University FNP REVISED AND UPDATED
FOR 2026/2027 ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED
ANSWERS) |ALREADY GRADED
A+||BRAND NEW!!
NSG6998 Pre-Predictor Comprehensive Exam
jh jh jh
Instructions: Select the single best answer for each question.
jh jh jh jh jh jh jh jh
Section 1: Cardiovascular & Hematology
jh jh jh jh
1. A 68-year-
jh jh
old male with a history of hypertension presents with complaints of gradual onset shortnes
jh jh jh jh jh jh jh jh jh jh jh jh jh
s of breath and non-
jh jh jh jh
productive cough over the past 3 months. On auscultation, you hear an S3 gallop and bibas
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ilar crackles. What is the most likely diagnosis?
jh jh jh jh jh jh jh
• A) Acute bronchitis
jh jh
• B) Asthma exacerbation
jh jh
• C) Heart failure with reduced ejection fraction
jh jh jh jh jh jh
• D) Heart failure with preserved ejection fraction
jh jh jh jh jh jh
Rationale: The gradual onset of symptoms, S3 gallop (indicating volume overload), and crackles poin
jh jh jh jh jh jh jh jh jh jh jh jh jh
t toward heart failure. An S3 is classic for systolic dysfunction (HFrEF), but the question describes gra
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
dual onset; however, in older adults with hypertension, HFpEF is very common. The presence of an S3
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh j
actually indicates HFrEF, so the best answer here is C. (Correction: The correct answer should be Hea
h jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
rt failure with reduced ejection fraction if S3 is present. Let's adjust the options).
jh jh jh jh jh jh jh jh jh jh jh jh jh
(REVISED QUESTION 1) jh jh
1. A 68-year-
jh jh
old male with a history of hypertension presents with progressive dyspnea on exertion and
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
,orthopnea. On exam, JVD is noted, and auscultation reveals an S3 gallop. What is the most
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
likely pathophysiological finding?
jh jh
• A) Decreased left ventricular compliance
jh jh jh jh
• B) Reduced left ventricular ejection fraction
jh jh jh jh jh
• C) Constrictive pericarditis
jh jh
• D) Severe aortic stenosis
jh jh jh
Rationale: An S3 gallop is a hallmark of systolic dysfunction (reduced ejection fraction) due to rapid v
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
entricular filling in a dilated, failing ventricle.
jh jh jh jh jh jh
2. A 55-year-old female with a history of type 2 diabetes presents with a 2-
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
day history of progressive swelling and redness in her left lower leg. She reports a fever of
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
101.5°F. On exam, the leg is warm, erythematous, and tender to palpation. There is no crepi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tus. What is the first-line treatment?
jh jh jh jh jh
• A) Vancomycin 15 mg/kg IV
jh jh jh jh
• B) Cephalexin 500 mg PO QID
jh jh jh jh jh
• C) Doxycycline 100 mg PO BID
jh jh jh jh jh
• D) Clindamycin 300 mg PO QID
jh jh jh jh jh
Rationale: This is classic cellulitis. In the context of diabetes or MRSA risk, Doxycycline covers commu
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
nity-acquired MRSA and strep species. Cephalexin is for non-purulent cellulitis without MRSA risk.
jh jh jh jh jh jh jh jh jh jh jh jh
3. A patient with Atrial Fibrillation has a CHA₂DS₂-
jh jh jh jh jh jh jh jh
VASc score of 4. Which of the following is the most appropriate anticoagulant to prevent st
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
roke in a patient with severe renal impairment (CrCl < 15 mL/min)?
jh jh jh jh jh jh jh jh jh jh jh
• A) Apixabanjh
• B) Rivaroxaban
jh
• C) Dabigatran
jh
• D) Warfarin jh
Rationale: Direct oral anticoagulants (DOACs) are contraindicated in severe renal impairment (CrCl
jh jh jh jh jh jh jh jh jh jh jh jh
< 15) except for apixaban (which is used in ESRD but not preferred). Warfarin is the only safe option f
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
or CrCl < 15.
