FNP Exam Mastery Bundle:
Comprehensive Topic Test (2026
Edition)|| Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Student Name: _________________________
Total Questions: 85
Time Limit: 120 minutes
Passing Score: 75% (64 correct)
Instructions: Select the single best answer for each question. Rationales are
provided for self-study.
Domain 1: Health Assessment & Differential Diagnosis (Questions 1–20)
1. A 58-year-old male presents with a painless, raised, pearly-white nodule
with telangiectasias on his right cheek. Which diagnosis is most likely?
A. Seborrheic keratosis
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Melanoma
Rationale: Basal cell carcinoma (BCC) classically appears as a pearly,
telangiectatic papule or nodule. It is the most common skin cancer, rarely
metastatic.
2. A 45-year-old female reports fatigue, cold intolerance, and weight gain.
Exam shows bradycardia, coarse hair, and delayed relaxation of deep tendon
reflexes. The most specific diagnostic test is:
,A. Free T3
B. TSH
C. Thyroid ultrasound
D. Antithyroglobulin antibody
Rationale: TSH is the most sensitive and specific test for primary hypothyroidism.
Elevated TSH with low free T4 confirms the diagnosis.
3. Which heart sound is best heard with the bell of the stethoscope at the apex
with the patient in the left lateral decubitus position?
A. Aortic regurgitation diastolic murmur
B. S3 gallop
C. Pericardial friction rub
D. Mitral stenosis opening snap
Rationale: An S3 is a low-pitched sound best heard with the bell at the apex in left
lateral decubitus; it indicates reduced ventricular compliance or volume overload.
4. A 22-year-old college student presents with acute-onset severe sore throat,
fever, malaise, and posterior cervical lymphadenopathy. Rapid strep test is
negative. Next best step:
A. Prescribe amoxicillin empirically
B. Order Monospot test
C. Perform throat culture for Group A Strep
D. Prescribe analgesics and wait 5 days
Rationale: The presentation (posterior cervical lymphadenopathy, negative rapid
strep) suggests infectious mononucleosis (EBV). Monospot confirms diagnosis.
5. A 70-year-old with diabetes and hypertension reports lightheadedness when
standing. BP supine 140/85, standing 100/60 with dizziness. Most likely cause:
A. Hypovolemia
B. Autonomic neuropathy
C. Vasovagal syncope
D. Medication nonadherence
Rationale: Orthostatic hypotension in a diabetic patient is often due to autonomic
neuropathy affecting baroreflex responses. Medications may contribute, but
neuropathy is common after years of DM.
, 6. Palpation of the thyroid reveals a firm, fixed, solitary nodule in a 55-year-
old male. Which finding most increases suspicion for malignancy?
A. Hoarseness
B. Thyroid tenderness
C. Hyperthyroidism
D. Positive family history of goiter
Rationale: Hoarseness suggests recurrent laryngeal nerve invasion from thyroid
cancer (e.g., papillary or anaplastic). Malignancy risk factors: male sex, fixed
nodule, rapid growth, voice changes.
7. Which abdominal exam finding is most consistent with early appendicitis?
A. Rebound tenderness in LLQ
B. Periumbilical pain migrating to RLQ
C. Auscultation of bruit over epigastrium
D. Palpable pulsatile mass
Rationale: Classic appendicitis begins with vague periumbilical pain (visceral
afferent fibers T10) that later localizes to RLQ (parietal peritoneum irritation).
8. A 32-year-old pregnant patient at 28 weeks presents with round,
erythematous patches with an advancing scaly border and central clearing on
the trunk. Most likely:
A. Pityriasis rosea
B. Tinea corporis
C. Erythema migrans
D. Pruritic urticarial papules and plaques of pregnancy (PUPPP)
Rationale: Tinea corporis (ringworm) presents as annular plaques with central
clearing and active border. Pregnant women can develop it; KOH prep confirms.
9. A 16-year-old female has 3 months of intermittent right knee swelling
without trauma. No redness, fever, or night pain. Exam: effusion, full range of
motion. Most likely diagnosis:
A. Septic arthritis
B. Pauciarticular juvenile idiopathic arthritis
C. Osteosarcoma
D. Patellofemoral syndrome
Comprehensive Topic Test (2026
Edition)|| Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Student Name: _________________________
Total Questions: 85
Time Limit: 120 minutes
Passing Score: 75% (64 correct)
Instructions: Select the single best answer for each question. Rationales are
provided for self-study.
