NR667 FNP Exam 6 — Comprehensive Practice
Question Bank (Verified Update)
Format: Question → Answer → Detailed Rationale | Complete
Verified Questions | Graded A+
SECTION 1: CARDIOVASCULAR (Questions)
1. During which phase of the cardiac cycle is the first heart
sound (S1) best heard on auscultation?
A) Diastole
B) Atrial filling phase
C) Ventricular systole
D) Isovolumetric relaxation
Correct Answer: C
Rationale: S1 occurs at the onset of ventricular systole when
the mitral and tricuspid valves close, producing the "lub" sound.
2. A 55-year-old man with hypertension and dyslipidemia
presents with substernal chest pressure, diaphoresis, and
nausea. 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 II, III, aVF indicates inferior wall MI,
typically supplied by the RCA in a right-dominant circulation.
LAD supplies anterior (V1-V4); LCx supplies lateral (I, aVL, V5-
V6).
3. A 62-year-old male with a history of hypertension presents
with substernal chest pressure that radiates to his left jaw,
occurring at rest and lasting 15 minutes. He is diaphoretic and
nauseated. What is the most appropriate initial diagnostic
test?
A) Chest X-ray
B) 12-lead ECG
C) Exercise stress test
D) Echocardiogram
Correct Answer: B
Rationale: A 12-lead ECG is the first diagnostic test in suspected
acute coronary syndrome. It identifies ST-segment changes and
guides immediate management.
4. A 72-year-old man with HFrEF (LVEF 30%) is on lisinopril,
carvedilol, and furosemide. eGFR is 32 mL/min, K+ 4.8. Which
additional medication class has a mortality benefit?
A) Digoxin
,B) Spironolactone
C) Diltiazem
D) Amlodipine
Correct Answer: B
Rationale: MRAs reduce mortality in HFrEF if eGFR >30 and K+
≤5.0. Digoxin reduces hospitalizations only. Diltiazem is
contraindicated; amlodipine does not improve mortality.
5. A patient on warfarin for a mechanical mitral valve has an
INR of 1.8. What is the appropriate target INR range?
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Correct Answer: C
Rationale: Mechanical mitral valves require INR 2.5–3.5. Aortic
mechanical valves generally target 2.0–3.0. The patient is
subtherapeutic.
6. A patient with stable angina is prescribed sublingual
nitroglycerin. Which instruction is correct?
A) Take one tablet every 5 minutes for up to 3 doses; if pain
persists after the first dose, call 911
B) Swallow the tablet with water
C) Take only when blood pressure is high
D) Wait 30 minutes between doses
, Correct Answer: A
Rationale: For acute angina, take up to 3 doses 5 minutes apart;
call 911 if pain unrelieved 5 minutes after the first dose. The
tablet is dissolved sublingually.
7. A 62-year-old African American male, BP 156/96 x2 visits,
no CKD/DM, BMI 31, 10-year ASCVD 12%. What is the FNP's
first-line antihypertensive choice?
A) Lisinopril alone
B) Thiazide-type diuretic or dihydropyridine CCB
C) Beta-blocker atenolol
D) Clonidine
Correct Answer: B
Rationale: For Black adults with hypertension without CKD or
HF, thiazide diuretics or CCBs are first-line per JNC-8/AHA, with
superior stroke reduction. ACE inhibitors/ARBs are less effective
as monotherapy in this population.
8. A 60-year-old man with hypertension and diabetes presents
with sudden severe headache, blurred vision, and BP 200/110
mmHg. The FNP should:
A) Start an oral ACE inhibitor and schedule follow-up in one
week
B) Refer the patient immediately to the emergency department
C) Order a stat CT scan and manage as outpatient
D) Recommend lifestyle modifications and recheck in 48 hours
Question Bank (Verified Update)
Format: Question → Answer → Detailed Rationale | Complete
Verified Questions | Graded A+
SECTION 1: CARDIOVASCULAR (Questions)
1. During which phase of the cardiac cycle is the first heart
sound (S1) best heard on auscultation?
A) Diastole
B) Atrial filling phase
C) Ventricular systole
D) Isovolumetric relaxation
Correct Answer: C
Rationale: S1 occurs at the onset of ventricular systole when
the mitral and tricuspid valves close, producing the "lub" sound.
2. A 55-year-old man with hypertension and dyslipidemia
presents with substernal chest pressure, diaphoresis, and
nausea. 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 II, III, aVF indicates inferior wall MI,
typically supplied by the RCA in a right-dominant circulation.
LAD supplies anterior (V1-V4); LCx supplies lateral (I, aVL, V5-
V6).
3. A 62-year-old male with a history of hypertension presents
with substernal chest pressure that radiates to his left jaw,
occurring at rest and lasting 15 minutes. He is diaphoretic and
nauseated. What is the most appropriate initial diagnostic
test?
A) Chest X-ray
B) 12-lead ECG
C) Exercise stress test
D) Echocardiogram
Correct Answer: B
Rationale: A 12-lead ECG is the first diagnostic test in suspected
acute coronary syndrome. It identifies ST-segment changes and
guides immediate management.
4. A 72-year-old man with HFrEF (LVEF 30%) is on lisinopril,
carvedilol, and furosemide. eGFR is 32 mL/min, K+ 4.8. Which
additional medication class has a mortality benefit?
A) Digoxin
,B) Spironolactone
C) Diltiazem
D) Amlodipine
Correct Answer: B
Rationale: MRAs reduce mortality in HFrEF if eGFR >30 and K+
≤5.0. Digoxin reduces hospitalizations only. Diltiazem is
contraindicated; amlodipine does not improve mortality.
5. A patient on warfarin for a mechanical mitral valve has an
INR of 1.8. What is the appropriate target INR range?
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Correct Answer: C
Rationale: Mechanical mitral valves require INR 2.5–3.5. Aortic
mechanical valves generally target 2.0–3.0. The patient is
subtherapeutic.
6. A patient with stable angina is prescribed sublingual
nitroglycerin. Which instruction is correct?
A) Take one tablet every 5 minutes for up to 3 doses; if pain
persists after the first dose, call 911
B) Swallow the tablet with water
C) Take only when blood pressure is high
D) Wait 30 minutes between doses
, Correct Answer: A
Rationale: For acute angina, take up to 3 doses 5 minutes apart;
call 911 if pain unrelieved 5 minutes after the first dose. The
tablet is dissolved sublingually.
7. A 62-year-old African American male, BP 156/96 x2 visits,
no CKD/DM, BMI 31, 10-year ASCVD 12%. What is the FNP's
first-line antihypertensive choice?
A) Lisinopril alone
B) Thiazide-type diuretic or dihydropyridine CCB
C) Beta-blocker atenolol
D) Clonidine
Correct Answer: B
Rationale: For Black adults with hypertension without CKD or
HF, thiazide diuretics or CCBs are first-line per JNC-8/AHA, with
superior stroke reduction. ACE inhibitors/ARBs are less effective
as monotherapy in this population.
8. A 60-year-old man with hypertension and diabetes presents
with sudden severe headache, blurred vision, and BP 200/110
mmHg. The FNP should:
A) Start an oral ACE inhibitor and schedule follow-up in one
week
B) Refer the patient immediately to the emergency department
C) Order a stat CT scan and manage as outpatient
D) Recommend lifestyle modifications and recheck in 48 hours
