PSI FNP ACTUAL CERTIFICATION TEST
2026 QUESTIONS WITH SOLUTIONS
GRADED A+
● An older adult male presents with complaints of sharp flank and back
pain. The patient has difficulty answering questions because of severity
of pain. Blood pressure is 90/60 mmHg. The patient has a 20-pack-year
smoking history. Abdomen is distended upon palpitation. Which
diagnosis is most likely?
Congestive heart failure
Infective endocarditis
Dissecting abdominal aortic aneurysm
Acute myocardial infarction. Answer: Dissecting abdominal aortic
aneurysm.
Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp,
excruciating pain located in the abdomen, back, or flank area,
accompanied by a distended abdomen and hypotension. Older male
adults with a smoking history and hypertension are at higher risk.
Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and
swollen feet and ankles. Patients with infective endocarditis present with
fever, chills, and malaise, along with the presence of a new murmur.
Acute myocardial infarction generally presents with a gradual onset of
intense and heavy chest discomfort that feels like a squeezing, tightness,
and heavy pressure in the chest.
,● Mrs. Harris a 67-year-old woman who is in the early stages of
Alzheimer disease. She suffers from mild dementia. In this type of
Alzheimer dementia which of the following would you use as the
mainstay treatment?
Vitamin E 1000 IU twice daily
cholinesterase inhibitors
NSAIDS
Selgiline 5 mg twice daily. Answer: cholinesterase inhibitors
The mainstay treatment for mild to moderate stage Alzheimer-type
dementia is the use of cholinesterase inhibitors. These include donepezil
(Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They
have a clear, although minor and time-limited benefit.
● When listening to your 86-year-old patient's heart murmur, you note
that it is so loud that it can be heard with the stethoscope completely off
the chest. How do you grade the murmur?
IV/VI.
I/VI.
V/VI.
VI/VI.. Answer: VI/VI.
,Grading heart murmurs follows this system: I/VI: Heart murmur makes
faint sound and may not be heard when patient changes position. II/VI:
Heart murmur is quiet but can be heard as soon as the stethoscope is
placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI:
Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart
murmur is very loud and can be heard with the stethoscope partially off
the chest. VI/VI: Heart murmur is very loud and can be heard with the
stethoscope completely off the patient's chest.
● Which of the following persons would not be a candidate for the
antipneumococcal vaccine?
a 65-year-old healthy female living with her family
a 35-year-old patient with HIV infection
a 58-year-old male resident of a nursing home
a 55-year-old female living alone. Answer: a 55-year-old female living
alone
The antipneumococcal vaccine is not indicated for an otherwise healthy
person who is under the age of 65 unless there are other health factors
involved. Living alone has no bearing on the need for the vaccine. The
vaccine is indicated for persons with HIV infection, persons living in
nursing homes, and all adults 65 years or older regardless of health
status.
, ● Which of the following diseases is more likely to cause chronic pelvic
pain rather than acute pelvic pain?
ectopic pregnancy
PID
ovarian cysts
interstitial cystitis. Answer: interstitial cystitisInterstitial cystitis is more
likely to cause chronic pelvic pain rather than acute pelvic pain as in the
other choices. Other causes of chronic pelvic pain include:
endometriosis, leiomyomas, and malignancy.
● You have a 58-year-old male patient with possible pancreatic cancer.
You will not order an abdominal ultrasound for diagnosis because it is
limited by which of the following?
previous history of pancreatic disease
patient's age
the presence of intestinal gas
size of tumor. Answer: the presence of intestinal gas
The usefulness of abdominal ultrasound is limited by the presence of
intestinal gas. Abdominal CT scan is more helpful in identifying
pancreatic cancer.
2026 QUESTIONS WITH SOLUTIONS
GRADED A+
● An older adult male presents with complaints of sharp flank and back
pain. The patient has difficulty answering questions because of severity
of pain. Blood pressure is 90/60 mmHg. The patient has a 20-pack-year
smoking history. Abdomen is distended upon palpitation. Which
diagnosis is most likely?
Congestive heart failure
Infective endocarditis
Dissecting abdominal aortic aneurysm
Acute myocardial infarction. Answer: Dissecting abdominal aortic
aneurysm.
Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp,
excruciating pain located in the abdomen, back, or flank area,
accompanied by a distended abdomen and hypotension. Older male
adults with a smoking history and hypertension are at higher risk.
Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and
swollen feet and ankles. Patients with infective endocarditis present with
fever, chills, and malaise, along with the presence of a new murmur.
Acute myocardial infarction generally presents with a gradual onset of
intense and heavy chest discomfort that feels like a squeezing, tightness,
and heavy pressure in the chest.
,● Mrs. Harris a 67-year-old woman who is in the early stages of
Alzheimer disease. She suffers from mild dementia. In this type of
Alzheimer dementia which of the following would you use as the
mainstay treatment?
Vitamin E 1000 IU twice daily
cholinesterase inhibitors
NSAIDS
Selgiline 5 mg twice daily. Answer: cholinesterase inhibitors
The mainstay treatment for mild to moderate stage Alzheimer-type
dementia is the use of cholinesterase inhibitors. These include donepezil
(Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They
have a clear, although minor and time-limited benefit.
● When listening to your 86-year-old patient's heart murmur, you note
that it is so loud that it can be heard with the stethoscope completely off
the chest. How do you grade the murmur?
IV/VI.
I/VI.
V/VI.
VI/VI.. Answer: VI/VI.
,Grading heart murmurs follows this system: I/VI: Heart murmur makes
faint sound and may not be heard when patient changes position. II/VI:
Heart murmur is quiet but can be heard as soon as the stethoscope is
placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI:
Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart
murmur is very loud and can be heard with the stethoscope partially off
the chest. VI/VI: Heart murmur is very loud and can be heard with the
stethoscope completely off the patient's chest.
● Which of the following persons would not be a candidate for the
antipneumococcal vaccine?
a 65-year-old healthy female living with her family
a 35-year-old patient with HIV infection
a 58-year-old male resident of a nursing home
a 55-year-old female living alone. Answer: a 55-year-old female living
alone
The antipneumococcal vaccine is not indicated for an otherwise healthy
person who is under the age of 65 unless there are other health factors
involved. Living alone has no bearing on the need for the vaccine. The
vaccine is indicated for persons with HIV infection, persons living in
nursing homes, and all adults 65 years or older regardless of health
status.
, ● Which of the following diseases is more likely to cause chronic pelvic
pain rather than acute pelvic pain?
ectopic pregnancy
PID
ovarian cysts
interstitial cystitis. Answer: interstitial cystitisInterstitial cystitis is more
likely to cause chronic pelvic pain rather than acute pelvic pain as in the
other choices. Other causes of chronic pelvic pain include:
endometriosis, leiomyomas, and malignancy.
● You have a 58-year-old male patient with possible pancreatic cancer.
You will not order an abdominal ultrasound for diagnosis because it is
limited by which of the following?
previous history of pancreatic disease
patient's age
the presence of intestinal gas
size of tumor. Answer: the presence of intestinal gas
The usefulness of abdominal ultrasound is limited by the presence of
intestinal gas. Abdominal CT scan is more helpful in identifying
pancreatic cancer.