Domain 1: Health Assessment & Differential Diagnosis (Questions 1–20)
1. A 58-year-old male presents with a painless, raised, pearly-white nodule
with telangiectasias on his right cheek. Which diagnosis is most likely?
A. Seborrheic keratosis
B. Squamous cell carcinoma
C. Basal cell carcinoma
D. Melanoma
Rationale: Basal cell carcinoma (BCC) classically appears as a pearly,
telangiectatic papule or nodule. It is the most common skin cancer, rarely
metastatic.
2. A 45-year-old female reports fatigue, cold intolerance, and weight gain.
Exam shows bradycardia, coarse hair, and delayed relaxation of deep tendon
reflexes. The most specific diagnostic test is:
,A. Free T3
B. TSH
C. Thyroid ultrasound
D. Antithyroglobulin antibody
Rationale: TSH is the most sensitive and specific test for primary hypothyroidism.
Elevated TSH with low free T4 confirms the diagnosis.
3. Which heart sound is best heard with the bell of the stethoscope at the apex
with the patient in the left lateral decubitus position?
A. Aortic regurgitation diastolic murmur
B. S3 gallop
C. Pericardial friction rub
D. Mitral stenosis opening snap
Rationale: An S3 is a low-pitched sound best heard with the bell at the apex in left
lateral decubitus; it indicates reduced ventricular compliance or volume overload.
4. A 22-year-old college student presents with acute-onset severe sore throat,
fever, malaise, and posterior cervical lymphadenopathy. Rapid strep test is
negative. Next best step:
A. Prescribe amoxicillin empirically
B. Order Monospot test
C. Perform throat culture for Group A Strep
D. Prescribe analgesics and wait 5 days
Rationale: The presentation (posterior cervical lymphadenopathy, negative rapid
strep) suggests infectious mononucleosis (EBV). Monospot confirms diagnosis.
5. A 70-year-old with diabetes and hypertension reports lightheadedness when
standing. BP supine 140/85, standing 100/60 with dizziness. Most likely cause:
A. Hypovolemia
B. Autonomic neuropathy
C. Vasovagal syncope
D. Medication nonadherence
Rationale: Orthostatic hypotension in a diabetic patient is often due to autonomic
neuropathy affecting baroreflex responses. Medications may contribute, but
neuropathy is common after years of DM.
, 6. Palpation of the thyroid reveals a firm, fixed, solitary nodule in a 55-year-
old male. Which finding most increases suspicion for malignancy?
A. Hoarseness
B. Thyroid tenderness
C. Hyperthyroidism
D. Positive family history of goiter
Rationale: Hoarseness suggests recurrent laryngeal nerve invasion from thyroid
cancer (e.g., papillary or anaplastic). Malignancy risk factors: male sex, fixed
nodule, rapid growth, voice changes.
7. Which abdominal exam finding is most consistent with early appendicitis?
A. Rebound tenderness in LLQ
B. Periumbilical pain migrating to RLQ
C. Auscultation of bruit over epigastrium
D. Palpable pulsatile mass
Rationale: Classic appendicitis begins with vague periumbilical pain (visceral
afferent fibers T10) that later localizes to RLQ (parietal peritoneum irritation).
8. A 32-year-old pregnant patient at 28 weeks presents with round,
erythematous patches with an advancing scaly border and central clearing on
the trunk. Most likely:
A. Pityriasis rosea
B. Tinea corporis
C. Erythema migrans
D. Pruritic urticarial papules and plaques of pregnancy (PUPPP)
Rationale: Tinea corporis (ringworm) presents as annular plaques with central
clearing and active border. Pregnant women can develop it; KOH prep confirms.
9. A 16-year-old female has 3 months of intermittent right knee swelling
without trauma. No redness, fever, or night pain. Exam: effusion, full range of
motion. Most likely diagnosis:
A. Septic arthritis
B. Pauciarticular juvenile idiopathic arthritis
C. Osteosarcoma
D. Patellofemoral syndrome
