1|Page
NR 667 AANP FNP EXAM TEST BANK (2026–2027
EDITION) 200+ COMPREHENSIVE QUESTIONS &
RATIONALES FOR A+ GRADE
## Section 1: Cardiovascular Disorders (Questions 1–20)
**1. A 58-year-old male with hypertension and type 2 diabetes presents
for a follow-up. His blood pressure today is 142/88 mm Hg. He reports
adherence to lisinopril 20 mg daily. What is the most appropriate next
step?**
- A) Add amlodipine 5 mg daily
- B) Increase lisinopril to 40 mg daily
- C) Add hydrochlorothiazide 12.5 mg daily
- D) Continue current regimen and reassess in 3 months
**Answer: A) Add amlodipine 5 mg daily**
*Rationale:* For patients with diabetes and hypertension, the target BP
is <130/80 mm Hg (2026 ACC/AHA guidelines). If BP remains elevated
on an ACE inhibitor, adding a calcium channel blocker (amlodipine) is
preferred over doubling the ACE inhibitor dose due to better
cardiovascular outcomes and fewer adverse effects.
,2|Page
---
**2. A 72-year-old female presents with fatigue and dyspnea on
exertion. ECG shows atrial fibrillation with a ventricular rate of 110
bpm. She has a history of heart failure with preserved ejection fraction
(HFpEF). Which medication is contraindicated?**
- A) Metoprolol succinate
- B) Digoxin
- C) Diltiazem
- D) Apixaban
**Answer: C) Diltiazem**
*Rationale:* Non-dihydropyridine calcium channel blockers (diltiazem,
verapamil) are contraindicated in heart failure with reduced ejection
fraction (HFrEF) and should be used with caution in HFpEF due to
negative inotropic effects. Beta-blockers (metoprolol) are safer. Digoxin
is used for rate control. Apixaban is indicated for stroke prevention.
---
**3. A 45-year-old male presents with acute onset of severe, tearing
chest pain radiating to his back. BP is 160/90 mm Hg in the right arm
and 110/70 mm Hg in the left arm. What is the most appropriate initial
diagnostic test?**
,3|Page
- A) Chest X-ray
- B) ECG
- C) CT angiography of the chest
- D) Transthoracic echocardiogram
**Answer: C) CT angiography of the chest**
*Rationale:* These findings are highly suspicious for aortic dissection.
CT angiography is the test of choice for rapid diagnosis. ECG is used to
rule out MI but will not diagnose dissection. Chest X-ray may show a
widened mediastinum but is not diagnostic.
---
**4. A 68-year-old female with chronic venous insufficiency presents
with a painful, red, warm, palpable cord along the right calf. Which
finding would most suggest superficial vein thrombosis rather than deep
vein thrombosis?**
- A) Homan's sign positive
- B) Unilateral leg swelling
- C) Palpable, firm, cord-like vein
- D) Positive D-dimer
**Answer: C) Palpable, firm, cord-like vein**
, 4|Page
*Rationale:* A palpable, cord-like, tender vein is classic for superficial
vein thrombosis (SVT). DVT typically presents with diffuse swelling,
not a discrete cord. Homan's sign is neither sensitive nor specific for
DVT.
---
**5. A 55-year-old male with stage 3 chronic kidney disease (eGFR 45
mL/min) has hypertension. Which antihypertensive is preferred for renal
protection?**
- A) Metoprolol
- B) Amlodipine
- C) Lisinopril
- D) Hydrochlorothiazide
**Answer: C) Lisinopril**
*Rationale:* ACE inhibitors (and ARBs) are preferred in CKD due to
their renoprotective effects (reducing proteinuria and slowing
progression). Thiazides are less effective when eGFR <30. Metoprolol
and amlodipine do not provide specific renal protection.
---
NR 667 AANP FNP EXAM TEST BANK (2026–2027
EDITION) 200+ COMPREHENSIVE QUESTIONS &
RATIONALES FOR A+ GRADE
## Section 1: Cardiovascular Disorders (Questions 1–20)
**1. A 58-year-old male with hypertension and type 2 diabetes presents
for a follow-up. His blood pressure today is 142/88 mm Hg. He reports
adherence to lisinopril 20 mg daily. What is the most appropriate next
step?**
- A) Add amlodipine 5 mg daily
- B) Increase lisinopril to 40 mg daily
- C) Add hydrochlorothiazide 12.5 mg daily
- D) Continue current regimen and reassess in 3 months
**Answer: A) Add amlodipine 5 mg daily**
*Rationale:* For patients with diabetes and hypertension, the target BP
is <130/80 mm Hg (2026 ACC/AHA guidelines). If BP remains elevated
on an ACE inhibitor, adding a calcium channel blocker (amlodipine) is
preferred over doubling the ACE inhibitor dose due to better
cardiovascular outcomes and fewer adverse effects.
,2|Page
---
**2. A 72-year-old female presents with fatigue and dyspnea on
exertion. ECG shows atrial fibrillation with a ventricular rate of 110
bpm. She has a history of heart failure with preserved ejection fraction
(HFpEF). Which medication is contraindicated?**
- A) Metoprolol succinate
- B) Digoxin
- C) Diltiazem
- D) Apixaban
**Answer: C) Diltiazem**
*Rationale:* Non-dihydropyridine calcium channel blockers (diltiazem,
verapamil) are contraindicated in heart failure with reduced ejection
fraction (HFrEF) and should be used with caution in HFpEF due to
negative inotropic effects. Beta-blockers (metoprolol) are safer. Digoxin
is used for rate control. Apixaban is indicated for stroke prevention.
---
**3. A 45-year-old male presents with acute onset of severe, tearing
chest pain radiating to his back. BP is 160/90 mm Hg in the right arm
and 110/70 mm Hg in the left arm. What is the most appropriate initial
diagnostic test?**
,3|Page
- A) Chest X-ray
- B) ECG
- C) CT angiography of the chest
- D) Transthoracic echocardiogram
**Answer: C) CT angiography of the chest**
*Rationale:* These findings are highly suspicious for aortic dissection.
CT angiography is the test of choice for rapid diagnosis. ECG is used to
rule out MI but will not diagnose dissection. Chest X-ray may show a
widened mediastinum but is not diagnostic.
---
**4. A 68-year-old female with chronic venous insufficiency presents
with a painful, red, warm, palpable cord along the right calf. Which
finding would most suggest superficial vein thrombosis rather than deep
vein thrombosis?**
- A) Homan's sign positive
- B) Unilateral leg swelling
- C) Palpable, firm, cord-like vein
- D) Positive D-dimer
**Answer: C) Palpable, firm, cord-like vein**
, 4|Page
*Rationale:* A palpable, cord-like, tender vein is classic for superficial
vein thrombosis (SVT). DVT typically presents with diffuse swelling,
not a discrete cord. Homan's sign is neither sensitive nor specific for
DVT.
---
**5. A 55-year-old male with stage 3 chronic kidney disease (eGFR 45
mL/min) has hypertension. Which antihypertensive is preferred for renal
protection?**
- A) Metoprolol
- B) Amlodipine
- C) Lisinopril
- D) Hydrochlorothiazide
**Answer: C) Lisinopril**
*Rationale:* ACE inhibitors (and ARBs) are preferred in CKD due to
their renoprotective effects (reducing proteinuria and slowing
progression). Thiazides are less effective when eGFR <30. Metoprolol
and amlodipine do not provide specific renal protection.
---
