ANCC FNP Board Practice Exam (Latest 2026/2027
Version)
200 Questions and Correct Answers with Comprehensive Rationales | Verified A+
Aligned with ANCC Family Nurse Practitioner Certification Content Outline
Evidence-Based Practice Standards | USPSTF, CDC, ACOG, AAP, ADA, AHA/ACC Guidelines
Section 1: Assessment and Diagnosis (Health History, Physical Exam, and
Diagnostic Testing) - Q1-Q35
Q1: A 45-year-old female presents for an annual physical. She reports fatigue, weight gain, and
cold intolerance over the past 3 months. Her TSH is 8.2 mIU/L (normal 0.4-4.0) and Free T4 is
0.6 ng/dL (normal 0.8-1.8). What is the most likely diagnosis?
A. Subclinical hypothyroidism with normal T4
B. Primary hypothyroidism [CORRECT]
C. Secondary hypothyroidism
D. Hashimoto thyroiditis with hyperthyroid phase
Correct Answer: B
Rationale: The elevated TSH with low Free T4 indicates primary hypothyroidism, where the thyroid gland
fails to produce sufficient thyroid hormone, causing TSH to rise. Subclinical hypothyroidism (A) would have
a normal Free T4. Secondary hypothyroidism (C) would present with low or normal TSH. Hashimoto
thyroiditis (D) is the most common cause but the question asks for the diagnosis based on lab
interpretation, which is primary hypothyroidism.
Q2: A 62-year-old male presents with chest pain that began 2 hours ago while walking uphill.
The pain is substernal, pressure-like, radiates to the left arm, and is relieved by rest. His ECG
shows ST-segment depression in leads V1-V4. What is the most likely diagnosis?
A. Stable angina [CORRECT]
B. Unstable angina
C. Acute myocardial infarction (STEMI)
D. Costochondritis
Correct Answer: A
Rationale: Stable angina is characterized by predictable chest pain triggered by exertion, relieved by rest,
with ST-segment depression on ECG. Unstable angina (B) occurs at rest or with minimal exertion and is not
relieved by rest. STEMI (C) would show ST-segment elevation, not depression. Costochondritis (D) is a
musculoskeletal cause that is reproducible with palpation and does not radiate.
Q3: A nurse practitioner is performing a comprehensive health history using the OLDCARTS
mnemonic. Which component of OLDCARTS assesses what provokes or worsens the symptom?
A. Onset
B. Location
C. Aggravating factors [CORRECT]
D. Relieving factors
Correct Answer: C
,Rationale: In the OLDCARTS mnemonic (Onset, Location, Duration, Character, Aggravating factors,
Relieving factors, Timing, Severity), the 'A' stands for Aggravating factors, which identifies what makes the
symptom worse. Onset (A) addresses when the symptom began. Location (B) identifies where the symptom
occurs. Relieving factors (D) identifies what makes it better, the opposite of aggravating factors.
Q4: A 28-year-old female presents with a chief complaint of recurrent headaches. Her blood
pressure is 168/102 mmHg on two separate readings. She has no family history of hypertension.
Laboratory results show hypokalemia. What is the most likely cause of her secondary
hypertension?
A. Renal artery stenosis
B. Primary hyperaldosteronism (Conn syndrome) [CORRECT]
C. Pheochromocytoma
D. Cushing syndrome
Correct Answer: B
Rationale: Primary hyperaldosteronism (Conn syndrome) is characterized by hypertension with
hypokalemia due to excess aldosterone secretion from the adrenal glands. Renal artery stenosis (A)
typically presents with abdominal bruit and asymmetric kidney size. Pheochromocytoma (C) presents with
episodic hypertension, headaches, diaphoresis, and palpitations. Cushing syndrome (D) presents with
central obesity, moon facies, and striae.
Q5: A 70-year-old male presents for a wellness visit. His BMI is 32, blood pressure 146/88
mmHg, fasting glucose 118 mg/dL, triglycerides 185 mg/dL, and HDL 38 mg/dL. He meets
criteria for which of the following?
