NR-708 NR708 Comprehensive Practice Exam
2025-2026: 100 Questions with Detailed Rationales
for Advanced Nurse Practitioner Mastery
1. A 35-year-old female presents with fatigue, pallor, and
shortness of breath. Lab results show hemoglobin 8 g/dL and
MCV 70 fL. The most likely diagnosis is:
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Aplastic anemia
D. Sickle cell anemia
Rationale: Low MCV indicates microcytic anemia, and iron
deficiency is the most common cause.
2. A 50-year-old male with a history of hypertension presents
with sudden-onset severe headache and vomiting. The most
important initial diagnostic test is:
A. MRI brain
B. CT scan without contrast
C. Lumbar puncture
D. EEG
Rationale: Sudden severe headache raises concern for
subarachnoid hemorrhage; CT without contrast is the first-line
test.
,3. A patient presents with a 2-week history of fever, sore
throat, and tender cervical lymphadenopathy. Rapid strep test
is negative. Next best step:
A. Start antibiotics empirically
B. Throat culture
C. Order EBV serology
D. Symptomatic care only
Rationale: A negative rapid strep test should be confirmed with
a throat culture before antibiotics.
4. In performing cardiac auscultation, a midsystolic click
followed by a late systolic murmur at the apex most likely
indicates:
A. Aortic stenosis
B. Mitral valve prolapse
C. Tricuspid regurgitation
D. Pulmonic stenosis
Rationale: Classic presentation of mitral valve prolapse is a
midsystolic click with late systolic murmur.
5. A patient presents with acute onset of unilateral facial
droop, inability to close the eye, and drooling. This
presentation suggests:
A. Stroke
B. Bell’s palsy
C. Myasthenia gravis
,D. Trigeminal neuralgia
Rationale: Peripheral facial nerve palsy affects both upper and
lower face; stroke usually spares the forehead.
6. Which of the following is the most sensitive test for
diagnosing early type 2 diabetes?
A. Random glucose
B. Fasting glucose
C. HbA1c
D. Oral glucose tolerance test
Rationale: HbA1c reflects average glucose over 2-3 months and
is highly sensitive for diagnosis.
7. On abdominal examination, a patient has dullness in the
flanks and shifting dullness. The most likely finding is:
A. Bowel obstruction
B. Ascites
C. Hepatomegaly
D. Splenomegaly
Rationale: Shifting dullness is a classic sign of ascites due to
fluid in the peritoneal cavity.
8. A 60-year-old male with a history of smoking presents with
hematuria. The next best step is:
A. Urinalysis only
, B. Referral for cystoscopy
C. Kidney ultrasound
D. PSA testing
Rationale: Painless hematuria in adults, especially smokers,
raises concern for bladder cancer; cystoscopy is indicated.
9. A 28-year-old female presents with polyuria, polydipsia,
and nocturia. Lab results: fasting glucose 185 mg/dL. Best next
step:
A. Start insulin
B. Repeat fasting glucose or HbA1c
C. Order 24-hour urine collection
D. Order renal ultrasound
Rationale: Diagnosis of diabetes requires confirmatory testing
on a separate day unless symptoms are classic.
10. During a neurological exam, a patient has decreased
vibration sense and proprioception in the lower extremities.
The most likely deficiency is:
A. Vitamin C
B. Vitamin D
C. Vitamin B12
D. Folate
Rationale: B12 deficiency affects posterior column function,
leading to loss of vibration and proprioception.
2025-2026: 100 Questions with Detailed Rationales
for Advanced Nurse Practitioner Mastery
1. A 35-year-old female presents with fatigue, pallor, and
shortness of breath. Lab results show hemoglobin 8 g/dL and
MCV 70 fL. The most likely diagnosis is:
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Aplastic anemia
D. Sickle cell anemia
Rationale: Low MCV indicates microcytic anemia, and iron
deficiency is the most common cause.
2. A 50-year-old male with a history of hypertension presents
with sudden-onset severe headache and vomiting. The most
important initial diagnostic test is:
A. MRI brain
B. CT scan without contrast
C. Lumbar puncture
D. EEG
Rationale: Sudden severe headache raises concern for
subarachnoid hemorrhage; CT without contrast is the first-line
test.
,3. A patient presents with a 2-week history of fever, sore
throat, and tender cervical lymphadenopathy. Rapid strep test
is negative. Next best step:
A. Start antibiotics empirically
B. Throat culture
C. Order EBV serology
D. Symptomatic care only
Rationale: A negative rapid strep test should be confirmed with
a throat culture before antibiotics.
4. In performing cardiac auscultation, a midsystolic click
followed by a late systolic murmur at the apex most likely
indicates:
A. Aortic stenosis
B. Mitral valve prolapse
C. Tricuspid regurgitation
D. Pulmonic stenosis
Rationale: Classic presentation of mitral valve prolapse is a
midsystolic click with late systolic murmur.
5. A patient presents with acute onset of unilateral facial
droop, inability to close the eye, and drooling. This
presentation suggests:
A. Stroke
B. Bell’s palsy
C. Myasthenia gravis
,D. Trigeminal neuralgia
Rationale: Peripheral facial nerve palsy affects both upper and
lower face; stroke usually spares the forehead.
6. Which of the following is the most sensitive test for
diagnosing early type 2 diabetes?
A. Random glucose
B. Fasting glucose
C. HbA1c
D. Oral glucose tolerance test
Rationale: HbA1c reflects average glucose over 2-3 months and
is highly sensitive for diagnosis.
7. On abdominal examination, a patient has dullness in the
flanks and shifting dullness. The most likely finding is:
A. Bowel obstruction
B. Ascites
C. Hepatomegaly
D. Splenomegaly
Rationale: Shifting dullness is a classic sign of ascites due to
fluid in the peritoneal cavity.
8. A 60-year-old male with a history of smoking presents with
hematuria. The next best step is:
A. Urinalysis only
, B. Referral for cystoscopy
C. Kidney ultrasound
D. PSA testing
Rationale: Painless hematuria in adults, especially smokers,
raises concern for bladder cancer; cystoscopy is indicated.
9. A 28-year-old female presents with polyuria, polydipsia,
and nocturia. Lab results: fasting glucose 185 mg/dL. Best next
step:
A. Start insulin
B. Repeat fasting glucose or HbA1c
C. Order 24-hour urine collection
D. Order renal ultrasound
Rationale: Diagnosis of diabetes requires confirmatory testing
on a separate day unless symptoms are classic.
10. During a neurological exam, a patient has decreased
vibration sense and proprioception in the lower extremities.
The most likely deficiency is:
A. Vitamin C
B. Vitamin D
C. Vitamin B12
D. Folate
Rationale: B12 deficiency affects posterior column function,
leading to loss of vibration and proprioception.
