AANP Family Nurse Practitioner (FNP)
Certification Exam Complete Practice
Exam – 300 Questions with Answers,
Rationales & Key Exam Tips
Question 1
All diastolic murmurs are:
A) Innocent findings in athletes
B) Pathological and require evaluation
C) Normal in elderly patients
D) Always associated with fever
✓Correct Answer>: B) Pathological and require evaluation
Rationale: All diastolic murmurs are pathological and require further evaluation.
Systolic murmurs can be innocent or physiological, but diastolic murmurs always
indicate underlying cardiac pathology such as aortic regurgitation or mitral
stenosis .
Key Tip: Remember: "Diastolic = Dangerous." Any murmur occurring during
diastole warrants an echocardiogram and cardiology referral.
Question 2
A heart murmur that radiates to the axilla is most likely:
A) Aortic stenosis
B) Mitral regurgitation (MR)
C) Pulmonic stenosis
D) Tricuspid regurgitation
✓Correct Answer>: B) Mitral regurgitation (MR)
,Rationale: Mitral regurgitation (MR) is a holosystolic or pansystolic murmur that
radiates to the axilla and is best heard at the 5th intercostal space, midclavicular
line (apex). Use the mnemonic "MR ASSH" - MR radiates to Axilla, AS (Aortic
Stenosis) radiates to the neck .
Key Tip: Aortic stenosis radiates to the carotids; mitral regurgitation radiates to
the axilla. Think "Mitral goes to the armpit."
Question 3
A patient with hypertension and coronary artery disease has palpable femoral
pulses but absent pedal pulses. This finding is most consistent with:
A) Chronic venous insufficiency
B) Peripheral arterial disease (PAD)
C) Deep vein thrombosis
D) Neurogenic claudication
✓Correct Answer>: B) Peripheral arterial disease (PAD)
Rationale: Peripheral arterial disease (PAD) presents with diminished or absent
pulses distal to the blockage, intermittent claudication (pain with walking),
nocturnal pain relieved by dangling legs, dependent rubor, and shiny, hairless
skin. Diagnosis is confirmed with Doppler and ABI <0.9 .
Key Tip: PAD = "Pulse Deficit." Check ABI (Ankle-Brachial Index); values <0.9
indicate PAD, values <0.5 indicate severe disease.
Question 4
A bounding radial pulse with a weak femoral pulse suggests:
A) Aortic stenosis
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosus
D) Mitral valve prolapse
✓Correct Answer>: B) Coarctation of the aorta (COA)
,Rationale: Coarctation of the aorta (COA) presents with bounding radial pulses
and weak or delayed femoral pulses, along with increased blood pressure in the
arms and lower pressure in the legs. It is a congenital cardiac condition
characterized by narrowing of the aorta .
Key Tip: "Arms > Legs" in blood pressure measurement suggests coarctation.
Always check femoral pulses in hypertensive patients.
Question 5
Jugular vein distention (JVD) can be caused by all of the following EXCEPT:
A) Tension pneumothorax
B) Right-sided heart failure
C) Cardiac tamponade
D) Hypovolemic shock
✓Correct Answer>: D) Hypovolemic shock
Rationale: JVD results from increased central venous pressure. Causes include
tension pneumothorax, right-sided heart failure, cardiac tamponade, and
traumatic asphyxia. Hypovolemic shock causes decreased venous pressure and
flat neck veins, not distention .
Key Tip: "JVD = Fluid Overload or Obstruction." Hypovolemia makes veins flat, not
full.
Question 6
An S3 heart sound is associated with:
A) Left ventricular hypertrophy
B) Heart failure (HF)
C) Mitral valve prolapse
D) Aortic stenosis
✓Correct Answer>: B) Heart failure (HF)
, Rationale: S3 (ventricular gallop) occurs in early diastole and is associated with
heart failure (HF). It is abnormal after age 35. Use the mnemonic "S3-Kentucky"
(sounds like "Ken-tuc-ky"). S4 (atrial gallop) occurs in late diastole, is associated
with left ventricular hypertrophy (LVH) and stiffening, and sounds like "Ten-ness-
see" .
Key Tip: S3 = "Sloshing in" (volume overload), S4 = "Stiff heart" (pressure
overload).
Question 7
Pulsus paradoxus is defined as:
A) Increase in systolic pressure during inspiration
B) Decrease in systolic pressure >10 mm Hg during inspiration
C) Decrease in diastolic pressure during expiration
D) Widened pulse pressure during inspiration
✓Correct Answer>: B) Decrease in systolic pressure >10 mm Hg during
inspiration
Rationale: Pulsus paradoxus is an exaggerated drop in systolic blood pressure
(>10 mmHg) during inspiration. It occurs in cardiac tamponade, constrictive
pericarditis, severe asthma, and tension pneumothorax .
Key Tip: "Paradoxus" is misnamed—it's actually an exaggeration of the normal
inspiratory drop. Check for it in suspected tamponade.
Question 8
Which medication is the first-line treatment for stable angina?
A) Nitroglycerin sublingual PRN
B) Atenolol
C) Amlodipine
D) Ranolazine
✓Correct Answer>: A) Nitroglycerin sublingual PRN
Certification Exam Complete Practice
Exam – 300 Questions with Answers,
Rationales & Key Exam Tips
Question 1
All diastolic murmurs are:
A) Innocent findings in athletes
B) Pathological and require evaluation
C) Normal in elderly patients
D) Always associated with fever
✓Correct Answer>: B) Pathological and require evaluation
Rationale: All diastolic murmurs are pathological and require further evaluation.
Systolic murmurs can be innocent or physiological, but diastolic murmurs always
indicate underlying cardiac pathology such as aortic regurgitation or mitral
stenosis .
Key Tip: Remember: "Diastolic = Dangerous." Any murmur occurring during
diastole warrants an echocardiogram and cardiology referral.
Question 2
A heart murmur that radiates to the axilla is most likely:
A) Aortic stenosis
B) Mitral regurgitation (MR)
C) Pulmonic stenosis
D) Tricuspid regurgitation
✓Correct Answer>: B) Mitral regurgitation (MR)
,Rationale: Mitral regurgitation (MR) is a holosystolic or pansystolic murmur that
radiates to the axilla and is best heard at the 5th intercostal space, midclavicular
line (apex). Use the mnemonic "MR ASSH" - MR radiates to Axilla, AS (Aortic
Stenosis) radiates to the neck .
Key Tip: Aortic stenosis radiates to the carotids; mitral regurgitation radiates to
the axilla. Think "Mitral goes to the armpit."
Question 3
A patient with hypertension and coronary artery disease has palpable femoral
pulses but absent pedal pulses. This finding is most consistent with:
A) Chronic venous insufficiency
B) Peripheral arterial disease (PAD)
C) Deep vein thrombosis
D) Neurogenic claudication
✓Correct Answer>: B) Peripheral arterial disease (PAD)
Rationale: Peripheral arterial disease (PAD) presents with diminished or absent
pulses distal to the blockage, intermittent claudication (pain with walking),
nocturnal pain relieved by dangling legs, dependent rubor, and shiny, hairless
skin. Diagnosis is confirmed with Doppler and ABI <0.9 .
Key Tip: PAD = "Pulse Deficit." Check ABI (Ankle-Brachial Index); values <0.9
indicate PAD, values <0.5 indicate severe disease.
Question 4
A bounding radial pulse with a weak femoral pulse suggests:
A) Aortic stenosis
B) Coarctation of the aorta (COA)
C) Patent ductus arteriosus
D) Mitral valve prolapse
✓Correct Answer>: B) Coarctation of the aorta (COA)
,Rationale: Coarctation of the aorta (COA) presents with bounding radial pulses
and weak or delayed femoral pulses, along with increased blood pressure in the
arms and lower pressure in the legs. It is a congenital cardiac condition
characterized by narrowing of the aorta .
Key Tip: "Arms > Legs" in blood pressure measurement suggests coarctation.
Always check femoral pulses in hypertensive patients.
Question 5
Jugular vein distention (JVD) can be caused by all of the following EXCEPT:
A) Tension pneumothorax
B) Right-sided heart failure
C) Cardiac tamponade
D) Hypovolemic shock
✓Correct Answer>: D) Hypovolemic shock
Rationale: JVD results from increased central venous pressure. Causes include
tension pneumothorax, right-sided heart failure, cardiac tamponade, and
traumatic asphyxia. Hypovolemic shock causes decreased venous pressure and
flat neck veins, not distention .
Key Tip: "JVD = Fluid Overload or Obstruction." Hypovolemia makes veins flat, not
full.
Question 6
An S3 heart sound is associated with:
A) Left ventricular hypertrophy
B) Heart failure (HF)
C) Mitral valve prolapse
D) Aortic stenosis
✓Correct Answer>: B) Heart failure (HF)
, Rationale: S3 (ventricular gallop) occurs in early diastole and is associated with
heart failure (HF). It is abnormal after age 35. Use the mnemonic "S3-Kentucky"
(sounds like "Ken-tuc-ky"). S4 (atrial gallop) occurs in late diastole, is associated
with left ventricular hypertrophy (LVH) and stiffening, and sounds like "Ten-ness-
see" .
Key Tip: S3 = "Sloshing in" (volume overload), S4 = "Stiff heart" (pressure
overload).
Question 7
Pulsus paradoxus is defined as:
A) Increase in systolic pressure during inspiration
B) Decrease in systolic pressure >10 mm Hg during inspiration
C) Decrease in diastolic pressure during expiration
D) Widened pulse pressure during inspiration
✓Correct Answer>: B) Decrease in systolic pressure >10 mm Hg during
inspiration
Rationale: Pulsus paradoxus is an exaggerated drop in systolic blood pressure
(>10 mmHg) during inspiration. It occurs in cardiac tamponade, constrictive
pericarditis, severe asthma, and tension pneumothorax .
Key Tip: "Paradoxus" is misnamed—it's actually an exaggeration of the normal
inspiratory drop. Check for it in suspected tamponade.
Question 8
Which medication is the first-line treatment for stable angina?
A) Nitroglycerin sublingual PRN
B) Atenolol
C) Amlodipine
D) Ranolazine
✓Correct Answer>: A) Nitroglycerin sublingual PRN
