Fitz, Dunphy, Leik; Exam 2 fnp 2- CARDIAC Exam with Verified Rationales Practice Questions and Answers 2026 with complete solution

Fitz, Dunphy, Leik; Exam 2 fnp 2-
CARDIAC Exam with Verified Rationales
Practice Questions and Answers 2026
with complete solution

Fitz/Dunphy/Leik Style | FNP Exam 2: CARDIAC
FOCUS

Question 1:
A 68-year-old male with hypertension presents with
sudden onset of "crushing" substernal chest pain radiating
to his left jaw and associated with diaphoresis. Vital signs:
BP 168/92, HR 110, RR 24, SpO2 94% on room air. ECG
shows ST-segment elevation in leads II, III, and aVF. What
is the most appropriate immediate intervention?
A. Administer sublingual nitroglycerin 0.4 mg
B. Start aspirin 325 mg chewed
C. Administer morphine 4 mg IV
D. Begin heparin infusion
Answer: B. Start aspirin 325 mg chewed
Rationale: In acute STEMI, time is muscle. The FIRST
medication administered should be aspirin 325 mg
chewed (not swallowed whole) for its antiplatelet effect.
This should occur within 5 minutes of arrival. While
nitroglycerin (A) may be given after aspirin if BP >90, it's

,not first. Morphine (C) is for pain unrelieved by
nitroglycerin. Heparin (D) and other anticoagulants follow
aspirin administration. The order of priority: 1) Aspirin, 2)
Oxygen (if needed), 3) Nitro (if no hypotension), 4)
Morphine (if pain persists).




Question 2:
A 55-year-old female with diabetes presents for a routine
visit. Her BP readings over the past 3 visits average 142/88
mmHg. She follows a low-sodium diet and walks 30
minutes daily. What is the blood pressure goal according
to current ACC/AHA guidelines?
A. <130/80 mmHg
B. <140/90 mmHg
C. <150/90 mmHg
D. <120/80 mmHg
Answer: A. <130/80 mmHg
Rationale: The 2017 ACC/AHA Hypertension
Guidelines established a goal of <130/80 mmHg for
nearly all adults, including those with diabetes. This
represents a significant change from previous JNC8
guidelines (<140/90). For this diabetic patient with
cardiovascular risk, tight control is essential. The 140/90

,threshold (B) is now considered Stage 2 hypertension,
not a treatment goal.




Question 3:
A 72-year-old male with atrial fibrillation (on warfarin)
presents with acute onset of right-sided weakness and
slurred speech lasting 45 minutes but now completely
resolved. CT head without contrast is negative. What is
the next appropriate step?
A. Discharge home with outpatient neurology follow-up
B. Admit for observation and start aspirin 81 mg daily
C. Admit for TEE and consider cardioversion
D. Administer IV tPA immediately
Answer: B. Admit for observation and start aspirin 81
mg daily
Rationale: This is a TIA (transient ischemic attack) in a
patient with AFib. Even though symptoms resolved, he
remains at high risk for stroke. Patients with TIA should
be admitted for observation (24-hour rule: 50% of
strokes occur within 24-48 hours after TIA). Since he's
already on warfarin (presumably therapeutic INR), adding
aspirin (dual therapy) may be considered but requires
careful bleeding risk assessment. tPA (D) is contraindicated

, as symptoms have resolved. TEE (C) might be considered
later but isn't the immediate next step.




Question 4:
During a cardiac exam, you auscultate a murmur that
is holosystolic, heard best at the apex, and radiates to
the axilla. The patient has no thrill. What valve
abnormality does this describe?
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Mitral stenosis
Answer: B. Mitral regurgitation
Rationale: Mitral regurgitation
murmur characteristics: Holosystolic (starts with S1,
continues through S2), loudest at apex, radiates to axilla.
Think: "MR goes to the aRmpit." Aortic stenosis (A)
is crescendo-decrescendo, heard at right 2nd ICS,
radiates to carotids. Tricuspid regurgitation (C) is
holosystolic at left lower sternal border, increases with
inspiration. Mitral stenosis (D) is diastolic, low-pitched
rumble at apex.