1
ANCC FNP BOARD EXAM LATEST 2025/ 2026 ACTUAL
EXAM TEST BANK| COMPLETE 350 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+| FAMILY
NURSING PRACTITIONER ANCC BOARD EXAM PREP
(MOST RECENT!!)
Question 1: Endocrine/Adrenal
A 45-year-old male presents with episodic palpitations, sweating, and headache. His blood
pressure is 180/100 mm Hg during one episode but normal between episodes. What is the
most likely diagnosis?
A) Essential hypertension
B) Panic disorder
C) Pheochromocytoma
D) Hyperthyroidism
Correct Answer-: C) Pheochromocytoma
Rationale: Pheochromocytoma presents with paroxysmal hypertension, palpitations,
diaphoresis, and headache. Episodic symptoms with normal inter-episode BP are classic for a
catecholamine-secreting tumor. Panic disorder can mimic this but is a diagnosis of exclusion
after ruling out organic causes. Hyperthyroidism typically presents with sustained tachycardia,
weight loss, and heat intolerance, not episodic hypertension.
Domain: Diagnosis & Pathophysiology
Question 2: Cardiovascular
A 68-year-old female reports several weeks of generalized weakness, unintentional weight loss,
and low-grade fevers. On exam, you palpate a painless, non-tender, pulsatile mass in the mid-
abdomen. What is the most appropriate next step?
A) Abdominal ultrasound
B) CBC with differential
C) Colonoscopy
D) Empiric antibiotics
,2
Correct Answer-: A) Abdominal ultrasound
Rationale: A pulsatile abdominal mass in an older patient suggests abdominal aortic aneurysm
(AAA). Ultrasound is the initial imaging modality to confirm diagnosis and measure size.
Symptomatic or large AAA (>5.5 cm in men, >5.0 cm in women) requires surgical referral. A CBC
might show anemia but does not confirm AAA; colonoscopy and antibiotics are not indicated
without additional signs of infection or GI bleeding.
Domain: Assessment & Diagnosis
Question 3: Women's Health/OB-GYN
A 32-year-old G2P1 at 28 weeks gestation presents with a blood pressure of 150/95 mm Hg and
2+ proteinuria on dipstick. She denies headache or visual changes. What is the most
appropriate next step?
A) Diagnose gestational hypertension and schedule follow-up in 1 week
B) Order 24-hour urine protein and initiate labetalol
C) Admit for magnesium sulfate and delivery
D) Diagnose preeclampsia without severe features and monitor with twice-weekly testing
Correct Answer-: D) Diagnose preeclampsia without severe features and monitor with twice-
weekly testing
Rationale: New-onset hypertension after 20 weeks with proteinuria defines preeclampsia.
Without severe features (no CNS symptoms, no thrombocytopenia, normal LFTs, no pulmonary
edema, and no right upper quadrant pain), outpatient monitoring with fetal surveillance and BP
checks is appropriate. Admission and delivery are reserved for severe features or term
gestation.
Domain: Antepartum Care & Management
Question 4: Pharmacology
A 55-year-old female with type 2 diabetes on metformin and glipizide presents with a fasting
glucose of 240 mg/dL and HbA1c 8.5%. She has stable cardiovascular disease. What is the most
appropriate next medication?
A) Add sitagliptin
B) Add pioglitazone
C) Add empagliflozin
D) Add insulin glargine
Correct Answer-: C) Add empagliflozin
Rationale: For patients with type 2 diabetes and established cardiovascular disease, SGLT2
inhibitors (empagliflozin, canagliflozin) or GLP-1 agonists with proven cardiovascular benefit are
,3
preferred add-ons after metformin. Empagliflozin has FDA-approved indications for reducing
cardiovascular mortality and heart failure hospitalizations. Sitagliptin and pioglitazone do not
have demonstrated cardiovascular benefit; insulin is not first-line when oral agents remain
viable options.
Domain: Pharmacology & Prescribing
Question 5: Infectious Disease
A 42-year-old female presents with dysuria, frequency, and suprapubic discomfort. Urinalysis
shows positive nitrites and leukocyte esterase. She has no drug allergies. What is first-line
antibiotic therapy?
A) Ciprofloxacin 500 mg BID × 3 days
B) Nitrofurantoin 100 mg BID × 5 days
C) Trimethoprim-sulfamethoxazole DS BID × 3 days
D) Amoxicillin 500 mg TID × 7 days
Correct Answer-: B) Nitrofurantoin 100 mg BID × 5 days
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis per IDSA guidelines due to low
resistance rates and minimal impact on gut flora. TMP-SMX is also first-line if local resistance is
<20%. Fluoroquinolones (ciprofloxacin) are reserved for complicated cases or when other
agents are contraindicated due to risk of adverse effects and resistance. Amoxicillin is no longer
recommended due to high E. coli resistance.