A. Metabolic syndrome [CORRECT]
B. Type 2 diabetes mellitus
C. Cushing syndrome
D. Hyperthyroidism
Correct Answer: A
Rationale: Metabolic syndrome requires at least 3 of 5 criteria: elevated waist circumference, elevated
triglycerides (>=150 mg/dL), reduced HDL (<40 mg/dL in men), elevated blood pressure (>=130/85), and
elevated fasting glucose (>=100 mg/dL). This patient meets 4 criteria (BP, fasting glucose, triglycerides,
HDL). Type 2 diabetes (B) requires fasting glucose >=126 mg/dL on two occasions. Cushing syndrome (C)
and hyperthyroidism (D) do not fit this clinical picture.
Q6: A 5-year-old child is brought to the clinic for a well-child visit. The NP observes that the
child cannot hop on one foot, cannot identify four colors, and has difficulty with counting to 10.
These findings suggest a delay in which developmental domain?
A. Gross motor only
B. Fine motor only
C. Cognitive and gross motor [CORRECT]
D. Language and social
Correct Answer: C
Rationale: By age 5, a child should be able to hop on one foot (gross motor milestone), identify four or more
colors (cognitive milestone), and count to 10 (cognitive milestone). Difficulty with both hopping and color
identification/counting indicates delays in both gross motor and cognitive domains. Fine motor (B) would
involve difficulty with drawing, buttoning, or using scissors. Language and social delays (D) would involve
speech and peer interaction difficulties.
,Q7: A 48-year-old female undergoes screening mammography. The radiologist reports BI-RADS
category 4, with a suspicious mass requiring biopsy. What is the appropriate next step in
management?
A. Repeat mammography in 6 months
B. Recommend ultrasound follow-up in 3 months
C. Refer for core needle biopsy [CORRECT]
D. Reassure and continue annual screening
Correct Answer: C
Rationale: BI-RADS category 4 indicates a suspicious abnormality with a 2-95% probability of malignancy,
requiring tissue diagnosis via biopsy. Repeat mammography (A) and ultrasound follow-up (B) are
appropriate for BI-RADS 3 (probably benign). Reassurance with continued annual screening (D) is
appropriate for BI-RADS 1 (negative) or 2 (benign). Core needle biopsy is the standard next step for
BI-RADS 4.
Q8: An NP is interpreting a urinalysis result. The dipstick shows: specific gravity 1.030, pH 5.5,
leukocyte esterase positive, nitrite positive, and WBC 25-50/hpf. What is the most likely
diagnosis?
A. Asymptomatic bacteriuria
B. Uncomplicated bacterial cystitis [CORRECT]
C. Urethritis
D. Nephrolithiasis
Correct Answer: B
Rationale: Positive leukocyte esterase, positive nitrites, and elevated WBCs in the urine strongly indicate a
bacterial urinary tract infection, specifically cystitis. Nitrites are produced by Enterobacteriaceae (most
commonly E. coli) converting nitrates to nitrites. Asymptomatic bacteriuria (A) has similar lab findings but
requires the patient to be asymptomatic. Urethritis (C) typically does not produce nitrite-positive urine.
Nephrolithiasis (D) would show hematuria rather than pyuria with positive nitrites.
Q9: A 55-year-old male presents for a preoperative evaluation before elective knee surgery. His
ECG shows normal sinus rhythm with a rate of 72 bpm, PR interval 0.16 seconds, QRS duration
0.08 seconds, and QTc interval of 460 ms. Which finding requires further evaluation?
A. Normal sinus rhythm at 72 bpm
B. PR interval of 0.16 seconds
C. QRS duration of 0.08 seconds
D. QTc interval of 460 ms [CORRECT]
Correct Answer: D
Rationale: A QTc interval >450 ms in males or >470 ms in females is considered prolonged and requires
further evaluation, as it increases the risk of torsades de pointes. Normal sinus rhythm (A), PR interval 0.16
seconds (normal 0.12-0.20s) (B), and QRS duration 0.08 seconds (normal 0.06-0.10s) (C) are all within
normal limits. QTc prolongation may be congenital or drug-induced and is a significant preoperative
concern.
