ANCC FNP Board Exam Study Guide Part 2 EXAM 60
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
COMPREHENSIVE ANCC FNP BOARD EXAMINATION STUDY GUIDE PART 2
Clinical Presentations, Differential Diagnoses, and Treatment Guidelines
Total Questions: 60
Time Allowed: 120 minutes
SECTION 1: PEDIATRIC CONDITIONS
Questions 1-12
Question 1
A 2-week-old infant presents with yellow purulent drainage from the right eye. The mother reports the
eye has been swollen and draining for 2 days. What is the most likely causative organism?
A. Haemophilus influenzae
B. Neisseria gonorrhoeae
C. Chlamydia trachomatis
D. Streptococcus pneumoniae
Correct Answer-: C. Chlamydia trachomatis
Rationale: Chlamydial ophthalmia neonatorum typically presents 5-14 days after birth with mild to
moderate purulent discharge. Gonococcal ophthalmia presents earlier (1-7 days) with more severe,
copious purulent discharge and is a medical emergency. The timing (2 weeks) and yellow drainage are
classic for chlamydial infection.
• A, D: Bacterial conjunctivitis from these organisms can occur but are less common in this age
group
, • B: Gonococcal infection presents earlier and more severely
Question 2
A 5-week-old male infant, first-born, presents with projectile, non-bilious vomiting immediately after
feeding. The parents report the vomiting has been getting worse over the past week. On examination,
you palpate an olive-like mass in the epigastrium after the infant vomits. What is the most likely
diagnosis?
A. Gastroesophageal reflux disease (GERD)
B. Pyloric stenosis
C. Milk protein intolerance
D. Intestinal malrotation
Correct Answer-: B. Pyloric stenosis
Rationale: Pyloric stenosis classically presents in first-born males at 4-6 weeks of age with projectile,
non-bilious vomiting. The olive-like mass is the hypertrophied pylorus, best palpated immediately after
vomiting when the stomach is empty. Diagnosis is confirmed by ultrasound. Management is surgical
correction (laparoscopic pyloromyotomy).
• A: GERD presents with regurgitation, not projectile vomiting
• C: Milk protein intolerance presents with diarrhea, bloody stools, failure to thrive
• D: Intestinal malrotation presents with bilious vomiting
Question 3
A 4-year-old child presents with fever, malaise, conjunctivitis, coryza, and cough. On examination, you
note small white-blue elevations on the buccal mucosa resembling grains of sand. What is the most
likely diagnosis?
A. Rubella
B. Rubeola (measles)
C. Roseola
D. Scarlet fever
Correct Answer-: B. Rubeola (measles)
Rationale: Rubeola (measles) presents with fever, malaise, and the "3 Cs": conjunctivitis, coryza, and
cough. Koplik spots (1-3mm white/blue/gray elevations on buccal mucosa) are pathognomonic and
precede the maculopapular rash that starts on the head/neck and spreads centrifugally.
, • A: Rubella presents with milder symptoms and post-auricular lymphadenopathy
• C: Roseola presents with high fever followed by rash after fever breaks
• D: Scarlet fever presents with sandpaper rash and strawberry tongue
Question 4
A 5-year-old child who was fully potty trained at age 3 has been soiling his underwear for the past 3
months. The parents are frustrated and concerned. What is the most likely underlying cause?
A. Sexual abuse
B. Constipation (80% of cases)
C. Psychological stress
D. Anatomical abnormality
Correct Answer-: B. Constipation (80% of cases)
Rationale: Encopresis is involuntary soiling in a child 4 years or older. Constipation is the underlying
cause in 80% of cases. As stool accumulates in the rectum, enlargement causes loss of sensation and
urge to defecate, leading to leakage. Encopresis is 4 times more common in males; in females, sexual
abuse should be investigated.
• A: More likely in females
• C: May contribute but is not the most common cause
• D: Anatomical abnormalities are rare
Question 5
Management of encopresis includes all of the following EXCEPT:
A. Laxatives for initial bowel cleansing
B. Behavior modification and toileting schedule
C. Dietary changes to increase fiber
D. Immediate surgical consultation
Correct Answer-: D. Immediate surgical consultation
Rationale: Management of encopresis includes:
• Laxatives for initial cleansing of impacted stool
• Behavior changes (scheduled toileting, positive reinforcement)
, • Dietary changes (increased fiber and fluids)
Goal is one soft stool per day. Surgical consultation is not indicated.
• A, B, C: All are appropriate management strategies
Question 6
A 6-month-old infant presents with decreased urine output, no tears when crying, dry mucous
membranes, and a sunken fontanel. What is the estimated percentage of dehydration?
A. Mild (3-5%)
B. Moderate (6-9%)
C. Severe (>10%)
D. Not dehydrated
Correct Answer-: B. Moderate (6-9%)
Rationale: Signs of moderate dehydration (6-9%) in infants include:
• Sunken fontanel
• Decreased urine output
• No tears when crying
• Dry/sticky mucous membranes
• Irritability
Severe dehydration (>10%) would include lethargy, poor skin turgor, and signs of shock.
Question 7
A 7-year-old child presents with a rash on the hands that is intensely pruritic, worse at night, and
interferes with sleep. On examination, you note linear burrows in the interdigital webs. What is the
most likely diagnosis?
