PSI FAMILY NURSE PRACTITIONER EXAM
2026 STUDY GUIDE | COMPLETE
CERTIFICATION REVIEW & PRACTICE
Domain 1: Assessment & Diagnosis (Questions 1-30)
1. A 24-year-old female presents with sudden onset of sharp, right-sided lower abdominal
pain radiating to the right labia. Urinalysis is negative for leukocytes and nitrites. The most
likely diagnosis is:
A) Pelvic inflammatory disease
B) Ruptured ovarian cyst
C) Ectopic pregnancy
D) Acute appendicitis
2. When assessing a child with suspected developmental dysplasia of the hip (DDH), which
clinical finding is most indicative in a 3-month-old?
A) Trendelenburg gait
B) Limb length discrepancy
C) Asymmetric gluteal or thigh folds
D) Pain with hip abduction
3. A 65-year-old male with a 50-pack-year smoking history presents with hemoptysis and a 10-
pound weight loss. The initial diagnostic test of choice is:
A) Sputum culture
B) Chest X-ray
C) Bronchoscopy
D) CT scan of the chest
4. The most sensitive physical exam finding for early detection of rotator cuff tendinopathy is:
A) Positive Neer's impingement sign
B) Painful arc sign (60-120 degrees)
C) Weakness in external rotation
D) Positive drop arm test
,5. A 7-year-old presents with a 3-day history of perioral papules and vesicles, some with
crusting, and complaints of mouth pain. The most likely causative agent is:
A) Varicella-Zoster Virus
B) Herpes Simplex Virus Type 1
C) Coxsackievirus A16
D) Streptococcus pyogenes
6. In a patient with suspected bacterial meningitis, the diagnostic gold standard is:
A) Blood cultures
B) CT Head without contrast
C) Lumbar puncture with CSF analysis
D) PCR testing of serum
7. A 50-year-old female presents with fatigue, weight gain, cold intolerance, and dry skin. The
most specific initial laboratory test to order is:
A) Complete blood count (CBC)
B) Thyroid Stimulating Hormone (TSH)
C) Free T4
D) Comprehensive metabolic panel (CMP)
8. Which of the following is a diagnostic criterion for Major Depressive Disorder?
A) Symptoms must be present for at least 3 months
B) Presence of manic episodes
C) Depressed mood or anhedonia nearly every day for ≥2 weeks
D) Symptoms attributable to a substance or medical condition
9. The classic triad for diagnosing multiple sclerosis includes:
A) Tremor, ataxia, and incontinence
B) Nystagmus, intention tremor, and scanning speech
C) Hemiparesis, aphasia, and hemianopia
D) Vertigo, tinnitus, and hearing loss
10. A 2-month-old infant has a loud, holosystolic murmur heard best at the left lower sternal
border. The infant is feeding well and gaining weight appropriately. This is most characteristic
of:
A) Tetralogy of Fallot
B) Ventricular Septal Defect (VSD)
C) Patent Ductus Arteriosus (PDA)
D) Coarctation of the Aorta
,11. A 70-year-old male with diabetes and hypertension presents with acute onset of the
"worst headache of his life." The most urgent diagnostic test is:
A) ESR and CRP
B) Non-contrast CT of the head
C) Lumbar puncture
D) MRI Brain
12. To confirm a diagnosis of Iron Deficiency Anemia, the laboratory value that is most
decreased is:
A) Mean Corpuscular Volume (MCV)
B) Serum Ferritin
C) Total Iron Binding Capacity (TIBC)
D) Red Blood Cell Distribution Width (RDW)
13. A 45-year-old female with a history of rheumatoid arthritis presents with shortness of
breath and a dry cough. Chest X-ray shows bilateral interstitial infiltrates. The most likely
diagnosis is:
