Family Nurse Practitioner Exam 1
Overview 150 Questions and
Answers
EXAM
1. A 58-year-old male with a history of hypertension presents with substernal
chest pressure radiating to the jaw, occurring at rest for 20 minutes. His BP is
150/90, HR 100. An ECG shows ST-segment depression. What is the most
appropriate next step?
a) Administer sublingual nitroglycerin and discharge with aspirin
b) Obtain a chest X-ray and schedule a stress test for tomorrow
c) Administer aspirin, nitroglycerin, morphine, and arrange immediate transfer to
the ED
d) Prescribe a proton pump inhibitor for suspected GERD
Rationale: The presentation suggests unstable angina or NSTEMI. This is a medical
emergency requiring hospitalization. Aspirin reduces mortality; nitroglycerin and
morphine manage pain and preload.
2. Which medication is considered first-line for chronic stable angina and also
reduces mortality in post-MI patients?
a) Amlodipine
b) Metoprolol
c) Isosorbide mononitrate
d) Ranolazine
,Rationale: Beta-blockers (metoprolol, carvedilol, bisoprolol) decrease myocardial
oxygen demand and are first-line for stable angina and post-MI management to prevent
remodeling and death.
3. A 45-year-old female presents with a blood pressure of 148/92 mm Hg on three
separate occasions. She has no comorbidities. According to JNC 8/ACC guidelines,
what is the initial treatment?
a) Hydrochlorothiazide
b) Lifestyle modification for 3-6 months then reassess
c) Amlodipine
d) Lisinopril
Rationale: For Stage 1 hypertension (130-139/80-89) in patients without ASCVD or 10-
year risk <10%, lifestyle modifications are recommended before initiating
pharmacotherapy.
4. What is the most common cause of heart failure exacerbation?
a) Non-adherence to medications
b) Dietary non-compliance (sodium/fluid overload)
c) Myocardial infarction
d) Anemia
Rationale: While all are causes, dietary indiscretion (excess sodium/fluid) is the most
common precipitating factor for acute decompensated heart failure.
Domain: Pulmonary
5. A 22-year-old college student presents with sudden onset of sharp right-sided
chest pain and dyspnea. He is tall and thin. Lung sounds are diminished on the
right. What is the most likely diagnosis?
, a) Pneumonia
b) Spontaneous pneumothorax
c) Pulmonary embolism
d) Pericarditis
Rationale: Spontaneous pneumothorax is common in tall, thin, young males (Marfanoid
habitus) due to rupture of apical blebs.
6. A patient with a 40-pack-year history presents with chronic cough, sputum
production, and dyspnea on exertion. Spirometry shows FEV1/FVC < 0.70 with a
decreased FEV1. What is the diagnosis?
a) Restrictive lung disease
b) Asthma
c) COPD
d) Bronchiectasis
Rationale: An FEV1/FVC ratio <0.70 post-bronchodilator confirms airflow obstruction
consistent with COPD.
7. Which of the following is a contraindication for prescribing montelukast?
a) Hepatic impairment
b) Neuropsychiatric events (aggression, suicidal ideation)
c) Glaucoma
d) Pregnancy
Rationale: Montelukast carries an FDA black box warning regarding serious
neuropsychiatric events. Patients must be counseled on this risk.
8. A 5-year-old presents with barking cough, stridor, and low-grade fever.
Symptoms are worse at night. What is the most likely diagnosis?
a) Epiglottitis
b) Bacterial tracheitis
Overview 150 Questions and
Answers
EXAM
1. A 58-year-old male with a history of hypertension presents with substernal
chest pressure radiating to the jaw, occurring at rest for 20 minutes. His BP is
150/90, HR 100. An ECG shows ST-segment depression. What is the most
appropriate next step?
a) Administer sublingual nitroglycerin and discharge with aspirin
b) Obtain a chest X-ray and schedule a stress test for tomorrow
c) Administer aspirin, nitroglycerin, morphine, and arrange immediate transfer to
the ED
d) Prescribe a proton pump inhibitor for suspected GERD
Rationale: The presentation suggests unstable angina or NSTEMI. This is a medical
emergency requiring hospitalization. Aspirin reduces mortality; nitroglycerin and
morphine manage pain and preload.
2. Which medication is considered first-line for chronic stable angina and also
reduces mortality in post-MI patients?
a) Amlodipine
b) Metoprolol
c) Isosorbide mononitrate
d) Ranolazine
,Rationale: Beta-blockers (metoprolol, carvedilol, bisoprolol) decrease myocardial
oxygen demand and are first-line for stable angina and post-MI management to prevent
remodeling and death.
3. A 45-year-old female presents with a blood pressure of 148/92 mm Hg on three
separate occasions. She has no comorbidities. According to JNC 8/ACC guidelines,
what is the initial treatment?
a) Hydrochlorothiazide
b) Lifestyle modification for 3-6 months then reassess
c) Amlodipine
d) Lisinopril
Rationale: For Stage 1 hypertension (130-139/80-89) in patients without ASCVD or 10-
year risk <10%, lifestyle modifications are recommended before initiating
pharmacotherapy.
4. What is the most common cause of heart failure exacerbation?
a) Non-adherence to medications
b) Dietary non-compliance (sodium/fluid overload)
c) Myocardial infarction
d) Anemia
Rationale: While all are causes, dietary indiscretion (excess sodium/fluid) is the most
common precipitating factor for acute decompensated heart failure.
Domain: Pulmonary
5. A 22-year-old college student presents with sudden onset of sharp right-sided
chest pain and dyspnea. He is tall and thin. Lung sounds are diminished on the
right. What is the most likely diagnosis?
, a) Pneumonia
b) Spontaneous pneumothorax
c) Pulmonary embolism
d) Pericarditis
Rationale: Spontaneous pneumothorax is common in tall, thin, young males (Marfanoid
habitus) due to rupture of apical blebs.
6. A patient with a 40-pack-year history presents with chronic cough, sputum
production, and dyspnea on exertion. Spirometry shows FEV1/FVC < 0.70 with a
decreased FEV1. What is the diagnosis?
a) Restrictive lung disease
b) Asthma
c) COPD
d) Bronchiectasis
Rationale: An FEV1/FVC ratio <0.70 post-bronchodilator confirms airflow obstruction
consistent with COPD.
7. Which of the following is a contraindication for prescribing montelukast?
a) Hepatic impairment
b) Neuropsychiatric events (aggression, suicidal ideation)
c) Glaucoma
d) Pregnancy
Rationale: Montelukast carries an FDA black box warning regarding serious
neuropsychiatric events. Patients must be counseled on this risk.
8. A 5-year-old presents with barking cough, stridor, and low-grade fever.
Symptoms are worse at night. What is the most likely diagnosis?
a) Epiglottitis
b) Bacterial tracheitis