Q10: A 32-year-old female presents with a painful, swollen, erythematous right knee following a
cat bite 5 days ago. Arthrocentesis reveals WBC count of 85,000/mm3 with 90% neutrophils and
Gram-negative rods on Gram stain. What is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Pasteurella multocida [CORRECT]
, D. Neisseria gonorrhoeae
Correct Answer: C
Rationale: Pasteurella multocida is the most common organism causing infection after cat bites, and it
classically presents as a rapidly progressive cellulitis, tenosynovitis, or septic arthritis within 24-72 hours.
The Gram-negative rod morphology on Gram stain is consistent with Pasteurella. S. aureus (A) is the most
common cause of septic arthritis overall but is Gram-positive. S. pyogenes (B) is also Gram-positive. N.
gonorrhoeae (D) causes septic arthritis in sexually active young adults but is a Gram-negative diplococcus,
not a rod.
Q11: A nurse practitioner is documenting a patient encounter using the SOAP format. Which
component of the SOAP note includes the review of systems and physical examination findings?
A. Subjective
B. Objective [CORRECT]
C. Assessment
D. Plan
Correct Answer: B
Rationale: The Objective section of the SOAP note includes measurable, observable data obtained during
the encounter, including vital signs, physical examination findings, review of systems (when documented as
findings), and laboratory/imaging results. Subjective (A) includes the patient's reported symptoms, history,
and chief complaint. Assessment (C) is the clinical diagnosis or differential diagnoses. Plan (D) includes
treatment, follow-up, and referrals.
Q12: A 67-year-old female presents with progressive memory loss over 18 months, difficulty
managing finances, and getting lost in familiar places. Her Mini-Mental State Examination
(MMSE) score is 22/30. The MoCA score is 18/30. What is the most appropriate initial diagnostic
step?
A. Order brain MRI without contrast
B. Prescribe donepezil immediately
C. Check TSH, B12, and CMP [CORRECT]
D. Refer for lumbar puncture
Correct Answer: C
Rationale: The initial step in evaluating suspected dementia is to rule out reversible causes through
laboratory testing including TSH (hypothyroidism), vitamin B12 (deficiency), and CMP (electrolyte
abnormalities, renal/liver dysfunction). Brain MRI (A) is important but is a secondary step after reversible
causes are excluded. Donepezil (B) should not be prescribed until a diagnosis is confirmed. Lumbar
puncture (D) is not part of the initial dementia workup.
Q13: A 42-year-old male presents with a 3-day history of epigastric pain that worsens after
eating, melena, and fatigue. He takes ibuprofen 800 mg three times daily for chronic back pain.
What is the most likely diagnosis?
A. Gastric ulcer [CORRECT]
B. Duodenal ulcer
C. Gastroesophageal reflux disease
D. Gastritis
Correct Answer: A
Rationale: This patient's chronic NSAID use with epigastric pain worsening after eating and melena
(indicating upper GI bleeding) is most consistent with a gastric ulcer. Gastric ulcers typically cause pain
that worsens with eating, unlike duodenal ulcers (B) which improve with eating. GERD (C) presents with
heartburn and regurgitation, not melena. Gastritis (D) can cause epigastric pain but melena suggests
Version)
200 Questions and Correct Answers with Comprehensive Rationales | Verified A+
Aligned with ANCC Family Nurse Practitioner Certification Content Outline
Evidence-Based Practice Standards | USPSTF, CDC, ACOG, AAP, ADA, AHA/ACC Guidelines
Section 1: Assessment and Diagnosis (Health History, Physical Exam, and
Diagnostic Testing) - Q1-Q35
Q1: A 45-year-old female presents for an annual physical. She reports fatigue, weight gain, and
cold intolerance over the past 3 months. Her TSH is 8.2 mIU/L (normal 0.4-4.0) and Free T4 is
0.6 ng/dL (normal 0.8-1.8). What is the most likely diagnosis?
A. Subclinical hypothyroidism with normal T4
B. Primary hypothyroidism [CORRECT]
C. Secondary hypothyroidism
D. Hashimoto thyroiditis with hyperthyroid phase
Correct Answer: B
Rationale: The elevated TSH with low Free T4 indicates primary hypothyroidism, where the thyroid gland
fails to produce sufficient thyroid hormone, causing TSH to rise. Subclinical hypothyroidism (A) would have
a normal Free T4. Secondary hypothyroidism (C) would present with low or normal TSH. Hashimoto
thyroiditis (D) is the most common cause but the question asks for the diagnosis based on lab
interpretation, which is primary hypothyroidism.
