ANCC FNP Examination:
Comprehensive Topic Test Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Domain 1: Assessment & Diagnosis (20 Questions)
1. A 58-year-old male with a 30-pack-year history presents with a new cough
and unintentional weight loss. Which screening test has the highest USPSTF
grade recommendation?
A. Chest X-ray annually
B. Low-dose CT chest annually
C. Low-dose CT chest annually if age 50–80 years with ≥20 pack-year history
and currently smoking or quit within 15 years
D. Sputum cytology
*Rationale: USPSTF Grade B recommends annual LDCT for lung cancer
screening in asymptomatic adults 50–80 with ≥20 pack-year history who currently
smoke or quit within 15 years.*
2. A 72-year-old female presents with acute onset of right lower quadrant pain,
nausea, and fever. She has dementia and cannot provide a clear history. What
is the most appropriate next step?
A. Discharge with analgesics
B. CT abdomen with oral contrast only
C. CT abdomen with IV contrast
D. Diagnostic laparoscopy
Rationale: CT with IV contrast is the imaging modality of choice for suspected
appendicitis in elderly patients with atypical presentation.
3. Which finding on a diabetic foot exam is the earliest indicator of peripheral
neuropathy?
A. Absent dorsalis pedis pulse
,B. Loss of protective sensation via monofilament testing
C. Decreased Achilles reflex
D. Hammer toe deformity
*Rationale: 10-g monofilament testing detects loss of protective sensation, the
earliest sign of diabetic peripheral neuropathy.*
4. A 45-year-old female reports palpitations, heat intolerance, and tremor.
TSH is <0.01 mIU/L, free T4 elevated. What is the most likely diagnosis?
A. Subclinical hyperthyroidism
B. Overt hyperthyroidism
C. Thyroiditis
D. Pituitary adenoma
Rationale: Suppressed TSH with elevated free T4 confirms overt hyperthyroidism.
5. A 3-year-old presents with barking cough, stridor, and subcostal retractions.
Symptoms worse at night. Likely diagnosis?
A. Croup
B. Epiglottitis
C. Bronchiolitis
D. Foreign body aspiration
Rationale: Barking cough + stridor + worse at night = viral croup
(laryngotracheobronchitis).
6. A 68-year-old with HTN and DM reports bilateral calf pain when walking 1
block, relieved by rest. Ankle-brachial index (ABI) is 0.65. Diagnosis?
A. Peripheral artery disease
B. Spinal stenosis
C. Diabetic neuropathy
D. Venous claudication
Rationale: ABI <0.90 confirms PAD; classic intermittent claudication.
7. Which breast lump characteristic is most suspicious for malignancy?
A. Mobile, tender, cyclic
B. Fixed, hard, painless, irregular borders
C. Smooth, rubbery, well-circumscribed
D. Fluctuant and tender
Rationale: Fixed, hard, painless, irregular = malignancy until proven otherwise.
8. A 25-year-old male has a tick bite and expanding erythematous rash with
central clearing. Best initial test?
, A. Western blot for Lyme
B. Clinical diagnosis; no testing needed
C. ELISA for Lyme
D. PCR of rash
Rationale: Erythema migrans is diagnostic of early Lyme disease; serology often
negative initially.
9. A 55-year-old female with fatigue, joint pain, and photosensitivity. ANA
positive, anti-dsDNA positive. Diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Sjögren’s syndrome
Rationale: Anti-dsDNA is highly specific for SLE.
10. A newborn with bilious vomiting and abdominal distension. Most likely
cause?
A. Malrotation with volvulus
B. Pyloric stenosis
C. GERD
D. Necrotizing enterocolitis
Rationale: Bilious vomiting in newborn is malrotation until proven otherwise;
surgical emergency.
11. A 30-year-old G2P1 at 32 weeks presents with painless bright red vaginal
bleeding. Next step?
A. Digital cervical exam
B. Ultrasound to rule out placenta previa
C. Non-stress test only
D. Biophysical profile
*Rationale: Painless bleeding in 3rd trimester = previa; digital exam
contraindicated.*
12. A 14-year-old male with sore throat, fever, tender anterior cervical nodes,
and palatal petechiae. Rapid strep negative. Next step?
