A. Expectant management
ANCC Family Nurse Practitioner (FNP-BC) Certification Practice Examination — Version 3 for the
B. Methotrexate IM
2026/2027 Academic Year: 175 Questions (150 Scored + 25 Pretest) Across All Domains
C. Salpingectomy
D. Serial beta-hCG
7. A 68-year-old male with chronic cough, hemoptysis, and 50 pack-year smoking history. Chest X-ray
Domain A: Assessment & Diagnosis (40 scored + 6 pretest) shows right hilar mass. Next best step?
A. CT chest with contrast
1. A 62-year-old male with hypertension and hyperlipidemia presents with acute-onset right-sided B. PET scan
weakness and aphasia. Symptoms began 45 minutes ago. BP 185/100, HR 88, NIHSS 12. Non-contrast C. Bronchoscopy with biopsy
head CT shows no hemorrhage. Next best step? D. Sputum cytology
A. Administer IV alteplase (tPA)
B. Lower BP aggressively to <140/90 8. (Pretest) A 16-year-old male with acute scrotal pain for 3 hours. Testis is tender, high-riding, absent
C. Start aspirin 325 mg cremasteric reflex. Next best step?
D. MRI brain with diffusion A. Scrotal ultrasound with Doppler
B. Immediate surgical exploration
2. A 28-year-old female with fatigue, joint pain, and a butterfly rash on the face. ANA positive 1:1280, C. Antibiotics and ice
anti-dsDNA positive, low C3/C4. Urinalysis shows RBC casts and protein 3+. Most likely diagnosis? D. Manual detorsion then surgery
A. Rheumatoid arthritis
B. Systemic lupus erythematosus with lupus nephritis 9. A 55-year-old female with episodic vertigo, tinnitus, and ear fullness. Episodes last 2–4 hours with
C. Mixed connective tissue disease nausea and vomiting. Asymptomatic between episodes. Most likely diagnosis?
D. IgA nephropathy A. BPPV
B. Ménière’s disease
3. (Pretest) A 55-year-old male with sudden-onset severe headache, vomiting, and photophobia. Non- C. Vestibular neuritis
contrast head CT shows hyperdensity in the basilar cisterns. Next best step? D. Labyrinthitis
A. Lumbar puncture
B. CT angiography 10. A 4-year-old with fever, barking cough, and inspiratory stridor worse at night. No drooling, no toxic
C. Cerebral angiography appearance. Most likely diagnosis?
D. IV nimodipine A. Epiglottitis
B. Croup
4. A 45-year-old female with palpitations, heat intolerance, weight loss, and fine tremor. TSH <0.01, C. Bacterial tracheitis
free T4 3.5, free T3 elevated. Thyroid uptake scan shows diffuse increased uptake. Best initial D. Peritonsillar abscess
treatment?
A. Methimazole 11. A 70-year-old male with history of stroke presents with urinary urgency, frequency, and urge
B. Radioactive iodine ablation incontinence. Post-void residual 50 mL. Most likely type of incontinence?
C. Propranolol alone A. Stress incontinence
D. Thyroidectomy B. Urge incontinence
C. Overflow incontinence
5. A 6-month-old infant with fever 39.5°C, irritability, and poor feeding. No focal findings on exam. D. Functional incontinence
Vaccines up to date. Appearance nontoxic. Next best step?
A. Lumbar puncture 12. A 35-year-old obese female with right upper quadrant pain after fatty meals. Ultrasound shows
B. Urinalysis and urine culture gallstones. WBC normal, LFTs normal, afebrile. Next best step?
C. Chest X-ray A. Laparoscopic cholecystectomy
D. Empiric IV antibiotics B. ERCP
C. Ursodiol
6. A 30-year-old G2P1001 at 8 weeks gestation with right lower quadrant pain and spotting. D. Low-fat diet and observation
Transvaginal ultrasound shows empty uterus, right adnexal mass with fetal pole and cardiac activity.
Next best step?
