PSI FNP EXAM 1 COMPLETE GUIDE WITH 100% RATED QUESTIONS
AND CORRECT ANSWERS| GRADED A+ | 2025 LATEST VERSION
A 90-year-old woman is diagnosed with isolated systolic hypertension of the elderly. Which of
the following antihypertensive medications are preferred for the treatment of this condition?
Calcium channel blockers and thiazide diuretics
Angiotensin-converting enzyme inhibitors and loop diuretics
Beta-blockers and potassium-sparing diuretics
Alpha-blockers and calcium channel blockers - (CORRECT ANSWER)Calcium channel
blockers and thiazide diuretics
Calcium channel blockers (CCBs) and thiazide diuretics are preferred for treatment of isolated
systolic hypertension of the elderly. There is no preference of one over the other, and therapy
may be started with either a thiazide diuretic or a CCB. Isolated systolic hypertension of the
elderly is caused by hardening of the arteries, resulting in increased peripheral vascular
resistance. The goal for patients aged 60 years or older is blood pressure less than 150/90 mmHg
unless diabetic or they have chronic kidney disease (goal BP <140/90 mmHg). Watch for
orthostatic hypotension (or decrease in systolic blood pressure of >20 mmHg), which is a risk
factor for falls.
A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which
diagnostic test will the provider order?
a. Abdominal CT with contrast
b. Abdominal ultrasound
c. MRI of the abdomen
d. Plain abdominal radiographs - (CORRECT ANSWER)b. Abdominal ultrasound.
Per UpToDate: Right upper quadrant pain may involve liver or biliary tree and if there is an
indication of hepatobiliary pain patients should have an abdominal ultrasound for evaluation.
Also patients with right upper quadrant pain should have the following laboratory studies:
●Complete blood count with differential
,●Electrolytes, blood urea nitrogen (BUN), creatinine, and glucose
●Aminotransferases, alkaline phosphatase, and bilirubin
●Lipase and/or amylase
A 50 y/o male presents with acute, excruciating, LUQ, epigastric pain that he also feels in the
flank and L shoulder. These symptoms best describe:
a. Cholecystitis
b. Intestinal obstruction
c. Pancreatitis
d. Biliary stones - (CORRECT ANSWER)c. Pancreatitis
Patients with epigastric pain should be evaluated for pancreatitis as well as gastric etiologies.
Also consider splenic etiologies such as splenomegaly.
"Must-Not-Miss" Patients with epigastric pain and cardiac risk factors and/or other symptoms
concerning for angina (eg, shortness of breath, exertional symptoms) should have appropriate
cardiac evaluation.
Labs to order for Epigastric suspected Pancreatitis:
●Complete blood count with differential
●Electrolytes, BUN, creatinine, and glucose
●Aminotransferases, alkaline phosphatase, and bilirubin
●Lipase and/or amylase
An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid
onset of severe low-back pain accompanied by abdominal pain that is gradually worsening. The
patient appears pale and complains that he does not feel well. During the abdominal exam, the
nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area
with her hand. Which of the following conditions is most likely?
Abdominal aortic aneurysm
,Cauda equina syndrome
Acute diverticulitis
Adenocarcinoma of the colon - (CORRECT ANSWER)Abdominal aortic aneurysm
Elderly males who are ex-smokers are at higher risk for abdominal aortic aneurysm. The
aneurysm is usually asymptomatic and is discovered incidentally during a routine chest x-ray or
abdominal ultrasound. Although small aneurysms are usually not detectable during abdominal
exams, the larger aneurysms may be palpable during an abdominal exam, but abdominal obesity
will obscure the findings. The symptoms in this case point toward a rapidly dissecting aneurysm.
The best action is to call 911 stat.
A 55-year-old male is at the emergency department complaining of severe acute epigastric pain
radiating to the back. He has a history of smoking and drinking alcohol for over 20 years. Patient
states that the pain is relieved if he leans forward with trunk flexed. The patient's symptoms are
suggestive of what condition?
a) Acute pancreatitis
b) Acute cholecystitis
c) Appendicitis
d) Gastric reflux (GERD) - (CORRECT ANSWER)A (Analysis)
Sudden knife-like epigastric pain radiating to the back is typical of acute pancreatitis.
