NR667 FNP Final Comprehensive Exam — Master
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 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.
3. 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.
4. A 58-year-old patient presents with new onset atrial
fibrillation. Which medication is considered first-line for rate
control?
,A) Amiodarone
B) Metoprolol succinate
C) Flecainide
D) Digoxin
Correct Answer: B
Rationale: Beta-blockers such as metoprolol succinate are first-
line for rate control in atrial fibrillation.
5. A patient with a new onset rapid heart rate that is
irregularly irregular, HR 100, BP 120/74. This has been going
on for the past four days straight. First priority intervention:
A) Immediate synchronized cardioversion
B) Maintain rate control and anticoagulation prior to rhythm
conversion
C) Administer adenosine 6 mg IV push
D) Start amiodarone infusion
Correct Answer: B
Rationale: For atrial fibrillation lasting >48 hours, rate control
and anticoagulation are priorities prior to rhythm conversion to
prevent thromboembolic events.
6. A 65-year-old alcoholic patient with irregularly irregular
rhythm. First priority:
A) Ordering a BNP and Vitamin D level
B) Prescribing amiodarone 150mg IV bolus
, C) Ordering a transthoracic echocardiogram
D) Palpating pulses bilaterally to identify unilateral pulse deficit
Correct Answer: D
Rationale: Palpating pulses bilaterally to identify a pulse deficit
is the first priority in assessing a patient with an irregularly
irregular rhythm to evaluate for hemodynamic compromise.
7. A "code blue" is called with organized rhythm but no pulse.
Diagnosis?
A) Idioventricular rhythm
B) Junctional tachycardia
C) Wandering atrial pacemaker
D) Pulseless electrical activity (PEA)
Correct Answer: D
Rationale: PEA appears as an organized rhythm without a
palpable pulse.
8. A 72-year-old with sudden severe tearing chest pain
radiating to the back. Diagnosis?
A) Acute MI
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: B
Rationale: Sudden severe tearing chest pain radiating to the
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 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.
3. 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.
4. A 58-year-old patient presents with new onset atrial
fibrillation. Which medication is considered first-line for rate
control?
,A) Amiodarone
B) Metoprolol succinate
C) Flecainide
D) Digoxin
Correct Answer: B
Rationale: Beta-blockers such as metoprolol succinate are first-
line for rate control in atrial fibrillation.
5. A patient with a new onset rapid heart rate that is
irregularly irregular, HR 100, BP 120/74. This has been going
on for the past four days straight. First priority intervention:
A) Immediate synchronized cardioversion
B) Maintain rate control and anticoagulation prior to rhythm
conversion
C) Administer adenosine 6 mg IV push
D) Start amiodarone infusion
Correct Answer: B
Rationale: For atrial fibrillation lasting >48 hours, rate control
and anticoagulation are priorities prior to rhythm conversion to
prevent thromboembolic events.
6. A 65-year-old alcoholic patient with irregularly irregular
rhythm. First priority:
A) Ordering a BNP and Vitamin D level
B) Prescribing amiodarone 150mg IV bolus
, C) Ordering a transthoracic echocardiogram
D) Palpating pulses bilaterally to identify unilateral pulse deficit
Correct Answer: D
Rationale: Palpating pulses bilaterally to identify a pulse deficit
is the first priority in assessing a patient with an irregularly
irregular rhythm to evaluate for hemodynamic compromise.
7. A "code blue" is called with organized rhythm but no pulse.
Diagnosis?
A) Idioventricular rhythm
B) Junctional tachycardia
C) Wandering atrial pacemaker
D) Pulseless electrical activity (PEA)
Correct Answer: D
Rationale: PEA appears as an organized rhythm without a
palpable pulse.
8. A 72-year-old with sudden severe tearing chest pain
radiating to the back. Diagnosis?
A) Acute MI
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Correct Answer: B
Rationale: Sudden severe tearing chest pain radiating to the