, 13. (Pretest) A 50-year-old male with chronic low back pain worse at night, morning stiffness >1 hour. C. MRI brain
ESR 65, CRP 30. X-ray shows bilateral sacroiliitis. Most likely diagnosis? D. Observation
A. Lumbar spinal stenosis
B. Ankylosing spondylitis 20. A 72-year-old female with sudden painless hematuria. No dysuria, no trauma. 50 pack-year
C. Metastatic cancer smoking history. Next best step?
D. Osteoporotic fracture A. CT urogram
B. Cystoscopy
14. A 25-year-old female with dysuria, frequency, suprapubic pain. Urinalysis: + leukocytes, + nitrites. C. Renal ultrasound
Pregnancy test negative. First-line antibiotic if local E. coli resistance to TMP-SMX is <20%? D. Urine cytology
A. Nitrofurantoin 100 mg BID x 5 days
B. TMP-SMX DS BID x 3 days 21. A 2-week-old neonate with poor feeding, lethargy, and hypothermia. Lumbar puncture shows 500
C. Ciprofloxacin 500 mg BID x 3 days WBC (90% lymphs), protein 200, glucose 20. Most likely organism?
D. Fosfomycin 3 g x 1 dose A. Group B Streptococcus
B. Listeria monocytogenes
15. A 60-year-old with heart failure with reduced ejection fraction (LVEF 30%) presents with worsening C. E. coli
dyspnea, orthopnea, and 5 lb weight gain in 3 days. BP 110/70, HR 95, lungs with crackles. Next best D. Herpes simplex virus
step?
A. Increase furosemide 22. A 40-year-old female with progressive dyspnea on exertion, dry cough. HRCT shows bilateral
B. Start digoxin reticular opacities and honeycombing in peripheral lower lobes. Most likely diagnosis?
C. Increase carvedilol A. Idiopathic pulmonary fibrosis
D. Admit for IV diuresis B. Hypersensitivity pneumonitis
C. Sarcoidosis
16. A 3-year-old with fever for 5 days, bilateral conjunctival injection without exudate, red cracked lips, D. Silicosis
strawberry tongue, polymorphous rash, and cervical adenopathy >1.5 cm. Most likely complication if
untreated? 23. A 65-year-old male with chronic kidney disease stage 4 (eGFR 25) presents with fatigue, bone pain,
A. Coronary artery aneurysms and pruritus. Labs: calcium 8.0, phosphorus 6.0, PTH 500. Next best step?
B. Meningitis A. Sevelamer carbonate
C. Myocarditis B. Calcitriol
D. Arthritis C. Cinacalcet
D. Parathyroidectomy
17. A 45-year-old male with acute epigastric pain radiating to back, nausea, vomiting. Heavy alcohol
use. Lipase 1500. CT shows pancreatic necrosis. Next best step? 24. (Pretest) A 30-year-old G1P0 at 34 weeks with BP 155/95, proteinuria 2+ on dipstick. No headache
A. IV fluids, pain control, NPO or vision changes. Platelets normal, LFTs normal. Diagnosis?
B. ERCP A. Chronic hypertension
C. IV antibiotics B. Preeclampsia without severe features
D. Immediate surgical debridement C. Gestational hypertension
D. HELLP syndrome
18. (Pretest) A 28-year-old female with fatigue, photosensitivity, oral ulcers, and malar rash. ANA
positive, anti-Smith positive, low C4. Urinalysis normal. Best initial treatment? 25. A 45-year-old male with acute monoarthritis of the right first MTP joint. Red, hot, swollen. Serum
A. Hydroxychloroquine uric acid 9.5 mg/dL. Arthrocentesis shows negatively birefringent crystals. Next step for acute flare?
B. Prednisone 60 mg daily A. Colchicine
C. Mycophenolate mofetil B. NSAIDs (if no contraindication)
D. Azathioprine C. Intra-articular corticosteroid
D. All of the above
19. A 55-year-old male with acute onset of vertigo, dysarthria, and ataxia. Symptoms began 90 minutes
ago. Non-contrast head CT normal. Next best step? 26. A 6-year-old with sore throat, fever, headache. Pharynx erythematous with exudates, palatal
A. IV tPA petechiae, anterior cervical adenopathy. Rapid strep negative. Next best step?
B. Aspirin 325 mg A. Treat with amoxicillin
ANCC Family Nurse Practitioner (FNP-BC) Certification Practice Examination — Version 3 for the
B. Methotrexate IM
2026/2027 Academic Year: 175 Questions (150 Scored + 25 Pretest) Across All Domains
C. Salpingectomy
D. Serial beta-hCG
7. A 68-year-old male with chronic cough, hemoptysis, and 50 pack-year smoking history. Chest X-ray
Domain A: Assessment & Diagnosis (40 scored + 6 pretest) shows right hilar mass. Next best step?