A. Atopic dermatitis
B. Scabies
C. Contact dermatitis
D. Tinea manuum
Correct Answer-: B. Scabies
Rationale: Scabies is caused by infestation with Sarcoptes scabiei mite. Classic presentation includes:
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
COMPREHENSIVE ANCC FNP BOARD EXAMINATION STUDY GUIDE PART 2
Clinical Presentations, Differential Diagnoses, and Treatment Guidelines
Total Questions: 60
Time Allowed: 120 minutes
SECTION 1: PEDIATRIC CONDITIONS
Questions 1-12
Question 1
A 2-week-old infant presents with yellow purulent drainage from the right eye. The mother reports the
eye has been swollen and draining for 2 days. What is the most likely causative organism?
A. Haemophilus influenzae
B. Neisseria gonorrhoeae
C. Chlamydia trachomatis
D. Streptococcus pneumoniae
Correct Answer-: C. Chlamydia trachomatis
Rationale: Chlamydial ophthalmia neonatorum typically presents 5-14 days after birth with mild to
moderate purulent discharge. Gonococcal ophthalmia presents earlier (1-7 days) with more severe,
copious purulent discharge and is a medical emergency. The timing (2 weeks) and yellow drainage are
classic for chlamydial infection.
• A, D: Bacterial conjunctivitis from these organisms can occur but are less common in this age
group
, • B: Gonococcal infection presents earlier and more severely
Question 2
A 5-week-old male infant, first-born, presents with projectile, non-bilious vomiting immediately after
feeding. The parents report the vomiting has been getting worse over the past week. On examination,
you palpate an olive-like mass in the epigastrium after the infant vomits. What is the most likely
diagnosis?
A. Gastroesophageal reflux disease (GERD)
B. Pyloric stenosis
C. Milk protein intolerance
D. Intestinal malrotation
Correct Answer-: B. Pyloric stenosis
Rationale: Pyloric stenosis classically presents in first-born males at 4-6 weeks of age with projectile,
non-bilious vomiting. The olive-like mass is the hypertrophied pylorus, best palpated immediately after
vomiting when the stomach is empty. Diagnosis is confirmed by ultrasound. Management is surgical
correction (laparoscopic pyloromyotomy).
• A: GERD presents with regurgitation, not projectile vomiting
• C: Milk protein intolerance presents with diarrhea, bloody stools, failure to thrive
• D: Intestinal malrotation presents with bilious vomiting
Question 3
A 4-year-old child presents with fever, malaise, conjunctivitis, coryza, and cough. On examination, you
note small white-blue elevations on the buccal mucosa resembling grains of sand. What is the most
likely diagnosis?
A. Rubella
B. Rubeola (measles)
C. Roseola
D. Scarlet fever
Correct Answer-: B. Rubeola (measles)
Rationale: Rubeola (measles) presents with fever, malaise, and the "3 Cs": conjunctivitis, coryza, and
cough. Koplik spots (1-3mm white/blue/gray elevations on buccal mucosa) are pathognomonic and
precede the maculopapular rash that starts on the head/neck and spreads centrifugally.
, • A: Rubella presents with milder symptoms and post-auricular lymphadenopathy
• C: Roseola presents with high fever followed by rash after fever breaks
• D: Scarlet fever presents with sandpaper rash and strawberry tongue
Question 4
A 5-year-old child who was fully potty trained at age 3 has been soiling his underwear for the past 3
months. The parents are frustrated and concerned. What is the most likely underlying cause?
A. Sexual abuse
B. Constipation (80% of cases)
C. Psychological stress
D. Anatomical abnormality
Correct Answer-: B. Constipation (80% of cases)
Rationale: Encopresis is involuntary soiling in a child 4 years or older. Constipation is the underlying
cause in 80% of cases. As stool accumulates in the rectum, enlargement causes loss of sensation and
urge to defecate, leading to leakage. Encopresis is 4 times more common in males; in females, sexual
abuse should be investigated.
• A: More likely in females
• C: May contribute but is not the most common cause
• D: Anatomical abnormalities are rare
Question 5
Management of encopresis includes all of the following EXCEPT:
A. Laxatives for initial bowel cleansing
B. Behavior modification and toileting schedule
C. Dietary changes to increase fiber
D. Immediate surgical consultation
Correct Answer-: D. Immediate surgical consultation
Rationale: Management of encopresis includes:
• Laxatives for initial cleansing of impacted stool
• Behavior changes (scheduled toileting, positive reinforcement)
, • Dietary changes (increased fiber and fluids)
Goal is one soft stool per day. Surgical consultation is not indicated.
• A, B, C: All are appropriate management strategies
Question 6
A 6-month-old infant presents with decreased urine output, no tears when crying, dry mucous
membranes, and a sunken fontanel. What is the estimated percentage of dehydration?
A. Mild (3-5%)
B. Moderate (6-9%)
C. Severe (>10%)
D. Not dehydrated
Correct Answer-: B. Moderate (6-9%)
Rationale: Signs of moderate dehydration (6-9%) in infants include:
• Sunken fontanel
• Decreased urine output
• No tears when crying
• Dry/sticky mucous membranes
• Irritability
Severe dehydration (>10%) would include lethargy, poor skin turgor, and signs of shock.
Question 7
A 7-year-old child presents with a rash on the hands that is intensely pruritic, worse at night, and
interferes with sleep. On examination, you note linear burrows in the interdigital webs. What is the
most likely diagnosis?
A. Atopic dermatitis
B. Scabies
C. Contact dermatitis
D. Tinea manuum
Correct Answer-: B. Scabies
Rationale: Scabies is caused by infestation with Sarcoptes scabiei mite. Classic presentation includes:
