FITZ Exit Exam | 2025/2026 Edition
| Verified Questions and 100%
Correct Answers | A+ Graded Nurse
Practitioner Board Review
1. A 68-year-old male with a history of hypertension presents
with a headache and palpitations. His BP is 180/110 mmHg.
He reports taking his usual dose of lisinopril this morning.
What is the most appropriate next step?
A. Administer a STAT dose of IV hydralazine.
B. Prescribe a beta-blocker and send him home.
C. Repeat BP measurement in the opposite arm after 5
minutes of rest.
D. Start a second oral antihypertensive agent.
Answer: C. Repeat BP measurement in the opposite arm after
5 minutes of rest.
Rationale: Before diagnosing a hypertensive urgency, an
elevated BP reading must be confirmed with a repeat
measurement using proper technique to rule out a false
reading.
2. You are evaluating a 55-year-old female with a new heart
murmur. On auscultation, you hear a harsh, mid-systolic
ejection murmur at the right second intercostal space that
radiates to the carotids. The murmur does not vary with
respiration. Which of the following is the most likely
diagnosis?
, A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Ventricular septal defect
Answer: B. Aortic stenosis
Rationale: A harsh, mid-systolic ejection murmur at the right
2nd intercostal space radiating to the carotids is classic for
aortic stenosis, often due to calcific degeneration in older
adults.
3. A 72-year-old male with a history of heart failure with
reduced ejection fraction (HFrEF) presents with progressive
dyspnea on exertion and 2+ pitting edema in his lower
extremities. His current medications include lisinopril,
metoprolol succinate, and furosemide. Which of the following
medication adjustments is most appropriate at this time?
A. Increase the dose of metoprolol succinate.
B. Add spironolactone.
C. Discontinue lisinopril and start losartan.
D. Increase the dose of furosemide.
Answer: D. Increase the dose of furosemide.
Rationale: The patient has signs of fluid overload (dyspnea,
edema). The first step is to optimize diuresis by increasing the
loop diuretic dose to relieve congestion before adding other
GDMT.
4. A 60-year-old male presents with sudden onset of sharp,
stabbing chest pain that is worse with deep inspiration. He is
tachycardic and hypoxic. On exam, you note distended neck
veins. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
, C. Pulmonary embolism
D. Aortic dissection
Answer: C. Pulmonary embolism
Rationale: The triad of pleuritic chest pain, hypoxia, and
tachycardia in a patient with risk factors is highly suggestive
of a pulmonary embolism. Distended neck veins suggest
right heart strain.
5. A 48-year-old female with no significant past medical history
presents with episodic palpitations. An ECG shows a heart
rate of 160 bpm, no visible P waves, and narrow QRS
complexes with an irregularly irregular rhythm. What is the
most appropriate initial management?
A. Immediate synchronized cardioversion
B. Administer adenosine 6 mg IV push
C. Start oral metoprolol
D. Obtain a serum TSH and basic metabolic panel
Answer: D. Obtain a serum TSH and basic metabolic panel
Rationale: The ECG findings are consistent with atrial
fibrillation. If the patient is hemodynamically stable, the initial
workup should include labs to identify reversible causes (e.g.,
hyperthyroidism, electrolyte imbalances) before proceeding
with rate or rhythm control.
6. A 65-year-old male with a history of hypertension and type 2
diabetes is noted to have a blood pressure of 150/92 mmHg
in the clinic. His home BP logs show an average of 148/90
mmHg. His current medications include metformin and
atorvastatin. What is the most appropriate initial
antihypertensive medication to add?
A. Amlodipine
B. Lisinopril
, C. Hydrochlorothiazide
D. Metoprolol
Answer: B. Lisinopril
Rationale: For patients with diabetes and hypertension, an
ACE inhibitor (or ARB) is recommended as first-line therapy
due to their reno-protective effects.
7. A 70-year-old male presents with a 2-day history of
substernal chest pressure that occurs at rest and lasts for 15-
20 minutes. His ECG shows T-wave inversions in leads V2-V4.
His initial high-sensitivity troponin is elevated. What is the
most appropriate next step?
A. Admit to the hospital for management of NSTEMI.
B. Reassure the patient and discharge with a prescription for
nitroglycerin.
C. Order an echocardiogram as an outpatient.
D. Perform an exercise stress test in the office.
Answer: A. Admit to the hospital for management of
NSTEMI.
Rationale: This patient presents with a Non-ST-Elevation
Myocardial Infarction (NSTEMI), indicated by rest angina, ECG
changes, and an elevated troponin. He requires immediate
hospitalization for further management.
8. A 55-year-old male with a history of hypertension and
hyperlipidemia presents for a routine physical. He has no
complaints. His blood pressure is 128/82 mmHg. A
cardiovascular risk assessment using the ASCVD risk
estimator shows his 10-year risk of a cardiovascular event is
12%. What is the most appropriate recommendation
regarding statin therapy?