A. Treat with amoxicillin
B. Throat culture
C. Monospot test
D. Observation
Comprehensive Topic Test Questions
And Answers With Rationales/Graded
A+/2026 Update/100% Correct
/Instant Download
Domain 1: Assessment & Diagnosis (20 Questions)
1. A 58-year-old male with a 30-pack-year history presents with a new cough
and unintentional weight loss. Which screening test has the highest USPSTF
grade recommendation?
A. Chest X-ray annually
B. Low-dose CT chest annually
C. Low-dose CT chest annually if age 50–80 years with ≥20 pack-year history
and currently smoking or quit within 15 years
D. Sputum cytology
*Rationale: USPSTF Grade B recommends annual LDCT for lung cancer
screening in asymptomatic adults 50–80 with ≥20 pack-year history who currently
smoke or quit within 15 years.*
2. A 72-year-old female presents with acute onset of right lower quadrant pain,
nausea, and fever. She has dementia and cannot provide a clear history. What
is the most appropriate next step?
A. Discharge with analgesics
B. CT abdomen with oral contrast only
C. CT abdomen with IV contrast
D. Diagnostic laparoscopy
Rationale: CT with IV contrast is the imaging modality of choice for suspected
appendicitis in elderly patients with atypical presentation.
3. Which finding on a diabetic foot exam is the earliest indicator of peripheral
neuropathy?
A. Absent dorsalis pedis pulse
,B. Loss of protective sensation via monofilament testing
C. Decreased Achilles reflex
D. Hammer toe deformity
*Rationale: 10-g monofilament testing detects loss of protective sensation, the
earliest sign of diabetic peripheral neuropathy.*
4. A 45-year-old female reports palpitations, heat intolerance, and tremor.
TSH is <0.01 mIU/L, free T4 elevated. What is the most likely diagnosis?
A. Subclinical hyperthyroidism
B. Overt hyperthyroidism
C. Thyroiditis
D. Pituitary adenoma
Rationale: Suppressed TSH with elevated free T4 confirms overt hyperthyroidism.
5. A 3-year-old presents with barking cough, stridor, and subcostal retractions.
Symptoms worse at night. Likely diagnosis?
A. Croup
B. Epiglottitis
C. Bronchiolitis
D. Foreign body aspiration
Rationale: Barking cough + stridor + worse at night = viral croup
(laryngotracheobronchitis).
6. A 68-year-old with HTN and DM reports bilateral calf pain when walking 1
block, relieved by rest. Ankle-brachial index (ABI) is 0.65. Diagnosis?
A. Peripheral artery disease
B. Spinal stenosis
C. Diabetic neuropathy
D. Venous claudication
Rationale: ABI <0.90 confirms PAD; classic intermittent claudication.
7. Which breast lump characteristic is most suspicious for malignancy?
A. Mobile, tender, cyclic
B. Fixed, hard, painless, irregular borders
C. Smooth, rubbery, well-circumscribed
D. Fluctuant and tender
Rationale: Fixed, hard, painless, irregular = malignancy until proven otherwise.
8. A 25-year-old male has a tick bite and expanding erythematous rash with
central clearing. Best initial test?
, A. Western blot for Lyme
B. Clinical diagnosis; no testing needed
C. ELISA for Lyme
D. PCR of rash
Rationale: Erythema migrans is diagnostic of early Lyme disease; serology often
negative initially.
9. A 55-year-old female with fatigue, joint pain, and photosensitivity. ANA
positive, anti-dsDNA positive. Diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Sjögren’s syndrome
Rationale: Anti-dsDNA is highly specific for SLE.
10. A newborn with bilious vomiting and abdominal distension. Most likely
cause?
A. Malrotation with volvulus
B. Pyloric stenosis
C. GERD
D. Necrotizing enterocolitis
Rationale: Bilious vomiting in newborn is malrotation until proven otherwise;
surgical emergency.
11. A 30-year-old G2P1 at 32 weeks presents with painless bright red vaginal
bleeding. Next step?
A. Digital cervical exam
B. Ultrasound to rule out placenta previa
C. Non-stress test only
D. Biophysical profile
*Rationale: Painless bleeding in 3rd trimester = previa; digital exam
contraindicated.*
12. A 14-year-old male with sore throat, fever, tender anterior cervical nodes,
and palatal petechiae. Rapid strep negative. Next step?
A. Treat with amoxicillin
B. Throat culture
C. Monospot test
D. Observation