A. CT chest with contrast
1. A 62-year-old male with hypertension and hyperlipidemia presents with acute-onset right-sided B. PET scan
weakness and aphasia. Symptoms began 45 minutes ago. BP 185/100, HR 88, NIHSS 12. Non-contrast C. Bronchoscopy with biopsy
head CT shows no hemorrhage. Next best step? D. Sputum cytology
A. Administer IV alteplase (tPA)
B. Lower BP aggressively to <140/90 8. (Pretest) A 16-year-old male with acute scrotal pain for 3 hours. Testis is tender, high-riding, absent
C. Start aspirin 325 mg cremasteric reflex. Next best step?
D. MRI brain with diffusion A. Scrotal ultrasound with Doppler
B. Immediate surgical exploration
2. A 28-year-old female with fatigue, joint pain, and a butterfly rash on the face. ANA positive 1:1280, C. Antibiotics and ice
anti-dsDNA positive, low C3/C4. Urinalysis shows RBC casts and protein 3+. Most likely diagnosis? D. Manual detorsion then surgery
A. Rheumatoid arthritis
B. Systemic lupus erythematosus with lupus nephritis 9. A 55-year-old female with episodic vertigo, tinnitus, and ear fullness. Episodes last 2–4 hours with
C. Mixed connective tissue disease nausea and vomiting. Asymptomatic between episodes. Most likely diagnosis?
D. IgA nephropathy A. BPPV
B. Ménière’s disease
3. (Pretest) A 55-year-old male with sudden-onset severe headache, vomiting, and photophobia. Non- C. Vestibular neuritis
contrast head CT shows hyperdensity in the basilar cisterns. Next best step? D. Labyrinthitis
A. Lumbar puncture
B. CT angiography 10. A 4-year-old with fever, barking cough, and inspiratory stridor worse at night. No drooling, no toxic
C. Cerebral angiography appearance. Most likely diagnosis?
D. IV nimodipine A. Epiglottitis
B. Croup
4. A 45-year-old female with palpitations, heat intolerance, weight loss, and fine tremor. TSH <0.01, C. Bacterial tracheitis
free T4 3.5, free T3 elevated. Thyroid uptake scan shows diffuse increased uptake. Best initial D. Peritonsillar abscess
treatment?
A. Methimazole 11. A 70-year-old male with history of stroke presents with urinary urgency, frequency, and urge
B. Radioactive iodine ablation incontinence. Post-void residual 50 mL. Most likely type of incontinence?
C. Propranolol alone A. Stress incontinence
D. Thyroidectomy B. Urge incontinence
C. Overflow incontinence
5. A 6-month-old infant with fever 39.5°C, irritability, and poor feeding. No focal findings on exam. D. Functional incontinence
Vaccines up to date. Appearance nontoxic. Next best step?
A. Lumbar puncture 12. A 35-year-old obese female with right upper quadrant pain after fatty meals. Ultrasound shows
B. Urinalysis and urine culture gallstones. WBC normal, LFTs normal, afebrile. Next best step?
C. Chest X-ray A. Laparoscopic cholecystectomy
D. Empiric IV antibiotics B. ERCP
C. Ursodiol
6. A 30-year-old G2P1001 at 8 weeks gestation with right lower quadrant pain and spotting. D. Low-fat diet and observation
Transvaginal ultrasound shows empty uterus, right adnexal mass with fetal pole and cardiac activity.
Next best step?
