• NUR 509 09/07/2026
NUR 509 - FNP ADULTS FINAL EXAM 1 PREP
NEWEST 2026/2027 ACTUAL EXAM COMPLETE
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH RATIONALE
A 44-year-old female mathematician presents to clinic with a complaint of a mass in the right breast. Her partner
noticed this mass 2 days ago, and the patient feels guilty because she has only had one mammogram and does
not engage in breast self-examination (BSE) on any regular basis. She has no family history of breast cancer, and
her prior mammogram was ordered as a routine screening test at age 43 years after a brief discussion with her
primary care provider. After a thorough investigation reveals a benign cyst, what advice should be given to this
patient about screening for breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual examinations
P 1
, • NUR 509 09/07/2026
starting at age 30 years.
c. This patient was in compliance with the U.S. Preventive Services Task Fo
C. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF) recommendations for
her age group and risk factors prior to her current complaint.
The USPSTF recommends that women age <50 years discuss risks and benefits with their provider and decide on
appropriate screening for their individual preferences and needs
A 42-year-old female website developer presents for an annual preventive examination with questions about
breast cancer screening. She is concerned about the radiation exposure associated with mammography and is
interested in magnetic resonance imaging (MRI) as a possible alternative for routine screening. She is otherwise
healthy with no family history of breast, ovarian, or colon cancer. Which of the following is true about MRI as a
screening modality for breast cancer in the general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
c. This patient is an ideal candidate for screening via breast MRI based on current evidence.
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo screening MRI.
e. Known BRCA1 or BRCA2 mutation is insufficient cr
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Increased sensitivity (in this case, higher-resolution imaging to pick up subtler disease) is often traded for
reduced specificity (in the form of discovering many small items of no pathological significance).
A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge. This discharge
started several weeks ago and has occurred at irregular intervals since that time. She does not complain of local
tenderness, redness, fever, or any other systemic symptoms aside from slightly irregular periods over the last
few months. On examination, she is able to express a small amount of discharge, which is sent to the laboratory
and found to be consistent with breast milk but without any signs of blood or pus. Screening laboratories are
P 2
, • NUR 509 09/07/2026
also sent, which reveal a normal blood count, metabolic panel, thyroid-stimulating hormone, and human
chorionic gonadotropin (HCG) level. Further laboratories are still pending. Which of the following is the most
likely diagnosis?
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes the production of breast milk
and can suppress menstruation.
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-
examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlying swelling. She
has heard that most breast cancers are found by patients themselves, and she is very concerned that she may
have breast cancer. Which of the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to be malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and diagnosis because the
risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-examination. In this patient's
age range (15-25 years), palpable masses are most likely to be benign fibroadenomas.
A 48-year-old female psychologist presents to clinic with concerns about her breast cancer risk after an age-
matched cousin was recently diagnosed with this disease. This cousin is the third family member on her father's
side in as many years to be diagnosed with breast cancer, including the patient's own father, who had surgery
and subsequent treatment 3 years ago for breast cancer. The patient has little other knowledge of her family
history, only that her grandparents independently arrived from Eastern Europe near the end of World War II and
were among very few members of their family that survived the war. The patient has read about testing for the
P 3
, • NUR 509 09/07/2026
breast cancer genes (BRCA1 and BRCA2) and desires further information about whether this would be
appropriate for her. Which of the following is true about this patient's indications for BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and
d. This patient carries several risk factors that together justify BRCA testing.
Rationale: This patient has both a first-degree male relative with breast cancer and several relatives in the same
lineage with breast cancer. Both of these suggest risk for the BRCA genes, but the BRCAPRO calculator can
further refine the numerical risk and help decide if screening might be helpful.
A 68-year-old former paleontologist presents to clinic with concerns about her breast cancer risk. Her mother
developed the disease in her 50s and died from it in her 60s. A younger cousin developed the disease a few
years ago before the age of 50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In
addition, the patient suffered from lymphoma in her 20s and had radiation to the chest. She did take hormone
replacement therapy for a few years before data emerged that this may contribute to breast cancer risk. She has
had several abnormal mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up
biopsies never showed any malignant pathology. Which of the following is true regarding magnetic resonance
imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who has moderately but not extraordinary
risk factors for br
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e., the ability to rule out disease in healthy breasts).
Rationale: Regardless of recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e., the ability to rule out disease in health breasts). Sensitivity and specificity of screening
test are almost always trade-offs; that is, a test that picks up more true cases is also very likely to then pick up
more false positives, and vice versa.
A 66-year-old female museum curator presents for a routine annual examination. On examination, a notably
enlarged supraclavicular lymph node is appreciated on the right side. The lymph node is nontender and feels firm
and rubbery. She denies any localized or systemic symptoms such as breast lumps, fevers, or night sweats. She
has been taking conjugated estrogen tablets for 9 years since menopause, though she has not taken progestin
compounds since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true
about this presentation of lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the breast uniformly
drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further evaluation or follow-up.
