1
KAPLAN FNP CERTIFICATION EXAM COMPLETE REVIEW
\ 175 High-Yield Board Questions with Rationales
SECTION 1: CARDIOVASCULAR (Questions 1–25)
1. A 55-year-old man with hypertension and dyslipidemia presents with
substernal chest pressure radiating to the left arm, diaphoresis, and nausea. An
ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery
is most likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. Right coronary artery (RCA)
D. Left main coronary artery
: Correct Answer : C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction. The inferior wall is typically supplied by the right coronary artery in a
right-dominant circulation. The LAD supplies the anterior wall (V1–V4), the LCx
supplies the lateral wall (I, aVL, V5–V6), and left main occlusion causes
widespread ischemia.
2. A 65-year-old woman with atrial fibrillation not on anticoagulation presents
with acute onset of right-sided weakness and aphasia. CT head is negative for
hemorrhage. Her INR is 1.2. The FNP should anticipate administration of:
A. Aspirin 325 mg
B. IV alteplase if within the treatment window and no other contraindications
C. Heparin infusion
D. Clopidogrel loading dose
: Correct Answer : B
Rationale: The patient has an acute ischemic stroke within the thrombolytic
window (≤4.5 hours from onset). With a negative CT and no contraindications
pg. 1
,2
(INR not elevated, no recent surgery, etc.), IV alteplase is the standard of care to
restore perfusion. Antiplatelet agents are not given acutely with thrombolytics;
heparin is not first-line.
3. A 72-year-old man with heart failure and reduced ejection fraction (HFrEF) is
on lisinopril, carvedilol, and furosemide. He has an eGFR of 32 mL/min and a
potassium of 4.8 mEq/L. Which additional medication class has a mortality
benefit in HFrEF?
A. Digoxin
B. Spironolactone
C. Diltiazem
D. Amlodipine
: Correct Answer : B
Rationale: Mineralocorticoid receptor antagonists (MRAs) like spironolactone
reduce mortality and heart failure hospitalizations in HFrEF (LVEF ≤35%) and are
indicated if eGFR >30 mL/min and potassium ≤5.0 mEq/L. This patient meets
criteria. Digoxin reduces hospitalizations but not mortality; diltiazem is
contraindicated; amlodipine is safe but does not improve mortality.
4. A patient on warfarin for a mechanical mitral valve has an INR of 1.8. What is
the appropriate target INR range for this patient?
A. 1.5–2.0
B. 2.0–3.0
C. 2.5–3.5
D. 3.0–4.0
: Correct Answer : C
Rationale: For mechanical mitral valves, the target INR is 2.5–3.5. Aortic
mechanical valves may have a target of 2.0–3.0, depending on additional risk
factors. The current INR is subtherapeutic and requires dose adjustment.
pg. 2
,3
5. A 50-year-old man with stable angina is prescribed sublingual nitroglycerin.
The FNP instructs him to:
A. Take one tablet every 5 minutes for up to 3 doses; if pain persists after 5
minutes of the first dose, call 911
B. Take one tablet and wait 30 minutes before taking another
C. Swallow the tablet with water
D. Use only when blood pressure is high
: Correct Answer : A
Rationale: Standard protocol for acute angina: stop activity, take one nitroglycerin
tablet sublingually every 5 minutes for up to 3 doses. If pain is not relieved 5
minutes after the first dose, call 911. The tablet is dissolved under the tongue, not
swallowed.
6. A patient with hypertension and diabetes has a blood pressure of 148/88
mmHg on hydrochlorothiazide. Microalbuminuria is present. Which medication
should be added to slow the progression of nephropathy?
A. Metoprolol
B. Amlodipine
C. Lisinopril
D. Clonidine
: Correct Answer : C
Rationale: ACE inhibitors (or ARBs) are first-line in diabetic patients with
albuminuria because they reduce intraglomerular pressure, slow progression of
kidney disease, and provide cardiovascular protection. Metoprolol and clonidine
do not have this renal protective effect; amlodipine is a second-line option.
