Fitzgerald NP Board Review Exam V2
Nurse Practitioner Certification Actual
Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
Section 1: Assessment & Differential Diagnosis (Health
history, Physical exam, Diagnostic testing, Risk factors) – 15
Questions
Q1. Which component of the health history provides the most detailed information about the
patient's presenting symptom, including onset, location, duration, character, aggravating factors,
relieving factors, and associated symptoms?
A. Chief complaint
B. History of present illness
C. Review of systems
,D. Social history
B. History of present illness [CORRECT]
Rationale: The best answer is B. The HPI is where you document the comprehensive story of the
patient's chief complaint using the OLDCART or OPQRST framework. In NP practice, a thorough
HPI is essential for accurate differential diagnosis and guides your physical exam and diagnostic
testing.
Correct Answer: B
Q2. During cardiac auscultation, the nurse practitioner places the stethoscope at the second
intercostal space just right of the sternum to best hear which valve?
A. Mitral valve
B. Tricuspid valve
C. Aortic valve
D. Pulmonic valve
C. Aortic valve [CORRECT]
Rationale: The best answer is C. The aortic valve is best auscultated at the second right intercostal
space, while the pulmonic valve is at the second left ICS, tricuspid at the lower left sternal border,
and mitral at the fifth ICS midclavicular line. The nurse practitioner should be aware that correct
stethoscope placement is fundamental to identifying valvular murmurs.
,Correct Answer: C
Q3. A 58-year-old male presents with fatigue. CBC shows: WBC 7.2, Hgb 10.8 g/dL, Hct 32.5%,
MCV 72 fL, MCHC 28 g/dL, RDW 16.5%, platelets 380,000. Which is the most likely diagnosis?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folate deficiency
D. Anemia of chronic disease
B. Iron deficiency anemia [CORRECT]
Rationale: The best answer is B. The low MCV (microcytic), low MCHC (hypochromic), and elevated
RDW are classic for iron deficiency anemia, while B12 and folate deficiencies cause macrocytic
anemia. In NP practice, when you see microcytic hypochromic indices, you should evaluate for
blood loss and consider iron studies.
Correct Answer: B
Q4. A 45-year-old female with obesity and Type 2 diabetes presents for follow-up. CMP shows:
Sodium 138, Potassium 4.2, Chloride 102, CO2 24, BUN 18, Creatinine 0.9, Glucose 142, Calcium
9.5. ALT 68 U/L, AST 52 U/L, Alk Phos 110 U/L, Total Bilirubin 0.8, Albumin 4.2. Which abnormality
requires the most attention?
, A. Elevated ALT and AST
B. Elevated alkaline phosphatase
C. Elevated blood urea nitrogen
D. Elevated total bilirubin
A. Elevated ALT and AST [CORRECT]
Rationale: The best answer is A. Mildly elevated transaminases in a patient with obesity and Type 2
diabetes most likely indicate non-alcoholic fatty liver disease, which is common in metabolic
syndrome and requires monitoring and lifestyle intervention. The other values are within normal
limits or only mildly elevated without clinical significance in this context.
Correct Answer: A
Q5. A 38-year-old female presents with weight gain, constipation, and cold intolerance. TSH is 8.5
mIU/L (normal 0.4-4.0), free T4 is 0.9 ng/dL (normal 0.8-1.8). Which is the most appropriate initial
management?
A. Start levothyroxine 125 mcg daily
B. Start levothyroxine 25-50 mcg daily
C. Repeat TSH in 6 months
D. Order thyroid ultrasound
Nurse Practitioner Certification Actual
Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
Section 1: Assessment & Differential Diagnosis (Health
history, Physical exam, Diagnostic testing, Risk factors) – 15
Questions
Q1. Which component of the health history provides the most detailed information about the
patient's presenting symptom, including onset, location, duration, character, aggravating factors,
relieving factors, and associated symptoms?
A. Chief complaint
B. History of present illness
C. Review of systems
,D. Social history
B. History of present illness [CORRECT]
Rationale: The best answer is B. The HPI is where you document the comprehensive story of the
patient's chief complaint using the OLDCART or OPQRST framework. In NP practice, a thorough
HPI is essential for accurate differential diagnosis and guides your physical exam and diagnostic
testing.
Correct Answer: B
Q2. During cardiac auscultation, the nurse practitioner places the stethoscope at the second
intercostal space just right of the sternum to best hear which valve?
A. Mitral valve
B. Tricuspid valve
C. Aortic valve
D. Pulmonic valve
C. Aortic valve [CORRECT]
Rationale: The best answer is C. The aortic valve is best auscultated at the second right intercostal
space, while the pulmonic valve is at the second left ICS, tricuspid at the lower left sternal border,
and mitral at the fifth ICS midclavicular line. The nurse practitioner should be aware that correct
stethoscope placement is fundamental to identifying valvular murmurs.
,Correct Answer: C
Q3. A 58-year-old male presents with fatigue. CBC shows: WBC 7.2, Hgb 10.8 g/dL, Hct 32.5%,
MCV 72 fL, MCHC 28 g/dL, RDW 16.5%, platelets 380,000. Which is the most likely diagnosis?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folate deficiency
D. Anemia of chronic disease
B. Iron deficiency anemia [CORRECT]
Rationale: The best answer is B. The low MCV (microcytic), low MCHC (hypochromic), and elevated
RDW are classic for iron deficiency anemia, while B12 and folate deficiencies cause macrocytic
anemia. In NP practice, when you see microcytic hypochromic indices, you should evaluate for
blood loss and consider iron studies.
Correct Answer: B
Q4. A 45-year-old female with obesity and Type 2 diabetes presents for follow-up. CMP shows:
Sodium 138, Potassium 4.2, Chloride 102, CO2 24, BUN 18, Creatinine 0.9, Glucose 142, Calcium
9.5. ALT 68 U/L, AST 52 U/L, Alk Phos 110 U/L, Total Bilirubin 0.8, Albumin 4.2. Which abnormality
requires the most attention?
, A. Elevated ALT and AST
B. Elevated alkaline phosphatase
C. Elevated blood urea nitrogen
D. Elevated total bilirubin
A. Elevated ALT and AST [CORRECT]
Rationale: The best answer is A. Mildly elevated transaminases in a patient with obesity and Type 2
diabetes most likely indicate non-alcoholic fatty liver disease, which is common in metabolic
syndrome and requires monitoring and lifestyle intervention. The other values are within normal
limits or only mildly elevated without clinical significance in this context.
Correct Answer: A
Q5. A 38-year-old female presents with weight gain, constipation, and cold intolerance. TSH is 8.5
mIU/L (normal 0.4-4.0), free T4 is 0.9 ng/dL (normal 0.8-1.8). Which is the most appropriate initial
management?
A. Start levothyroxine 125 mcg daily
B. Start levothyroxine 25-50 mcg daily
C. Repeat TSH in 6 months
D. Order thyroid ultrasound