Q2: A 62-year-old male presents with chest pain that began 2 hours ago while walking uphill.
The pain is substernal, pressure-like, radiates to the left arm, and is relieved by rest. His ECG
shows ST-segment depression in leads V1-V4. What is the most likely diagnosis?
A. Stable angina [CORRECT]
B. Unstable angina
C. Acute myocardial infarction (STEMI)
D. Costochondritis
Correct Answer: A
Rationale: Stable angina is characterized by predictable chest pain triggered by exertion, relieved by rest,
with ST-segment depression on ECG. Unstable angina (B) occurs at rest or with minimal exertion and is not
relieved by rest. STEMI (C) would show ST-segment elevation, not depression. Costochondritis (D) is a
musculoskeletal cause that is reproducible with palpation and does not radiate.
Q3: A nurse practitioner is performing a comprehensive health history using the OLDCARTS
mnemonic. Which component of OLDCARTS assesses what provokes or worsens the symptom?
A. Onset
B. Location
C. Aggravating factors [CORRECT]
D. Relieving factors
Correct Answer: C
,Rationale: In the OLDCARTS mnemonic (Onset, Location, Duration, Character, Aggravating factors,
Relieving factors, Timing, Severity), the 'A' stands for Aggravating factors, which identifies what makes the
symptom worse. Onset (A) addresses when the symptom began. Location (B) identifies where the symptom
occurs. Relieving factors (D) identifies what makes it better, the opposite of aggravating factors.
Q4: A 28-year-old female presents with a chief complaint of recurrent headaches. Her blood
pressure is 168/102 mmHg on two separate readings. She has no family history of hypertension.
Laboratory results show hypokalemia. What is the most likely cause of her secondary
hypertension?
A. Renal artery stenosis
B. Primary hyperaldosteronism (Conn syndrome) [CORRECT]
C. Pheochromocytoma
D. Cushing syndrome
Correct Answer: B
Rationale: Primary hyperaldosteronism (Conn syndrome) is characterized by hypertension with
hypokalemia due to excess aldosterone secretion from the adrenal glands. Renal artery stenosis (A)
typically presents with abdominal bruit and asymmetric kidney size. Pheochromocytoma (C) presents with
episodic hypertension, headaches, diaphoresis, and palpitations. Cushing syndrome (D) presents with
central obesity, moon facies, and striae.
Q5: A 70-year-old male presents for a wellness visit. His BMI is 32, blood pressure 146/88
mmHg, fasting glucose 118 mg/dL, triglycerides 185 mg/dL, and HDL 38 mg/dL. He meets
criteria for which of the following?
A. Metabolic syndrome [CORRECT]
B. Type 2 diabetes mellitus
C. Cushing syndrome
D. Hyperthyroidism
Correct Answer: A
Rationale: Metabolic syndrome requires at least 3 of 5 criteria: elevated waist circumference, elevated
triglycerides (>=150 mg/dL), reduced HDL (<40 mg/dL in men), elevated blood pressure (>=130/85), and
elevated fasting glucose (>=100 mg/dL). This patient meets 4 criteria (BP, fasting glucose, triglycerides,
HDL). Type 2 diabetes (B) requires fasting glucose >=126 mg/dL on two occasions. Cushing syndrome (C)
and hyperthyroidism (D) do not fit this clinical picture.
Q6: A 5-year-old child is brought to the clinic for a well-child visit. The NP observes that the
child cannot hop on one foot, cannot identify four colors, and has difficulty with counting to 10.
These findings suggest a delay in which developmental domain?
A. Gross motor only
B. Fine motor only
C. Cognitive and gross motor [CORRECT]
D. Language and social
Correct Answer: C
Rationale: By age 5, a child should be able to hop on one foot (gross motor milestone), identify four or more
colors (cognitive milestone), and count to 10 (cognitive milestone). Difficulty with both hopping and color
identification/counting indicates delays in both gross motor and cognitive domains. Fine motor (B) would
involve difficulty with drawing, buttoning, or using scissors. Language and social delays (D) would involve
speech and peer interaction difficulties.
,Q7: A 48-year-old female undergoes screening mammography. The radiologist reports BI-RADS
category 4, with a suspicious mass requiring biopsy. What is the appropriate next step in
management?
