CMN 568 Final Exam – Family Nurse Practitioner
(FNP) Comprehensive Assessment – 2026/2027
Academic Year – Verified Questions and Answers
Cardiology & Pulmonary
Question 1
A 58-year-old male with a history of hypertension presents with substernal chest
pressure that occurs with exertion and resolves with rest. The pain is relieved within 5
minutes of taking sublingual nitroglycerin. Which diagnosis is most likely?
A) Unstable angina
B) Stable angina
C) Non-ST elevation myocardial infarction (NSTEMI)
D) Pericarditis
Answer: B) Stable angina
,Rationale: Stable angina is characterized by chest pain or pressure that is reproducible
with exertion or stress, relieved by rest or nitroglycerin, and has a predictable pattern.
Unstable angina (A) occurs at rest or with minimal exertion and is increasing in
frequency or severity. NSTEMI (C) would present with prolonged pain and elevated
cardiac biomarkers. Pericarditis (D) typically presents with sharp pleuritic chest pain
relieved by sitting forward .
Question 2
A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) is
prescribed lisinopril, furosemide, and carvedilol. Which finding would indicate a need to
adjust or hold the carvedilol?
A) Heart rate 72 bpm
B) Blood pressure 110/70 mmHg
C) Heart rate 52 bpm with dizziness upon standing
D) Respiratory rate 18 breaths per minute
Answer: C) Heart rate 52 bpm with dizziness upon standing
Rationale: Carvedilol is a beta-blocker that can cause bradycardia and hypotension.
Symptomatic bradycardia (heart rate <60 bpm with dizziness, fatigue, or syncope)
warrants dose reduction or holding the medication. The other options are within
acceptable ranges for a patient with HFrEF on guideline-directed medical therapy .
Question 3
A 55-year-old male presents with chest pain that occurs with exertion and resolves with
rest. Which pathophysiological process is most likely responsible?
,A) Fixed coronary artery stenosis with demand-supply mismatch
B) Coronary artery vasospasm unrelated to exertion
C) Aortic dissection extending into the coronary arteries
D) Pulmonary embolism with right heart strain
Answer: A) Fixed coronary artery stenosis with demand-supply mismatch
Rationale: Stable angina is caused by fixed coronary artery atherosclerosis. During
exertion, oxygen demand increases, but stenotic vessels cannot supply adequate blood
flow. Vasospasm (B) causes Prinzmetal/variant angina (unrelated to exertion). Dissection
(C) is sudden and catastrophic. PE (D) causes dyspnea, not exertion-related chest pain .
Question 4
A 68-year-old male with a 50-pack-year smoking history presents with worsening
dyspnea, chronic cough, and barrel-shaped chest. Spirometry shows FEV1/FVC <0.70.
Which pathophysiological change is most consistent with this presentation?
A) Alveolar destruction with loss of elastic recoil
B) Mast cell degranulation with bronchoconstriction
C) Pulmonary vascular remodeling
D) Airway hyperresponsiveness
Answer: A) Alveolar destruction with loss of elastic recoil
Rationale: This patient has COPD characterized by alveolar destruction (emphysema)
leading to loss of elastic recoil, air trapping, and barrel-shaped chest. Mast cell
degranulation (B) and airway hyperresponsiveness (D) are characteristic of asthma.
Pulmonary vascular remodeling (C) occurs in pulmonary hypertension .
, Question 5
A 70-year-old male with a 60-pack-year smoking history presents with a chronic cough
productive of sputum for the past 3 years. He has dyspnea on exertion and a barrel-
shaped chest. Spirometry shows FEV1/FVC <0.70. The most appropriate initial
pharmacological therapy is:
A) Prednisone 40 mg daily for 5 days
B) Albuterol as needed
C) Long-acting bronchodilator (LABA or LAMA)
D) Oxygen therapy at 2 L/min
Answer: C) Long-acting bronchodilator (LABA or LAMA)
Rationale: This patient has COPD based on smoking history, chronic cough, dyspnea,
and spirometry. GOLD guidelines recommend initial pharmacotherapy with a long-
acting bronchodilator (LABA or LAMA) for patients with moderate COPD based on
symptoms and exacerbation risk. Albuterol as needed (B) may be added for rescue but is
not sufficient as monotherapy. Prednisone (A) is for acute exacerbations. Oxygen (D) is
indicated for resting hypoxemia (SpO2 ≤88% on room air) .
Question 6
A 63-year-old male with COPD (GOLD Group C) visits your office for medication
treatment. As the nurse practitioner, what preferred first-choice medication will you
prescribe?