Cholecystitis is a gradual onset of pain in the upper right quadrant.
Appendicitis is mostly found in the right upper quadrant. GERD is located in the epigastric area
but feels more like a burning sensation. https://www.aafp.org/afp/2007/0515/p1513.html
Cullen's sign is most commonly associated with which of the following?
Acute pancreatitis
Myocardial infarction
Acute pyelonephritis
, Preeclampsia - (CORRECT ANSWER)Cullen's sign is commonly seen in acute pancreatitis.
It refers to a yellowish-blue skin color change around the umbilicus. It is thought to occur due to
the pancreatic enzymes that run along the ligament and subcutaneous tissues around the
umbilicus.
What type of murmur can radiate to the left axilla?
Aortic regurgitation
Aortic stenosis
Mitral stenosis
Mitral regurgitation - (CORRECT ANSWER)Mitral regurgitation
Rationale
The murmur of mitral regurgitation occurs during systole (holosystolic) and is located in the
mitral area of the chest. The location of the mitral area (fifth intercostal space on the left side of
the midclavicular line) is near the left axilla, so that a loud murmur can radiate to the left axilla.
The causes can be congenital or it may a be sequela of rheumatic fever, mitral valve prolapse, or
papillary muscle dysfunction secondary to acute or prior myocardial infarction.
John is a 26-year-old graduate student comes into the clinic complaining of abdominal pain for 4
days. He states the pain started at the umbilicus and has frequent symptoms of nausea. A few
hours before coming to the clinic, the pain became more severe. He currently has a lot of pain of
any movement including light walking. The pain migrates to the right lower quadrant of the
abdomen. Which of the following is causing the abdominal pain?
a. Appendicitis
b. Cholecystitis
c. Pancreatitis
d. Gastroesophageal Reflux Disease - (CORRECT ANSWER)A. This is a sign for appendicitis.
The pain of appendicitis classically begins near the umbilicus, then migrates to the Right Lower
Quadrant
AND CORRECT ANSWERS| GRADED A+ | 2025 LATEST VERSION
A 90-year-old woman is diagnosed with isolated systolic hypertension of the elderly. Which of
the following antihypertensive medications are preferred for the treatment of this condition?
Calcium channel blockers and thiazide diuretics
Angiotensin-converting enzyme inhibitors and loop diuretics
Beta-blockers and potassium-sparing diuretics
Alpha-blockers and calcium channel blockers - (CORRECT ANSWER)Calcium channel
blockers and thiazide diuretics
Calcium channel blockers (CCBs) and thiazide diuretics are preferred for treatment of isolated
systolic hypertension of the elderly. There is no preference of one over the other, and therapy
may be started with either a thiazide diuretic or a CCB. Isolated systolic hypertension of the
elderly is caused by hardening of the arteries, resulting in increased peripheral vascular
resistance. The goal for patients aged 60 years or older is blood pressure less than 150/90 mmHg
unless diabetic or they have chronic kidney disease (goal BP <140/90 mmHg). Watch for
orthostatic hypotension (or decrease in systolic blood pressure of >20 mmHg), which is a risk
factor for falls.
A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which
diagnostic test will the provider order?
a. Abdominal CT with contrast
b. Abdominal ultrasound
c. MRI of the abdomen
d. Plain abdominal radiographs - (CORRECT ANSWER)b. Abdominal ultrasound.
Per UpToDate: Right upper quadrant pain may involve liver or biliary tree and if there is an
indication of hepatobiliary pain patients should have an abdominal ultrasound for evaluation.
Also patients with right upper quadrant pain should have the following laboratory studies:
●Complete blood count with differential
,●Electrolytes, blood urea nitrogen (BUN), creatinine, and glucose
●Aminotransferases, alkaline phosphatase, and bilirubin
●Lipase and/or amylase
A 50 y/o male presents with acute, excruciating, LUQ, epigastric pain that he also feels in the
flank and L shoulder. These symptoms best describe:
a. Cholecystitis
b. Intestinal obstruction
c. Pancreatitis
d. Biliary stones - (CORRECT ANSWER)c. Pancreatitis
Patients with epigastric pain should be evaluated for pancreatitis as well as gastric etiologies.
