ANCC FNP Board Exam Mastery Guide | 2026 Edition
900+ PRACTICE QUESTIONS & REVIEW TERMS FOR CERTIFICATION SUCCESS
(1) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(2) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(3) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(4) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(5) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
(6) What is the first-line treatment for a patient diagnosed with uncomplicated Community-Acquired Pneumonia (CAP) with no recent antibiotic
use?
A. Levofloxacin | B. Amoxicillin or Doxycycline | C. Ciprofloxacin | D. Ceftriaxone
Correct: B
Rationale: Current guidelines recommend Amoxicillin (1g TID) or Doxycycline as first-line for healthy outpatients with no comorbidities/risk factors for
MRSA/Pseudomonas.
(7) An elderly patient presents with a 'curtain-like' shadow over their field of vision and floaters. This is a medical emergency known as:
A. Macular Degeneration | B. Cataracts | C. Retinal Detachment | D. Glaucoma
Correct: C
Rationale: Retinal detachment presents as a sudden shadow or 'curtain' across the vision. It requires immediate referral to ophthalmology to prevent permanent
vision loss.
(8) Which cranial nerve is being tested when the NP asks the patient to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal) | B. CN X (Vagus) | C. CN XI (Spinal Accessory) | ed. CN XII (Hypoglossal)
Correct: C
Rationale: CN XI controls the sternocleidomastoid and trapezius muscles used for shoulder shrugging and head turning.
,(9) A patient has a TSH of 0.1 mIU/L and a high Free T4. Which physical finding would support a diagnosis of Graves' Disease?
A. Pretibial Myxedema | B. Periorbital Edema | C. Dry, brittle hair | D. Bradycardia
Correct: A
Rationale: Pretibial myxedema (thickening of the skin on the shins) and exophthalmos are specific to Graves' Disease (hyperthyroidism).
(10) According to the ANA Code of Ethics, when an NP advocates for a patient's right to refuse treatment, which principle is being upheld?
A. Beneficence | B. Justice | C. Autonomy | D. Veracity
Correct: C
Rationale: Autonomy is the patient's right to self-determination and to make their own healthcare decisions.
(11) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(12) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(13) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(14) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(15) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
(16) What is the first-line treatment for a patient diagnosed with uncomplicated Community-Acquired Pneumonia (CAP) with no recent
antibiotic use?
A. Levofloxacin | B. Amoxicillin or Doxycycline | C. Ciprofloxacin | D. Ceftriaxone
Correct: B
Rationale: Current guidelines recommend Amoxicillin (1g TID) or Doxycycline as first-line for healthy outpatients with no comorbidities/risk factors for
MRSA/Pseudomonas.
(17) An elderly patient presents with a 'curtain-like' shadow over their field of vision and floaters. This is a medical emergency known as:
A. Macular Degeneration | B. Cataracts | C. Retinal Detachment | D. Glaucoma
Correct: C
Rationale: Retinal detachment presents as a sudden shadow or 'curtain' across the vision. It requires immediate referral to ophthalmology to prevent permanent
vision loss.
,(18) Which cranial nerve is being tested when the NP asks the patient to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal) | B. CN X (Vagus) | C. CN XI (Spinal Accessory) | ed. CN XII (Hypoglossal)
Correct: C
Rationale: CN XI controls the sternocleidomastoid and trapezius muscles used for shoulder shrugging and head turning.
(19) A patient has a TSH of 0.1 mIU/L and a high Free T4. Which physical finding would support a diagnosis of Graves' Disease?
A. Pretibial Myxedema | B. Periorbital Edema | C. Dry, brittle hair | D. Bradycardia
Correct: A
Rationale: Pretibial myxedema (thickening of the skin on the shins) and exophthalmos are specific to Graves' Disease (hyperthyroidism).
(20) According to the ANA Code of Ethics, when an NP advocates for a patient's right to refuse treatment, which principle is being upheld?
A. Beneficence | B. Justice | C. Autonomy | D. Veracity
Correct: C
Rationale: Autonomy is the patient's right to self-determination and to make their own healthcare decisions.
(21) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(22) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(23) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(24) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(25) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
(26) What is the first-line treatment for a patient diagnosed with uncomplicated Community-Acquired Pneumonia (CAP) with no recent
antibiotic use?
A. Levofloxacin | B. Amoxicillin or Doxycycline | C. Ciprofloxacin | D. Ceftriaxone
Correct: B
Rationale: Current guidelines recommend Amoxicillin (1g TID) or Doxycycline as first-line for healthy outpatients with no comorbidities/risk factors for
MRSA/Pseudomonas.
