ANCC FNP Exam Prep 2026 | 600+ Questions Bank with
Rationales | Pass Guarantee
,Cardiovascular & Respiratory
Question 1:
A 68-year-old patient with a history of hypertension and myocardial infarction 6
years ago presents with mild shortness of breath. He takes quinapril, aspirin,
metoprolol, and a statin daily. What symptom is NOT indicative of a heart failure
exacerbation?
A. Fatigue
B. Headache
C. Orthopnea
D. Cough
Answer: B. Headache
Rationale: Fatigue is a common symptom in cardiac patients that can represent
worsening heart failure. Orthopnea and cough (especially nocturnal) are classic
heart failure symptoms. Headache is not typically associated with heart failure
exacerbation and would suggest another etiology such as hypertension or
medication side effects .
Question 2:
To evaluate for heart failure in a patient with lower extremity swelling, which
diagnostic test should the nurse practitioner order?
A. Ankle-brachial index
B. Brain natriuretic peptide (BNP) test
C. D-dimer assay
D. Spirometry study
Answer: B. Brain natriuretic peptide (BNP) test
Rationale: BNP is a hormone involved in regulating blood pressure and fluid
volume. When BNP level is 80 pg/mL or greater, sensitivity and specificity are 98%
and 92% respectively, favoring a heart failure diagnosis. BNP levels less than 80
pg/mL strongly suggest heart failure is not present. Other conditions may elevate
BNP including renal failure and thoracic surgery, so careful patient assessment
remains essential .
,Question 3:
A 40-year-old African American patient has BP readings of 175/100 and 170/102.
What is the reasonable plan of care?
A. Start low-dose thiazide diuretic
B. Start an ACE inhibitor twice daily
C. Initiate low-dose HCTZ and candesartan
D. Initiate amlodipine, beta blocker, or ACE inhibitor alone
Answer: C. Initiate low-dose HCTZ and candesartan
Rationale: This patient has Stage 2 hypertension based on JNC VII classification.
Stage 2 hypertension should be treated initially with two medications plus
lifestyle modifications. A single medication is unlikely to decrease blood pressure
to normal range. The combination of a thiazide diuretic and an ARB (candesartan)
is appropriate initial therapy .
Infectious Disease & Dermatology
Question 4:
A middle-age female patient presents with recurrence of mild hidradenitis
suppurativa after topical therapies failed. Which first-line treatment is
recommended?
A. Clindamycin monotherapy
B. Oral tetracycline for 12 weeks
C. Intralesional steroids
D. Adalimumab (Humira)
Answer: B. Oral tetracycline for 12 weeks
Rationale: Twelve weeks of oral tetracycline (Sumycin) is the recommended first-
line treatment for hidradenitis suppurativa. This disorder affects terminal
follicular epithelium in apocrine gland-bearing skin and is characterized by
comedone-like follicular occlusion, chronic inflammation, and progressive
scarring. For patients not responding to doxycycline, next step is combination
clindamycin and rifampin for 10-12 weeks. Dermatology consultation should be
considered for moderate to severe cases .
Question 5:
A 30-year-old female patient has a two-week history of nausea, vomiting,
, abdominal pain, and a long-term history of multiple sexual partners. Physical
examination reveals abdominal tenderness with icteric sclerae and skin. Which
laboratory test confirms active hepatitis B?
A. Hepatitis B antibody
B. Enzyme-linked immunosorbent assay
C. Immune globulin G
D. Hepatitis B surface antigen
Answer: D. Hepatitis B surface antigen
Rationale: Hepatitis B surface antigen (HBsAg) indicates active infection. It is the
earliest marker of acute hepatitis B and persists in chronic infection. Antibody
tests indicate previous infection or vaccination. The presence of HBsAg confirms
the patient is currently infected and potentially infectious to others .
Neurological & Sensory
Question 6:
You have a 35-year-old female patient complaining of wrist pain. She works as an
administrative assistant with significant computer work. When you tap at the
volar surface of the wrist, you are performing which test?
A. Phalen's test
B. Tinel's sign
C. Finkelstein's test
D. Allen test
Answer: B. Tinel's sign
Rationale: Tinel's sign is performed by tapping over the median nerve at the volar
wrist surface. A positive test produces paresthesia in the median nerve
distribution, indicating nerve irritation or regeneration. Phalen's test involves
wrist flexion, Finkelstein's tests for de Quervain's tenosynovitis, and Allen test
evaluates arterial blood flow to the hand .
Question 7:
The nurse practitioner sees an older adult patient reporting hearing loss and
fullness in the right ear, suspecting conductive hearing loss. Which could
contribute to this?
