ANCC FNP BOARD
CERTIFICATION EXAM 2026-2027
– COMPREHENSIVE TOPIC TEST
QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular
1. A 58-year-old male with hypertension and DM type 2 has a BP of 138/86
mmHg on lisinopril 20 mg daily. His home BP readings average 135/82 mmHg.
What is the most appropriate next step?
A. Add HCTZ 12.5 mg daily
B. Increase lisinopril to 40 mg daily
C. Continue current plan, recheck in 6 months
D. Add amlodipine 5 mg daily
Correct Answer: A
Rationale: 2024 ACC/AHA guidelines target BP <130/80 for high-risk patients (DM,
CKD). Lisinopril is at half-max dose; adding a thiazide (HCTZ) is synergistic and first-
line add-on.
2. A 72-year-old female presents with acute onset of substernal chest pain
radiating to jaw, diaphoresis, and nausea. ECG shows ST elevation in leads V2-
V4. Immediate next step?
A. Administer sublingual nitroglycerin
B. Obtain serial troponins
C. Activate STEMI protocol for emergent PCI
D. Give 324 mg aspirin and wait for cardiology
,Correct Answer: C
Rationale: STEMI requires immediate reperfusion. Door-to-balloon time <90 minutes.
Aspirin is given immediately but activation of PCI is priority.
3. Which finding is most specific for heart failure with preserved ejection
fraction (HFpEF)?
A. LVEF 35% on echo
B. Elevated BNP with normal LVEF
C. S3 gallop
D. Pulmonary edema on CXR with LVEF 60%
Correct Answer: B
Rationale: HFpEF = HF with LVEF ≥50%. Elevated natriuretic peptides confirm HF. S3
is more common in HFrEF.
Section 2: Pulmonology
4. A 6-year-old with cough, wheeze, and nocturnal symptoms 3 nights/week.
Albuterol provides relief. What is the step 1 controller therapy per 2025 GINA
guidelines?
A. Low-dose ICS-formoterol as needed
B. Low-dose ICS daily
C. Montelukast daily
D. Low-dose ICS + LABA daily
Correct Answer: A
Rationale: GINA 2025 recommends as-needed low-dose ICS-formoterol for mild
asthma (Step 1) in adults and children ≥6 years.
5. A 34-year-old with dyspnea, dry cough, and bilateral hilar lymphadenopathy
on CXR. Most likely diagnosis?
A. Tuberculosis
B. Sarcoidosis
C. Lymphoma
D. Histoplasmosis
Correct Answer: B
Rationale: Bilateral hilar lymphadenopathy is classic for sarcoidosis. TB is often
unilateral. Histoplasmosis may have calcified granulomas.
, Section 3: Endocrine
6. A 45-year-old obese female with fasting glucose 138 mg/dL, A1c 7.2%.
Metformin 1000 mg BID. A1c now 7.0%. What is the next step per ADA 2026?
A. Add insulin glargine
B. Add semaglutide
C. Add sitagliptin
D. Continue metformin, recheck in 3 months
Correct Answer: B
Rationale: ADA 2026 recommends adding GLP-1 agonist (semaglutide) for additional
glycemic control and cardiovascular/renal benefit in patients with established ASCVD
or high risk (obesity).
7. A 28-year-old postpartum female presents with palpitations, weight loss
despite increased appetite, and fine tremor. TSH <0.01, free T4 elevated.
Thyroid uptake scan shows high uptake. Best treatment?
A. Methimazole
B. Propylthiouracil
C. Radioactive iodine
D. Propranolol monotherapy
Correct Answer: A
Rationale: Postpartum thyroiditis vs Graves? High uptake = Graves. Methimazole is
first-line for Graves (PTU in first trimester of pregnancy only). Radioactive iodine is
contraindicated if breastfeeding.
Section 4: Pediatrics
8. A 15-month-old is brought for well-child exam. Immunizations: 2, 4, 6
months (DTaP, IPV, Hib, PCV13, RV). No 12-month vaccines yet. Which vaccines
are due now?
