FULL EXAM
high-yield questions designed to mirror
the latest ANCC blueprint (2025).
Pass on the first attempt.
Features include:
**Comprehensive Content Coverage**
**Detailed Expert Rationales**
Multiple choice questions (MCQs) with single best
answer.
**Updates & Evidence-Based Content**
**Accessibility and Convenience**
,### 1. A 9-month-old female infant presents to the clinic for a routine well-
child visit. Six months ago, she was prescribed omeprazole (Prilosec) due
to gastroesophageal reflux and poor weight gain. At the present visit, her
parents report that she is drinking approximately 24 ounces of formula daily
and eating some solid foods. They report no current issues with reflux.
While reviewing the patient's growth chart, the nurse practitioner notes
steady and appropriate weight gain over the past 6 months. Which of the
following is the next best step in management?
A. Continue omeprazole (Prilosec) as prescribed
B. Decrease the dose of omeprazole (Prilosec) and reevaluate in 3 weeks
C. Discontinue omeprazole (Prilosec) and prescribe metoclopramide
(Reglan)
D. Discontinue omeprazole (Prilosec) and reevaluate in 3 months
**Correct Answer:** B. Decrease the dose of omeprazole (Prilosec) and
reevaluate in 3 weeks
**Rationale:**
In infants with gastroesophageal reflux disease (GERD), once symptoms
have resolved and appropriate weight gain is achieved, gradual weaning or
dose reduction of acid suppression therapy is recommended to minimize
risks associated with prolonged use of PPIs (e.g., increased infection risk,
nutrient malabsorption). Continuing full-dose therapy unnecessarily is not
advised. Metoclopramide is no longer recommended for routine use due to
limited efficacy and safety concerns. Monitoring for recurrence with a short
follow-up is appropriate before complete discontinuation.
---
,### 2. A 70-year-old man presents to the clinic for a routine checkup. He
has a history of smoking one pack of cigarettes per day for the past 40
years. He reports no discomfort today. Which of the following is the most
appropriate recommendation regarding abdominal aortic aneurysm (AAA)
screening for this patient?
A. Advise him to quit smoking but defer screening since he is asymptomatic
B. No screening necessary, as he is beyond the recommended age
C. Order an abdominal ultrasound for screening today
D. Perform a physical examination of the abdomen to assess for a pulsatile
mass
**Correct Answer:** C. Order an abdominal ultrasound for screening today
**Rationale:**
The USPSTF recommends one-time screening for AAA with abdominal
ultrasound in men aged 65-75 who have ever smoked. Given his heavy
smoking history and age, this is an evidence-based, preventative
recommendation. Physical examination alone lacks sensitivity and
specificity to detect AAA. Delaying or deferring screening ignores guideline-
based opportunities to detect asymptomatic aneurysms and intervene
early.
---
### 3. Which of the following is the most important first step when
evaluating a 15-year-old girl with a 4-month history of secondary
amenorrhea?
A. Checking weight
, B. Measuring FSH
C. Measuring human chorionic gonadotropin levels
D. Measuring TSH
**Correct Answer:** C. Measuring human chorionic gonadotropin levels
**Rationale:**
Pregnancy must be ruled out first in any adolescent or woman of
reproductive age presenting with secondary amenorrhea, as it is the most
common cause. A qualitative hCG test is fast, noninvasive, and cost-
effective. Further hormonal workup (FSH, TSH) may be considered only if
pregnancy is excluded.
---
### 4. While reading a journal article, a nurse practitioner comes across a
section discussing the efficacy of a new drug. The article mentions a P
value of .03 in relation to the drug's effect. Which of the following best
defines what a P value is?
A. A measure of the relationship between two variables
B. The odds of an event in one group versus another
C. The percentage of patients who responded to the drug
D. The probability that observed results occurred by chance
**Correct Answer:** D. The probability that observed results occurred by
chance