A. Age-related hearing loss (presbycusis)
Rationales | Pass Guarantee
,Cardiovascular & Respiratory
Question 1:
A 68-year-old patient with a history of hypertension and myocardial infarction 6
years ago presents with mild shortness of breath. He takes quinapril, aspirin,
metoprolol, and a statin daily. What symptom is NOT indicative of a heart failure
exacerbation?
A. Fatigue
B. Headache
C. Orthopnea
D. Cough
Answer: B. Headache
Rationale: Fatigue is a common symptom in cardiac patients that can represent
worsening heart failure. Orthopnea and cough (especially nocturnal) are classic
heart failure symptoms. Headache is not typically associated with heart failure
exacerbation and would suggest another etiology such as hypertension or
medication side effects .
Question 2:
To evaluate for heart failure in a patient with lower extremity swelling, which
diagnostic test should the nurse practitioner order?
A. Ankle-brachial index
B. Brain natriuretic peptide (BNP) test
C. D-dimer assay
D. Spirometry study
Answer: B. Brain natriuretic peptide (BNP) test
Rationale: BNP is a hormone involved in regulating blood pressure and fluid
volume. When BNP level is 80 pg/mL or greater, sensitivity and specificity are 98%
and 92% respectively, favoring a heart failure diagnosis. BNP levels less than 80
pg/mL strongly suggest heart failure is not present. Other conditions may elevate
BNP including renal failure and thoracic surgery, so careful patient assessment
remains essential .
,Question 3:
A 40-year-old African American patient has BP readings of 175/100 and 170/102.
What is the reasonable plan of care?
A. Start low-dose thiazide diuretic
B. Start an ACE inhibitor twice daily
C. Initiate low-dose HCTZ and candesartan
D. Initiate amlodipine, beta blocker, or ACE inhibitor alone
Answer: C. Initiate low-dose HCTZ and candesartan
Rationale: This patient has Stage 2 hypertension based on JNC VII classification.
Stage 2 hypertension should be treated initially with two medications plus
lifestyle modifications. A single medication is unlikely to decrease blood pressure
to normal range. The combination of a thiazide diuretic and an ARB (candesartan)
is appropriate initial therapy .
Infectious Disease & Dermatology
Question 4:
A middle-age female patient presents with recurrence of mild hidradenitis
suppurativa after topical therapies failed. Which first-line treatment is
recommended?
A. Clindamycin monotherapy
B. Oral tetracycline for 12 weeks
C. Intralesional steroids
D. Adalimumab (Humira)
Answer: B. Oral tetracycline for 12 weeks
Rationale: Twelve weeks of oral tetracycline (Sumycin) is the recommended first-
line treatment for hidradenitis suppurativa. This disorder affects terminal
follicular epithelium in apocrine gland-bearing skin and is characterized by
comedone-like follicular occlusion, chronic inflammation, and progressive
scarring. For patients not responding to doxycycline, next step is combination
clindamycin and rifampin for 10-12 weeks. Dermatology consultation should be
considered for moderate to severe cases .
Question 5:
A 30-year-old female patient has a two-week history of nausea, vomiting,
, abdominal pain, and a long-term history of multiple sexual partners. Physical
examination reveals abdominal tenderness with icteric sclerae and skin. Which
laboratory test confirms active hepatitis B?
A. Hepatitis B antibody
B. Enzyme-linked immunosorbent assay
C. Immune globulin G
D. Hepatitis B surface antigen
Answer: D. Hepatitis B surface antigen
Rationale: Hepatitis B surface antigen (HBsAg) indicates active infection. It is the
earliest marker of acute hepatitis B and persists in chronic infection. Antibody
tests indicate previous infection or vaccination. The presence of HBsAg confirms
the patient is currently infected and potentially infectious to others .
Neurological & Sensory
Question 6:
You have a 35-year-old female patient complaining of wrist pain. She works as an
administrative assistant with significant computer work. When you tap at the
volar surface of the wrist, you are performing which test?
A. Phalen's test
B. Tinel's sign
C. Finkelstein's test
D. Allen test
Answer: B. Tinel's sign
Rationale: Tinel's sign is performed by tapping over the median nerve at the volar
wrist surface. A positive test produces paresthesia in the median nerve
distribution, indicating nerve irritation or regeneration. Phalen's test involves
wrist flexion, Finkelstein's tests for de Quervain's tenosynovitis, and Allen test
evaluates arterial blood flow to the hand .
Question 7:
The nurse practitioner sees an older adult patient reporting hearing loss and
fullness in the right ear, suspecting conductive hearing loss. Which could
contribute to this?
A. Age-related hearing loss (presbycusis)
