APEA FNP FINAL SIMULATION –
HIGH YIELD CLINICAL
QUESTIONS (2026 Update)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Total Questions: 85
Time Limit: 120 minutes
Passing Score: 78%
Select the best answer. Correct answers are highlighted in bold. Rationales are
provided for each answer.
Section 1: Cardiovascular Disorders (Questions 1–10)
1. A 58-year-old male with hypertension presents with a BP of 152/94 mmHg.
He has type 2 diabetes and CKD stage 3 (eGFR 45). According to 2026
ACC/AHA guidelines, what is the first-line antihypertensive?
A) HCTZ 12.5 mg daily
B) Amlodipine 5 mg daily
C) Lisinopril 10 mg daily
D) Metoprolol 50 mg BID
Rationale : ACE inhibitors (lisinopril) are first-line in hypertension with CKD and
diabetes due to renoprotection.
2. A 72-year-old woman reports shortness of breath when walking up 10 stairs,
but no symptoms at rest. Ankle edema 1+. Lungs clear. BP 130/80. HR 88,
,irregularly irregular. What is the most likely diagnosis?
A) COPD
B) Deconditioning
C) Heart failure with preserved ejection fraction (HFpEF)
D) Pulmonary embolism
Rationale : Symptoms of exertional dyspnea + ankle edema + atrial fibrillation
(irregularly irregular) suggest HFpEF, common in elderly women with AFib.
3. Which lab finding is most specific for acute myocardial infarction 2 hours
post-symptom onset?
A) CK-MB
B) Myoglobin
C) High-sensitivity troponin I
D) LDH
Rationale : hs-troponin is the gold standard for early MI detection; rises within 1–
3 hours.
4. A 65-year-old with chronic stable angina on metoprolol 25 mg BID
continues to have weekly exertional chest pain. Next step?
A) Increase metoprolol to 50 mg BID
B) Add amlodipine
C) Add ranolazine
D) Refer for coronary angiogram
Rationale : First-line is optimizing beta-blocker dose before adding second-line
agents.
5. Which murmur increases with squatting?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral regurgitation
D) Aortic regurgitation
, Rationale : Squatting increases preload, decreasing LV outflow obstruction in
HCM.
6. An asymptomatic 55-year-old has a carotid bruit. USPSTF 2026
recommendation?
A) Carotid duplex ultrasound
B) Aspirin 81 mg daily
C) Carotid endarterectomy
D) No routine screening for asymptomatic carotid stenosis
Rationale : USPSTF 2026 (updated 2025) continues to recommend against
screening asymptomatic adults for carotid stenosis.
7. Best initial test for a patient with palpitations and suspected paroxysmal
atrial fibrillation?
A) 12-lead ECG
B) Exercise stress test
C) 24-hour Holter monitor
D) Echocardiogram
Rationale : Holter captures intermittent arrhythmias.
8. Which antihypertensive is contraindicated in pregnancy?
A) Labetalol
B) Nifedipine
C) Methyldopa
D) Lisinopril
Rationale : ACE inhibitors cause fetal renal agenesis and oligohydramnios.
9. LDL target for a 50-year-old with diabetes and 10-year ASCVD risk of
22%?
A) <130 mg/dL
B) <100 mg/dL
HIGH YIELD CLINICAL
QUESTIONS (2026 Update)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Total Questions: 85
Time Limit: 120 minutes
Passing Score: 78%
Select the best answer. Correct answers are highlighted in bold. Rationales are
provided for each answer.
Section 1: Cardiovascular Disorders (Questions 1–10)
1. A 58-year-old male with hypertension presents with a BP of 152/94 mmHg.
He has type 2 diabetes and CKD stage 3 (eGFR 45). According to 2026
ACC/AHA guidelines, what is the first-line antihypertensive?
A) HCTZ 12.5 mg daily
B) Amlodipine 5 mg daily
C) Lisinopril 10 mg daily
D) Metoprolol 50 mg BID
Rationale : ACE inhibitors (lisinopril) are first-line in hypertension with CKD and
diabetes due to renoprotection.
2. A 72-year-old woman reports shortness of breath when walking up 10 stairs,
but no symptoms at rest. Ankle edema 1+. Lungs clear. BP 130/80. HR 88,
,irregularly irregular. What is the most likely diagnosis?
A) COPD
B) Deconditioning
C) Heart failure with preserved ejection fraction (HFpEF)
D) Pulmonary embolism
Rationale : Symptoms of exertional dyspnea + ankle edema + atrial fibrillation
(irregularly irregular) suggest HFpEF, common in elderly women with AFib.
3. Which lab finding is most specific for acute myocardial infarction 2 hours
post-symptom onset?
A) CK-MB
B) Myoglobin
C) High-sensitivity troponin I
D) LDH
Rationale : hs-troponin is the gold standard for early MI detection; rises within 1–
3 hours.
4. A 65-year-old with chronic stable angina on metoprolol 25 mg BID
continues to have weekly exertional chest pain. Next step?
A) Increase metoprolol to 50 mg BID
B) Add amlodipine
C) Add ranolazine
D) Refer for coronary angiogram
Rationale : First-line is optimizing beta-blocker dose before adding second-line
agents.
5. Which murmur increases with squatting?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral regurgitation
D) Aortic regurgitation
, Rationale : Squatting increases preload, decreasing LV outflow obstruction in
HCM.
6. An asymptomatic 55-year-old has a carotid bruit. USPSTF 2026
recommendation?
A) Carotid duplex ultrasound
B) Aspirin 81 mg daily
C) Carotid endarterectomy
D) No routine screening for asymptomatic carotid stenosis
Rationale : USPSTF 2026 (updated 2025) continues to recommend against
screening asymptomatic adults for carotid stenosis.
7. Best initial test for a patient with palpitations and suspected paroxysmal
atrial fibrillation?
A) 12-lead ECG
B) Exercise stress test
C) 24-hour Holter monitor
D) Echocardiogram
Rationale : Holter captures intermittent arrhythmias.
8. Which antihypertensive is contraindicated in pregnancy?
A) Labetalol
B) Nifedipine
C) Methyldopa
D) Lisinopril
Rationale : ACE inhibitors cause fetal renal agenesis and oligohydramnios.
9. LDL target for a 50-year-old with diabetes and 10-year ASCVD risk of
22%?
A) <130 mg/dL
B) <100 mg/dL
