NP Clinical Mastery Exam: 2026
Evidence-Based Blueprint||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 82
Format: Multiple Choice
Target Audience: Family & Adult-Gerontology NP students
Focus: Screening, diagnosis, pharmacotherapy, and management per latest 2026
guidelines (ACC/AHA, ADA, GINA, USPSTF, CDC)
Section 1: Cardiovascular & Hypertension (10 Questions)
1. A 58-year-old Black patient with hypertension and stage 3 CKD (eGFR 48)
has BP 148/92 mmHg. Optimal initial therapy according to 2026 ACC/AHA
guidelines is:
A) Hydrochlorothiazide alone
B) Lisinopril alone
C) Amlodipine plus chlorthalidone
D) Metoprolol plus hydralazine
Rationale: 2026 guidelines recommend CCB or thiazide-like diuretic as first-line
in Black patients without heart failure or albuminuria. CKD adds chlorthalidone
for cardiovascular benefit. ACEi alone not preferred without albuminuria in this
group.
2. Which BP threshold initiates pharmacotherapy in a 72-year-old with
diabetes, 10-year ASCVD risk >15%, and BP consistently 135/80 mmHg?
A) >150/90
B) >130/80
,C) >140/90
D) >135/85
Rationale: 2026 ACC/AHA and ADA harmonize: treat to goal <130/80 if ASCVD
risk >15% or established CVD/ CKD/ diabetes. Initiate at >130/80.
3. A 45-year-old presents with BP 162/98, hypokalemia (K 3.2), metabolic
alkalosis, and low renin. Next step:
A) Start HCTZ
B) MRI abdomen for pheochromocytoma
C) Plasma aldosterone/renin ratio
D) 24-hour urine metanephrines
Rationale: Suspect primary hyperaldosteronism (resistant hypertension +
hypokalemia). Confirm with aldosterone-renin ratio before adrenal imaging.
4. After starting lisinopril, a 62-year-old develops angioedema. Best
alternative class:
A) ARB (e.g., losartan)
B) Direct renin inhibitor
C) Beta-blocker
D) Hydralazine
Rationale: ARBs have <1% cross-reactivity for angioedema; first alternative after
ACEi-induced angioedema.
5. Which medication is preferred for rate control in atrial fibrillation with
HFrEF (LVEF 30%) per 2026 guidelines?
A) Metoprolol tartrate
B) Carvedilol
C) Diltiazem
D) Digoxin
Rationale: Carvedilol (or bisoprolol/meto succinate) reduces mortality in HFrEF.
Non-dihydropyridine CCBs contraindicated in HFrEF.
, 6. A 68-year-old with new AF, CHA₂DS₂-VASc score 5, creatinine 1.9 (eGFR
35). Choose anticoagulation:
A) Warfarin only
B) Apixaban 5 mg BID
C) Apixaban 2.5 mg BID
D) Rivaroxaban 15 mg daily
Rationale: DOACs preferred. Apixaban reduced dose (2.5 mg BID) for eGFR 25-
50 with ≥2 of: age ≥80, weight ≤60 kg, Cr ≥1.5.
7. LDL goal for a 55-year-old with diabetes and known coronary artery
disease per 2026 ACC:
A) <100 mg/dL
B) <70 mg/dL
C) <55 mg/dL
D) <40 mg/dL
Rationale: Very high-risk (CVD + diabetes) patients: LDL <55 mg/dL or ≥50%
reduction. High-intensity statin ± ezetimibe/PCSK9i.
8. First-line therapy for heart failure with preserved ejection fraction (HFpEF,
LVEF 60%) with obesity?
A) Spironolactone
B) SGLT2 inhibitor (empagliflozin)
C) GLP-1 agonist (semaglutide)
D) Both B and C
Rationale: 2026 guidelines: SGLT2i (HF hospitalization reduction) + GLP-1
(weight, symptoms) recommended in HFpEF with BMI ≥30.
9. Which screening test for abdominal aortic aneurysm (AAA) is USPSTF
2026 grade B?
