FNP Mastery Exam: Diagnostic,
Treatment & Pharmacology Bundle-
Latest 2026 Edition||questions and
answers with rationales/graded
A+/2026 update/100% correct /instant
download
*80+ Questions | Rationales Provided*
Instructions: Select the best answer. Correct answers are highlighted in bold.
Section 1: Cardiovascular & Hypertension Management (Questions 1-10)
1. A 58-year-old Black male with stage 2 HTN (152/96 mmHg) and type 2
diabetes has an eGFR of 55 mL/min. First-line antihypertensive regimen?
A) Lisinopril + HCTZ
B) Amlodipine + Metoprolol
C) Chlorthalidone + Amlodipine
D) Hydralazine + Clonidine
Rationale : 2026 AHA/ACC guidelines recommend a thiazide-like diuretic
(chlorthalidone) plus CCB (amlodipine) as initial therapy in Black patients with
CKD/diabetes, avoiding ACEi/ARB monotherapy unless albuminuria present.
2. Which diagnostic test is most specific for heart failure with preserved
ejection fraction (HFpEF)?
A) BNP
B) HFA-PEFF score (≥5)
C) Ejection fraction <40%
D) Chest X-ray
Rationale : HFA-PEFF (Heart Failure Association Pre-test assessment,
,Echocardiography, Functional testing, Final etiology) score ≥5 is the 2026 standard
for HFpEF diagnosis; BNP can be normal in HFpEF.
3. First-line pharmacotherapy for stable angina with no revascularization
planned
A) Nitroglycerin PRN
B) Ranolazine
C) Beta-blocker (bisoprolol)
D) Ivabradine
Rationale : Beta-blockers reduce myocardial oxygen demand and mortality; 2026
ESC guidelines reaffirm BB as first-line for chronic coronary syndrome.
4. A patient on warfarin for atrial fibrillation has an INR of 1.2. Next step?
A) Hold warfarin for 3 days
B) Give vitamin K 5 mg IV
C) Increase weekly warfarin dose by 10-20%
D) Switch to apixaban immediately
Rationale : Subtherapeutic INR without bleeding → dose adjustment, not reversal.
Increase maintenance dose and recheck in 1 week.
5. Most sensitive initial test for suspected acute aortic dissection
A) Chest X-ray
B) D-dimer
C) CT angiography
D) Troponin I
Rationale : High-sensitivity D-dimer has >98% negative predictive value for
dissection within 24h of symptom onset; CTA is confirmatory.
6. Which medication class reduces cardiovascular mortality in HFrEF
regardless of ejection fraction improvement?
A) Digoxin
B) SGLT2 inhibitor (empagliflozin)
C) Hydralazine
D) Amiodarone
Rationale : EMPEROR-Preserved and DELIVER trials (2026 meta-analysis)
show SGLT2 inhibitors reduce HF hospitalization and CV death in HFrEF and
HFpEF.
7. Lipid panel: LDL 190 mg/dL, TG 150 mg/dL, HDL 35 mg/dL. No ASCVD.
Next step?
, A) Start atorvastatin 20 mg
B) Start rosuvastatin 10 mg
C) Lifestyle only
D) Refer for genetic testing
Rationale : LDL ≥190 mg/dL = high-risk primary prevention; moderate-high
intensity statin (rosuvastatin 5-10mg or atorvastatin 20mg) per 2026 ACC/AHA.
8. Which finding on ECG suggests digoxin toxicity?
A) Prolonged PR interval
B) Downsloping ST depression with “salvage” pattern
C) Tall peaked T waves
D) Pathologic Q waves
Rationale : Digitalis effect causes scooping ST depression; toxicity causes
arrhythmias, nausea, visual changes – ST changes alone are not toxicity.
9. First-line diuretic for acute decompensated heart failure with volume
overload
A) Spironolactone 50 mg
B) Furosemide 40 mg IV
C) Metolazone 5 mg
D) Bumetanide 2 mg PO
Rationale : IV loop diuretic (furosemide) rapidly reduces preload; metolazone
added for resistance.
10. A patient with resistant HTN (155/95 on lisinopril 40mg, amlodipine 10mg,
chlorthalidone 25mg). Next medication?
A) Hydralazine
B) Spironolactone 25 mg
C) Clonidine patch
D) Doxazosin
Rationale : 2026 guidelines recommend adding low-dose spironolactone (or
eplerenone) for resistant HTN unless hyperkalemia.
Section 2: Diabetes & Endocrinology (Questions 11-20)
11. A 50-year-old with T2DM, HbA1c 7.8%, eGFR 40, established ASCVD.
Best add-on to metformin?