A. MMR, Varicella, HepA, PCV13 booster
B. MMR, Varicella, DTaP, IPV
C. MMR, Varicella, Hib, PCV13
D. MMR, Varicella, HepB, RV
CERTIFICATION EXAM 2026-2027
– COMPREHENSIVE TOPIC TEST
QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Cardiovascular
1. A 58-year-old male with hypertension and DM type 2 has a BP of 138/86
mmHg on lisinopril 20 mg daily. His home BP readings average 135/82 mmHg.
What is the most appropriate next step?
A. Add HCTZ 12.5 mg daily
B. Increase lisinopril to 40 mg daily
C. Continue current plan, recheck in 6 months
D. Add amlodipine 5 mg daily
Correct Answer: A
Rationale: 2024 ACC/AHA guidelines target BP <130/80 for high-risk patients (DM,
CKD). Lisinopril is at half-max dose; adding a thiazide (HCTZ) is synergistic and first-
line add-on.
2. A 72-year-old female presents with acute onset of substernal chest pain
radiating to jaw, diaphoresis, and nausea. ECG shows ST elevation in leads V2-
V4. Immediate next step?
A. Administer sublingual nitroglycerin
B. Obtain serial troponins
C. Activate STEMI protocol for emergent PCI
D. Give 324 mg aspirin and wait for cardiology
,Correct Answer: C
Rationale: STEMI requires immediate reperfusion. Door-to-balloon time <90 minutes.
Aspirin is given immediately but activation of PCI is priority.
3. Which finding is most specific for heart failure with preserved ejection
fraction (HFpEF)?
A. LVEF 35% on echo
B. Elevated BNP with normal LVEF
C. S3 gallop
D. Pulmonary edema on CXR with LVEF 60%
Correct Answer: B
Rationale: HFpEF = HF with LVEF ≥50%. Elevated natriuretic peptides confirm HF. S3
is more common in HFrEF.
Section 2: Pulmonology
4. A 6-year-old with cough, wheeze, and nocturnal symptoms 3 nights/week.
Albuterol provides relief. What is the step 1 controller therapy per 2025 GINA
guidelines?
A. Low-dose ICS-formoterol as needed
B. Low-dose ICS daily
C. Montelukast daily
D. Low-dose ICS + LABA daily
Correct Answer: A
Rationale: GINA 2025 recommends as-needed low-dose ICS-formoterol for mild
asthma (Step 1) in adults and children ≥6 years.
5. A 34-year-old with dyspnea, dry cough, and bilateral hilar lymphadenopathy
on CXR. Most likely diagnosis?
A. Tuberculosis
B. Sarcoidosis
C. Lymphoma
D. Histoplasmosis
Correct Answer: B
Rationale: Bilateral hilar lymphadenopathy is classic for sarcoidosis. TB is often
unilateral. Histoplasmosis may have calcified granulomas.
, Section 3: Endocrine
6. A 45-year-old obese female with fasting glucose 138 mg/dL, A1c 7.2%.
Metformin 1000 mg BID. A1c now 7.0%. What is the next step per ADA 2026?
A. Add insulin glargine
B. Add semaglutide
C. Add sitagliptin
D. Continue metformin, recheck in 3 months
Correct Answer: B
Rationale: ADA 2026 recommends adding GLP-1 agonist (semaglutide) for additional
glycemic control and cardiovascular/renal benefit in patients with established ASCVD
or high risk (obesity).
7. A 28-year-old postpartum female presents with palpitations, weight loss
despite increased appetite, and fine tremor. TSH <0.01, free T4 elevated.
Thyroid uptake scan shows high uptake. Best treatment?
A. Methimazole
B. Propylthiouracil
C. Radioactive iodine
D. Propranolol monotherapy
Correct Answer: A
Rationale: Postpartum thyroiditis vs Graves? High uptake = Graves. Methimazole is
first-line for Graves (PTU in first trimester of pregnancy only). Radioactive iodine is
contraindicated if breastfeeding.
Section 4: Pediatrics
8. A 15-month-old is brought for well-child exam. Immunizations: 2, 4, 6
months (DTaP, IPV, Hib, PCV13, RV). No 12-month vaccines yet. Which vaccines
are due now?
A. MMR, Varicella, HepA, PCV13 booster
B. MMR, Varicella, DTaP, IPV
C. MMR, Varicella, Hib, PCV13
D. MMR, Varicella, HepB, RV
