs and drinks several alcoholic beverages each week. There is no
weight loss, gastrointestinal bleeding, progressive dysphagia, or anemia.
Which initial approach is most appropriate?
pg. 4
2026/2027 – COMPLETE ACCURATE PRACTICE QUESTIONS
1. A nurse practitioner is preparing to practice in Maryland and has completed
a graduate-level nurse practitioner program but has not yet obtained the
required Maryland nurse practitioner certification. The NP has a current RN
license and national certification. Which action is most appropriate before
beginning independent practice as a nurse practitioner in Maryland?
A. Begin practicing independently because national certification
automatically grants Maryland NP authority
B. Practice independently for up to 90 days while the Maryland application
is processed
C. Obtain Maryland nurse practitioner certification before commencing
practice unless a specific regulatory pathway for practice before
certification applies
D. Practice independently if a supervising physician signs a general
employment agreement
Answer: C
2. A 58-year-old patient presents to a primary care clinic with progressive
fatigue, exertional dyspnea, and intermittent palpitations. The patient
reports heavy menstrual bleeding and follows a diet low in iron-containing
foods. Laboratory studies show hemoglobin 9.2 g/dL, hematocrit 29%, MCV
72 fL, and elevated RDW. Which diagnosis should the nurse practitioner
consider most likely based on the clinical presentation and laboratory
pattern?
A. Iron-deficiency anemia
B. Vitamin B12 deficiency anemia
C. Hemolytic anemia
D. Aplastic anemia
Answer: A
pg. 1
, 3. A 67-year-old patient with hypertension, type 2 diabetes, and chronic
kidney disease presents for routine follow-up. The patient reports taking
the prescribed antihypertensive medication but has not been checking
blood pressure at home. The clinic blood pressure is 168/94 mm Hg. Which
assessment should the nurse practitioner prioritize before modifying long-
term therapy?
A. Determine whether the patient has consumed carbohydrates that
morning
B. Confirm medication adherence, dosing, technique of blood-pressure
measurement, and possible contributing factors
C. Immediately prescribe three additional antihypertensive medications
D. Discontinue the current antihypertensive because it has failed
Answer: B
4. A 45-year-old patient presents with episodic unilateral throbbing headaches
associated with nausea, photophobia, and worsening symptoms with
routine activity. The patient reports experiencing similar episodes for
several years and denies focal neurologic deficits, fever, or recent trauma.
Which diagnosis is most consistent with this presentation?
A. Tension-type headache
B. Cluster headache
C. Migraine without an identified secondary cause
D. Bacterial meningitis
Answer: C
5. A 29-year-old patient presents with dysuria and urinary frequency for two
days. The patient denies flank pain, fever, vomiting, pregnancy, or vaginal
discharge. Urinalysis demonstrates leukocyte esterase and nitrites. Which
diagnosis is most consistent with these findings?
A. Acute uncomplicated cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Vaginitis
pg. 2
,Answer: A
6. A 72-year-old patient with atrial fibrillation is taking an oral anticoagulant
and reports several episodes of black, tarry stools accompanied by
increasing fatigue. Vital signs reveal tachycardia and mild hypotension.
Which action should the nurse practitioner prioritize?
A. Reassure the patient that dark stools are expected with anticoagulant
therapy
B. Recommend increasing dietary iron and reassessing in one month
C. Evaluate urgently for gastrointestinal bleeding and hemodynamic
compromise
D. Tell the patient to take the anticoagulant with food and continue the
current regimen
Answer: C
7. A 34-year-old patient presents with recurrent episodes of wheezing, chest
tightness, and cough that occur primarily at night and after exposure to cat
dander. Between episodes, the patient reports normal exercise tolerance
and no daily symptoms. Which diagnostic approach is most appropriate for
evaluating suspected asthma?
A. Confirm variable airflow limitation using spirometry or an appropriate
objective pulmonary assessment
B. Diagnose asthma solely from the presence of nighttime cough
C. Diagnose chronic obstructive pulmonary disease based on intermittent
wheezing
D. Begin long-term oxygen therapy before pulmonary testing
Answer: A
8. A 61-year-old patient with a 40-pack-year smoking history presents with
chronic productive cough and progressive exertional dyspnea. Spirometry
demonstrates persistent airflow limitation that does not completely
normalize after bronchodilator administration. Which condition should the
nurse practitioner consider?
pg. 3
, A. Acute bacterial sinusitis
B. Chronic obstructive pulmonary disease
C. Restrictive pleural disease
D. Acute pulmonary embolism
Answer: B
9. A 26-year-old patient presents with sore throat, fever, tender anterior
cervical lymph nodes, and tonsillar exudates. The patient has no cough.
Which diagnostic strategy is most appropriate when streptococcal
pharyngitis is suspected?
A. Treat every patient empirically without testing
B. Use an appropriate rapid antigen test and/or throat culture according to
age and clinical circumstances
C. Obtain a chest CT scan
D. Diagnose infectious mononucleosis solely from the presence of tonsillar
exudates
Answer: B
10. A 38-year-old patient presents with fever, facial pain, purulent nasal
discharge, and worsening symptoms after initially improving from an upper
respiratory infection. Symptoms have persisted for more than a week.
Which diagnosis should be considered?
A. Acute bacterial rhinosinusitis
B. Allergic rhinitis
C. Migraine without sinus involvement
D. Viral gastroenteritis
Answer: A
11. A 50-year-old patient reports burning epigastric discomfort that occurs after
large meals and when lying down at night. The patient frequently uses
NSAIDs and drinks several alcoholic beverages each week. There is no
weight loss, gastrointestinal bleeding, progressive dysphagia, or anemia.
Which initial approach is most appropriate?
pg. 4