, (27) An elderly patient presents with a 'curtain-like' shadow over their field of vision and floaters. This is a medical emergency known as:
A. Macular Degeneration | B. Cataracts | C. Retinal Detachment | D. Glaucoma
Correct: C
Rationale: Retinal detachment presents as a sudden shadow or 'curtain' across the vision. It requires immediate referral to ophthalmology to prevent permanent
vision loss.
(28) Which cranial nerve is being tested when the NP asks the patient to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal) | B. CN X (Vagus) | C. CN XI (Spinal Accessory) | ed. CN XII (Hypoglossal)
Correct: C
Rationale: CN XI controls the sternocleidomastoid and trapezius muscles used for shoulder shrugging and head turning.
(29) A patient has a TSH of 0.1 mIU/L and a high Free T4. Which physical finding would support a diagnosis of Graves' Disease?
A. Pretibial Myxedema | B. Periorbital Edema | C. Dry, brittle hair | D. Bradycardia
Correct: A
Rationale: Pretibial myxedema (thickening of the skin on the shins) and exophthalmos are specific to Graves' Disease (hyperthyroidism).
(30) According to the ANA Code of Ethics, when an NP advocates for a patient's right to refuse treatment, which principle is being upheld?
A. Beneficence | B. Justice | C. Autonomy | D. Veracity
Correct: C
Rationale: Autonomy is the patient's right to self-determination and to make their own healthcare decisions.
(31) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(32) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(33) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(34) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(35) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
900+ PRACTICE QUESTIONS & REVIEW TERMS FOR CERTIFICATION SUCCESS
(1) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(2) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(3) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(4) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(5) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
(6) What is the first-line treatment for a patient diagnosed with uncomplicated Community-Acquired Pneumonia (CAP) with no recent antibiotic
use?
A. Levofloxacin | B. Amoxicillin or Doxycycline | C. Ciprofloxacin | D. Ceftriaxone
Correct: B
Rationale: Current guidelines recommend Amoxicillin (1g TID) or Doxycycline as first-line for healthy outpatients with no comorbidities/risk factors for
MRSA/Pseudomonas.
(7) An elderly patient presents with a 'curtain-like' shadow over their field of vision and floaters. This is a medical emergency known as:
A. Macular Degeneration | B. Cataracts | C. Retinal Detachment | D. Glaucoma
Correct: C
Rationale: Retinal detachment presents as a sudden shadow or 'curtain' across the vision. It requires immediate referral to ophthalmology to prevent permanent
vision loss.
(8) Which cranial nerve is being tested when the NP asks the patient to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal) | B. CN X (Vagus) | C. CN XI (Spinal Accessory) | ed. CN XII (Hypoglossal)
Correct: C
Rationale: CN XI controls the sternocleidomastoid and trapezius muscles used for shoulder shrugging and head turning.
,(9) A patient has a TSH of 0.1 mIU/L and a high Free T4. Which physical finding would support a diagnosis of Graves' Disease?
A. Pretibial Myxedema | B. Periorbital Edema | C. Dry, brittle hair | D. Bradycardia
Correct: A
Rationale: Pretibial myxedema (thickening of the skin on the shins) and exophthalmos are specific to Graves' Disease (hyperthyroidism).
(10) According to the ANA Code of Ethics, when an NP advocates for a patient's right to refuse treatment, which principle is being upheld?
A. Beneficence | B. Justice | C. Autonomy | D. Veracity
Correct: C
Rationale: Autonomy is the patient's right to self-determination and to make their own healthcare decisions.
(11) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(12) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(13) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(14) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(15) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
(16) What is the first-line treatment for a patient diagnosed with uncomplicated Community-Acquired Pneumonia (CAP) with no recent
antibiotic use?
A. Levofloxacin | B. Amoxicillin or Doxycycline | C. Ciprofloxacin | D. Ceftriaxone
Correct: B
Rationale: Current guidelines recommend Amoxicillin (1g TID) or Doxycycline as first-line for healthy outpatients with no comorbidities/risk factors for
MRSA/Pseudomonas.
(17) An elderly patient presents with a 'curtain-like' shadow over their field of vision and floaters. This is a medical emergency known as:
A. Macular Degeneration | B. Cataracts | C. Retinal Detachment | D. Glaucoma
Correct: C
Rationale: Retinal detachment presents as a sudden shadow or 'curtain' across the vision. It requires immediate referral to ophthalmology to prevent permanent
vision loss.
,(18) Which cranial nerve is being tested when the NP asks the patient to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal) | B. CN X (Vagus) | C. CN XI (Spinal Accessory) | ed. CN XII (Hypoglossal)
Correct: C
Rationale: CN XI controls the sternocleidomastoid and trapezius muscles used for shoulder shrugging and head turning.
(19) A patient has a TSH of 0.1 mIU/L and a high Free T4. Which physical finding would support a diagnosis of Graves' Disease?
