,FITZ EXIT EXAM – COMPLETE PRACTICE TEST BANK
Nurse Practitioner Board Review | 2025/2026 Edition
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–30)
Question 1
A 62-year-old male with a history of hypertension and type 2 diabetes presents with
progressive shortness of breath on exertion, orthopnea, and paroxysmal nocturnal
dyspnea over the past 3 weeks. On examination, he has elevated jugular venous
pressure, bibasilar crackles, and an S3 gallop. His legs show 2+ pitting edema. Which of
the following is the most appropriate initial pharmacological therapy?
A. Digoxin
B. Furosemide
C. Metoprolol succinate
D. Spironolactone
Correct Answer: B
Rationale: This patient presents with acute decompensated heart failure with volume
overload (crackles, edema, elevated JVP). Loop diuretics (furosemide) are the first-line
therapy for managing fluid overload in acute heart failure. While ACE inhibitors, beta-
blockers, and aldosterone antagonists are important for chronic management, they are
not the initial treatment for acute decompensation.
Question 2
A 58-year-old male with a history of hypertension presents with a 2-week history of
progressive dyspnea and orthopnea. On examination, he has crackles at the lung bases
,and an S3 gallop. His ejection fraction is 30%. Which of the following is the most
appropriate therapy for long-term management?
A. ACE inhibitor and beta-blocker
B. Digoxin
C. Furosemide
D. Spironolactone
Correct Answer: A
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF). ACE
inhibitors and beta-blockers are the cornerstone of therapy for HFrEF and improve
survival. Digoxin is used for rate control in atrial fibrillation or refractory heart failure.
Furosemide is used for symptom management of volume overload. Spironolactone is
used in NYHA class III-IV HFrEF.
Question 3
A 55-year-old male with a history of hypertension presents with a 3-month history of
progressive dyspnea on exertion and fatigue. On examination, he has a systolic ejection
murmur at the right upper sternal border that radiates to the carotid arteries. What is
the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Hypertrophic cardiomyopathy
Correct Answer: A
Rationale: This patient presents with aortic stenosis: progressive dyspnea, fatigue, and a
systolic ejection murmur at the right upper sternal border radiating to the carotids.
These are classic findings of aortic stenosis. Mitral regurgitation presents with a
holosystolic murmur at the apex radiating to the axilla. Aortic regurgitation presents
with a diastolic murmur at the left upper sternal border. Hypertrophic cardiomyopathy
presents with a systolic ejection murmur that increases with Valsalva.
Question 4
A 68-year-old male with a history of diabetes and hypertension presents with a 3-month
history of progressive dyspnea on exertion and fatigue. On examination, he has a
, systolic ejection murmur at the right upper sternal border that radiates to the carotid
arteries. His echocardiogram shows a peak gradient of 50 mmHg across the aortic valve.
What is the most appropriate next step?
A. Valve replacement
B. Medical management
C. Percutaneous balloon valvuloplasty
D. Observation
Correct Answer: A
Rationale: This patient has severe aortic stenosis (peak gradient >40 mmHg) with
symptoms (dyspnea, fatigue). The presence of symptoms in severe aortic stenosis is an
indication for aortic valve replacement. Medical management is not appropriate for
symptomatic severe aortic stenosis. Percutaneous balloon valvuloplasty is a palliative
procedure primarily used in patients who are not candidates for surgery. Observation is
not appropriate for symptomatic patients.
Question 5
A 45-year-old male presents with acute-onset, substernal chest pain radiating to his left
arm, associated with diaphoresis and nausea. ECG shows ST-segment elevation in leads
V1-V4. Which of the following is the most appropriate immediate management?
A. Sublingual nitroglycerin
B. Aspirin and emergent percutaneous coronary intervention (PCI)
C. IV heparin
D. Oxygen therapy and morphine
Correct Answer: B
Rationale: This patient presents with an ST-elevation myocardial infarction (STEMI).
Emergent reperfusion therapy (PCI or thrombolysis) is the priority. Aspirin should be
administered immediately. PCI is preferred if available within 90 minutes of first medical
contact. While nitroglycerin, heparin, and oxygen/morphine are appropriate adjunctive
therapies, they are not the primary intervention for STEMI.
