AANP FNP LEIK Practice Exam 2025/2026:
800+ Verified Questions & Answers |
Guaranteed Pass, Exams of Clinical Medicine
A 44 year old male patient comes to the clinic for his routine well visit. He has a history of
obesity, hypertension, and migraines. He takes lisinopril for his hypertension. He has not had
any complaints. Upon examination, the nurse practitioner hears a sound over the pulmonic area
during inspiration and disappears at expiration. The nurse practitioner knows that:
a. This may indicate malformation of his heart
b. This patient should be referred to cardiology
c. This is a benign variant
d. This is a common finding in obese patients c
Hearing physiologic S2 that disappears at expiration is considered a benign variant. It does not
indicate a malformation of the heart and the patient does not need referred to cardiology for
this isolated finding.
The nurse practitioner knows that the Erb's Point is located:
a. Second intercostal space to the right of the sternum
b. Third intercostal space to the left of the sternum
c. Fifth intercostal space, 8-9 cm left from midsternal line
d. First intercostal space to the left of the sternum b
Erb's point is the third or fourth intercostal space to the left of the sternum. The Aortic area is
the second intercostal space to the right of the sternum. The first intercostal space, 8-9 cm to
the left of the midsternal line is the mitral area.
All of the following heart sounds are all indicated of heart disease except:
a. Mitral regurgitation
b. Mitral stenosis
1|Page
,c. Aortic regurgitation
d. S2 a
MS, AR, and S2 sounds are all indicative of of heart disease (diastolic murmur).
A 81 year old patient comes to the clinic following diagnosis of diseased aortic valve, aortic
regurgitation. The nurse practitioner knows that the best place to hear this murmur is:
a. Second intercostal space, right of the sternum
b. Second intercostal space, left of the sternum
c. Third intercostal space, left of the sternum
c. Fifth intercostal space, left of the sternum c
AR is due to a diseased aortic valve. Best heard 3rd intercostal space, left of sternum also known
as Erbs point.
All of the following murmurs radiate except:
a. Mitral regurgitation
b. Aortic stenosis
c. Aortic regurgitation
d. S1 c
Only systolic murmurs radiate to the axilla in MR and the neck in AS.
The nurse practitioner knows that a split S2 is best heard on what part of the body?
a. Second intercostal space, right of the sternum
b. Second intercostal space, left of the sternum
c. Fourth intercostal space, left of the sternum
d. Apex b
Aplist S2 is best heard at the pulmonic area (second intercostal space, left of the sternum).
2|Page
,At which of the following grades is a thrill present?
a. Grade III
b. Grade IV
c. Grade V
d. Grade VI b
Grade IV is a loud murmur, first time a thrill is present. It is considered like a "palpable murmur".
Grade V the thrill can be heard with edge of stethoscope. Grade VI thrill can be heard through
chest cavity.
A 71 year old male patient comes to the clinic with new onset of shortness of breath. During
examination, the nurse practitioner finds a pulsating abdominal mass that is 4 cm wide. What is
the next step for this patient?
a. Reevaluate in one month
b. Refer to cardiology
c. Order an MRI and abdominal ultrasound
d. Order an abdominal ultrasound and CT d
An abdominal ultrasound and CT should be ordered for a patient that has a pulsating abdominal
mass greater than 3 cm.
A patient comes to the clinic with complaint of palpitations and shortness of breath for the past
week. His vital signs are BP of 98/64, HR 108, RR 16, Temp 97.2. CHA(s)DS(s)-VAS(c) score is 5.
What does this indicate?
a. Patient has new onset atrial fibrillation and needs medically treated.
b. Patient has new onset atrial fibrillation and needs to be sent to the ED
c. Patient has new onset SVT and needs troponin levels drawn
d. Patient has new onset SVT and needs medically treated a
3|Page
, CHA(s)DS(s)-VAS(c) - C (CHF), H (HTN), A (age >75), D (diabetes), S (stroke/TIA), V (vascular
disease), A (age 65-74), S (female gender is at higher risk).
This tool is used for atrial fibrillation. A score of 2 or more indicates that the patient needs
treatment for a-fib. Patient should be referred to cardiology for new onset.
A 59 year old female patient has a synthetic valve and is on warfarin therapy. What is her INR
goal?
a. 2.0 - 3.0
b. 2.5 - 3.5
c. 1.5 - 2.5
d. 3.5 - 4.5 b
INR goal for synthetic valve is 2.5 - 3.5. Atrial fibrillation INR goal is 2 - 3.
A 61 year old female patient with a history of atrial fibrillation calls the clinic because her INR is
4.5. What should the nurse practitioner advise the patient?
a. This is a normal number. Continue the medication as prescribed.
b. This is slightly elevated. Hold two doses and take vitamin K.
c. This is seriously elevated. Refer to ED.
d. This is elevated. Hold one dose and do not take vitamin K d
INR between 4.01-4.99 is slightly elevated and patient should hold one dose.
