NP BOARD CRASH COURCE (SARAH MICHELLE)
FNP /AGNP ACTUAL EXAM 2026/2027
COMPLETE ACCURATE EXAM AND A NEW
UPDATED STUDY GUIDE ACCURATE
QUESTIONS AND RELIABLE SOLUTIONS WITH
DETAILED RATIONALES (VERIFIED ANSWERS)
LATEST UPDATED VERSION 2026 EDITION
|ALREADY GRADED A+ (BRAND NEW!) FULL
REVISED
1. A 65-year-old with hypertension reports chest pressure when walking
uphill that resolves with rest. What is the most appropriate initial
diagnostic test?
A. Resting ECG
B. Exercise stress test
C. Coronary angiography
D. Chest X-ray
Rationale: Stable angina suggests coronary artery disease; exercise
stress test is first-line for diagnosis and risk stratification.
2. A patient with heart failure and reduced ejection fraction (HFrEF) is on
lisinopril, metoprolol, and furosemide. Which additional medication has
been shown to reduce mortality?
A. Digoxin
B. Spironolactone
C. Hydralazine
,D. Diltiazem
Rationale: Aldosterone antagonists (spironolactone, eplerenone) reduce
mortality in HFrEF (RALES, EMPHASIS-HF trials).
3. An 80-year-old with atrial fibrillation (AF) has a CHA₂DS₂-VASc score of
4 and HAS-BLED score of 2. What is the best anticoagulation strategy?
A. Aspirin 81 mg daily
B. Direct oral anticoagulant (e.g., apixaban)
C. Warfarin (INR 2-3)
D. No anticoagulation
Rationale: AF with CHA₂DS₂-VASc ≥2 (male) or ≥3 (female) benefits from
anticoagulation. DOACs are preferred over warfarin in most elderly.
4. A 45-year-old smoker presents with dyspnea, wheezing, and chronic
cough. Spirometry shows FEV₁/FVC 0.65, FEV₁ 55% predicted. Which
diagnosis is most likely?
A. Asthma
B. COPD
C. Restrictive lung disease
D. Heart failure
Rationale: Post-bronchodilator FEV₁/FVC <0.70 confirms airway
obstruction, consistent with COPD in a smoker.
5. A patient reports palpitations, sweating, weight loss, and heat
intolerance. On exam, thyroid is diffusely enlarged with bruit. TSH is <0.01
mIU/L. Next step?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Free T4 and T3 (already implied)
D. Methimazole prescription
Rationale: Low TSH + symptoms suggests hyperthyroidism. RAIU
distinguishes Graves (diffuse uptake) from thyroiditis (low uptake).
,6. A 60-year-old with diabetes has BP 145/90, LDL 130 mg/dL, and eGFR
55 mL/min. Which statin intensity is recommended?
A. Low-intensity (pravastatin 20 mg)
B. Moderate-intensity (atorvastatin 20 mg)
C. High-intensity (atorvastatin 80 mg)
D. No statin needed
Rationale: Diabetes with LDL ≥70 or known CVD → moderate-intensity
statin. High-intensity if ASCVD risk >20% or established ASCVD.
7. A patient with acute onset of severe, tearing chest pain radiating to the
back has a blood pressure of 180/100 in the right arm and 100/60 in the
left. Most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Musculoskeletal pain
Rationale: Asymmetric blood pressures and tearing pain are classic for
aortic dissection. Urgent imaging (CT angiography) needed.
8. A 70-year-old has a murmur: late-peaking systolic ejection murmur at
right 2nd ICS radiating to carotids, with a weak and delayed carotid
upstroke. Diagnosis?
A. Hypertrophic cardiomyopathy
B. Severe aortic stenosis
C. Mitral regurgitation
D. Aortic sclerosis
Rationale: Late-peaking murmur + pulsus parvus et tardus indicates
severe aortic stenosis. Early-peaking is mild.
9. A 55-year-old with obesity and hypertension presents with daytime
sleepiness, loud snoring, and morning headaches. Best initial diagnostic
test?
, A. Thyroid function tests
B. Polysomnography (sleep study)
C. Chest X-ray
D. ECG
Rationale: Symptoms suggest obstructive sleep apnea (OSA);
polysomnography is gold standard for diagnosis.
10. A 30-year-old with dyspnea and cough has spirometry showing
FEV₁/FVC 0.75 (normal), but FEV₁ and FVC are 60% of predicted. This
pattern indicates:
A. Obstructive disease
B. Restrictive disease
C. Mixed defect
D. Normal
Rationale: Reduced FVC with normal FEV₁/FVC ratio suggests restriction
(e.g., interstitial lung disease, chest wall disorder).
11. A patient with type 2 diabetes on metformin and glipizide has HbA1c
8.5%. Which is the best next add-on therapy?
A. Sitagliptin
B. Empagliflozin (SGLT2 inhibitor)
C. Pioglitazone
D. Insulin glargine
Rationale: SGLT2 inhibitors have cardiovascular and renal benefits;
preferred in patients with or at risk for CVD/HF.
12. A 68-year-old with heart failure (HFrEF) has worsening dyspnea and
leg edema. Creatinine rises from 1.0 to 2.5 mg/dL after starting
sacubitril/valsartan. What should the NP do?