A) One-time ultrasound in men 65-75 with smoking history
B) One-time ultrasound in all women ≥70
C) CT angiogram in all diabetics at 60
D) Annual ultrasound in all >80
Evidence-Based Blueprint||Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Total Questions: 82
Format: Multiple Choice
Target Audience: Family & Adult-Gerontology NP students
Focus: Screening, diagnosis, pharmacotherapy, and management per latest 2026
guidelines (ACC/AHA, ADA, GINA, USPSTF, CDC)
Section 1: Cardiovascular & Hypertension (10 Questions)
1. A 58-year-old Black patient with hypertension and stage 3 CKD (eGFR 48)
has BP 148/92 mmHg. Optimal initial therapy according to 2026 ACC/AHA
guidelines is:
A) Hydrochlorothiazide alone
B) Lisinopril alone
C) Amlodipine plus chlorthalidone
D) Metoprolol plus hydralazine
Rationale: 2026 guidelines recommend CCB or thiazide-like diuretic as first-line
in Black patients without heart failure or albuminuria. CKD adds chlorthalidone
for cardiovascular benefit. ACEi alone not preferred without albuminuria in this
group.
2. Which BP threshold initiates pharmacotherapy in a 72-year-old with
diabetes, 10-year ASCVD risk >15%, and BP consistently 135/80 mmHg?
A) >150/90
B) >130/80
,C) >140/90
D) >135/85
Rationale: 2026 ACC/AHA and ADA harmonize: treat to goal <130/80 if ASCVD
risk >15% or established CVD/ CKD/ diabetes. Initiate at >130/80.
3. A 45-year-old presents with BP 162/98, hypokalemia (K 3.2), metabolic
alkalosis, and low renin. Next step:
A) Start HCTZ
B) MRI abdomen for pheochromocytoma
C) Plasma aldosterone/renin ratio
D) 24-hour urine metanephrines
Rationale: Suspect primary hyperaldosteronism (resistant hypertension +
hypokalemia). Confirm with aldosterone-renin ratio before adrenal imaging.
4. After starting lisinopril, a 62-year-old develops angioedema. Best
alternative class:
A) ARB (e.g., losartan)
B) Direct renin inhibitor
C) Beta-blocker
D) Hydralazine
Rationale: ARBs have <1% cross-reactivity for angioedema; first alternative after
ACEi-induced angioedema.
5. Which medication is preferred for rate control in atrial fibrillation with
HFrEF (LVEF 30%) per 2026 guidelines?
A) Metoprolol tartrate
B) Carvedilol
C) Diltiazem
D) Digoxin
Rationale: Carvedilol (or bisoprolol/meto succinate) reduces mortality in HFrEF.
Non-dihydropyridine CCBs contraindicated in HFrEF.
, 6. A 68-year-old with new AF, CHA₂DS₂-VASc score 5, creatinine 1.9 (eGFR
35). Choose anticoagulation:
A) Warfarin only
B) Apixaban 5 mg BID
C) Apixaban 2.5 mg BID
D) Rivaroxaban 15 mg daily
Rationale: DOACs preferred. Apixaban reduced dose (2.5 mg BID) for eGFR 25-
50 with ≥2 of: age ≥80, weight ≤60 kg, Cr ≥1.5.
7. LDL goal for a 55-year-old with diabetes and known coronary artery
disease per 2026 ACC:
A) <100 mg/dL
B) <70 mg/dL
C) <55 mg/dL
D) <40 mg/dL
Rationale: Very high-risk (CVD + diabetes) patients: LDL <55 mg/dL or ≥50%
reduction. High-intensity statin ± ezetimibe/PCSK9i.
8. First-line therapy for heart failure with preserved ejection fraction (HFpEF,
LVEF 60%) with obesity?
A) Spironolactone
B) SGLT2 inhibitor (empagliflozin)
C) GLP-1 agonist (semaglutide)
D) Both B and C
Rationale: 2026 guidelines: SGLT2i (HF hospitalization reduction) + GLP-1
(weight, symptoms) recommended in HFpEF with BMI ≥30.
9. Which screening test for abdominal aortic aneurysm (AAA) is USPSTF
2026 grade B?
A) One-time ultrasound in men 65-75 with smoking history
B) One-time ultrasound in all women ≥70
C) CT angiogram in all diabetics at 60
D) Annual ultrasound in all >80
