FNP FINAL EXAM REVIEW (APEA
STYLE) – HIGH-YIELD TOPIC
TEST||Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
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Latest 2026 Edition | 80+ Questions with Rationales
Section 1: Cardiology & Hypertension
1. A 58-year-old male with a 10-year history of hypertension presents for a
follow-up. His blood pressure today is 148/92 mmHg despite being on
lisinopril 20 mg daily. His labs show potassium 4.2 mEq/L, creatinine 1.0
mg/dL. What is the MOST appropriate next step?
• A) Add hydrochlorothiazide 12.5 mg daily
• B) Increase lisinopril to 40 mg daily
• C) Add amlodipine 5 mg daily
• D) Switch to losartan 50 mg daily
Rationale: In stage 1 hypertension not at goal on monotherapy, increasing the
current ACE inhibitor dose is reasonable before adding a second agent, especially
with normal renal function and potassium.
2. Which of the following findings is MOST suggestive of heart failure with
preserved ejection fraction (HFpEF)?
• A) LVEF 35% on echocardiogram
• B) Elevated BNP with LVEF ≥ 50%
• C) History of anterior STEMI
, • D) S3 gallop on auscultation
Rationale: HFpEF diagnosis requires signs/symptoms of HF, LVEF ≥50%, and
elevated natriuretic peptides. LVEF <40% suggests HFrEF.
3. A 72-year-old woman presents with palpitations. ECG shows irregularly
irregular rhythm with no distinct P waves and ventricular rate of 130 bpm.
She is hemodynamically stable. What is the first-line medication for rate
control?
• A) Amiodarone
• B) Metoprolol
• C) Diltiazem
• D) Digoxin
Rationale: For stable atrial fibrillation, beta-blockers (e.g., metoprolol) or non-
dihydropyridine CCBs are first-line for rate control. Beta-blockers are preferred in
those with CAD or HF.
Section 2: Pulmonology
4. A 34-year-old with persistent asthma uses albuterol 3 times weekly and
wakes up at night with cough twice monthly. FEV1 is 78% predicted. Which
step therapy is indicated?
• A) Step 1: PRN albuterol only
• B) Step 2: Low-dose ICS
• C) Step 3: Low-dose ICS + LABA
• D) Step 4: Medium-dose ICS + LABA
Rationale: Symptoms >2 days/week but not daily, with nocturnal symptoms <3-
4x/month → Step 2: low-dose inhaled corticosteroid.
5. Which finding on chest x-ray is most characteristic of a primary
spontaneous pneumothorax?
• A) Deep sulcus sign
• B) Air bronchograms
, • C) Kerley B lines
• D) Pleural thickening
Rationale: Deep sulcus sign (hyperlucent deep costophrenic angle) suggests
pneumothorax in supine patients; common in spontaneous pneumothorax in tall,
thin young males.
6. A 65-year-old smoker presents with progressive dyspnea and chronic cough.
Spirometry shows FEV1/FVC 0.68, FEV1 52% predicted. What is the GOLD
stage?
• A) GOLD 1
• B) GOLD 2
• C) GOLD 3
• D) GOLD 4
Rationale: GOLD 3 (severe COPD) = FEV1 30-49% predicted. FEV1 52% is
GOLD 2 (moderate) — correction: 50-79% is GOLD 2, so actually 52% is GOLD
2. Let me correct: Answer should be GOLD 2.
Corrected Answer: B) GOLD 2
Section 3: Infectious Disease
7. A 22-year-old college student presents with sore throat, fever, and tender
anterior cervical lymphadenopathy. Rapid strep test is negative. What is the
next best step?
• A) Prescribe amoxicillin empirically
• B) Send throat culture
• C) Prescribe acyclovir
• D) Test for mononucleosis
Rationale: Negative rapid strep in adults with low-mod pretest probability →
throat culture is confirmatory for GAS pharyngitis. Mono testing if atypical
lymphocytosis or prolonged symptoms.