A. No statin is indicated at this time.
| Verified Questions and 100%
Correct Answers | A+ Graded Nurse
Practitioner Board Review
1. A 68-year-old male with a history of hypertension presents
with a headache and palpitations. His BP is 180/110 mmHg.
He reports taking his usual dose of lisinopril this morning.
What is the most appropriate next step?
A. Administer a STAT dose of IV hydralazine.
B. Prescribe a beta-blocker and send him home.
C. Repeat BP measurement in the opposite arm after 5
minutes of rest.
D. Start a second oral antihypertensive agent.
Answer: C. Repeat BP measurement in the opposite arm after
5 minutes of rest.
Rationale: Before diagnosing a hypertensive urgency, an
elevated BP reading must be confirmed with a repeat
measurement using proper technique to rule out a false
reading.
2. You are evaluating a 55-year-old female with a new heart
murmur. On auscultation, you hear a harsh, mid-systolic
ejection murmur at the right second intercostal space that
radiates to the carotids. The murmur does not vary with
respiration. Which of the following is the most likely
diagnosis?
, A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Ventricular septal defect
Answer: B. Aortic stenosis
Rationale: A harsh, mid-systolic ejection murmur at the right
2nd intercostal space radiating to the carotids is classic for
aortic stenosis, often due to calcific degeneration in older
adults.
3. A 72-year-old male with a history of heart failure with
reduced ejection fraction (HFrEF) presents with progressive
dyspnea on exertion and 2+ pitting edema in his lower
extremities. His current medications include lisinopril,
metoprolol succinate, and furosemide. Which of the following
medication adjustments is most appropriate at this time?
A. Increase the dose of metoprolol succinate.
B. Add spironolactone.
C. Discontinue lisinopril and start losartan.
D. Increase the dose of furosemide.
Answer: D. Increase the dose of furosemide.
Rationale: The patient has signs of fluid overload (dyspnea,
edema). The first step is to optimize diuresis by increasing the
loop diuretic dose to relieve congestion before adding other
GDMT.
4. A 60-year-old male presents with sudden onset of sharp,
stabbing chest pain that is worse with deep inspiration. He is
tachycardic and hypoxic. On exam, you note distended neck
veins. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
, C. Pulmonary embolism
D. Aortic dissection
Answer: C. Pulmonary embolism
Rationale: The triad of pleuritic chest pain, hypoxia, and
tachycardia in a patient with risk factors is highly suggestive
of a pulmonary embolism. Distended neck veins suggest
right heart strain.
5. A 48-year-old female with no significant past medical history
presents with episodic palpitations. An ECG shows a heart
rate of 160 bpm, no visible P waves, and narrow QRS
complexes with an irregularly irregular rhythm. What is the
most appropriate initial management?
A. Immediate synchronized cardioversion
B. Administer adenosine 6 mg IV push
C. Start oral metoprolol
D. Obtain a serum TSH and basic metabolic panel
Answer: D. Obtain a serum TSH and basic metabolic panel
Rationale: The ECG findings are consistent with atrial
fibrillation. If the patient is hemodynamically stable, the initial
workup should include labs to identify reversible causes (e.g.,
hyperthyroidism, electrolyte imbalances) before proceeding
with rate or rhythm control.
6. A 65-year-old male with a history of hypertension and type 2
diabetes is noted to have a blood pressure of 150/92 mmHg
in the clinic. His home BP logs show an average of 148/90
mmHg. His current medications include metformin and
atorvastatin. What is the most appropriate initial
antihypertensive medication to add?
A. Amlodipine
B. Lisinopril
, C. Hydrochlorothiazide
D. Metoprolol
Answer: B. Lisinopril
Rationale: For patients with diabetes and hypertension, an
ACE inhibitor (or ARB) is recommended as first-line therapy
due to their reno-protective effects.
7. A 70-year-old male presents with a 2-day history of
substernal chest pressure that occurs at rest and lasts for 15-
20 minutes. His ECG shows T-wave inversions in leads V2-V4.
His initial high-sensitivity troponin is elevated. What is the
most appropriate next step?
A. Admit to the hospital for management of NSTEMI.
B. Reassure the patient and discharge with a prescription for
nitroglycerin.
C. Order an echocardiogram as an outpatient.
D. Perform an exercise stress test in the office.
Answer: A. Admit to the hospital for management of
NSTEMI.
Rationale: This patient presents with a Non-ST-Elevation
Myocardial Infarction (NSTEMI), indicated by rest angina, ECG
changes, and an elevated troponin. He requires immediate
hospitalization for further management.
8. A 55-year-old male with a history of hypertension and
hyperlipidemia presents for a routine physical. He has no
complaints. His blood pressure is 128/82 mmHg. A
cardiovascular risk assessment using the ASCVD risk
estimator shows his 10-year risk of a cardiovascular event is
12%. What is the most appropriate recommendation
regarding statin therapy?
A. No statin is indicated at this time.
