Page 1 of 144
NEW YORK Nurse Practitioner Certification ACTUAL EXAM
2026/2027 COMPLETE ACCURATE EXAM REAL QUESTIONS
WITH WELL ELABORATED ANSWERS. (100% CORRECT
VERIFIED SOLUTIONS)
1. A 58-year-old male presents with chest pressure
radiating to the jaw, diaphoresis, and nausea. Vital signs:
BP 160/95, HR 110, RR 22, O2 sat 94%. What is the MOST
appropriate next step?
A) Order a chest x-ray
B) Administer sublingual nitroglycerin and obtain a stat ECG
C) Schedule a stress test for tomorrow
D) Prescribe ibuprofen for costochondritis
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Answer: B
Rationale: Symptoms suggest acute coronary syndrome.
Immediate action includes nitroglycerin (if no hypotension) and
ECG to assess for ischemia. Delaying for outpatient tests risks
serious complication.
2. On cardiac auscultation, you hear a harsh, crescendo-
decrescendo systolic murmur at the right second intercostal
space radiating to the carotids. This is most consistent with:
A) Mitral regurgitation
B) Aortic stenosis
C) Ventricular septal defect
D) Mitral valve prolapse
Answer: B
Rationale: Aortic stenosis murmur: systolic, harsh, best heard at
right 2nd ICS (aortic area) with radiation to carotids. Associated
with syncope, angina, dyspnea.
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3. A 45-year-old female presents with acute-onset severe
headache, photophobia, and neck stiffness. No fever.
Kernig’s sign is positive. What is the next best step?
A) Oral antibiotics
B) CT head without contrast
C) Lumbar puncture after CT if no mass effect
D) MRI brain with contrast
Answer: C
Rationale: Suspect subarachnoid hemorrhage or meningitis. CT
first to rule out mass effect, then LP. Delaying LP increases risk of
missing diagnosis.
4. You palpate a thrill at the left sternal border on a 32-
year-old asymptomatic male. The most likely diagnosis is:
A) Atrial septal defect
B) Aortic regurgitation
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C) Ventricular septal defect
D) Pulmonic stenosis
Answer: C
Rationale: Thrill at left sternal border suggests VSD (systolic
thrill). Asymptomatic small VSD can be found in adults.
5. A 70-year-old diabetic complains of painless unilateral
lower leg swelling with erythema and warmth. Homan’s
sign is negative. Most likely diagnosis?
A) Cellulitis
B) Deep vein thrombosis
C) Venous stasis dermatitis
D) Lymphedema
Answer: B
Rationale: DVT presents with unilateral swelling, warmth,
erythema. Homan’s sign is unreliable. Diabetics have atypical
presentations. Doppler ultrasound needed.
NEW YORK Nurse Practitioner Certification ACTUAL EXAM
2026/2027 COMPLETE ACCURATE EXAM REAL QUESTIONS
WITH WELL ELABORATED ANSWERS. (100% CORRECT
VERIFIED SOLUTIONS)
1. A 58-year-old male presents with chest pressure
radiating to the jaw, diaphoresis, and nausea. Vital signs:
BP 160/95, HR 110, RR 22, O2 sat 94%. What is the MOST
appropriate next step?
A) Order a chest x-ray
B) Administer sublingual nitroglycerin and obtain a stat ECG
C) Schedule a stress test for tomorrow
D) Prescribe ibuprofen for costochondritis
,Page 2 of 144
Answer: B
Rationale: Symptoms suggest acute coronary syndrome.
Immediate action includes nitroglycerin (if no hypotension) and
ECG to assess for ischemia. Delaying for outpatient tests risks
serious complication.
2. On cardiac auscultation, you hear a harsh, crescendo-
decrescendo systolic murmur at the right second intercostal
space radiating to the carotids. This is most consistent with:
A) Mitral regurgitation
B) Aortic stenosis
C) Ventricular septal defect
D) Mitral valve prolapse
Answer: B
Rationale: Aortic stenosis murmur: systolic, harsh, best heard at
right 2nd ICS (aortic area) with radiation to carotids. Associated
with syncope, angina, dyspnea.
,Page 3 of 144
3. A 45-year-old female presents with acute-onset severe
headache, photophobia, and neck stiffness. No fever.
Kernig’s sign is positive. What is the next best step?
A) Oral antibiotics
B) CT head without contrast
C) Lumbar puncture after CT if no mass effect
D) MRI brain with contrast
Answer: C
Rationale: Suspect subarachnoid hemorrhage or meningitis. CT
first to rule out mass effect, then LP. Delaying LP increases risk of
missing diagnosis.
4. You palpate a thrill at the left sternal border on a 32-
year-old asymptomatic male. The most likely diagnosis is:
A) Atrial septal defect
B) Aortic regurgitation
, Page 4 of 144
C) Ventricular septal defect
D) Pulmonic stenosis
Answer: C
Rationale: Thrill at left sternal border suggests VSD (systolic
thrill). Asymptomatic small VSD can be found in adults.
5. A 70-year-old diabetic complains of painless unilateral
lower leg swelling with erythema and warmth. Homan’s
sign is negative. Most likely diagnosis?
A) Cellulitis
B) Deep vein thrombosis
C) Venous stasis dermatitis
D) Lymphedema
Answer: B
Rationale: DVT presents with unilateral swelling, warmth,
erythema. Homan’s sign is unreliable. Diabetics have atypical
presentations. Doppler ultrasound needed.