A. Pretibial Myxedema | B. Periorbital Edema | C. Dry, brittle hair | D. Bradycardia
Correct: A
Rationale: Pretibial myxedema (thickening of the skin on the shins) and exophthalmos are specific to Graves' Disease (hyperthyroidism).
(20) According to the ANA Code of Ethics, when an NP advocates for a patient's right to refuse treatment, which principle is being upheld?
A. Beneficence | B. Justice | C. Autonomy | D. Veracity
Correct: C
Rationale: Autonomy is the patient's right to self-determination and to make their own healthcare decisions.
(21) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(22) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(23) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(24) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(25) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
(26) What is the first-line treatment for a patient diagnosed with uncomplicated Community-Acquired Pneumonia (CAP) with no recent
antibiotic use?
A. Levofloxacin | B. Amoxicillin or Doxycycline | C. Ciprofloxacin | D. Ceftriaxone
Correct: B
Rationale: Current guidelines recommend Amoxicillin (1g TID) or Doxycycline as first-line for healthy outpatients with no comorbidities/risk factors for
MRSA/Pseudomonas.
, (27) An elderly patient presents with a 'curtain-like' shadow over their field of vision and floaters. This is a medical emergency known as:
A. Macular Degeneration | B. Cataracts | C. Retinal Detachment | D. Glaucoma
Correct: C
Rationale: Retinal detachment presents as a sudden shadow or 'curtain' across the vision. It requires immediate referral to ophthalmology to prevent permanent
vision loss.
(28) Which cranial nerve is being tested when the NP asks the patient to shrug their shoulders against resistance?
A. CN IX (Glossopharyngeal) | B. CN X (Vagus) | C. CN XI (Spinal Accessory) | ed. CN XII (Hypoglossal)
Correct: C
Rationale: CN XI controls the sternocleidomastoid and trapezius muscles used for shoulder shrugging and head turning.
(29) A patient has a TSH of 0.1 mIU/L and a high Free T4. Which physical finding would support a diagnosis of Graves' Disease?
A. Pretibial Myxedema | B. Periorbital Edema | C. Dry, brittle hair | D. Bradycardia
Correct: A
Rationale: Pretibial myxedema (thickening of the skin on the shins) and exophthalmos are specific to Graves' Disease (hyperthyroidism).
(30) According to the ANA Code of Ethics, when an NP advocates for a patient's right to refuse treatment, which principle is being upheld?
A. Beneficence | B. Justice | C. Autonomy | D. Veracity
Correct: C
Rationale: Autonomy is the patient's right to self-determination and to make their own healthcare decisions.
(31) A 14-year-old male presents with a sudden onset of severe scrotal pain and a 'high-riding' testicle. The Cremasteric reflex is absent. What is
the most likely diagnosis?
A. Epididymitis | B. Hydrocele | C. Testicular Torsion | D. Varicocele
Correct: C
Rationale: Testicular torsion is a surgical emergency. The absent cremasteric reflex and high-riding testis are classic signs. Epididymitis usually has a positive
Prehn's sign and preserved reflex.
(32) According to the JNC-8 guidelines, what is the blood pressure goal for a 65-year-old patient with no diabetes or chronic kidney disease?
A. < 140/90 | B. < 150/90 | C. < 130/80 | D. < 120/80
Correct: B
Rationale: For patients aged 60 and older without DM or CKD, the JNC-8 goal is < 150/90. (Note: ACC/AHA guidelines differ, but ANCC often tests classic
standards).
(33) A patient presents with a 'velvety' hyperpigmentation in the skin folds of the neck and axilla. This finding, Acanthosis Nigricans, is most
commonly associated with:
A. Vitamin B12 deficiency | B. Hyperthyroidism | C. Insulin resistance | D. Systemic Lupus Erythematosus
Correct: C
Rationale: Acanthosis Nigricans is a classic skin marker for insulin resistance and is often seen in Type 2 Diabetes and PCOS.
(34) Which of the following murmurs is always considered pathological and requires further investigation with an echocardiogram?
A. Grade II/VI Systolic murmur | B. Diastolic murmur | C. Split S2 on inspiration | D. Murmur that decreases with Valsalva
Correct: B
Rationale: Diastolic murmurs (e.g., Mitral Stenosis, Aortic Regurgitation) are almost always pathological. Innocent murmurs are typically systolic and soft.
(35) A pregnant woman in her third trimester presents with sudden, painless, bright red vaginal bleeding. What should the NP suspect?
A. Abruptio Placentae | B. Placenta Previa | C. Ectopic Pregnancy | D. Labor onset
Correct: B
Rationale: Placenta Previa is characterized by painless bleeding. Abruptio Placentae usually presents with severe abdominal pain and dark red bleeding.
