ANCC Family Nurse Practitioner (FNP-BC) Certification Practice Examination for the 2026/2027
Academic Year — a 175-question test bank with 150 scored and 25 pretest items, reflecting official
domain weights.
Assessment & Diagnosis (40 scored, 6 pretest)
1. A 56-year-old male with HTN and DM type 2 reports 3 weeks of progressive dyspnea on exertion,
orthopnea, and bilateral ankle swelling. BP 148/92, HR 102, RR 20, O2 sat 94% RA. Jugular veins are
distended, S3 gallop present, lungs clear to auscultation. What is the most likely diagnosis?
A. COPD exacerbation
B. Acute pericarditis
C. Heart failure with reduced ejection fraction
D. Pulmonary embolism
2. A 34-year-old woman presents with fatigue, hair thinning, constipation, and weight gain of 12 lbs
over 6 months. TSH 12.4 mIU/L (0.4–4.0), free T4 0.6 ng/dL (0.8–1.8). Next best step?
A. Measure TPO antibodies
B. Start levothyroxine 1.6 mcg/kg/day
C. Order thyroid ultrasound
D. Repeat TSH in 6 weeks
3. (Pretest) A 48-year-old male with sudden-onset severe "tearing" anterior chest pain radiating to
back. BP 160/90 in right arm, 100/60 in left arm. Heart sounds normal. Most likely diagnosis?
A. Acute coronary syndrome
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
4. A 22-year-old sexually active female with dysuria, frequency, and suprapubic pain. Urinalysis: +
leukocytes, + nitrites. Pregnancy test negative. Best initial treatment?
A. Ciprofloxacin 500 mg BID x 3 days
B. Nitrofurantoin 100 mg BID x 5 days
C. Doxycycline 100 mg BID x 7 days
D. Azithromycin 1 g x 1 dose
5. A 72-year-old with chronic stable angina reports substernal chest pressure when walking 2 blocks,
relieved by rest or nitroglycerin. No change in pattern. Next step?
A. Refer for coronary angiography
B. Start aspirin 81 mg daily
C. Increase beta-blocker dose
D. Continue current management and optimize risk factors
6. A 6-month-old infant presents with fever 39.5°C (103.1°F), irritability, and poor feeding. No focal
findings on exam. Vaccines up to date. What is the most appropriate next step?
A. Acetaminophen and watchful waiting at home
,B. Urinalysis and urine culture
C. Chest X-ray
D. Lumbar puncture
7. A 45-year-old female with episodic palpitations, sweating, headache, and hypertension. Episodes
last 10–15 minutes. During an episode, BP 190/110, HR 130. Between episodes, BP 120/70. Most likely
diagnosis?
A. Panic disorder
B. Pheochromocytoma
C. Hyperthyroidism
D. Paroxysmal atrial tachycardia
8. (Pretest) A 68-year-old male with chronic cough, weight loss, and hemoptysis. 60 pack-year
smoking history. Chest X-ray shows right hilar mass. Next best step?
A. CT chest with contrast
B. Sputum cytology
C. Bronchoscopy with biopsy
D. PET scan
9. A 30-year-old G2P1001 at 10 weeks gestation reports right lower quadrant pain, nausea, and
spotting. Transvaginal ultrasound shows empty uterus, adnexal mass with fetal pole and cardiac
activity. Diagnosis?
A. Missed abortion
B. Ectopic pregnancy
C. Corpus luteum cyst
D. Appendicitis
10. A 15-year-old male with knee pain after twisting injury while playing soccer. On exam, effusion
present, positive Lachman test, negative McMurray test. Most likely injured structure?
A. Medial meniscus
B. Anterior cruciate ligament (ACL)
C. Posterior cruciate ligament (PCL)
D. Lateral collateral ligament
11. A 50-year-old female with rheumatoid arthritis for 10 years presents with bilateral hand
paresthesias worsening at night. Tinel sign positive. Diagnosis?
A. Cervical radiculopathy
B. Ulnar neuropathy
C. Carpal tunnel syndrome
D. Peripheral neuropathy
12. A 2-year-old child with fever for 5 days, bilateral conjunctival injection without exudate, cracked
lips, strawberry tongue, polymorphous rash, and cervical lymphadenopathy >1.5 cm. Most likely
diagnosis?