Domain: Pharmacology & Infectious Disease
Question 6: Mental Health
A 30-year-old male with no prior psychiatric history presents with depressed mood, anhedonia,
poor sleep, and low energy for 4 weeks. PHQ-9 score is 18. What is first-line pharmacologic
treatment?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Amitriptyline
Correct Answer-: A) Sertraline
Rationale: SSRIs (sertraline, escitalopram, fluoxetine) are first-line for major depressive
disorder. Sertraline is often preferred due to fewer drug interactions and a favorable side effect
profile. Bupropion is an alternative, especially if fatigue or smoking cessation is desired, but not
typically first-line due to seizure risk and anxiety exacerbation. Amitriptyline (tricyclic) is third-
line due to its side effect profile and overdose risk.
, 4
Domain: Psychiatric/Mental Health
Question 7: Hematology/Oncology
A 24-year-old female presents with fatigue, diffuse joint pain, and a malar rash. Labs show ANA
positive, anti-dsDNA positive, and hypocomplementemia. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Sjögren's syndrome
D) Fibromyalgia
Correct Answer-: B) Systemic lupus erythematosus
Rationale: Malar rash, arthritis, ANA positivity, anti-dsDNA (highly specific for SLE), and low
complement are diagnostic for systemic lupus erythematosus. Anti-dsDNA antibodies correlate
with disease activity and lupus nephritis. Rheumatoid arthritis typically presents with symmetric
small joint swelling and positive rheumatoid factor/anti-CCP, not malar rash or anti-dsDNA.
Domain: Diagnosis & Pathophysiology
Question 8: Urology/Emergency
A 35-year-old male with obesity presents with sudden-onset severe right scrotal pain, nausea,
and vomiting. The right testis is tender, elevated, and there is loss of the cremasteric reflex.
What is the most appropriate next step?
A) Obtain scrotal ultrasound with Doppler
B) Prescribe antibiotics for epididymitis
C) Perform immediate surgical exploration
D) Administer analgesics and reassess in 2 hours
Correct Answer-: C) Perform immediate surgical exploration
Rationale: Acute scrotum with sudden pain, absent cremasteric reflex, and nausea suggests
testicular torsion. This is a surgical emergency. Delaying for ultrasound is acceptable only if
immediate urology consultation is available and exploration is not delayed >4–6 hours from
symptom onset. Testicular salvage rates drop significantly after 6 hours.
Domain: Emergency & Genitourinary
Question 9: Endocrinology
A 28-year-old female with type 1 diabetes reports recurrent episodes of sweating, palpitations,
and confusion relieved by eating. What is the most likely cause?
A) Somogyi effect
B) Dawn phenomenon
ANCC FNP BOARD EXAM LATEST 2025/ 2026 ACTUAL
EXAM TEST BANK| COMPLETE 350 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+| FAMILY
NURSING PRACTITIONER ANCC BOARD EXAM PREP
(MOST RECENT!!)
Question 1: Endocrine/Adrenal
A 45-year-old male presents with episodic palpitations, sweating, and headache. His blood
pressure is 180/100 mm Hg during one episode but normal between episodes. What is the
most likely diagnosis?
A) Essential hypertension
B) Panic disorder
C) Pheochromocytoma
D) Hyperthyroidism
Correct Answer-: C) Pheochromocytoma
Rationale: Pheochromocytoma presents with paroxysmal hypertension, palpitations,
diaphoresis, and headache. Episodic symptoms with normal inter-episode BP are classic for a
catecholamine-secreting tumor. Panic disorder can mimic this but is a diagnosis of exclusion
after ruling out organic causes. Hyperthyroidism typically presents with sustained tachycardia,
weight loss, and heat intolerance, not episodic hypertension.
Domain: Diagnosis & Pathophysiology
Question 2: Cardiovascular
A 68-year-old female reports several weeks of generalized weakness, unintentional weight loss,
and low-grade fevers. On exam, you palpate a painless, non-tender, pulsatile mass in the mid-
abdomen. What is the most appropriate next step?
A) Abdominal ultrasound
B) CBC with differential
C) Colonoscopy
D) Empiric antibiotics
,2
Correct Answer-: A) Abdominal ultrasound
Rationale: A pulsatile abdominal mass in an older patient suggests abdominal aortic aneurysm
(AAA). Ultrasound is the initial imaging modality to confirm diagnosis and measure size.
Symptomatic or large AAA (>5.5 cm in men, >5.0 cm in women) requires surgical referral. A CBC
might show anemia but does not confirm AAA; colonoscopy and antibiotics are not indicated
without additional signs of infection or GI bleeding.
Domain: Assessment & Diagnosis
Question 3: Women's Health/OB-GYN
A 32-year-old G2P1 at 28 weeks gestation presents with a blood pressure of 150/95 mm Hg and
2+ proteinuria on dipstick. She denies headache or visual changes. What is the most
appropriate next step?
A) Diagnose gestational hypertension and schedule follow-up in 1 week
B) Order 24-hour urine protein and initiate labetalol
C) Admit for magnesium sulfate and delivery
D) Diagnose preeclampsia without severe features and monitor with twice-weekly testing
Correct Answer-: D) Diagnose preeclampsia without severe features and monitor with twice-
weekly testing
Rationale: New-onset hypertension after 20 weeks with proteinuria defines preeclampsia.