A. Stop sacubitril/valsartan immediately
B. Monitor creatinine and hold diuretics temporarily
C. Double the dose
FNP /AGNP ACTUAL EXAM 2026/2027
COMPLETE ACCURATE EXAM AND A NEW
UPDATED STUDY GUIDE ACCURATE
QUESTIONS AND RELIABLE SOLUTIONS WITH
DETAILED RATIONALES (VERIFIED ANSWERS)
LATEST UPDATED VERSION 2026 EDITION
|ALREADY GRADED A+ (BRAND NEW!) FULL
REVISED
1. A 65-year-old with hypertension reports chest pressure when walking
uphill that resolves with rest. What is the most appropriate initial
diagnostic test?
A. Resting ECG
B. Exercise stress test
C. Coronary angiography
D. Chest X-ray
Rationale: Stable angina suggests coronary artery disease; exercise
stress test is first-line for diagnosis and risk stratification.
2. A patient with heart failure and reduced ejection fraction (HFrEF) is on
lisinopril, metoprolol, and furosemide. Which additional medication has
been shown to reduce mortality?
A. Digoxin
B. Spironolactone
C. Hydralazine
,D. Diltiazem
Rationale: Aldosterone antagonists (spironolactone, eplerenone) reduce
mortality in HFrEF (RALES, EMPHASIS-HF trials).
3. An 80-year-old with atrial fibrillation (AF) has a CHA₂DS₂-VASc score of
4 and HAS-BLED score of 2. What is the best anticoagulation strategy?
A. Aspirin 81 mg daily
B. Direct oral anticoagulant (e.g., apixaban)
C. Warfarin (INR 2-3)
D. No anticoagulation
Rationale: AF with CHA₂DS₂-VASc ≥2 (male) or ≥3 (female) benefits from
anticoagulation. DOACs are preferred over warfarin in most elderly.
4. A 45-year-old smoker presents with dyspnea, wheezing, and chronic
cough. Spirometry shows FEV₁/FVC 0.65, FEV₁ 55% predicted. Which
diagnosis is most likely?
A. Asthma
B. COPD
C. Restrictive lung disease
D. Heart failure
Rationale: Post-bronchodilator FEV₁/FVC <0.70 confirms airway
obstruction, consistent with COPD in a smoker.
5. A patient reports palpitations, sweating, weight loss, and heat
intolerance. On exam, thyroid is diffusely enlarged with bruit. TSH is <0.01
mIU/L. Next step?
A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Free T4 and T3 (already implied)
D. Methimazole prescription
Rationale: Low TSH + symptoms suggests hyperthyroidism. RAIU
distinguishes Graves (diffuse uptake) from thyroiditis (low uptake).
,6. A 60-year-old with diabetes has BP 145/90, LDL 130 mg/dL, and eGFR
55 mL/min. Which statin intensity is recommended?
A. Low-intensity (pravastatin 20 mg)
B. Moderate-intensity (atorvastatin 20 mg)
C. High-intensity (atorvastatin 80 mg)
D. No statin needed
Rationale: Diabetes with LDL ≥70 or known CVD → moderate-intensity
statin. High-intensity if ASCVD risk >20% or established ASCVD.
7. A patient with acute onset of severe, tearing chest pain radiating to the
back has a blood pressure of 180/100 in the right arm and 100/60 in the
left. Most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Musculoskeletal pain
Rationale: Asymmetric blood pressures and tearing pain are classic for
aortic dissection. Urgent imaging (CT angiography) needed.
8. A 70-year-old has a murmur: late-peaking systolic ejection murmur at
right 2nd ICS radiating to carotids, with a weak and delayed carotid
upstroke. Diagnosis?
A. Hypertrophic cardiomyopathy
B. Severe aortic stenosis
C. Mitral regurgitation
D. Aortic sclerosis
Rationale: Late-peaking murmur + pulsus parvus et tardus indicates
severe aortic stenosis. Early-peaking is mild.
9. A 55-year-old with obesity and hypertension presents with daytime
sleepiness, loud snoring, and morning headaches. Best initial diagnostic
test?
, A. Thyroid function tests
B. Polysomnography (sleep study)
C. Chest X-ray
D. ECG
Rationale: Symptoms suggest obstructive sleep apnea (OSA);
polysomnography is gold standard for diagnosis.
10. A 30-year-old with dyspnea and cough has spirometry showing
FEV₁/FVC 0.75 (normal), but FEV₁ and FVC are 60% of predicted. This
pattern indicates:
A. Obstructive disease
B. Restrictive disease
C. Mixed defect
D. Normal
Rationale: Reduced FVC with normal FEV₁/FVC ratio suggests restriction
(e.g., interstitial lung disease, chest wall disorder).
11. A patient with type 2 diabetes on metformin and glipizide has HbA1c
8.5%. Which is the best next add-on therapy?
A. Sitagliptin
B. Empagliflozin (SGLT2 inhibitor)
C. Pioglitazone
D. Insulin glargine
Rationale: SGLT2 inhibitors have cardiovascular and renal benefits;
preferred in patients with or at risk for CVD/HF.
12. A 68-year-old with heart failure (HFrEF) has worsening dyspnea and
leg edema. Creatinine rises from 1.0 to 2.5 mg/dL after starting
sacubitril/valsartan. What should the NP do?
A. Stop sacubitril/valsartan immediately
B. Monitor creatinine and hold diuretics temporarily
C. Double the dose
