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Advanced Practice Nursing — 100 MCQs
(Questions 1–100)
1. A 58-year-old man reports increasing dyspnea on exertion and orthopnea. On exam you note
bibasilar crackles and S3. Which diagnosis is most likely?
A. COPD exacerbation
B. Left-sided heart failure
C. Pulmonary embolism
D. Community-acquired pneumonia
Answer: B
Rationale: Orthopnea, bibasilar crackles, and an S3 gallop indicate left ventricular systolic
dysfunction/left-sided heart failure.
2. Which antihypertensive class is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
D. Nifedipine
Answer: C
Rationale: ACE inhibitors are teratogenic (fetal renal damage) and contraindicated in
pregnancy.
3. A 30-year-old woman has sudden onset unilateral facial weakness with inability to raise the
eyebrow. Most likely cause:
A. Bell’s palsy (facial nerve palsy)
B. Ischemic stroke
C. Myasthenia gravis
D. Trigeminal neuralgia
Answer: A
Rationale: Peripheral facial nerve palsy affects the forehead (unable to wrinkle) — typical of
Bell’s palsy.
,4. In suspected bacterial meningitis, which action is highest priority before lumbar puncture?
A. Start empiric IV antibiotics
B. Obtain CT head for all patients
C. Administer oral acetaminophen
D. Wait for culture results
Answer: A
Rationale: If bacterial meningitis is suspected, start empiric IV antibiotics immediately; imaging
may delay treatment only if indicated.
5. A patient with atrial fibrillation and CHADS2VASC score of 3 — best anticoagulation choice
generally:
A. Aspirin alone
B. Warfarin or DOAC (direct oral anticoagulant)
C. No anticoagulation needed
D. Clopidogrel alone
Answer: B
Rationale: A CHADS2VASC ≥2 typically indicates need for systemic anticoagulation (warfarin
or DOAC).
6. Best initial test for suspected DVT in a stable patient:
A. D-dimer only
B. Lower extremity duplex ultrasonography
C. Ventilation-perfusion scan
D. CT pulmonary angiography
Answer: B
Rationale: Duplex ultrasound is first-line to evaluate suspected DVT; D-dimer is adjunctive
when pretest probability is low.
7. Which inhaler is most appropriate as first-line rescue therapy for acute bronchospasm?
A. Inhaled corticosteroid
B. Short-acting beta2-agonist (e.g., albuterol)
C. Long-acting beta2-agonist
D. Leukotriene receptor antagonist
Answer: B
Rationale: Short-acting beta2-agonists provide rapid bronchodilation and are used for rescue.
, 8. A hypertensive patient on an ACE inhibitor develops cough. Which alternative is preferred?
A. Add a beta-blocker and continue ACE inhibitor
B. Switch to an ARB (angiotensin receptor blocker)
C. Switch to a thiazide diuretic only
D. Stop therapy and monitor
Answer: B
Rationale: ARBs avoid ACE inhibitor–related cough and maintain RAAS blockade benefits.
9. For newly diagnosed type 2 diabetes with HbA1c 9.0% and no symptoms, first-line
pharmacotherapy:
A. Start insulin immediately
B. Metformin plus lifestyle modification
C. Sulfonylurea monotherapy
D. No treatment — lifestyle only
Answer: B
Rationale: Metformin and lifestyle interventions are first-line; insulin reserved for severe
hyperglycemia or symptoms.
10. Which heart murmur increases with Valsalva maneuver (phase II)?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic obstructive cardiomyopathy (HOCM) murmur
D. Tricuspid stenosis
Answer: C
Rationale: HOCM murmur increases with decreased venous return (Valsalva) due to reduced
LV volume increasing obstruction.
11. A patient has suspected community-acquired pneumonia and is allergic to penicillin
(anaphylaxis). Best empiric outpatient antibiotic:
A. Amoxicillin
B. Doxycycline or a respiratory fluoroquinolone (if risk factors)
C. Azithromycin only (macrolide) despite local resistance
D. Cephalexin
Answer: B
Rationale: Doxycycline is an alternative for penicillin-allergic outpatients; choice depends on
resistance patterns and comorbidities.
