Fitz exit Exam latest update Practice Questions
(Original) EXAM 2026–2027 Latest Update
Original Questions & Answers with Detailed
Rationales Graded A+.pdf
1. 28-year-old woman 32 weeks pregnant presents with BP
152/96, urine protein 2+, headache, brisk reflexes. Next
best step for APRN?
A. Bed rest at home
B. Admit, labs CBC, LFTs, platelets, creatinine, urine
protein/Cr ratio, fetal monitoring, magnesium sulfate
seizure prophylaxis, delivery planning
C. Give ibuprofen
D. No labs needed
Answer: B
Rationale: Preeclampsia with severe features BP ≥160/110
or ≥140/90 with proteinuria plus headache, labs abnormal,
brisk reflexes. Severe features need delivery, labs to assess
HELLP, magnesium prevents eclampsia, monitor fetal well-
being.
2. 65-year-old with AFib on warfarin INR 2.5, new
amiodarone started. What happens to INR?
A. No change
B. INR increases, warfarin dose may need reduction,
, amiodarone inhibits CYP450, increases bleeding risk,
monitor INR more frequently
C. INR decreases
D. Amiodarone safe
Answer: B
Rationale: Amiodarone inhibits CYP1A2, 2C9, 3A4
increasing warfarin levels. Also hypothyroid/hyperthyroid
effects. Check INR 3-5 days after starting.
3. 2-year-old with fever 39.2C, pulling ear, bulging tympanic
membrane. First-line antibiotic per 2026 guidelines?
A. Azithromycin
B. Amoxicillin high dose 80-90 mg/kg/day if no allergy, no
conjunctivitis, no recent amoxicillin
C. Ceftriaxone IV
D. No antibiotic needed
Answer: B
Rationale: AOM first-line amoxicillin high dose covers
resistant S. pneumoniae. If allergic non-severe use cefdinir,
severe allergy clindamycin. If conjunctivitis otitis syndrome
use amoxicillin-clavulanate for H. influenzae.
4. 45-year-old diabetic with LDL 190, ASCVD risk high, already
on atorvastatin 20 mg. LDL still 145 after 3 months
adherence. APRN action?
A. Continue same
, B. Intensify to high-intensity atorvastatin 80 mg or
rosuvastatin 20-40 mg, counsel diet, check adherence,
LFTs, CK if symptoms, ASCVD secondary prevention goal
LDL reduction ≥50%
C. Stop statin
D. Add gemfibrozil
Answer: B
Rationale: High-intensity statin reduces LDL ≥50%. Check
adherence and lifestyle. Gemfibrozil + statin increases
myopathy risk, avoid.
5. 30-year-old woman with dysuria, frequency, suprapubic
pain, no fever, no vaginal discharge. UA nitrite positive,
leukocyte esterase positive. Diagnosis and treatment?
A. Pyelonephritis, admit IV antibiotics
B. Uncomplicated cystitis, nitrofurantoin 100 mg BID x 5
days or TMP-SMX if resistance <20%, fosfomycin single
dose
C. No UTI
D. Ceftriaxone IM
Answer: B
Rationale: Uncomplicated cystitis in nonpregnant woman.
Avoid fluoroquinolones first-line due to resistance and
adverse effects.
, 6. 55-year-old smoker with COPD exacerbation increased
dyspnea, sputum purulence. ABG pH 7.30, pCO2 55, pO2
60. Management?
A. No steroids needed
B. Short-acting bronchodilators albuterol+ipratropium,
systemic corticosteroid prednisone 40 mg x 5 days,
antibiotics if purulence increased dyspnea, consider NIV if
hypercapnic, check ABG
C. Stop inhalers
D. Only antibiotics
Answer: B
Rationale: COPD exacerbation GOLD guidelines -
SABA+SAMA, steroids 5 days, antibiotics if Anthonisen
criteria, NIV for hypercapnic acidosis.
7. 22-year-old with sore throat, fever, tonsillar exudates,
tender anterior cervical nodes, no cough, Centor 4. Next
step?
A. No test needed
B. Rapid strep antigen test, if positive penicillin or
amoxicillin first-line, if allergic azithromycin or clindamycin
C. Ceftriaxone
D. Only symptomatic care
Answer: B
Rationale: Centor 4 high probability strep. Test and treat to
prevent rheumatic fever. If negative consider culture.