A) Glipizide
Treatment & Pharmacology Bundle-
Latest 2026 Edition||questions and
answers with rationales/graded
A+/2026 update/100% correct /instant
download
*80+ Questions | Rationales Provided*
Instructions: Select the best answer. Correct answers are highlighted in bold.
Section 1: Cardiovascular & Hypertension Management (Questions 1-10)
1. A 58-year-old Black male with stage 2 HTN (152/96 mmHg) and type 2
diabetes has an eGFR of 55 mL/min. First-line antihypertensive regimen?
A) Lisinopril + HCTZ
B) Amlodipine + Metoprolol
C) Chlorthalidone + Amlodipine
D) Hydralazine + Clonidine
Rationale : 2026 AHA/ACC guidelines recommend a thiazide-like diuretic
(chlorthalidone) plus CCB (amlodipine) as initial therapy in Black patients with
CKD/diabetes, avoiding ACEi/ARB monotherapy unless albuminuria present.
2. Which diagnostic test is most specific for heart failure with preserved
ejection fraction (HFpEF)?
A) BNP
B) HFA-PEFF score (≥5)
C) Ejection fraction <40%
D) Chest X-ray
Rationale : HFA-PEFF (Heart Failure Association Pre-test assessment,
,Echocardiography, Functional testing, Final etiology) score ≥5 is the 2026 standard
for HFpEF diagnosis; BNP can be normal in HFpEF.
3. First-line pharmacotherapy for stable angina with no revascularization
planned
A) Nitroglycerin PRN
B) Ranolazine
C) Beta-blocker (bisoprolol)
D) Ivabradine
Rationale : Beta-blockers reduce myocardial oxygen demand and mortality; 2026
ESC guidelines reaffirm BB as first-line for chronic coronary syndrome.
4. A patient on warfarin for atrial fibrillation has an INR of 1.2. Next step?
A) Hold warfarin for 3 days
B) Give vitamin K 5 mg IV
C) Increase weekly warfarin dose by 10-20%
D) Switch to apixaban immediately
Rationale : Subtherapeutic INR without bleeding → dose adjustment, not reversal.
Increase maintenance dose and recheck in 1 week.
5. Most sensitive initial test for suspected acute aortic dissection
A) Chest X-ray
B) D-dimer
C) CT angiography
D) Troponin I
Rationale : High-sensitivity D-dimer has >98% negative predictive value for
dissection within 24h of symptom onset; CTA is confirmatory.
6. Which medication class reduces cardiovascular mortality in HFrEF
regardless of ejection fraction improvement?
A) Digoxin
B) SGLT2 inhibitor (empagliflozin)
C) Hydralazine
D) Amiodarone
Rationale : EMPEROR-Preserved and DELIVER trials (2026 meta-analysis)
show SGLT2 inhibitors reduce HF hospitalization and CV death in HFrEF and
HFpEF.
7. Lipid panel: LDL 190 mg/dL, TG 150 mg/dL, HDL 35 mg/dL. No ASCVD.
Next step?
, A) Start atorvastatin 20 mg
B) Start rosuvastatin 10 mg
C) Lifestyle only
D) Refer for genetic testing
Rationale : LDL ≥190 mg/dL = high-risk primary prevention; moderate-high
intensity statin (rosuvastatin 5-10mg or atorvastatin 20mg) per 2026 ACC/AHA.
8. Which finding on ECG suggests digoxin toxicity?
A) Prolonged PR interval
B) Downsloping ST depression with “salvage” pattern
C) Tall peaked T waves
D) Pathologic Q waves
Rationale : Digitalis effect causes scooping ST depression; toxicity causes
arrhythmias, nausea, visual changes – ST changes alone are not toxicity.
9. First-line diuretic for acute decompensated heart failure with volume
overload
A) Spironolactone 50 mg
B) Furosemide 40 mg IV
C) Metolazone 5 mg
D) Bumetanide 2 mg PO
Rationale : IV loop diuretic (furosemide) rapidly reduces preload; metolazone
added for resistance.
10. A patient with resistant HTN (155/95 on lisinopril 40mg, amlodipine 10mg,
chlorthalidone 25mg). Next medication?
A) Hydralazine
B) Spironolactone 25 mg
C) Clonidine patch
D) Doxazosin
Rationale : 2026 guidelines recommend adding low-dose spironolactone (or
eplerenone) for resistant HTN unless hyperkalemia.
Section 2: Diabetes & Endocrinology (Questions 11-20)
11. A 50-year-old with T2DM, HbA1c 7.8%, eGFR 40, established ASCVD.
Best add-on to metformin?
A) Glipizide
