ANCC FNP-BCFree Family Nurse Practitioner practice test

Correct answer: B. With the patient supine, place your hand on his right knee and instruct him to flex that knee upward against resistance; alternatively, position him on his left side and have him extend the right leg at the hip.

This clinical picture is consistent with acute appendicitis. The psoas sign is the key maneuver: asking the patient to raise his right knee against resistance (supine) or extend his right leg at the hip while lying on the left side. Resultant pain constitutes a positive sign, indicating psoas muscle inflammation and peritoneal irritation strongly suggestive of appendicitis. Option A describes hepatic percussion technique. Option C is general abdominal palpation, important but not the most specific maneuver here. Option D tests for ascites via shifting dullness.

Correct answer: A. With the patient supine, you stand at her right side, hold her heel, flex both her knee and hip, place your other hand with fingers on the medial knee, loosen the joint by rotating the leg internally and externally, then apply external rotation with valgus stress before slowly extending the knee.

The McMurray test evaluates the medial or lateral meniscus; a palpable or audible click with knee pain during the maneuver suggests a tear. Option B describes Lachman's test for ACL integrity. Option C is the Apley grind test, also used for meniscal pathology. Option D is Ege's test, another meniscal assessment performed in the standing position.

Correct answer: A. Recent chlamydial urethritis infection

Reactive arthritis (ReA), previously called Reiter's syndrome, is an acute, non-purulent arthritis that arises after a remote bacterial infection, not a direct joint infection. It predominantly affects young adult males and typically develops 2–4 weeks after urogenital infections such as Chlamydia trachomatis or Ureaplasma urealyticum, or after enteric infections with Shigella, Salmonella, or Campylobacter. Trauma, malignancy, and orthopedic surgery are not triggers for ReA.

Correct answer: B. "The melasma may resolve spontaneously or it may persist. Using a broad-spectrum sunscreen consistently is the most important step to prevent further darkening."

Melasma results from estrogen-driven melanocyte stimulation and can occur with any OCP formulation or during pregnancy; it is not exclusive to any hormone combination. The condition may fade spontaneously after OCP discontinuation or may leave permanent pigmentation. Diligent sunscreen use (the AAD recommends zinc oxide, titanium dioxide, or iron oxide-containing products) is the cornerstone of management to prevent worsening. Option A incorrectly calls melasma universally permanent. Option C is inaccurate because all OCP formulations carry this risk. Option D misidentifies the mechanism as requiring both hormones in combination.

Correct answer: C. The left testicle is the side most commonly affected

Testicular torsion is a urologic emergency in which twisting of the testis and spermatic cord along a vertical axis causes ischemia. The left testicle is most frequently involved. Doppler ultrasound characteristically reveals decreased, not increased, blood flow due to vascular occlusion from torsion. PSA elevation and pyuria are not findings associated with testicular torsion; they suggest prostate pathology or urinary tract infection, respectively.

Correct answer: A. Anal cancer screening with an anal Pap smear

Genital warts are caused by low-risk HPV strains (6 and 11), but MSM are at significantly elevated risk for acquiring high-risk HPV strains associated with anal carcinoma. Although formal screening guidelines for anal Pap smears are not universally established, the success of cervical Pap smears in cancer prevention supports their use in high-risk populations such as this patient. Microscopic examination of wart scrapings does not screen for high-risk HPV strains. PCR is the preferred test for genital herpes, not HPV. A urethral wet prep is indicated when purulent penile discharge suggests gonorrhea or trichomoniasis.

Correct answer: C. Fluorescent treponemal antibody absorption (FTA-ABS) test

Palmoplantar rash with lymphadenopathy, systemic symptoms, and low-grade fever are hallmarks of secondary syphilis. The FTA-ABS test is confirmatory for antibodies against Treponema pallidum and is reliable after 3–4 weeks post-exposure. Screening tests (RPR, VDRL, rapid immunochromatographic test) should precede confirmatory testing. PCR is used for genital herpes diagnosis. Viral culture scraping is associated with HPV workup. Urethral culture targets gonorrhea.

Correct answer: B. Blumberg's sign

Rebound tenderness — pain that intensifies upon rapid release of deep abdominal palpation — at McBurney's point is described as a positive Blumberg's sign, indicating likely peritoneal irritation and supporting the diagnosis of acute appendicitis. The psoas sign involves passive thigh extension or active thigh flexion against resistance while the patient lies on one side. The obturator sign uses flexion with internal rotation of the hip. Homans' sign was historically associated with DVT but has been shown to lack clinical significance.

Correct answer: A. The patient has experienced these hand symptoms for over 3 years, with no associated systemic or autoimmune illness.

Primary (idiopathic) Raynaud's phenomenon requires recurrent vasospastic episodes persisting for more than 3 years without evidence of an underlying disorder. It disproportionately affects women ages 15–45 years (8:1 female predominance) and commonly involves the hands, feet, and nipples. Nipple Raynaud's frequently drives new mothers to seek evaluation. Option D describes secondary Raynaud's, which is associated with autoimmune conditions (e.g., scleroderma). Option C (repetitive digit motion) is a contributing factor in secondary Raynaud's. Pre-eclampsia has no established link to Raynaud's.

Correct answer: D. Rapid adrenocorticotropic hormone (ACTH) stimulation test

The gold standard for diagnosing primary adrenocortical insufficiency (Addison's disease) is the rapid ACTH stimulation test, which assesses the adrenal cortex's capacity to produce cortisol in response to ACTH. Serum potassium, sodium, and cortisol levels are supporting tests but not definitive on their own. Fasting glucose and calcium are not diagnostic for Addison's. Thyroid studies address a different autoimmune axis; MRI may be ordered after diagnosis to investigate secondary causes. Abdominal CT can evaluate adrenal gland size post-diagnosis but is not the confirmatory test.