A patient on warfarin therapy comes to the clinic for a routine visit. The patients INR has been
normal and she feels well. Upon examination the nurse practitioner notices that she has
significant bruising on both of her knees and right hip. The patient states that she fell three days
ago but she feels fine. The nurse practitioner should:
a. Discuss fall risks with the patient
b. Order H&H
c. Order INR with PT and PTT
4|Page
800+ Verified Questions & Answers |
Guaranteed Pass, Exams of Clinical Medicine
A 44 year old male patient comes to the clinic for his routine well visit. He has a history of
obesity, hypertension, and migraines. He takes lisinopril for his hypertension. He has not had
any complaints. Upon examination, the nurse practitioner hears a sound over the pulmonic area
during inspiration and disappears at expiration. The nurse practitioner knows that:
a. This may indicate malformation of his heart
b. This patient should be referred to cardiology
c. This is a benign variant
d. This is a common finding in obese patients c
Hearing physiologic S2 that disappears at expiration is considered a benign variant. It does not
indicate a malformation of the heart and the patient does not need referred to cardiology for
this isolated finding.
The nurse practitioner knows that the Erb's Point is located:
a. Second intercostal space to the right of the sternum
b. Third intercostal space to the left of the sternum
c. Fifth intercostal space, 8-9 cm left from midsternal line
d. First intercostal space to the left of the sternum b
Erb's point is the third or fourth intercostal space to the left of the sternum. The Aortic area is
the second intercostal space to the right of the sternum. The first intercostal space, 8-9 cm to
the left of the midsternal line is the mitral area.
All of the following heart sounds are all indicated of heart disease except:
a. Mitral regurgitation
b. Mitral stenosis
1|Page
,c. Aortic regurgitation
d. S2 a
MS, AR, and S2 sounds are all indicative of of heart disease (diastolic murmur).
A 81 year old patient comes to the clinic following diagnosis of diseased aortic valve, aortic
regurgitation. The nurse practitioner knows that the best place to hear this murmur is:
a. Second intercostal space, right of the sternum
b. Second intercostal space, left of the sternum
c. Third intercostal space, left of the sternum
c. Fifth intercostal space, left of the sternum c
AR is due to a diseased aortic valve. Best heard 3rd intercostal space, left of sternum also known
as Erbs point.
All of the following murmurs radiate except:
a. Mitral regurgitation
b. Aortic stenosis
c. Aortic regurgitation
d. S1 c
Only systolic murmurs radiate to the axilla in MR and the neck in AS.
The nurse practitioner knows that a split S2 is best heard on what part of the body?
a. Second intercostal space, right of the sternum
b. Second intercostal space, left of the sternum
c. Fourth intercostal space, left of the sternum
d. Apex b
Aplist S2 is best heard at the pulmonic area (second intercostal space, left of the sternum).
2|Page
,At which of the following grades is a thrill present?
a. Grade III
b. Grade IV
c. Grade V
d. Grade VI b
Grade IV is a loud murmur, first time a thrill is present. It is considered like a "palpable murmur".
Grade V the thrill can be heard with edge of stethoscope. Grade VI thrill can be heard through
chest cavity.
A 71 year old male patient comes to the clinic with new onset of shortness of breath. During
examination, the nurse practitioner finds a pulsating abdominal mass that is 4 cm wide. What is
the next step for this patient?
a. Reevaluate in one month
b. Refer to cardiology
c. Order an MRI and abdominal ultrasound
d. Order an abdominal ultrasound and CT d
An abdominal ultrasound and CT should be ordered for a patient that has a pulsating abdominal
mass greater than 3 cm.
A patient comes to the clinic with complaint of palpitations and shortness of breath for the past
week. His vital signs are BP of 98/64, HR 108, RR 16, Temp 97.2. CHA(s)DS(s)-VAS(c) score is 5.
What does this indicate?
a. Patient has new onset atrial fibrillation and needs medically treated.
b. Patient has new onset atrial fibrillation and needs to be sent to the ED
c. Patient has new onset SVT and needs troponin levels drawn
d. Patient has new onset SVT and needs medically treated a
3|Page
, CHA(s)DS(s)-VAS(c) - C (CHF), H (HTN), A (age >75), D (diabetes), S (stroke/TIA), V (vascular
disease), A (age 65-74), S (female gender is at higher risk).
This tool is used for atrial fibrillation. A score of 2 or more indicates that the patient needs
treatment for a-fib. Patient should be referred to cardiology for new onset.
A 59 year old female patient has a synthetic valve and is on warfarin therapy. What is her INR
goal?
a. 2.0 - 3.0
b. 2.5 - 3.5
c. 1.5 - 2.5
d. 3.5 - 4.5 b
INR goal for synthetic valve is 2.5 - 3.5. Atrial fibrillation INR goal is 2 - 3.
A 61 year old female patient with a history of atrial fibrillation calls the clinic because her INR is
4.5. What should the nurse practitioner advise the patient?
a. This is a normal number. Continue the medication as prescribed.
b. This is slightly elevated. Hold two doses and take vitamin K.
c. This is seriously elevated. Refer to ED.
d. This is elevated. Hold one dose and do not take vitamin K d
INR between 4.01-4.99 is slightly elevated and patient should hold one dose.
A patient on warfarin therapy comes to the clinic for a routine visit. The patients INR has been
normal and she feels well. Upon examination the nurse practitioner notices that she has
significant bruising on both of her knees and right hip. The patient states that she fell three days
ago but she feels fine. The nurse practitioner should:
a. Discuss fall risks with the patient
b. Order H&H
c. Order INR with PT and PTT
4|Page