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Stevens-Johnson syndrome
, 13. (Pretest) A 65-year-old with sudden painless vision loss in right eye described as "a curtain coming
down." No eye pain. Fundoscopy shows pale retina with cherry-red spot. Diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute angle-closure glaucoma
D. Vitreous hemorrhage
14. A 28-year-old female with 3 days of dysuria, frequency, and hematuria. No fever, no flank pain.
Urinalysis: many WBCs, RBCs, nitrite positive. Best initial management?
A. Urine culture and sensitivity, then antibiotics
B. Empiric antibiotics without culture
C. Renal ultrasound
D. CT urogram
15. A 75-year-old with history of stroke presents with urinary incontinence, unsteady gait, and
cognitive decline of 3 months’ duration. Likely diagnosis?
A. Alzheimer’s disease
B. Normal pressure hydrocephalus
C. Parkinson’s disease
D. Subdural hematoma
16. A 40-year-old obese female with episodic right upper quadrant pain after fatty meals. Pain lasts 2–3
hours, radiates to right shoulder. Afebrile, normal exam between episodes. Best initial test?
A. CT abdomen
B. Right upper quadrant ultrasound
C. HIDA scan
D. ERCP
17. A 55-year-old male with heavy alcohol use presents with jaundice, ascites, and asterixis. Labs: AST
220, ALT 100, total bilirubin 6.5, INR 1.8. Most likely diagnosis?
A. Choledocholithiasis
B. Acute viral hepatitis
C. Alcoholic hepatitis
D. Cirrhosis with variceal bleed
18. (Pretest) A 4-year-old with cough, coryza, conjunctivitis, and Koplik spots. Fever to 40°C. Rash
started on face, now spreading to trunk. Most likely pathogen?
A. Parvovirus B19
B. Measles virus
C. Rubella virus
D. HHV-6 (roseola)
19. A 32-year-old G1P0 at 36 weeks with painless, bright red vaginal bleeding. Uterus non-tender. Fetal
heart rate 140s. Next step?
A. Digital cervical exam
B. Sterile speculum exam followed by ultrasound to rule out placenta previa
C. Immediate cesarean section
D. External cephalic version
Academic Year — a 175-question test bank with 150 scored and 25 pretest items, reflecting official
domain weights.
Assessment & Diagnosis (40 scored, 6 pretest)
1. A 56-year-old male with HTN and DM type 2 reports 3 weeks of progressive dyspnea on exertion,
orthopnea, and bilateral ankle swelling. BP 148/92, HR 102, RR 20, O2 sat 94% RA. Jugular veins are
distended, S3 gallop present, lungs clear to auscultation. What is the most likely diagnosis?
A. COPD exacerbation
B. Acute pericarditis
C. Heart failure with reduced ejection fraction
D. Pulmonary embolism
2. A 34-year-old woman presents with fatigue, hair thinning, constipation, and weight gain of 12 lbs
over 6 months. TSH 12.4 mIU/L (0.4–4.0), free T4 0.6 ng/dL (0.8–1.8). Next best step?
A. Measure TPO antibodies
B. Start levothyroxine 1.6 mcg/kg/day
C. Order thyroid ultrasound
D. Repeat TSH in 6 weeks
3. (Pretest) A 48-year-old male with sudden-onset severe "tearing" anterior chest pain radiating to
back. BP 160/90 in right arm, 100/60 in left arm. Heart sounds normal. Most likely diagnosis?
A. Acute coronary syndrome
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
4. A 22-year-old sexually active female with dysuria, frequency, and suprapubic pain. Urinalysis: +
leukocytes, + nitrites. Pregnancy test negative. Best initial treatment?
A. Ciprofloxacin 500 mg BID x 3 days
B. Nitrofurantoin 100 mg BID x 5 days
C. Doxycycline 100 mg BID x 7 days
D. Azithromycin 1 g x 1 dose
5. A 72-year-old with chronic stable angina reports substernal chest pressure when walking 2 blocks,
relieved by rest or nitroglycerin. No change in pattern. Next step?
A. Refer for coronary angiography
B. Start aspirin 81 mg daily
C. Increase beta-blocker dose
D. Continue current management and optimize risk factors
6. A 6-month-old infant presents with fever 39.5°C (103.1°F), irritability, and poor feeding. No focal
findings on exam. Vaccines up to date. What is the most appropriate next step?