A) Pulmonary embolism
B) Community-acquired pneumonia
C) Tuberculosis
D) Interstitial lung disease secondary to RA
14. Which finding is most specific for bacterial conjunctivitis versus viral?
A) Mucopurulent discharge causing eyelids to stick together
B) Pre-auricular lymphadenopathy
C) Watery discharge
D) Concurrent upper respiratory symptoms
15. The gold standard for diagnosing gastroesophageal reflux disease (GERD) is:
A) Upper endoscopy with biopsy
B) Barium swallow
C) 24-hour pH monitoring
D) Empiric trial of a PPI
16. A patient with cirrhosis presents with altered mental status. On exam, they have asterixis.
This is most diagnostic of:
A) Hepatorenal syndrome
B) Hepatic encephalopathy
C) Spontaneous bacterial peritonitis
D) Variceal hemorrhage
, 17. A 30-year-old sexually active female has lower abdominal pain and cervical motion
tenderness. Pregnancy test is negative. The most appropriate next step is:
A) Schedule a pelvic ultrasound
B) Empiric treatment for PID with antibiotics
C) Refer for diagnostic laparoscopy
D) Prescribe NSAIDs and re-evaluate in 48 hours
18. In diagnosing osteoporosis in a postmenopausal female, the gold standard is:
A) Quantitative Ultrasound (QUS) of the heel
B) Dual-energy X-ray absorptiometry (DXA) scan
C) Serum calcium and vitamin D levels
D) Plain X-ray of the spine
19. Which ECG finding is pathognomonic for hypokalemia?
A) Peaked T waves
B) U waves
C) Prolonged PR interval
D) Short QT interval
20. A patient presents with recurrent, severe, unilateral throbbing headaches preceded by
visual aura. The diagnosis is most consistent with:
A) Tension-type headache
B) Cluster headache
C) Migraine with aura
D) Medication-overuse headache
21. The most sensitive test for detecting chronic kidney disease (CKD) is:
A) Serum Creatinine
B) Estimated Glomerular Filtration Rate (eGFR)
C) Blood Urea Nitrogen (BUN)
D) Urinalysis for protein
22. A 10-year-old with a sore throat has tonsillar exudates and tender anterior cervical
lymphadenopathy. A rapid strep test is negative. The next best step is:
A) Treat empirically with amoxicillin
B) Discharge with supportive care
C) Send a throat culture
D) Order Monospot test
2026 STUDY GUIDE | COMPLETE
CERTIFICATION REVIEW & PRACTICE
Domain 1: Assessment & Diagnosis (Questions 1-30)
1. A 24-year-old female presents with sudden onset of sharp, right-sided lower abdominal
pain radiating to the right labia. Urinalysis is negative for leukocytes and nitrites. The most
likely diagnosis is:
A) Pelvic inflammatory disease
B) Ruptured ovarian cyst
C) Ectopic pregnancy
D) Acute appendicitis
2. When assessing a child with suspected developmental dysplasia of the hip (DDH), which
clinical finding is most indicative in a 3-month-old?
A) Trendelenburg gait
B) Limb length discrepancy
C) Asymmetric gluteal or thigh folds
D) Pain with hip abduction
3. A 65-year-old male with a 50-pack-year smoking history presents with hemoptysis and a 10-
pound weight loss. The initial diagnostic test of choice is:
A) Sputum culture
B) Chest X-ray
C) Bronchoscopy
D) CT scan of the chest
4. The most sensitive physical exam finding for early detection of rotator cuff tendinopathy is:
A) Positive Neer's impingement sign
B) Painful arc sign (60-120 degrees)
C) Weakness in external rotation
D) Positive drop arm test
,5. A 7-year-old presents with a 3-day history of perioral papules and vesicles, some with
crusting, and complaints of mouth pain. The most likely causative agent is:
A) Varicella-Zoster Virus
B) Herpes Simplex Virus Type 1
C) Coxsackievirus A16
D) Streptococcus pyogenes
6. In a patient with suspected bacterial meningitis, the diagnostic gold standard is:
A) Blood cultures
B) CT Head without contrast
C) Lumbar puncture with CSF analysis
D) PCR testing of serum
7. A 50-year-old female presents with fatigue, weight gain, cold intolerance, and dry skin. The
most specific initial laboratory test to order is:
A) Complete blood count (CBC)
B) Thyroid Stimulating Hormone (TSH)
C) Free T4
D) Comprehensive metabolic panel (CMP)