, 13. (Pretest) A 50-year-old male with chronic low back pain worse at night, morning stiffness >1 hour. C. MRI brain
ESR 65, CRP 30. X-ray shows bilateral sacroiliitis. Most likely diagnosis? D. Observation
A. Lumbar spinal stenosis
B. Ankylosing spondylitis 20. A 72-year-old female with sudden painless hematuria. No dysuria, no trauma. 50 pack-year
C. Metastatic cancer smoking history. Next best step?
D. Osteoporotic fracture A. CT urogram
B. Cystoscopy
14. A 25-year-old female with dysuria, frequency, suprapubic pain. Urinalysis: + leukocytes, + nitrites. C. Renal ultrasound
Pregnancy test negative. First-line antibiotic if local E. coli resistance to TMP-SMX is <20%? D. Urine cytology
A. Nitrofurantoin 100 mg BID x 5 days
B. TMP-SMX DS BID x 3 days 21. A 2-week-old neonate with poor feeding, lethargy, and hypothermia. Lumbar puncture shows 500
C. Ciprofloxacin 500 mg BID x 3 days WBC (90% lymphs), protein 200, glucose 20. Most likely organism?
D. Fosfomycin 3 g x 1 dose A. Group B Streptococcus
B. Listeria monocytogenes
15. A 60-year-old with heart failure with reduced ejection fraction (LVEF 30%) presents with worsening C. E. coli
dyspnea, orthopnea, and 5 lb weight gain in 3 days. BP 110/70, HR 95, lungs with crackles. Next best D. Herpes simplex virus
step?
A. Increase furosemide 22. A 40-year-old female with progressive dyspnea on exertion, dry cough. HRCT shows bilateral
B. Start digoxin reticular opacities and honeycombing in peripheral lower lobes. Most likely diagnosis?
C. Increase carvedilol A. Idiopathic pulmonary fibrosis
D. Admit for IV diuresis B. Hypersensitivity pneumonitis
C. Sarcoidosis
16. A 3-year-old with fever for 5 days, bilateral conjunctival injection without exudate, red cracked lips, D. Silicosis
strawberry tongue, polymorphous rash, and cervical adenopathy >1.5 cm. Most likely complication if
untreated? 23. A 65-year-old male with chronic kidney disease stage 4 (eGFR 25) presents with fatigue, bone pain,
A. Coronary artery aneurysms and pruritus. Labs: calcium 8.0, phosphorus 6.0, PTH 500. Next best step?
B. Meningitis A. Sevelamer carbonate
C. Myocarditis B. Calcitriol
D. Arthritis C. Cinacalcet
D. Parathyroidectomy
17. A 45-year-old male with acute epigastric pain radiating to back, nausea, vomiting. Heavy alcohol
use. Lipase 1500. CT shows pancreatic necrosis. Next best step? 24. (Pretest) A 30-year-old G1P0 at 34 weeks with BP 155/95, proteinuria 2+ on dipstick. No headache
A. IV fluids, pain control, NPO or vision changes. Platelets normal, LFTs normal. Diagnosis?
B. ERCP A. Chronic hypertension
C. IV antibiotics B. Preeclampsia without severe features
D. Immediate surgical debridement C. Gestational hypertension
D. HELLP syndrome
18. (Pretest) A 28-year-old female with fatigue, photosensitivity, oral ulcers, and malar rash. ANA
positive, anti-Smith positive, low C4. Urinalysis normal. Best initial treatment? 25. A 45-year-old male with acute monoarthritis of the right first MTP joint. Red, hot, swollen. Serum
A. Hydroxychloroquine uric acid 9.5 mg/dL. Arthrocentesis shows negatively birefringent crystals. Next step for acute flare?
B. Prednisone 60 mg daily A. Colchicine
C. Mycophenolate mofetil B. NSAIDs (if no contraindication)
D. Azathioprine C. Intra-articular corticosteroid
D. All of the above
19. A 55-year-old male with acute onset of vertigo, dysarthria, and ataxia. Symptoms began 90 minutes
ago. Non-contrast head CT normal. Next best step? 26. A 6-year-old with sore throat, fever, headache. Pharynx erythematous with exudates, palatal
A. IV tPA petechiae, anterior cervical adenopathy. Rapid strep negative. Next best step?
B. Aspirin 325 mg A. Treat with amoxicillin