P 4
NUR 509 - FNP ADULTS FINAL EXAM 1 PREP
NEWEST 2026/2027 ACTUAL EXAM COMPLETE
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH RATIONALE
A 44-year-old female mathematician presents to clinic with a complaint of a mass in the right breast. Her partner
noticed this mass 2 days ago, and the patient feels guilty because she has only had one mammogram and does
not engage in breast self-examination (BSE) on any regular basis. She has no family history of breast cancer, and
her prior mammogram was ordered as a routine screening test at age 43 years after a brief discussion with her
primary care provider. After a thorough investigation reveals a benign cyst, what advice should be given to this
patient about screening for breast cancer in her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual examinations
P 1
, • NUR 509 09/07/2026
starting at age 30 years.
c. This patient was in compliance with the U.S. Preventive Services Task Fo
C. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF) recommendations for
her age group and risk factors prior to her current complaint.
The USPSTF recommends that women age <50 years discuss risks and benefits with their provider and decide on
appropriate screening for their individual preferences and needs
A 42-year-old female website developer presents for an annual preventive examination with questions about
breast cancer screening. She is concerned about the radiation exposure associated with mammography and is
interested in magnetic resonance imaging (MRI) as a possible alternative for routine screening. She is otherwise
healthy with no family history of breast, ovarian, or colon cancer. Which of the following is true about MRI as a
screening modality for breast cancer in the general population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
c. This patient is an ideal candidate for screening via breast MRI based on current evidence.
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo screening MRI.
e. Known BRCA1 or BRCA2 mutation is insufficient cr
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Rationale: Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
Increased sensitivity (in this case, higher-resolution imaging to pick up subtler disease) is often traded for
reduced specificity (in the form of discovering many small items of no pathological significance).
A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge. This discharge
started several weeks ago and has occurred at irregular intervals since that time. She does not complain of local
tenderness, redness, fever, or any other systemic symptoms aside from slightly irregular periods over the last
few months. On examination, she is able to express a small amount of discharge, which is sent to the laboratory
and found to be consistent with breast milk but without any signs of blood or pus. Screening laboratories are
P 2
, • NUR 509 09/07/2026
also sent, which reveal a normal blood count, metabolic panel, thyroid-stimulating hormone, and human
chorionic gonadotropin (HCG) level. Further laboratories are still pending. Which of the following is the most
likely diagnosis?
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
e. Prolactinoma
Rationale: Prolactinomas are pituitary tumors that secrete prolactin, which causes the production of breast milk
and can suppress menstruation.
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-
examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlying swelling. She
has heard that most breast cancers are found by patients themselves, and she is very concerned that she may
have breast cancer. Which of the following is true about BSE and self-detection of breast cancer?
a. Most masses that women find at home and bring to a provider's attention turn out to be malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and diagnosis because the
risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
Rationale: This patient is more likely to find a fibroadenoma than a cancer on self-examination. In this patient's
age range (15-25 years), palpable masses are most likely to be benign fibroadenomas.
A 48-year-old female psychologist presents to clinic with concerns about her breast cancer risk after an age-
matched cousin was recently diagnosed with this disease. This cousin is the third family member on her father's
side in as many years to be diagnosed with breast cancer, including the patient's own father, who had surgery
and subsequent treatment 3 years ago for breast cancer. The patient has little other knowledge of her family
history, only that her grandparents independently arrived from Eastern Europe near the end of World War II and
were among very few members of their family that survived the war. The patient has read about testing for the
P 3
, • NUR 509 09/07/2026
breast cancer genes (BRCA1 and BRCA2) and desires further information about whether this would be
appropriate for her. Which of the following is true about this patient's indications for BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and
d. This patient carries several risk factors that together justify BRCA testing.
Rationale: This patient has both a first-degree male relative with breast cancer and several relatives in the same
lineage with breast cancer. Both of these suggest risk for the BRCA genes, but the BRCAPRO calculator can
further refine the numerical risk and help decide if screening might be helpful.
A 68-year-old former paleontologist presents to clinic with concerns about her breast cancer risk. Her mother
developed the disease in her 50s and died from it in her 60s. A younger cousin developed the disease a few
years ago before the age of 50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In
addition, the patient suffered from lymphoma in her 20s and had radiation to the chest. She did take hormone
replacement therapy for a few years before data emerged that this may contribute to breast cancer risk. She has
had several abnormal mammograms in her 50s for persistently dense breasts with subtle findings, but follow-up
biopsies never showed any malignant pathology. Which of the following is true regarding magnetic resonance
imaging (MRI) screening of this patient?
a. No agency recommends breast MRI for a patient such as this one, who has moderately but not extraordinary
risk factors for br
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e., the ability to rule out disease in healthy breasts).
Rationale: Regardless of recommendations, the high sensitivity of breast MRI comes at the expense of markedly
decreased specificity (i.e., the ability to rule out disease in health breasts). Sensitivity and specificity of screening
test are almost always trade-offs; that is, a test that picks up more true cases is also very likely to then pick up
more false positives, and vice versa.
A 66-year-old female museum curator presents for a routine annual examination. On examination, a notably
enlarged supraclavicular lymph node is appreciated on the right side. The lymph node is nontender and feels firm
and rubbery. She denies any localized or systemic symptoms such as breast lumps, fevers, or night sweats. She
has been taking conjugated estrogen tablets for 9 years since menopause, though she has not taken progestin
compounds since she had a hysterectomy for heavy bleeding at age 45 years. Which of the following is true
about this presentation of lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics of the breast uniformly
drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further evaluation or follow-up.
P 4