A. Acetaminophen and watchful waiting at home
,B. Urinalysis and urine culture
C. Chest X-ray
D. Lumbar puncture
7. A 45-year-old female with episodic palpitations, sweating, headache, and hypertension. Episodes
last 10–15 minutes. During an episode, BP 190/110, HR 130. Between episodes, BP 120/70. Most likely
diagnosis?
A. Panic disorder
B. Pheochromocytoma
C. Hyperthyroidism
D. Paroxysmal atrial tachycardia
8. (Pretest) A 68-year-old male with chronic cough, weight loss, and hemoptysis. 60 pack-year
smoking history. Chest X-ray shows right hilar mass. Next best step?
A. CT chest with contrast
B. Sputum cytology
C. Bronchoscopy with biopsy
D. PET scan
9. A 30-year-old G2P1001 at 10 weeks gestation reports right lower quadrant pain, nausea, and
spotting. Transvaginal ultrasound shows empty uterus, adnexal mass with fetal pole and cardiac
activity. Diagnosis?
A. Missed abortion
B. Ectopic pregnancy
C. Corpus luteum cyst
D. Appendicitis
10. A 15-year-old male with knee pain after twisting injury while playing soccer. On exam, effusion
present, positive Lachman test, negative McMurray test. Most likely injured structure?
A. Medial meniscus
B. Anterior cruciate ligament (ACL)
C. Posterior cruciate ligament (PCL)
D. Lateral collateral ligament
11. A 50-year-old female with rheumatoid arthritis for 10 years presents with bilateral hand
paresthesias worsening at night. Tinel sign positive. Diagnosis?
A. Cervical radiculopathy
B. Ulnar neuropathy
C. Carpal tunnel syndrome
D. Peripheral neuropathy
12. A 2-year-old child with fever for 5 days, bilateral conjunctival injection without exudate, cracked
lips, strawberry tongue, polymorphous rash, and cervical lymphadenopathy >1.5 cm. Most likely
diagnosis?
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Stevens-Johnson syndrome
, 13. (Pretest) A 65-year-old with sudden painless vision loss in right eye described as "a curtain coming
down." No eye pain. Fundoscopy shows pale retina with cherry-red spot. Diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute angle-closure glaucoma
D. Vitreous hemorrhage
14. A 28-year-old female with 3 days of dysuria, frequency, and hematuria. No fever, no flank pain.
Urinalysis: many WBCs, RBCs, nitrite positive. Best initial management?
A. Urine culture and sensitivity, then antibiotics
B. Empiric antibiotics without culture
C. Renal ultrasound
D. CT urogram
15. A 75-year-old with history of stroke presents with urinary incontinence, unsteady gait, and
cognitive decline of 3 months’ duration. Likely diagnosis?
A. Alzheimer’s disease
B. Normal pressure hydrocephalus
C. Parkinson’s disease
D. Subdural hematoma
16. A 40-year-old obese female with episodic right upper quadrant pain after fatty meals. Pain lasts 2–3
hours, radiates to right shoulder. Afebrile, normal exam between episodes. Best initial test?
A. CT abdomen
B. Right upper quadrant ultrasound
C. HIDA scan
D. ERCP
17. A 55-year-old male with heavy alcohol use presents with jaundice, ascites, and asterixis. Labs: AST
220, ALT 100, total bilirubin 6.5, INR 1.8. Most likely diagnosis?
A. Choledocholithiasis
B. Acute viral hepatitis
C. Alcoholic hepatitis
D. Cirrhosis with variceal bleed
18. (Pretest) A 4-year-old with cough, coryza, conjunctivitis, and Koplik spots. Fever to 40°C. Rash
started on face, now spreading to trunk. Most likely pathogen?
A. Parvovirus B19
B. Measles virus
C. Rubella virus
D. HHV-6 (roseola)
19. A 32-year-old G1P0 at 36 weeks with painless, bright red vaginal bleeding. Uterus non-tender. Fetal
heart rate 140s. Next step?
A. Digital cervical exam
B. Sterile speculum exam followed by ultrasound to rule out placenta previa
C. Immediate cesarean section
D. External cephalic version
