FNP Comprehensive Predator Exam –
Latest 2026/2027 Update||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 85
Format: Multiple Choice
Instructions: Select the single best answer for each question. Correct answers
are bolded and highlighted. Rationales are provided for each answer.
Section 1: Cardiovascular Disorders (Questions 1–10)
1. A 58-year-old male with hypertension and DM type 2 presents with
substernal chest pressure radiating to the jaw, occurring at rest for 20
minutes. ECG shows ST-segment elevation in leads V1–V4. What is the most
appropriate immediate next step?
• A. Aspirin 81 mg and discharge with cardiology follow-up
• B. Nitroglycerin sublingual x 3 doses and repeat ECG
• C. Activate emergency medical services (EMS) for emergent reperfusion
• D. Oral beta-blocker and stress test in the morning
Rationale : ST elevation in contiguous leads indicates STEMI. Immediate
reperfusion via PCI or fibrinolysis is critical; EMS activation ensures transport to a
PCI-capable hospital.
2. Which medication improves mortality in chronic systolic HF (HFrEF) and
should be initiated early?
• A. Furosemide
• B. Sacubitril/valsartan
, • C. Metolazone
• D. Digoxin
Rationale : Sacubitril/valsartan (ARNI) reduces mortality and hospitalizations in
HFrEF. Loop diuretics manage symptoms but do not improve survival.
3. A 72-year-old with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which
agent is preferred for stroke prevention?
• A. Aspirin 325 mg daily
• B. Apixaban
• C. Clopidogrel
• D. Aspirin + clopidogrel
Rationale : DOACs (apixaban, rivaroxaban) are preferred over warfarin and
aspirin for stroke prevention in non-valvular AF with high CHA₂DS₂-VASc.
4. A patient reports leg pain with walking that resolves with rest; femoral
pulses are weak, and ankle-brachial index (ABI) is 0.65. What is the
diagnosis?
• A. Peripheral artery disease
• B. Chronic venous insufficiency
• C. Diabetic neuropathy
• D. Lumbar spinal stenosis
Rationale : Classic intermittent claudication with ABI <0.90 indicates PAD.
Venous disease presents with edema and skin changes.
5. Which beta-blocker is most appropriate for a patient with severe COPD
and stable angina?
• A. Propranolol
• B. Metoprolol succinate (β1-selective)
, • C. Carvedilol
• D. Labetalol
Rationale : Cardioselective beta-blockers (metoprolol, bisoprolol) have less risk of
bronchospasm and are safe in mild-to-moderate COPD.
6. First-line antihypertensive in a black patient with stage 1 hypertension and
no comorbidities?
• A. Lisinopril
• B. Amlodipine
• C. Hydrochlorothiazide
• D. Losartan
Rationale : ACC/AHA guidelines recommend thiazides or CCBs as first-line in
black hypertensive patients (with or without a diuretic), as ACEi/ARBs are less
effective as monotherapy in this group.
7. ECG shows narrow QRS tachycardia at 180 bpm, regular, no visible P
waves. The patient is stable. What is the next step?
• A. Synchronized cardioversion
• B. Adenosine 6 mg IV push
• C. Amiodarone 150 mg IV
• D. Vagal maneuvers
Rationale : This is AV nodal reentrant tachycardia (AVNRT). Vagal maneuvers are
first-line if stable, but adenosine is first-line pharmacologic therapy. The question
asks for “next step” after vagal maneuvers or if not specified, adenosine is
appropriate. (Note: In this case vagal maneuvers are a reasonable first attempt, but
adenosine is the correct drug answer.)
8. A 45-year-old with sudden severe “tearing” chest pain radiating to the back;
BP 100/60, unequal arm pulses. Most likely diagnosis?
, • A. Aortic dissection
• B. Acute MI
• C. Pulmonary embolism
• D. Pericarditis
Rationale : Tearing pain, pulse deficit, and mediastinal widening suggest aortic
dissection. Immediate CT angiography or TEE is diagnostic.
9. What is the target LDL cholesterol for a 60-year-old with diabetes and prior
stroke?
• A. <130 mg/dL
• B. <100 mg/dL
• C. <70 mg/dL
• D. <55 mg/dL
Rationale : Very high-risk patients (established ASCVD + diabetes or recurrent
events) have 2023 ACC/AHA guideline target LDL <70 mg/dL (some guidelines
say <55 mg/dL for extreme risk, but <70 is the standard for this presentation).
10. Most common cause of infective endocarditis in an IV drug user?
• A. Staphylococcus aureus
• B. Streptococcus viridans
• C. Enterococcus faecalis
• D. Coxiella burnetii
Rationale : S. aureus is the predominant organism in IV drug users, often affecting
the tricuspid valve.