Without severe features (no CNS symptoms, no thrombocytopenia, normal LFTs, no pulmonary
edema, and no right upper quadrant pain), outpatient monitoring with fetal surveillance and BP
checks is appropriate. Admission and delivery are reserved for severe features or term
gestation.
Domain: Antepartum Care & Management
Question 4: Pharmacology
A 55-year-old female with type 2 diabetes on metformin and glipizide presents with a fasting
glucose of 240 mg/dL and HbA1c 8.5%. She has stable cardiovascular disease. What is the most
appropriate next medication?
A) Add sitagliptin
B) Add pioglitazone
C) Add empagliflozin
D) Add insulin glargine
Correct Answer-: C) Add empagliflozin
Rationale: For patients with type 2 diabetes and established cardiovascular disease, SGLT2
inhibitors (empagliflozin, canagliflozin) or GLP-1 agonists with proven cardiovascular benefit are
,3
preferred add-ons after metformin. Empagliflozin has FDA-approved indications for reducing
cardiovascular mortality and heart failure hospitalizations. Sitagliptin and pioglitazone do not
have demonstrated cardiovascular benefit; insulin is not first-line when oral agents remain
viable options.
Domain: Pharmacology & Prescribing
Question 5: Infectious Disease
A 42-year-old female presents with dysuria, frequency, and suprapubic discomfort. Urinalysis
shows positive nitrites and leukocyte esterase. She has no drug allergies. What is first-line
antibiotic therapy?
A) Ciprofloxacin 500 mg BID × 3 days
B) Nitrofurantoin 100 mg BID × 5 days
C) Trimethoprim-sulfamethoxazole DS BID × 3 days
D) Amoxicillin 500 mg TID × 7 days
Correct Answer-: B) Nitrofurantoin 100 mg BID × 5 days
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis per IDSA guidelines due to low
resistance rates and minimal impact on gut flora. TMP-SMX is also first-line if local resistance is
<20%. Fluoroquinolones (ciprofloxacin) are reserved for complicated cases or when other
agents are contraindicated due to risk of adverse effects and resistance. Amoxicillin is no longer
recommended due to high E. coli resistance.
Domain: Pharmacology & Infectious Disease
Question 6: Mental Health
A 30-year-old male with no prior psychiatric history presents with depressed mood, anhedonia,
poor sleep, and low energy for 4 weeks. PHQ-9 score is 18. What is first-line pharmacologic
treatment?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Amitriptyline
Correct Answer-: A) Sertraline
Rationale: SSRIs (sertraline, escitalopram, fluoxetine) are first-line for major depressive
disorder. Sertraline is often preferred due to fewer drug interactions and a favorable side effect
profile. Bupropion is an alternative, especially if fatigue or smoking cessation is desired, but not
typically first-line due to seizure risk and anxiety exacerbation. Amitriptyline (tricyclic) is third-
line due to its side effect profile and overdose risk.
, 4
Domain: Psychiatric/Mental Health
Question 7: Hematology/Oncology
A 24-year-old female presents with fatigue, diffuse joint pain, and a malar rash. Labs show ANA
positive, anti-dsDNA positive, and hypocomplementemia. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Sjögren's syndrome
D) Fibromyalgia
Correct Answer-: B) Systemic lupus erythematosus
Rationale: Malar rash, arthritis, ANA positivity, anti-dsDNA (highly specific for SLE), and low
complement are diagnostic for systemic lupus erythematosus. Anti-dsDNA antibodies correlate
with disease activity and lupus nephritis. Rheumatoid arthritis typically presents with symmetric
small joint swelling and positive rheumatoid factor/anti-CCP, not malar rash or anti-dsDNA.
Domain: Diagnosis & Pathophysiology
Question 8: Urology/Emergency
A 35-year-old male with obesity presents with sudden-onset severe right scrotal pain, nausea,
and vomiting. The right testis is tender, elevated, and there is loss of the cremasteric reflex.
What is the most appropriate next step?
A) Obtain scrotal ultrasound with Doppler
B) Prescribe antibiotics for epididymitis
C) Perform immediate surgical exploration
D) Administer analgesics and reassess in 2 hours
Correct Answer-: C) Perform immediate surgical exploration
Rationale: Acute scrotum with sudden pain, absent cremasteric reflex, and nausea suggests
testicular torsion. This is a surgical emergency. Delaying for ultrasound is acceptable only if
immediate urology consultation is available and exploration is not delayed >4–6 hours from
symptom onset. Testicular salvage rates drop significantly after 6 hours.
Domain: Emergency & Genitourinary
Question 9: Endocrinology
A 28-year-old female with type 1 diabetes reports recurrent episodes of sweating, palpitations,
and confusion relieved by eating. What is the most likely cause?
A) Somogyi effect
B) Dawn phenomenon
