Cardiovascular High-Yield: What the FNP Boards Always Test

Clinical High-Yield · 10 min read · February 9, 2026

Why Cardiovascular Is Non-Negotiable

Cardiovascular disease is the leading cause of death in the United States. It's also one of the most heavily tested areas on the FNP boards. If you're going to invest time in any single content area, cardiovascular should be near the top of your list.

Here's the high-yield framework.

Hypertension: The Foundation

Classification (JNC 8 / ACC/AHA 2017):

  • Normal: <120/80
  • Elevated: 120–129/<80
  • Stage 1: 130–139/80–89
  • Stage 2: ≥140/≥90
  • Hypertensive crisis: >180/120

First-line treatment (know these cold):

  • General population: Thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers
  • Black patients: Thiazide diuretics or calcium channel blockers (NOT ACE inhibitors/ARBs as first-line)
  • Patients with CKD: ACE inhibitors or ARBs (renoprotective)
  • Patients with diabetes: ACE inhibitors or ARBs
  • Patients with heart failure: ACE inhibitors/ARBs + beta-blockers + diuretics

Board pearl: ACE inhibitors cause a dry cough (bradykinin accumulation). Switch to ARB if cough develops.

Heart Failure: Systolic vs. Diastolic

HFrEF (reduced ejection fraction, systolic):

  • EF <40%
  • Medications that improve mortality: ACE inhibitors/ARBs, beta-blockers (carvedilol, metoprolol succinate), aldosterone antagonists (spironolactone), ARNI (sacubitril/valsartan)
  • Diuretics for symptom relief (don't improve mortality)

HFpEF (preserved ejection fraction, diastolic):

  • EF ≥50%
  • No medications proven to improve mortality
  • Treat underlying causes (hypertension, atrial fibrillation)
  • Diuretics for congestion

Board pearl: SGLT2 inhibitors (empagliflozin, dapagliflozin) now have mortality benefit in both HFrEF and HFpEF.

Atrial Fibrillation: The Rate vs. Rhythm Decision

Rate control (goal HR <80 at rest):

  • Beta-blockers or calcium channel blockers (diltiazem, verapamil)
  • Digoxin (second-line, especially in heart failure)

Rhythm control:

  • Amiodarone, flecainide, propafenone, sotalol
  • Cardioversion (electrical or chemical)

Anticoagulation (CHA₂DS₂-VASc score):

  • Score ≥2 in men, ≥3 in women: anticoagulate
  • Preferred agents: DOACs (apixaban, rivaroxaban, dabigatran) over warfarin

Board pearl: Always assess stroke risk before cardioverting A-fib that has been present >48 hours.

Coronary Artery Disease: The Essentials

Stable angina: Nitrates for acute relief, beta-blockers for prevention, aspirin + statin for all patients

ACS (NSTEMI/STEMI): MONA (morphine, oxygen, nitrates, aspirin) — though oxygen is now given only if SpO2 <90%

Secondary prevention after MI: Aspirin + P2Y12 inhibitor (dual antiplatelet), beta-blocker, ACE inhibitor, statin

The Board Approach to Cardiovascular Questions

Most cardiovascular board questions follow one of three patterns:

  1. Patient presentation → identify the diagnosis
  2. Diagnosis given → choose the correct treatment
  3. Patient on treatment → identify the complication or next step

Know the present...