A) PRN short-acting beta-agonists
B) PRN short-acting anticholinergics
C) Daily long-acting anticholinergics
D) Daily low-dose inhaled corticosteroids
(FNP) Comprehensive Assessment – 2026/2027
Academic Year – Verified Questions and Answers
Cardiology & Pulmonary
Question 1
A 58-year-old male with a history of hypertension presents with substernal chest
pressure that occurs with exertion and resolves with rest. The pain is relieved within 5
minutes of taking sublingual nitroglycerin. Which diagnosis is most likely?
A) Unstable angina
B) Stable angina
C) Non-ST elevation myocardial infarction (NSTEMI)
D) Pericarditis
Answer: B) Stable angina
,Rationale: Stable angina is characterized by chest pain or pressure that is reproducible
with exertion or stress, relieved by rest or nitroglycerin, and has a predictable pattern.
Unstable angina (A) occurs at rest or with minimal exertion and is increasing in
frequency or severity. NSTEMI (C) would present with prolonged pain and elevated
cardiac biomarkers. Pericarditis (D) typically presents with sharp pleuritic chest pain
relieved by sitting forward .
Question 2
A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) is
prescribed lisinopril, furosemide, and carvedilol. Which finding would indicate a need to
adjust or hold the carvedilol?
A) Heart rate 72 bpm
B) Blood pressure 110/70 mmHg
C) Heart rate 52 bpm with dizziness upon standing
D) Respiratory rate 18 breaths per minute
Answer: C) Heart rate 52 bpm with dizziness upon standing
Rationale: Carvedilol is a beta-blocker that can cause bradycardia and hypotension.
Symptomatic bradycardia (heart rate <60 bpm with dizziness, fatigue, or syncope)
warrants dose reduction or holding the medication. The other options are within
acceptable ranges for a patient with HFrEF on guideline-directed medical therapy .
Question 3
A 55-year-old male presents with chest pain that occurs with exertion and resolves with
rest. Which pathophysiological process is most likely responsible?
,A) Fixed coronary artery stenosis with demand-supply mismatch
B) Coronary artery vasospasm unrelated to exertion
C) Aortic dissection extending into the coronary arteries
D) Pulmonary embolism with right heart strain
Answer: A) Fixed coronary artery stenosis with demand-supply mismatch
Rationale: Stable angina is caused by fixed coronary artery atherosclerosis. During
exertion, oxygen demand increases, but stenotic vessels cannot supply adequate blood
flow. Vasospasm (B) causes Prinzmetal/variant angina (unrelated to exertion). Dissection
(C) is sudden and catastrophic. PE (D) causes dyspnea, not exertion-related chest pain .
Question 4
A 68-year-old male with a 50-pack-year smoking history presents with worsening
dyspnea, chronic cough, and barrel-shaped chest. Spirometry shows FEV1/FVC <0.70.
Which pathophysiological change is most consistent with this presentation?
A) Alveolar destruction with loss of elastic recoil
B) Mast cell degranulation with bronchoconstriction
C) Pulmonary vascular remodeling
D) Airway hyperresponsiveness
Answer: A) Alveolar destruction with loss of elastic recoil
Rationale: This patient has COPD characterized by alveolar destruction (emphysema)
leading to loss of elastic recoil, air trapping, and barrel-shaped chest. Mast cell
degranulation (B) and airway hyperresponsiveness (D) are characteristic of asthma.
Pulmonary vascular remodeling (C) occurs in pulmonary hypertension .
, Question 5
A 70-year-old male with a 60-pack-year smoking history presents with a chronic cough
productive of sputum for the past 3 years. He has dyspnea on exertion and a barrel-
shaped chest. Spirometry shows FEV1/FVC <0.70. The most appropriate initial
pharmacological therapy is:
A) Prednisone 40 mg daily for 5 days
B) Albuterol as needed
C) Long-acting bronchodilator (LABA or LAMA)
D) Oxygen therapy at 2 L/min
Answer: C) Long-acting bronchodilator (LABA or LAMA)
Rationale: This patient has COPD based on smoking history, chronic cough, dyspnea,
and spirometry. GOLD guidelines recommend initial pharmacotherapy with a long-
acting bronchodilator (LABA or LAMA) for patients with moderate COPD based on
symptoms and exacerbation risk. Albuterol as needed (B) may be added for rescue but is
not sufficient as monotherapy. Prednisone (A) is for acute exacerbations. Oxygen (D) is
indicated for resting hypoxemia (SpO2 ≤88% on room air) .
Question 6
A 63-year-old male with COPD (GOLD Group C) visits your office for medication
treatment. As the nurse practitioner, what preferred first-choice medication will you
prescribe?
A) PRN short-acting beta-agonists
B) PRN short-acting anticholinergics
C) Daily long-acting anticholinergics
D) Daily low-dose inhaled corticosteroids
