ANCC FAMILY NURSE PRACTITIONER
COMPREHENSIVE EXAM PREP (2026-
2027) QUESTIONS AND ANSWERS
1. A 68-year-old male with a history of hypertension presents with new-onset atrial
fibrillation. His CHA2DS2-VASc score is 3. Which of the following is the most appropriate long-
term management strategy to prevent stroke?
A. Apixaban 5 mg twice daily
B. Clopidogrel 75 mg daily
C. Aspirin 81 mg daily
D. Aspirin 325 mg plus Clopidogrel
Answer: A
Conceptual Explanation: For patients with a CHA2DS2-VASc score of 2 or greater in men
(3 or greater in women), oral anticoagulation with a DOAC like Apixaban is preferred over
antiplatelet therapy for stroke prevention in non-valvular atrial fibrillation.
,2. A 35-year-old female presents with symptoms of palpitations, heat intolerance, and a
smooth, diffuse enlargement of the thyroid gland. Her TSH is < 0.01 mIU/L and Free T4 is
elevated. Radioactive iodine uptake scan shows diffuse, symmetric uptake. What is the most
likely diagnosis?
A. Graves’ Disease
B. Hashimoto’s Thyroiditis
C. Subacute Thyroiditis
D. Toxic Multinodular Goiter
Answer: A
Conceptual Explanation: Graves’ disease is characterized by hyperthyroidism, diffuse
goiter, and symmetric radioactive iodine uptake. Hashimoto’s typically causes
hypothyroidism.
3. Which of the following physical exam findings is most characteristic of an ACL (Anterior
Cruciate Ligament) tear?
A. Positive McMurray test
B. Positive Phalen test
C. Positive Finkelstein test
D. Positive Lachman test
Answer: D
, Conceptual Explanation: The Lachman test is the most sensitive physical exam maneuver
for detecting an ACL tear. McMurray is for meniscus, Finkelstein for De Quervain’s, and
Phalen for Carpal Tunnel.
4. An 82-year-old patient is diagnosed with community-acquired pneumonia. According to
the CURB-65 criteria, which factor would warrant immediate hospitalization?
A. Diastolic Blood Pressure of 85 mmHg
B. Respiratory rate of 22 breaths/min
C. Blood Urea Nitrogen (BUN) > 19 mg/dL
D. History of Diabetes Mellitus
Answer: C
Conceptual Explanation: CURB-65 stands for Confusion, Urea (>7 mmol/L or 19 mg/dL),
Respiratory rate (>30), Blood pressure (SBP <90 or DBP <60), and Age >= 65. A score of 2
or more usually indicates the need for hospitalization.
5. A patient presents with a ‘velvety,’ hyperpigmented plaque on the back of the neck and
axilla. This finding is most commonly associated with:
A. Insulin resistance
B. Iron deficiency anemia
C. Systemic Lupus Erythematosus
D. Hypothyroidism
COMPREHENSIVE EXAM PREP (2026-
2027) QUESTIONS AND ANSWERS
1. A 68-year-old male with a history of hypertension presents with new-onset atrial
fibrillation. His CHA2DS2-VASc score is 3. Which of the following is the most appropriate long-
term management strategy to prevent stroke?
A. Apixaban 5 mg twice daily
B. Clopidogrel 75 mg daily
C. Aspirin 81 mg daily
D. Aspirin 325 mg plus Clopidogrel
Answer: A
Conceptual Explanation: For patients with a CHA2DS2-VASc score of 2 or greater in men
(3 or greater in women), oral anticoagulation with a DOAC like Apixaban is preferred over
antiplatelet therapy for stroke prevention in non-valvular atrial fibrillation.
,2. A 35-year-old female presents with symptoms of palpitations, heat intolerance, and a
smooth, diffuse enlargement of the thyroid gland. Her TSH is < 0.01 mIU/L and Free T4 is
elevated. Radioactive iodine uptake scan shows diffuse, symmetric uptake. What is the most
likely diagnosis?
A. Graves’ Disease
B. Hashimoto’s Thyroiditis
C. Subacute Thyroiditis
D. Toxic Multinodular Goiter
Answer: A
Conceptual Explanation: Graves’ disease is characterized by hyperthyroidism, diffuse
goiter, and symmetric radioactive iodine uptake. Hashimoto’s typically causes
hypothyroidism.
3. Which of the following physical exam findings is most characteristic of an ACL (Anterior
Cruciate Ligament) tear?
A. Positive McMurray test
B. Positive Phalen test
C. Positive Finkelstein test
D. Positive Lachman test
Answer: D
, Conceptual Explanation: The Lachman test is the most sensitive physical exam maneuver
for detecting an ACL tear. McMurray is for meniscus, Finkelstein for De Quervain’s, and
Phalen for Carpal Tunnel.
4. An 82-year-old patient is diagnosed with community-acquired pneumonia. According to
the CURB-65 criteria, which factor would warrant immediate hospitalization?
A. Diastolic Blood Pressure of 85 mmHg
B. Respiratory rate of 22 breaths/min
C. Blood Urea Nitrogen (BUN) > 19 mg/dL
D. History of Diabetes Mellitus
Answer: C
Conceptual Explanation: CURB-65 stands for Confusion, Urea (>7 mmol/L or 19 mg/dL),
Respiratory rate (>30), Blood pressure (SBP <90 or DBP <60), and Age >= 65. A score of 2
or more usually indicates the need for hospitalization.
5. A patient presents with a ‘velvety,’ hyperpigmented plaque on the back of the neck and
axilla. This finding is most commonly associated with:
A. Insulin resistance
B. Iron deficiency anemia
C. Systemic Lupus Erythematosus
D. Hypothyroidism