8. Which of the following is a diagnostic criterion for Major Depressive Disorder?
A) Symptoms must be present for at least 3 months
B) Presence of manic episodes
C) Depressed mood or anhedonia nearly every day for ≥2 weeks
D) Symptoms attributable to a substance or medical condition
9. The classic triad for diagnosing multiple sclerosis includes:
A) Tremor, ataxia, and incontinence
B) Nystagmus, intention tremor, and scanning speech
C) Hemiparesis, aphasia, and hemianopia
D) Vertigo, tinnitus, and hearing loss
10. A 2-month-old infant has a loud, holosystolic murmur heard best at the left lower sternal
border. The infant is feeding well and gaining weight appropriately. This is most characteristic
of:
A) Tetralogy of Fallot
B) Ventricular Septal Defect (VSD)
C) Patent Ductus Arteriosus (PDA)
D) Coarctation of the Aorta
,11. A 70-year-old male with diabetes and hypertension presents with acute onset of the
"worst headache of his life." The most urgent diagnostic test is:
A) ESR and CRP
B) Non-contrast CT of the head
C) Lumbar puncture
D) MRI Brain
12. To confirm a diagnosis of Iron Deficiency Anemia, the laboratory value that is most
decreased is:
A) Mean Corpuscular Volume (MCV)
B) Serum Ferritin
C) Total Iron Binding Capacity (TIBC)
D) Red Blood Cell Distribution Width (RDW)
13. A 45-year-old female with a history of rheumatoid arthritis presents with shortness of
breath and a dry cough. Chest X-ray shows bilateral interstitial infiltrates. The most likely
diagnosis is:
A) Pulmonary embolism
B) Community-acquired pneumonia
C) Tuberculosis
D) Interstitial lung disease secondary to RA
14. Which finding is most specific for bacterial conjunctivitis versus viral?
A) Mucopurulent discharge causing eyelids to stick together
B) Pre-auricular lymphadenopathy
C) Watery discharge
D) Concurrent upper respiratory symptoms
15. The gold standard for diagnosing gastroesophageal reflux disease (GERD) is:
A) Upper endoscopy with biopsy
B) Barium swallow
C) 24-hour pH monitoring
D) Empiric trial of a PPI
16. A patient with cirrhosis presents with altered mental status. On exam, they have asterixis.
This is most diagnostic of:
A) Hepatorenal syndrome
B) Hepatic encephalopathy
C) Spontaneous bacterial peritonitis
D) Variceal hemorrhage
, 17. A 30-year-old sexually active female has lower abdominal pain and cervical motion
tenderness. Pregnancy test is negative. The most appropriate next step is:
A) Schedule a pelvic ultrasound
B) Empiric treatment for PID with antibiotics
C) Refer for diagnostic laparoscopy
D) Prescribe NSAIDs and re-evaluate in 48 hours
18. In diagnosing osteoporosis in a postmenopausal female, the gold standard is:
A) Quantitative Ultrasound (QUS) of the heel
B) Dual-energy X-ray absorptiometry (DXA) scan
C) Serum calcium and vitamin D levels
D) Plain X-ray of the spine
19. Which ECG finding is pathognomonic for hypokalemia?
A) Peaked T waves
B) U waves
C) Prolonged PR interval
D) Short QT interval
20. A patient presents with recurrent, severe, unilateral throbbing headaches preceded by
visual aura. The diagnosis is most consistent with:
A) Tension-type headache
B) Cluster headache
C) Migraine with aura
D) Medication-overuse headache
21. The most sensitive test for detecting chronic kidney disease (CKD) is:
A) Serum Creatinine
B) Estimated Glomerular Filtration Rate (eGFR)
C) Blood Urea Nitrogen (BUN)
D) Urinalysis for protein
22. A 10-year-old with a sore throat has tonsillar exudates and tender anterior cervical
lymphadenopathy. A rapid strep test is negative. The next best step is:
A) Treat empirically with amoxicillin
B) Discharge with supportive care
C) Send a throat culture
D) Order Monospot test
