FNP Clinical Exam Simulation:
Comprehensive Topic Test (2026
Edition)|| Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Total Questions: 85
Time Limit: 2 hours (simulated)
Instructions: Select the single best answer. Correct answers are bolded and
followed by a rationale.
Section 1: Cardiovascular (Questions 1–10)
1. A 58-year-old male with HTN and DM type 2 has a BP of 148/90 mmHg in
the office. Home readings average 135/82 mmHg. According to the 2024
ACC/AHA guidelines, what is the most appropriate next step?
• A) Start amlodipine 5 mg daily
• B) Increase lisinopril to next dose
• C) Confirm with ambulatory BP monitoring (ABPM)
• D) Recheck in 1 month
Rationale: ABPM is gold standard to rule out white coat hypertension before
medication change. Office and home readings discordant.
2. Which murmur is best heard at the left sternal border, increases with
handgrip, and decreases with Valsalva?
• A) Aortic stenosis
• B) Mitral regurgitation
, • C) Hypertrophic cardiomyopathy
• D) Mitral valve prolapse
Rationale: HCM murmur increases with decreased preload (Valsalva, standing)
and decreases with increased afterload (handgrip).
3. A 72-year-old female presents with acute onset R leg pain, pallor,
pulselessness, and paresthesia. Most likely diagnosis?
• A) DVT
• B) Acute limb ischemia
• C) Sciatica
• D) Cellulitis
Rationale: The “6 P’s” suggest embolic or thrombotic arterial occlusion – vascular
emergency.
4. Which lipid-lowering drug is first-line for a 45-year-old with LDL 190
mg/dL and no other risk factors?
• A) Ezetimibe
• B) Atorvastatin 20 mg
• C) Fenofibrate
• D) Repatha (PCSK9 inhibitor)
Rationale: High-intensity statin is first-line for LDL ≥190 or ASCVD risk >20%.
5. ECG shows irregularly irregular rhythm with no P waves. Rate 110 bpm.
Best next step?
• A) Adenosine IV push
• B) Rate control + anticoagulation
• C) Immediate cardioversion
• D) Beta-blocker alone
Rationale: Atrial fibrillation – rate control (beta-blocker/CCB) and stroke risk
assessment (CHA₂DS₂-VASc).
, 6. A 68-year-old with HFrEF (EF 35%) on carvedilol, lisinopril, furosemide
has worsening SOB and 3+ pitting edema. Cr 1.9 (baseline 1.2). Best next
action?
• A) Increase furosemide to 80 mg BID
• B) Hold lisinopril and check K+
• C) Add spironolactone 25 mg daily
• D) Refer for transplant evaluation
Rationale: Spironolactone reduces mortality in Stage C HFrEF despite mild renal
impairment (K+ <5.0, Cr <2.5).
7. Which anti-HTN agent is preferred in a 30-year-old woman with lupus and
proteinuria?
• A) HCTZ
• B) Amlodipine
• C) Lisinopril
• D) Metoprolol
Rationale: ACE inhibitors are renoprotective in proteinuric CKD, including lupus
nephritis.
8. A 55-year-old smoker with intermittent calf pain walking 2 blocks, relieved
by rest, has diminished pedal pulses. Ankle-brachial index (ABI) of 0.65. Next
best test?
• A) Lower extremity angiography
• B) Exercise treadmill ABI
• C) Venous duplex
• D) CBC with platelets
Rationale: Exercise ABI confirms functional limitation and guides severity in
PAD.
9. JVP elevated, S3 gallop, bilateral crackles. Most likely diagnosis?
• A) COPD exacerbation
Comprehensive Topic Test (2026
Edition)|| Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Total Questions: 85
Time Limit: 2 hours (simulated)
Instructions: Select the single best answer. Correct answers are bolded and
followed by a rationale.
Section 1: Cardiovascular (Questions 1–10)
1. A 58-year-old male with HTN and DM type 2 has a BP of 148/90 mmHg in
the office. Home readings average 135/82 mmHg. According to the 2024
ACC/AHA guidelines, what is the most appropriate next step?
• A) Start amlodipine 5 mg daily
• B) Increase lisinopril to next dose
• C) Confirm with ambulatory BP monitoring (ABPM)
• D) Recheck in 1 month
Rationale: ABPM is gold standard to rule out white coat hypertension before
medication change. Office and home readings discordant.
2. Which murmur is best heard at the left sternal border, increases with
handgrip, and decreases with Valsalva?
• A) Aortic stenosis
• B) Mitral regurgitation
, • C) Hypertrophic cardiomyopathy
• D) Mitral valve prolapse
Rationale: HCM murmur increases with decreased preload (Valsalva, standing)
and decreases with increased afterload (handgrip).
3. A 72-year-old female presents with acute onset R leg pain, pallor,
pulselessness, and paresthesia. Most likely diagnosis?
• A) DVT
• B) Acute limb ischemia
• C) Sciatica
• D) Cellulitis
Rationale: The “6 P’s” suggest embolic or thrombotic arterial occlusion – vascular
emergency.
4. Which lipid-lowering drug is first-line for a 45-year-old with LDL 190
mg/dL and no other risk factors?
• A) Ezetimibe
• B) Atorvastatin 20 mg
• C) Fenofibrate
• D) Repatha (PCSK9 inhibitor)
Rationale: High-intensity statin is first-line for LDL ≥190 or ASCVD risk >20%.
5. ECG shows irregularly irregular rhythm with no P waves. Rate 110 bpm.
Best next step?
• A) Adenosine IV push
• B) Rate control + anticoagulation
• C) Immediate cardioversion
• D) Beta-blocker alone
Rationale: Atrial fibrillation – rate control (beta-blocker/CCB) and stroke risk
assessment (CHA₂DS₂-VASc).
, 6. A 68-year-old with HFrEF (EF 35%) on carvedilol, lisinopril, furosemide
has worsening SOB and 3+ pitting edema. Cr 1.9 (baseline 1.2). Best next
action?
• A) Increase furosemide to 80 mg BID
• B) Hold lisinopril and check K+
• C) Add spironolactone 25 mg daily
• D) Refer for transplant evaluation
Rationale: Spironolactone reduces mortality in Stage C HFrEF despite mild renal
impairment (K+ <5.0, Cr <2.5).
7. Which anti-HTN agent is preferred in a 30-year-old woman with lupus and
proteinuria?
• A) HCTZ
• B) Amlodipine
• C) Lisinopril
• D) Metoprolol
Rationale: ACE inhibitors are renoprotective in proteinuric CKD, including lupus
nephritis.
8. A 55-year-old smoker with intermittent calf pain walking 2 blocks, relieved
by rest, has diminished pedal pulses. Ankle-brachial index (ABI) of 0.65. Next
best test?
• A) Lower extremity angiography
• B) Exercise treadmill ABI
• C) Venous duplex
• D) CBC with platelets
Rationale: Exercise ABI confirms functional limitation and guides severity in
PAD.
9. JVP elevated, S3 gallop, bilateral crackles. Most likely diagnosis?
• A) COPD exacerbation