7. A patient on amiodarone for atrial fibrillation should have which baseline and
periodic monitoring?
A. Liver function, thyroid function, and pulmonary function tests
B. Bone density and serum calcium
C. Renal function and electrolytes only
D. Complete blood count and iron studies
pg. 3
, 4
: Correct Answer : A
Rationale: Amiodarone can cause pulmonary fibrosis, hepatotoxicity, thyroid
dysfunction (both hypo- and hyperthyroidism), and corneal deposits. Baseline and
periodic monitoring of LFTs, TSH, and PFTs (or at minimum a chest X-ray and
symptom assessment) is recommended.
8. A patient with heart failure on digoxin and furosemide develops anorexia,
nausea, and yellow-tinged vision. Digoxin level is 2.5 ng/mL (therapeutic 0.5–0.9
for HF). What is the priority action?
A. Hold digoxin and check potassium and magnesium levels
B. Increase furosemide
C. Administer digoxin immune Fab
D. Continue current therapy
: Correct Answer : A
Rationale: The patient has signs and an elevated level consistent with digoxin
toxicity. Hypokalemia and hypomagnesemia (common with loop diuretics)
potentiate toxicity. The drug should be held, electrolytes checked and corrected,
and the provider notified. Digoxin immune Fab is reserved for severe toxicity (life-
threatening arrhythmias, potassium >5, or hemodynamic instability).
9. A 40-year-old woman with mitral valve prolapse is scheduled for dental
extraction. She has no other cardiac history. What is the appropriate antibiotic
prophylaxis?
A. Amoxicillin 2 g 30–60 minutes before the procedure
B. Clindamycin 600 mg 1 hour before
C. No prophylaxis needed
D. Vancomycin IV
: Correct Answer : C
Rationale: According to current AHA guidelines, antibiotic prophylaxis is no longer
recommended for mitral valve prolapse, even with regurgitation, unless there is a
history of infective endocarditis, a prosthetic valve, unrepaired cyanotic
pg. 4
KAPLAN FNP CERTIFICATION EXAM COMPLETE REVIEW
\ 175 High-Yield Board Questions with Rationales
SECTION 1: CARDIOVASCULAR (Questions 1–25)
1. A 55-year-old man with hypertension and dyslipidemia presents with
substernal chest pressure radiating to the left arm, diaphoresis, and nausea. An
ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery
is most likely occluded?
A. Left anterior descending (LAD)
B. Left circumflex (LCx)
C. Right coronary artery (RCA)
D. Left main coronary artery
: Correct Answer : C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction. The inferior wall is typically supplied by the right coronary artery in a
right-dominant circulation. The LAD supplies the anterior wall (V1–V4), the LCx
supplies the lateral wall (I, aVL, V5–V6), and left main occlusion causes
widespread ischemia.
2. A 65-year-old woman with atrial fibrillation not on anticoagulation presents
with acute onset of right-sided weakness and aphasia. CT head is negative for
hemorrhage. Her INR is 1.2. The FNP should anticipate administration of:
A. Aspirin 325 mg
B. IV alteplase if within the treatment window and no other contraindications
C. Heparin infusion
D. Clopidogrel loading dose
: Correct Answer : B
Rationale: The patient has an acute ischemic stroke within the thrombolytic
window (≤4.5 hours from onset). With a negative CT and no contraindications
pg. 1
,2
(INR not elevated, no recent surgery, etc.), IV alteplase is the standard of care to
restore perfusion. Antiplatelet agents are not given acutely with thrombolytics;
heparin is not first-line.
3. A 72-year-old man with heart failure and reduced ejection fraction (HFrEF) is
on lisinopril, carvedilol, and furosemide. He has an eGFR of 32 mL/min and a
potassium of 4.8 mEq/L. Which additional medication class has a mortality
benefit in HFrEF?
