NR667 FNP Exam 3 — 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 ("lub") occurs when the mitral and tricuspid
valves close at the beginning of ventricular systole. It signals the
start of ejection. Diastole and isovolumetric relaxation are
associated with S2 and S3/S4.
2. A 62-year-old African American male presents with BP
156/96 mmHg on two visits, no CKD or diabetes, BMI 31, 10-
year ASCVD risk 12%. What is the first-line antihypertensive
choice per JNC-8/AHA guidelines?
,A) Lisinopril alone
B) Thiazide-type diuretic or dihydropyridine CCB
(chlorthalidone/amlodipine)
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.
3. 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
Correct Answer: B
Rationale: This is a hypertensive emergency (BP ≥180/120
mmHg with acute target organ damage). Immediate IV
antihypertensive therapy in a controlled setting is required to
prevent stroke or renal failure.
,4. A 55-year-old male with diabetes presents with chest pain
radiating to the jaw and left arm. ECG shows ST-segment
elevation in leads V1–V4. Which cardiac biomarker rises
within 3–4 hours and is the preferred marker for MI diagnosis?
A) Creatine kinase-MB (CK-MB)
B) Myoglobin
C) Troponin I
D) B-type natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the preferred biomarker for MI
diagnosis due to high sensitivity and specificity for myocardial
necrosis. It rises within 3–4 hours and remains elevated for 7–
10 days. CK-MB rises within 4–6 hours but is less specific.
Myoglobin rises earliest but lacks specificity. BNP indicates
heart failure.
5. Which of the following antihypertensive agents is
contraindicated in pregnancy?
A) Labetalol
B) Nifedipine
C) ACE inhibitors (e.g., lisinopril)
D) Methyldopa
Correct Answer: C
Rationale: ACE inhibitors are contraindicated in pregnancy due
, to risk of fetal renal damage, oligohydramnios, and death.
Labetalol, nifedipine, and methyldopa are safe alternatives.
6. A 65-year-old man with a smoking history presents with
painless hematuria. What is the most likely diagnosis?
A) Bladder cancer
B) Nephrotic syndrome
C) Pyelonephritis
D) Glomerulonephritis
Correct Answer: A
Rationale: Painless hematuria in a smoker is a classic
presentation of bladder cancer until proven otherwise.
Immediate urology referral and cystoscopy are indicated.
7. A patient with COPD has increased sputum production and
purulence. What antibiotic class is preferred?
A) Fluoroquinolones
B) Macrolides (e.g., azithromycin)
C) Penicillins
D) Cephalosporins
Correct Answer: B
Rationale: Macrolides are preferred for COPD exacerbations
with increased sputum purulence.
8. What is the gold standard diagnostic test for pulmonary
embolism?
A) D-dimer
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 ("lub") occurs when the mitral and tricuspid
valves close at the beginning of ventricular systole. It signals the
start of ejection. Diastole and isovolumetric relaxation are
associated with S2 and S3/S4.
2. A 62-year-old African American male presents with BP
156/96 mmHg on two visits, no CKD or diabetes, BMI 31, 10-
year ASCVD risk 12%. What is the first-line antihypertensive
choice per JNC-8/AHA guidelines?
,A) Lisinopril alone
B) Thiazide-type diuretic or dihydropyridine CCB
(chlorthalidone/amlodipine)
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.
3. 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
Correct Answer: B
Rationale: This is a hypertensive emergency (BP ≥180/120
mmHg with acute target organ damage). Immediate IV
antihypertensive therapy in a controlled setting is required to
prevent stroke or renal failure.
,4. A 55-year-old male with diabetes presents with chest pain
radiating to the jaw and left arm. ECG shows ST-segment
elevation in leads V1–V4. Which cardiac biomarker rises
within 3–4 hours and is the preferred marker for MI diagnosis?
A) Creatine kinase-MB (CK-MB)
B) Myoglobin
C) Troponin I
D) B-type natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the preferred biomarker for MI
diagnosis due to high sensitivity and specificity for myocardial
necrosis. It rises within 3–4 hours and remains elevated for 7–
10 days. CK-MB rises within 4–6 hours but is less specific.
Myoglobin rises earliest but lacks specificity. BNP indicates
heart failure.
5. Which of the following antihypertensive agents is
contraindicated in pregnancy?
A) Labetalol
B) Nifedipine
C) ACE inhibitors (e.g., lisinopril)
D) Methyldopa
Correct Answer: C
Rationale: ACE inhibitors are contraindicated in pregnancy due
, to risk of fetal renal damage, oligohydramnios, and death.
Labetalol, nifedipine, and methyldopa are safe alternatives.
6. A 65-year-old man with a smoking history presents with
painless hematuria. What is the most likely diagnosis?
A) Bladder cancer
B) Nephrotic syndrome
C) Pyelonephritis
D) Glomerulonephritis
Correct Answer: A
Rationale: Painless hematuria in a smoker is a classic
presentation of bladder cancer until proven otherwise.
Immediate urology referral and cystoscopy are indicated.
7. A patient with COPD has increased sputum production and
purulence. What antibiotic class is preferred?
A) Fluoroquinolones
B) Macrolides (e.g., azithromycin)
C) Penicillins
D) Cephalosporins
Correct Answer: B
Rationale: Macrolides are preferred for COPD exacerbations
with increased sputum purulence.
8. What is the gold standard diagnostic test for pulmonary
embolism?
A) D-dimer