Advanced Practice Nursing — 100 MCQs
(Questions 1–100)
1. A 58-year-old man reports increasing dyspnea on exertion and orthopnea. On exam you note
bibasilar crackles and S3. Which diagnosis is most likely?
A. COPD exacerbation
B. Left-sided heart failure
C. Pulmonary embolism
D. Community-acquired pneumonia
Answer: B
Rationale: Orthopnea, bibasilar crackles, and an S3 gallop indicate left ventricular systolic
dysfunction/left-sided heart failure.
2. Which antihypertensive class is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
D. Nifedipine
Answer: C
Rationale: ACE inhibitors are teratogenic (fetal renal damage) and contraindicated in
pregnancy.
3. A 30-year-old woman has sudden onset unilateral facial weakness with inability to raise the
eyebrow. Most likely cause:
A. Bell’s palsy (facial nerve palsy)
B. Ischemic stroke
C. Myasthenia gravis
D. Trigeminal neuralgia
Answer: A
Rationale: Peripheral facial nerve palsy affects the forehead (unable to wrinkle) — typical of
Bell’s palsy.
,4. In suspected bacterial meningitis, which action is highest priority before lumbar puncture?
A. Start empiric IV antibiotics
B. Obtain CT head for all patients
C. Administer oral acetaminophen
D. Wait for culture results
Answer: A
Rationale: If bacterial meningitis is suspected, start empiric IV antibiotics immediately; imaging
may delay treatment only if indicated.
5. A patient with atrial fibrillation and CHADS2VASC score of 3 — best anticoagulation choice
generally:
A. Aspirin alone
B. Warfarin or DOAC (direct oral anticoagulant)
C. No anticoagulation needed
D. Clopidogrel alone
Answer: B
Rationale: A CHADS2VASC ≥2 typically indicates need for systemic anticoagulation (warfarin
or DOAC).
6. Best initial test for suspected DVT in a stable patient:
A. D-dimer only
B. Lower extremity duplex ultrasonography
C. Ventilation-perfusion scan
D. CT pulmonary angiography
Answer: B
Rationale: Duplex ultrasound is first-line to evaluate suspected DVT; D-dimer is adjunctive
when pretest probability is low.
7. Which inhaler is most appropriate as first-line rescue therapy for acute bronchospasm?
A. Inhaled corticosteroid
B. Short-acting beta2-agonist (e.g., albuterol)
C. Long-acting beta2-agonist
D. Leukotriene receptor antagonist
Answer: B
Rationale: Short-acting beta2-agonists provide rapid bronchodilation and are used for rescue.
, 8. A hypertensive patient on an ACE inhibitor develops cough. Which alternative is preferred?
A. Add a beta-blocker and continue ACE inhibitor
B. Switch to an ARB (angiotensin receptor blocker)
C. Switch to a thiazide diuretic only
D. Stop therapy and monitor
Answer: B
Rationale: ARBs avoid ACE inhibitor–related cough and maintain RAAS blockade benefits.
9. For newly diagnosed type 2 diabetes with HbA1c 9.0% and no symptoms, first-line
pharmacotherapy:
A. Start insulin immediately
B. Metformin plus lifestyle modification
C. Sulfonylurea monotherapy
D. No treatment — lifestyle only
Answer: B
Rationale: Metformin and lifestyle interventions are first-line; insulin reserved for severe
hyperglycemia or symptoms.
10. Which heart murmur increases with Valsalva maneuver (phase II)?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic obstructive cardiomyopathy (HOCM) murmur
D. Tricuspid stenosis
Answer: C
Rationale: HOCM murmur increases with decreased venous return (Valsalva) due to reduced
LV volume increasing obstruction.
11. A patient has suspected community-acquired pneumonia and is allergic to penicillin
(anaphylaxis). Best empiric outpatient antibiotic:
A. Amoxicillin
B. Doxycycline or a respiratory fluoroquinolone (if risk factors)
C. Azithromycin only (macrolide) despite local resistance
D. Cephalexin
Answer: B
Rationale: Doxycycline is an alternative for penicillin-allergic outpatients; choice depends on
resistance patterns and comorbidities.