Section 2: Pulmonary Disorders (Questions 11–18)
Latest 2026/2027 Update||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 85
Format: Multiple Choice
Instructions: Select the single best answer for each question. Correct answers
are bolded and highlighted. Rationales are provided for each answer.
Section 1: Cardiovascular Disorders (Questions 1–10)
1. A 58-year-old male with hypertension and DM type 2 presents with
substernal chest pressure radiating to the jaw, occurring at rest for 20
minutes. ECG shows ST-segment elevation in leads V1–V4. What is the most
appropriate immediate next step?
• A. Aspirin 81 mg and discharge with cardiology follow-up
• B. Nitroglycerin sublingual x 3 doses and repeat ECG
• C. Activate emergency medical services (EMS) for emergent reperfusion
• D. Oral beta-blocker and stress test in the morning
Rationale : ST elevation in contiguous leads indicates STEMI. Immediate
reperfusion via PCI or fibrinolysis is critical; EMS activation ensures transport to a
PCI-capable hospital.
2. Which medication improves mortality in chronic systolic HF (HFrEF) and
should be initiated early?
• A. Furosemide
• B. Sacubitril/valsartan
, • C. Metolazone
• D. Digoxin
Rationale : Sacubitril/valsartan (ARNI) reduces mortality and hospitalizations in
HFrEF. Loop diuretics manage symptoms but do not improve survival.
3. A 72-year-old with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which
agent is preferred for stroke prevention?
• A. Aspirin 325 mg daily
• B. Apixaban
• C. Clopidogrel
• D. Aspirin + clopidogrel
Rationale : DOACs (apixaban, rivaroxaban) are preferred over warfarin and
aspirin for stroke prevention in non-valvular AF with high CHA₂DS₂-VASc.
4. A patient reports leg pain with walking that resolves with rest; femoral
pulses are weak, and ankle-brachial index (ABI) is 0.65. What is the
diagnosis?
• A. Peripheral artery disease
• B. Chronic venous insufficiency
• C. Diabetic neuropathy
• D. Lumbar spinal stenosis
Rationale : Classic intermittent claudication with ABI <0.90 indicates PAD.
Venous disease presents with edema and skin changes.
5. Which beta-blocker is most appropriate for a patient with severe COPD
and stable angina?
• A. Propranolol
• B. Metoprolol succinate (β1-selective)
, • C. Carvedilol
• D. Labetalol
Rationale : Cardioselective beta-blockers (metoprolol, bisoprolol) have less risk of
bronchospasm and are safe in mild-to-moderate COPD.
6. First-line antihypertensive in a black patient with stage 1 hypertension and
no comorbidities?
• A. Lisinopril
• B. Amlodipine
• C. Hydrochlorothiazide
• D. Losartan
Rationale : ACC/AHA guidelines recommend thiazides or CCBs as first-line in
black hypertensive patients (with or without a diuretic), as ACEi/ARBs are less
effective as monotherapy in this group.
7. ECG shows narrow QRS tachycardia at 180 bpm, regular, no visible P
waves. The patient is stable. What is the next step?
• A. Synchronized cardioversion
• B. Adenosine 6 mg IV push
• C. Amiodarone 150 mg IV
• D. Vagal maneuvers
Rationale : This is AV nodal reentrant tachycardia (AVNRT). Vagal maneuvers are
first-line if stable, but adenosine is first-line pharmacologic therapy. The question
asks for “next step” after vagal maneuvers or if not specified, adenosine is
appropriate. (Note: In this case vagal maneuvers are a reasonable first attempt, but
adenosine is the correct drug answer.)
8. A 45-year-old with sudden severe “tearing” chest pain radiating to the back;
BP 100/60, unequal arm pulses. Most likely diagnosis?
, • A. Aortic dissection
• B. Acute MI
• C. Pulmonary embolism
• D. Pericarditis
Rationale : Tearing pain, pulse deficit, and mediastinal widening suggest aortic
dissection. Immediate CT angiography or TEE is diagnostic.
9. What is the target LDL cholesterol for a 60-year-old with diabetes and prior
stroke?
• A. <130 mg/dL
• B. <100 mg/dL
• C. <70 mg/dL
• D. <55 mg/dL
Rationale : Very high-risk patients (established ASCVD + diabetes or recurrent
events) have 2023 ACC/AHA guideline target LDL <70 mg/dL (some guidelines
say <55 mg/dL for extreme risk, but <70 is the standard for this presentation).
10. Most common cause of infective endocarditis in an IV drug user?
• A. Staphylococcus aureus
• B. Streptococcus viridans
• C. Enterococcus faecalis
• D. Coxiella burnetii
Rationale : S. aureus is the predominant organism in IV drug users, often affecting
the tricuspid valve.
Section 2: Pulmonary Disorders (Questions 11–18)