Also consider splenic etiologies such as splenomegaly.
"Must-Not-Miss" Patients with epigastric pain and cardiac risk factors and/or other symptoms
concerning for angina (eg, shortness of breath, exertional symptoms) should have appropriate
cardiac evaluation.
Labs to order for Epigastric suspected Pancreatitis:
●Complete blood count with differential
●Electrolytes, BUN, creatinine, and glucose
●Aminotransferases, alkaline phosphatase, and bilirubin
●Lipase and/or amylase
An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid
onset of severe low-back pain accompanied by abdominal pain that is gradually worsening. The
patient appears pale and complains that he does not feel well. During the abdominal exam, the
nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area
with her hand. Which of the following conditions is most likely?
Abdominal aortic aneurysm
,Cauda equina syndrome
Acute diverticulitis
Adenocarcinoma of the colon - (CORRECT ANSWER)Abdominal aortic aneurysm
Elderly males who are ex-smokers are at higher risk for abdominal aortic aneurysm. The
aneurysm is usually asymptomatic and is discovered incidentally during a routine chest x-ray or
abdominal ultrasound. Although small aneurysms are usually not detectable during abdominal
exams, the larger aneurysms may be palpable during an abdominal exam, but abdominal obesity
will obscure the findings. The symptoms in this case point toward a rapidly dissecting aneurysm.
The best action is to call 911 stat.
A 55-year-old male is at the emergency department complaining of severe acute epigastric pain
radiating to the back. He has a history of smoking and drinking alcohol for over 20 years. Patient
states that the pain is relieved if he leans forward with trunk flexed. The patient's symptoms are
suggestive of what condition?
a) Acute pancreatitis
b) Acute cholecystitis
c) Appendicitis
d) Gastric reflux (GERD) - (CORRECT ANSWER)A (Analysis)
Sudden knife-like epigastric pain radiating to the back is typical of acute pancreatitis.
Cholecystitis is a gradual onset of pain in the upper right quadrant.
Appendicitis is mostly found in the right upper quadrant. GERD is located in the epigastric area
but feels more like a burning sensation. https://www.aafp.org/afp/2007/0515/p1513.html
Cullen's sign is most commonly associated with which of the following?
Acute pancreatitis
Myocardial infarction
Acute pyelonephritis
, Preeclampsia - (CORRECT ANSWER)Cullen's sign is commonly seen in acute pancreatitis.
It refers to a yellowish-blue skin color change around the umbilicus. It is thought to occur due to
the pancreatic enzymes that run along the ligament and subcutaneous tissues around the
umbilicus.
What type of murmur can radiate to the left axilla?
Aortic regurgitation
Aortic stenosis
Mitral stenosis
Mitral regurgitation - (CORRECT ANSWER)Mitral regurgitation
Rationale
The murmur of mitral regurgitation occurs during systole (holosystolic) and is located in the
mitral area of the chest. The location of the mitral area (fifth intercostal space on the left side of
the midclavicular line) is near the left axilla, so that a loud murmur can radiate to the left axilla.
The causes can be congenital or it may a be sequela of rheumatic fever, mitral valve prolapse, or
papillary muscle dysfunction secondary to acute or prior myocardial infarction.
John is a 26-year-old graduate student comes into the clinic complaining of abdominal pain for 4
days. He states the pain started at the umbilicus and has frequent symptoms of nausea. A few
hours before coming to the clinic, the pain became more severe. He currently has a lot of pain of
any movement including light walking. The pain migrates to the right lower quadrant of the
abdomen. Which of the following is causing the abdominal pain?
a. Appendicitis
b. Cholecystitis
c. Pancreatitis
d. Gastroesophageal Reflux Disease - (CORRECT ANSWER)A. This is a sign for appendicitis.
The pain of appendicitis classically begins near the umbilicus, then migrates to the Right Lower
Quadrant