8. Which antibiotic is contraindicated in a patient with G6PD deficiency?
STYLE) – HIGH-YIELD TOPIC
TEST||Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Latest 2026 Edition | 80+ Questions with Rationales
Section 1: Cardiology & Hypertension
1. A 58-year-old male with a 10-year history of hypertension presents for a
follow-up. His blood pressure today is 148/92 mmHg despite being on
lisinopril 20 mg daily. His labs show potassium 4.2 mEq/L, creatinine 1.0
mg/dL. What is the MOST appropriate next step?
• A) Add hydrochlorothiazide 12.5 mg daily
• B) Increase lisinopril to 40 mg daily
• C) Add amlodipine 5 mg daily
• D) Switch to losartan 50 mg daily
Rationale: In stage 1 hypertension not at goal on monotherapy, increasing the
current ACE inhibitor dose is reasonable before adding a second agent, especially
with normal renal function and potassium.
2. Which of the following findings is MOST suggestive of heart failure with
preserved ejection fraction (HFpEF)?
• A) LVEF 35% on echocardiogram
• B) Elevated BNP with LVEF ≥ 50%
• C) History of anterior STEMI
, • D) S3 gallop on auscultation
Rationale: HFpEF diagnosis requires signs/symptoms of HF, LVEF ≥50%, and
elevated natriuretic peptides. LVEF <40% suggests HFrEF.
3. A 72-year-old woman presents with palpitations. ECG shows irregularly
irregular rhythm with no distinct P waves and ventricular rate of 130 bpm.
She is hemodynamically stable. What is the first-line medication for rate
control?
• A) Amiodarone
• B) Metoprolol
• C) Diltiazem
• D) Digoxin
Rationale: For stable atrial fibrillation, beta-blockers (e.g., metoprolol) or non-
dihydropyridine CCBs are first-line for rate control. Beta-blockers are preferred in
those with CAD or HF.
Section 2: Pulmonology
4. A 34-year-old with persistent asthma uses albuterol 3 times weekly and
wakes up at night with cough twice monthly. FEV1 is 78% predicted. Which
step therapy is indicated?
• A) Step 1: PRN albuterol only
• B) Step 2: Low-dose ICS
• C) Step 3: Low-dose ICS + LABA
• D) Step 4: Medium-dose ICS + LABA
Rationale: Symptoms >2 days/week but not daily, with nocturnal symptoms <3-
4x/month → Step 2: low-dose inhaled corticosteroid.
5. Which finding on chest x-ray is most characteristic of a primary
spontaneous pneumothorax?
• A) Deep sulcus sign
• B) Air bronchograms
, • C) Kerley B lines
• D) Pleural thickening
Rationale: Deep sulcus sign (hyperlucent deep costophrenic angle) suggests
pneumothorax in supine patients; common in spontaneous pneumothorax in tall,
thin young males.
6. A 65-year-old smoker presents with progressive dyspnea and chronic cough.
Spirometry shows FEV1/FVC 0.68, FEV1 52% predicted. What is the GOLD
stage?
• A) GOLD 1
• B) GOLD 2
• C) GOLD 3
• D) GOLD 4
Rationale: GOLD 3 (severe COPD) = FEV1 30-49% predicted. FEV1 52% is
GOLD 2 (moderate) — correction: 50-79% is GOLD 2, so actually 52% is GOLD
2. Let me correct: Answer should be GOLD 2.
Corrected Answer: B) GOLD 2
Section 3: Infectious Disease
7. A 22-year-old college student presents with sore throat, fever, and tender
anterior cervical lymphadenopathy. Rapid strep test is negative. What is the
next best step?
• A) Prescribe amoxicillin empirically
• B) Send throat culture
• C) Prescribe acyclovir
• D) Test for mononucleosis
Rationale: Negative rapid strep in adults with low-mod pretest probability →
throat culture is confirmatory for GAS pharyngitis. Mono testing if atypical
lymphocytosis or prolonged symptoms.
8. Which antibiotic is contraindicated in a patient with G6PD deficiency?