A. Digoxin
B. Spironolactone
C. Diltiazem
D. Amlodipine
: Correct Answer : B
Rationale: Mineralocorticoid receptor antagonists (MRAs) like spironolactone
reduce mortality and heart failure hospitalizations in HFrEF (LVEF ≤35%) and are
indicated if eGFR >30 mL/min and potassium ≤5.0 mEq/L. This patient meets
criteria. Digoxin reduces hospitalizations but not mortality; diltiazem is
contraindicated; amlodipine is safe but does not improve mortality.
4. A patient on warfarin for a mechanical mitral valve has an INR of 1.8. What is
the appropriate target INR range for this patient?
A. 1.5–2.0
B. 2.0–3.0
C. 2.5–3.5
D. 3.0–4.0
: Correct Answer : C
Rationale: For mechanical mitral valves, the target INR is 2.5–3.5. Aortic
mechanical valves may have a target of 2.0–3.0, depending on additional risk
factors. The current INR is subtherapeutic and requires dose adjustment.
pg. 2
,3
5. A 50-year-old man with stable angina is prescribed sublingual nitroglycerin.
The FNP instructs him to:
A. Take one tablet every 5 minutes for up to 3 doses; if pain persists after 5
minutes of the first dose, call 911
B. Take one tablet and wait 30 minutes before taking another
C. Swallow the tablet with water
D. Use only when blood pressure is high
: Correct Answer : A
Rationale: Standard protocol for acute angina: stop activity, take one nitroglycerin
tablet sublingually every 5 minutes for up to 3 doses. If pain is not relieved 5
minutes after the first dose, call 911. The tablet is dissolved under the tongue, not
swallowed.
6. A patient with hypertension and diabetes has a blood pressure of 148/88
mmHg on hydrochlorothiazide. Microalbuminuria is present. Which medication
should be added to slow the progression of nephropathy?
A. Metoprolol
B. Amlodipine
C. Lisinopril
D. Clonidine
: Correct Answer : C
Rationale: ACE inhibitors (or ARBs) are first-line in diabetic patients with
albuminuria because they reduce intraglomerular pressure, slow progression of
kidney disease, and provide cardiovascular protection. Metoprolol and clonidine
do not have this renal protective effect; amlodipine is a second-line option.
7. A patient on amiodarone for atrial fibrillation should have which baseline and
periodic monitoring?
A. Liver function, thyroid function, and pulmonary function tests
B. Bone density and serum calcium
C. Renal function and electrolytes only
D. Complete blood count and iron studies
pg. 3
, 4
: Correct Answer : A
Rationale: Amiodarone can cause pulmonary fibrosis, hepatotoxicity, thyroid
dysfunction (both hypo- and hyperthyroidism), and corneal deposits. Baseline and
periodic monitoring of LFTs, TSH, and PFTs (or at minimum a chest X-ray and
symptom assessment) is recommended.
8. A patient with heart failure on digoxin and furosemide develops anorexia,
nausea, and yellow-tinged vision. Digoxin level is 2.5 ng/mL (therapeutic 0.5–0.9
for HF). What is the priority action?
A. Hold digoxin and check potassium and magnesium levels
B. Increase furosemide
C. Administer digoxin immune Fab
D. Continue current therapy
: Correct Answer : A
Rationale: The patient has signs and an elevated level consistent with digoxin
toxicity. Hypokalemia and hypomagnesemia (common with loop diuretics)
potentiate toxicity. The drug should be held, electrolytes checked and corrected,
and the provider notified. Digoxin immune Fab is reserved for severe toxicity (life-
threatening arrhythmias, potassium >5, or hemodynamic instability).
9. A 40-year-old woman with mitral valve prolapse is scheduled for dental
extraction. She has no other cardiac history. What is the appropriate antibiotic
prophylaxis?
A. Amoxicillin 2 g 30–60 minutes before the procedure
B. Clindamycin 600 mg 1 hour before
C. No prophylaxis needed
D. Vancomycin IV
: Correct Answer : C
Rationale: According to current AHA guidelines, antibiotic prophylaxis is no longer
recommended for mitral valve prolapse, even with regurgitation, unless there is a
history of infective endocarditis, a prosthetic valve, unrepaired cyanotic
pg. 4