jh jh jh
,4. A 72-year-
jh jh
old male is started on Lisinopril for hypertension. One week later, he calls reporting a dry c
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ough and angioedema of his lips. What is the best alternative medication?
jh jh jh jh jh jh jh jh jh jh jh
• A) Amlodipine
jh
• B) Hydrochlorothiazide
jh
• C) Losartan
jh
• D) Metoprolol
jh
Rationale: Angioedema and cough are classic ACE inhibitor side effects. An ARB (Losartan) is the best
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
substitute, as it has a lower risk of cough/angioedema.
jh jh jh jh jh jh jh jh jh
Section 2: Pulmonology & ENT jh jh jh jh
5. A 45-year-
jh jh
old asthmatic patient is using their Albuterol inhaler daily. Which of the following changes
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
to their medication regimen would best manage underlying airway inflammation?
jh jh jh jh jh jh jh jh jh
• A) Increase Albuterol dose to 2 puffs QID
jh jh jh jh jh jh jh
• B) Add Montelukast (Singulair)
jh jh jh
• C) Add Low-dose Inhaled Corticosteroid (Fluticasone)
jh jh jh jh jh
• D) Add Theophylline
jh jh
Rationale: Daily rescue inhaler use indicates poor control. Inhaled corticosteroids are the cornerstone
jh jh jh jh jh jh jh jh jh jh jh jh
of anti-inflammatory therapy for persistent asthma.
jh jh jh jh jh jh
6. A 6-month-
jh jh
old infant presents with a barking cough, stridor, and hoarseness. Symptoms are worse at n
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ight. What is the most likely diagnosis?
jh jh jh jh jh jh
• A) Epiglottitis
jh
• B) Croup (Laryngotracheobronchitis)
jh jh
• C) Bronchiolitis
jh
• D) Foreign body aspiration
jh jh jh
, Rationale: The classic "barking" cough and stridor in an infant, worse at night, is pathognomonic for
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
Croup (viral). Epiglottitis presents with drooling and tripod positioning.
jh jh jh jh jh jh jh jh
7. A patient with COPD has an FEV1/FVC ratio of 55%. They are currently on a LABA/LAMA
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
combination. They continue to have exacerbations. Which of the following should be adde
jh jh jh jh jh jh jh jh jh jh jh jh
d?
• A) Theophylline
jh
• B) Montelukast
jh
• C) Inhaled Corticosteroid (ICS)
jh jh jh
• D) Cromolyn Sodium
jh jh
Rationale: For GOLD Group E (frequent exacerbations), the addition of an ICS to LABA/LAMA (Triple
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
Therapy) is recommended. jh jh
Section 3: Endocrinology & Metabolic
jh jh jh jh
8. A 52-year-
jh jh
old obese female presents with acanthosis nigricans on her neck. Fasting blood glucose is 1
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
30 mg/dL. What is the most appropriate next step?
jh jh jh jh jh jh jh jh
• A) Start Metformin immediately
jh jh jh
• B) Fasting lipid panel
jh jh jh
• C) Repeat fasting glucose and perform Hemoglobin A1c
jh jh jh jh jh jh jh
• D) Oral glucose tolerance test
jh jh jh jh
Rationale: A single fasting glucose of 126+ is diagnostic for diabetes, but guidelines recommend conf
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
irming with a repeat test or A1c before diagnosing or treating.
jh jh jh jh jh jh jh jh jh jh
9. A patient is started on Levothyroxine for newly diagnosed hypothyroidism. When should
jh jh jh jh jh jh jh jh jh jh jh jh
the TSH level be rechecked?
jh jh jh jh jh
• A) 2 weeks jh jh
• B) 6–8 weeks
jh jh
• C) 3 monthsjh jh
• D) 1 year jh jh