Question 6
A 72-year-old female with a history of hypertension presents with a 2-week history of
progressive dyspnea and orthopnea. On examination, she has crackles at the lung bases
Nurse Practitioner Board Review | 2025/2026 Edition
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–30)
Question 1
A 62-year-old male with a history of hypertension and type 2 diabetes presents with
progressive shortness of breath on exertion, orthopnea, and paroxysmal nocturnal
dyspnea over the past 3 weeks. On examination, he has elevated jugular venous
pressure, bibasilar crackles, and an S3 gallop. His legs show 2+ pitting edema. Which of
the following is the most appropriate initial pharmacological therapy?
A. Digoxin
B. Furosemide
C. Metoprolol succinate
D. Spironolactone
Correct Answer: B
Rationale: This patient presents with acute decompensated heart failure with volume
overload (crackles, edema, elevated JVP). Loop diuretics (furosemide) are the first-line
therapy for managing fluid overload in acute heart failure. While ACE inhibitors, beta-
blockers, and aldosterone antagonists are important for chronic management, they are
not the initial treatment for acute decompensation.
Question 2
A 58-year-old male with a history of hypertension presents with a 2-week history of
progressive dyspnea and orthopnea. On examination, he has crackles at the lung bases
,and an S3 gallop. His ejection fraction is 30%. Which of the following is the most
appropriate therapy for long-term management?
A. ACE inhibitor and beta-blocker
B. Digoxin
C. Furosemide
D. Spironolactone
Correct Answer: A
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF). ACE
inhibitors and beta-blockers are the cornerstone of therapy for HFrEF and improve
survival. Digoxin is used for rate control in atrial fibrillation or refractory heart failure.
Furosemide is used for symptom management of volume overload. Spironolactone is
used in NYHA class III-IV HFrEF.
Question 3
A 55-year-old male with a history of hypertension presents with a 3-month history of
progressive dyspnea on exertion and fatigue. On examination, he has a systolic ejection
murmur at the right upper sternal border that radiates to the carotid arteries. What is
the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Hypertrophic cardiomyopathy
Correct Answer: A
Rationale: This patient presents with aortic stenosis: progressive dyspnea, fatigue, and a
systolic ejection murmur at the right upper sternal border radiating to the carotids.
These are classic findings of aortic stenosis. Mitral regurgitation presents with a
holosystolic murmur at the apex radiating to the axilla. Aortic regurgitation presents
with a diastolic murmur at the left upper sternal border. Hypertrophic cardiomyopathy
presents with a systolic ejection murmur that increases with Valsalva.
Question 4
A 68-year-old male with a history of diabetes and hypertension presents with a 3-month
history of progressive dyspnea on exertion and fatigue. On examination, he has a
, systolic ejection murmur at the right upper sternal border that radiates to the carotid
arteries. His echocardiogram shows a peak gradient of 50 mmHg across the aortic valve.
What is the most appropriate next step?
A. Valve replacement
B. Medical management
C. Percutaneous balloon valvuloplasty
D. Observation
Correct Answer: A
Rationale: This patient has severe aortic stenosis (peak gradient >40 mmHg) with
symptoms (dyspnea, fatigue). The presence of symptoms in severe aortic stenosis is an
indication for aortic valve replacement. Medical management is not appropriate for
symptomatic severe aortic stenosis. Percutaneous balloon valvuloplasty is a palliative
procedure primarily used in patients who are not candidates for surgery. Observation is
not appropriate for symptomatic patients.
Question 5
A 45-year-old male presents with acute-onset, substernal chest pain radiating to his left
arm, associated with diaphoresis and nausea. ECG shows ST-segment elevation in leads
V1-V4. Which of the following is the most appropriate immediate management?
A. Sublingual nitroglycerin
B. Aspirin and emergent percutaneous coronary intervention (PCI)
C. IV heparin
D. Oxygen therapy and morphine
Correct Answer: B
Rationale: This patient presents with an ST-elevation myocardial infarction (STEMI).
Emergent reperfusion therapy (PCI or thrombolysis) is the priority. Aspirin should be
administered immediately. PCI is preferred if available within 90 minutes of first medical
contact. While nitroglycerin, heparin, and oxygen/morphine are appropriate adjunctive
therapies, they are not the primary intervention for STEMI.
Question 6
A 72-year-old female with a history of hypertension presents with a 2-week history of
progressive dyspnea and orthopnea. On examination, she has crackles at the lung bases
