WALDEN FNP PREDICTOR EXAM:
Clinical Scenarios & Rationales (2026
Edition)|| Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Instructions: Choose the best answer. Correct answers are bolded and
highlighted with a rationale.
Section 1: Cardiovascular Disorders
1. A 58-year-old male with a 40-pack-year smoking history presents with
exertional substernal chest pressure relieved by rest. ECG is normal. What is
the most appropriate next step?
• A) Coronary angiography
• B) Exercise stress test
Rationale : Normal ECG with typical stable angina symptoms warrants risk
stratification with an exercise stress test before invasive testing.
• C) High-dose statin only
• D) Holter monitor
2. A 72-year-old female with heart failure with reduced ejection fraction
(HFrEF) presents with worsening dyspnea, jugular venous distension, and 3+
pitting edema. She is on lisinopril, metoprolol, and furosemide. Which
medication should be added first?
• A) Digoxin
, • B) Spironolactone
Rationale : Adding a mineralocorticoid receptor antagonist (spironolactone)
reduces mortality in HFrEF despite diuretic therapy.
• C) Hydralazine
• D) Amiodarone
3. A 45-year-old with hypertension has an ECG showing left ventricular
hypertrophy. His BP is 152/94 mmHg. Which antihypertensive class is most
beneficial for regression of LVH?
• A) ACE inhibitors
Rationale : ACE inhibitors and ARBs are preferred for LVH regression and
reducing cardiovascular events.
• B) Beta-blockers
• C) Direct vasodilators
• D) Thiazides alone
Section 2: Respiratory Disorders
4. A 30-year-old with asthma has used albuterol 3 times/week for nocturnal
symptoms. FEV1 is 75% predicted. Which medication should be initiated?
• A) Low-dose inhaled corticosteroid (ICS)
*Rationale : Step 2 therapy per GINA guidelines – add low-dose ICS for
symptom control >2 days/week.*
• B) Oral prednisone
• C) Theophylline
• D) High-dose ICS/LABA
5. A 68-year-old smoker with COPD has increased dyspnea, purulent sputum,
and fever. CXR no infiltrate. What is first-line antibiotic?
• A) Doxycycline
Rationale : For acute exacerbation without pneumonia, doxycycline or a
macrolide covers typical pathogens (H. influenzae, M. catarrhalis).
, • B) Levofloxacin
• C) Amoxicillin-clavulanate
• D) Cefpodoxime
6. A 22-year-old with sudden onset pleuritic chest pain and dyspnea after a
long flight. SpO2 94% on RA. Lung exam: decreased breath sounds on right.
Next best step?
• A) CT pulmonary angiography
Rationale : High suspicion for PE – CT angiography is diagnostic in
hemodynamically stable patient.
• B) V/Q scan
• C) D-dimer
• D) Chest X-ray
Section 3: Endocrinology & Metabolism
7. A 55-year-old obese female with type 2 diabetes (HbA1c 8.9%) on
metformin 2000 mg/day reports weight gain and fatigue. Which medication is
best to add for weight-neutral benefit and cardiovascular protection?
• A) Glipizide
• B) Pioglitazone
• C) Empagliflozin (SGLT2 inhibitor)
Rationale : SGLT2 inhibitors reduce cardiovascular mortality and promote
weight loss without hypoglycemia.
• D) Insulin glargine
8. A 32-year-old with palpitations, heat intolerance, and weight loss. TSH
<0.01 mIU/L, free T4 elevated. Thyroid scan shows diffuse uptake. Best initial
treatment?
• A) Methimazole
Rationale : For Graves’ disease in non-pregnant, methimazole is first-line
antithyroid drug.
Clinical Scenarios & Rationales (2026
Edition)|| Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Instructions: Choose the best answer. Correct answers are bolded and
highlighted with a rationale.
Section 1: Cardiovascular Disorders
1. A 58-year-old male with a 40-pack-year smoking history presents with
exertional substernal chest pressure relieved by rest. ECG is normal. What is
the most appropriate next step?
• A) Coronary angiography
• B) Exercise stress test
Rationale : Normal ECG with typical stable angina symptoms warrants risk
stratification with an exercise stress test before invasive testing.
• C) High-dose statin only
• D) Holter monitor
2. A 72-year-old female with heart failure with reduced ejection fraction
(HFrEF) presents with worsening dyspnea, jugular venous distension, and 3+
pitting edema. She is on lisinopril, metoprolol, and furosemide. Which
medication should be added first?
• A) Digoxin
, • B) Spironolactone
Rationale : Adding a mineralocorticoid receptor antagonist (spironolactone)
reduces mortality in HFrEF despite diuretic therapy.
• C) Hydralazine
• D) Amiodarone
3. A 45-year-old with hypertension has an ECG showing left ventricular
hypertrophy. His BP is 152/94 mmHg. Which antihypertensive class is most
beneficial for regression of LVH?
• A) ACE inhibitors
Rationale : ACE inhibitors and ARBs are preferred for LVH regression and
reducing cardiovascular events.
• B) Beta-blockers
• C) Direct vasodilators
• D) Thiazides alone
Section 2: Respiratory Disorders
4. A 30-year-old with asthma has used albuterol 3 times/week for nocturnal
symptoms. FEV1 is 75% predicted. Which medication should be initiated?
• A) Low-dose inhaled corticosteroid (ICS)
*Rationale : Step 2 therapy per GINA guidelines – add low-dose ICS for
symptom control >2 days/week.*
• B) Oral prednisone
• C) Theophylline
• D) High-dose ICS/LABA
5. A 68-year-old smoker with COPD has increased dyspnea, purulent sputum,
and fever. CXR no infiltrate. What is first-line antibiotic?
• A) Doxycycline
Rationale : For acute exacerbation without pneumonia, doxycycline or a
macrolide covers typical pathogens (H. influenzae, M. catarrhalis).
, • B) Levofloxacin
• C) Amoxicillin-clavulanate
• D) Cefpodoxime
6. A 22-year-old with sudden onset pleuritic chest pain and dyspnea after a
long flight. SpO2 94% on RA. Lung exam: decreased breath sounds on right.
Next best step?
• A) CT pulmonary angiography
Rationale : High suspicion for PE – CT angiography is diagnostic in
hemodynamically stable patient.
• B) V/Q scan
• C) D-dimer
• D) Chest X-ray
Section 3: Endocrinology & Metabolism
7. A 55-year-old obese female with type 2 diabetes (HbA1c 8.9%) on
metformin 2000 mg/day reports weight gain and fatigue. Which medication is
best to add for weight-neutral benefit and cardiovascular protection?
• A) Glipizide
• B) Pioglitazone
• C) Empagliflozin (SGLT2 inhibitor)
Rationale : SGLT2 inhibitors reduce cardiovascular mortality and promote
weight loss without hypoglycemia.
• D) Insulin glargine
8. A 32-year-old with palpitations, heat intolerance, and weight loss. TSH
<0.01 mIU/L, free T4 elevated. Thyroid scan shows diffuse uptake. Best initial
treatment?
• A) Methimazole
Rationale : For Graves’ disease in non-pregnant, methimazole is first-line
antithyroid drug.
