ANCC FAMILY NURSE PRACTITIONER
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 68-year-old male presents with exertional chest pain and syncope. On auscultation, a
harsh, crescendo-decrescendo systolic murmur is heard at the second right intercostal space,
radiating to the carotid arteries. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Valve Prolapse
Answer: B
Conceptual Explanation: Aortic stenosis typically presents with a harsh systolic murmur
at the right upper sternal border that radiates to the neck, often associated with syncope,
angina, and heart failure (SAD triad).
,2. Which clinical research design is considered the highest level of evidence among individual
primary studies?
A. Case-Control Study
B. Cohort Study
C. Randomized Controlled Trial
D. Case Series
Answer: C
Conceptual Explanation: In the hierarchy of evidence, Randomized Controlled Trials
(RCTs) are considered the gold standard for primary studies, second only to systematic
reviews and meta-analyses.
3. A 35-year-old female patient with a history of Hashimoto’s thyroiditis presents for a
routine check-up. Her TSH is 12.5 mIU/L and her Free T4 is low. What is the next appropriate
step?
A. Decrease her dose of Levothyroxine
B. Initiate or increase Levothyroxine dosage
C. Recheck TSH in 6 months
D. Start Methimazole
Answer: B
, Conceptual Explanation: An elevated TSH with a low Free T4 indicates primary
hypothyroidism, requiring the initiation or titration of thyroid hormone replacement
therapy.
4. Which of the following physical exam findings is most suggestive of acute cholecystitis?
A. Murphy’s Sign
B. McBurney’s Sign
C. Rovsing’s Sign
D. Psoas Sign
Answer: A
Conceptual Explanation: Murphy’s sign is an inspiratory arrest upon deep palpation of
the right upper quadrant and is highly suggestive of acute cholecystitis.
5. Medicare Part B covers which of the following services?
A. Inpatient hospital stays
B. Hospice care
C. Prescription drug coverage
D. Outpatient provider visits and diagnostic tests
Answer: D
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 68-year-old male presents with exertional chest pain and syncope. On auscultation, a
harsh, crescendo-decrescendo systolic murmur is heard at the second right intercostal space,
radiating to the carotid arteries. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Valve Prolapse
Answer: B
Conceptual Explanation: Aortic stenosis typically presents with a harsh systolic murmur
at the right upper sternal border that radiates to the neck, often associated with syncope,
angina, and heart failure (SAD triad).
,2. Which clinical research design is considered the highest level of evidence among individual
primary studies?
A. Case-Control Study
B. Cohort Study
C. Randomized Controlled Trial
D. Case Series
Answer: C
Conceptual Explanation: In the hierarchy of evidence, Randomized Controlled Trials
(RCTs) are considered the gold standard for primary studies, second only to systematic
reviews and meta-analyses.
3. A 35-year-old female patient with a history of Hashimoto’s thyroiditis presents for a
routine check-up. Her TSH is 12.5 mIU/L and her Free T4 is low. What is the next appropriate
step?
A. Decrease her dose of Levothyroxine
B. Initiate or increase Levothyroxine dosage
C. Recheck TSH in 6 months
D. Start Methimazole
Answer: B
, Conceptual Explanation: An elevated TSH with a low Free T4 indicates primary
hypothyroidism, requiring the initiation or titration of thyroid hormone replacement
therapy.
4. Which of the following physical exam findings is most suggestive of acute cholecystitis?
A. Murphy’s Sign
B. McBurney’s Sign
C. Rovsing’s Sign
D. Psoas Sign
Answer: A
Conceptual Explanation: Murphy’s sign is an inspiratory arrest upon deep palpation of
the right upper quadrant and is highly suggestive of acute cholecystitis.
5. Medicare Part B covers which of the following services?
A. Inpatient hospital stays
B. Hospice care
C. Prescription drug coverage
D. Outpatient provider visits and diagnostic tests
Answer: D