(Original) EXAM 2026–2027 Latest Update
Original Questions & Answers with Detailed
Rationales Graded A+.pdf
1. 28-year-old woman 32 weeks pregnant presents with BP
152/96, urine protein 2+, headache, brisk reflexes. Next
best step for APRN?
A. Bed rest at home
B. Admit, labs CBC, LFTs, platelets, creatinine, urine
protein/Cr ratio, fetal monitoring, magnesium sulfate
seizure prophylaxis, delivery planning
C. Give ibuprofen
D. No labs needed
Answer: B
Rationale: Preeclampsia with severe features BP ≥160/110
or ≥140/90 with proteinuria plus headache, labs abnormal,
brisk reflexes. Severe features need delivery, labs to assess
HELLP, magnesium prevents eclampsia, monitor fetal well-
being.
2. 65-year-old with AFib on warfarin INR 2.5, new
amiodarone started. What happens to INR?
A. No change
B. INR increases, warfarin dose may need reduction,
, amiodarone inhibits CYP450, increases bleeding risk,
monitor INR more frequently
C. INR decreases
D. Amiodarone safe
Answer: B
Rationale: Amiodarone inhibits CYP1A2, 2C9, 3A4
increasing warfarin levels. Also hypothyroid/hyperthyroid
effects. Check INR 3-5 days after starting.
3. 2-year-old with fever 39.2C, pulling ear, bulging tympanic
membrane. First-line antibiotic per 2026 guidelines?
A. Azithromycin
B. Amoxicillin high dose 80-90 mg/kg/day if no allergy, no
conjunctivitis, no recent amoxicillin
C. Ceftriaxone IV
D. No antibiotic needed
Answer: B
Rationale: AOM first-line amoxicillin high dose covers
resistant S. pneumoniae. If allergic non-severe use cefdinir,
severe allergy clindamycin. If conjunctivitis otitis syndrome
use amoxicillin-clavulanate for H. influenzae.
4. 45-year-old diabetic with LDL 190, ASCVD risk high, already
on atorvastatin 20 mg. LDL still 145 after 3 months
adherence. APRN action?
A. Continue same
, B. Intensify to high-intensity atorvastatin 80 mg or
rosuvastatin 20-40 mg, counsel diet, check adherence,
LFTs, CK if symptoms, ASCVD secondary prevention goal
LDL reduction ≥50%
C. Stop statin
D. Add gemfibrozil
Answer: B
Rationale: High-intensity statin reduces LDL ≥50%. Check
adherence and lifestyle. Gemfibrozil + statin increases
myopathy risk, avoid.
5. 30-year-old woman with dysuria, frequency, suprapubic
pain, no fever, no vaginal discharge. UA nitrite positive,
leukocyte esterase positive. Diagnosis and treatment?
A. Pyelonephritis, admit IV antibiotics
B. Uncomplicated cystitis, nitrofurantoin 100 mg BID x 5
days or TMP-SMX if resistance <20%, fosfomycin single
dose
C. No UTI
D. Ceftriaxone IM
Answer: B
Rationale: Uncomplicated cystitis in nonpregnant woman.
Avoid fluoroquinolones first-line due to resistance and
adverse effects.
, 6. 55-year-old smoker with COPD exacerbation increased
dyspnea, sputum purulence. ABG pH 7.30, pCO2 55, pO2
60. Management?
A. No steroids needed
B. Short-acting bronchodilators albuterol+ipratropium,
systemic corticosteroid prednisone 40 mg x 5 days,
antibiotics if purulence increased dyspnea, consider NIV if
hypercapnic, check ABG
C. Stop inhalers
D. Only antibiotics
Answer: B
Rationale: COPD exacerbation GOLD guidelines -
SABA+SAMA, steroids 5 days, antibiotics if Anthonisen
criteria, NIV for hypercapnic acidosis.
7. 22-year-old with sore throat, fever, tonsillar exudates,
tender anterior cervical nodes, no cough, Centor 4. Next
step?
A. No test needed
B. Rapid strep antigen test, if positive penicillin or
amoxicillin first-line, if allergic azithromycin or clindamycin
C. Ceftriaxone
D. Only symptomatic care
Answer: B
Rationale: Centor 4 high probability strep. Test and treat to
prevent rheumatic fever. If negative consider culture.