A. Repeat mammography in 6 months
B. Recommend ultrasound follow-up in 3 months
C. Refer for core needle biopsy [CORRECT]
D. Reassure and continue annual screening
Correct Answer: C
Rationale: BI-RADS category 4 indicates a suspicious abnormality with a 2-95% probability of malignancy,
requiring tissue diagnosis via biopsy. Repeat mammography (A) and ultrasound follow-up (B) are
appropriate for BI-RADS 3 (probably benign). Reassurance with continued annual screening (D) is
appropriate for BI-RADS 1 (negative) or 2 (benign). Core needle biopsy is the standard next step for
BI-RADS 4.
Q8: An NP is interpreting a urinalysis result. The dipstick shows: specific gravity 1.030, pH 5.5,
leukocyte esterase positive, nitrite positive, and WBC 25-50/hpf. What is the most likely
diagnosis?
A. Asymptomatic bacteriuria
B. Uncomplicated bacterial cystitis [CORRECT]
C. Urethritis
D. Nephrolithiasis
Correct Answer: B
Rationale: Positive leukocyte esterase, positive nitrites, and elevated WBCs in the urine strongly indicate a
bacterial urinary tract infection, specifically cystitis. Nitrites are produced by Enterobacteriaceae (most
commonly E. coli) converting nitrates to nitrites. Asymptomatic bacteriuria (A) has similar lab findings but
requires the patient to be asymptomatic. Urethritis (C) typically does not produce nitrite-positive urine.
Nephrolithiasis (D) would show hematuria rather than pyuria with positive nitrites.
Q9: A 55-year-old male presents for a preoperative evaluation before elective knee surgery. His
ECG shows normal sinus rhythm with a rate of 72 bpm, PR interval 0.16 seconds, QRS duration
0.08 seconds, and QTc interval of 460 ms. Which finding requires further evaluation?
A. Normal sinus rhythm at 72 bpm
B. PR interval of 0.16 seconds
C. QRS duration of 0.08 seconds
D. QTc interval of 460 ms [CORRECT]
Correct Answer: D
Rationale: A QTc interval >450 ms in males or >470 ms in females is considered prolonged and requires
further evaluation, as it increases the risk of torsades de pointes. Normal sinus rhythm (A), PR interval 0.16
seconds (normal 0.12-0.20s) (B), and QRS duration 0.08 seconds (normal 0.06-0.10s) (C) are all within
normal limits. QTc prolongation may be congenital or drug-induced and is a significant preoperative
concern.
Q10: A 32-year-old female presents with a painful, swollen, erythematous right knee following a
cat bite 5 days ago. Arthrocentesis reveals WBC count of 85,000/mm3 with 90% neutrophils and
Gram-negative rods on Gram stain. What is the most likely causative organism?
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Pasteurella multocida [CORRECT]
, D. Neisseria gonorrhoeae
Correct Answer: C
Rationale: Pasteurella multocida is the most common organism causing infection after cat bites, and it
classically presents as a rapidly progressive cellulitis, tenosynovitis, or septic arthritis within 24-72 hours.
The Gram-negative rod morphology on Gram stain is consistent with Pasteurella. S. aureus (A) is the most
common cause of septic arthritis overall but is Gram-positive. S. pyogenes (B) is also Gram-positive. N.
gonorrhoeae (D) causes septic arthritis in sexually active young adults but is a Gram-negative diplococcus,
not a rod.
Q11: A nurse practitioner is documenting a patient encounter using the SOAP format. Which
component of the SOAP note includes the review of systems and physical examination findings?
A. Subjective
B. Objective [CORRECT]
C. Assessment
D. Plan
Correct Answer: B
Rationale: The Objective section of the SOAP note includes measurable, observable data obtained during
the encounter, including vital signs, physical examination findings, review of systems (when documented as
findings), and laboratory/imaging results. Subjective (A) includes the patient's reported symptoms, history,
and chief complaint. Assessment (C) is the clinical diagnosis or differential diagnoses. Plan (D) includes
treatment, follow-up, and referrals.
Q12: A 67-year-old female presents with progressive memory loss over 18 months, difficulty
managing finances, and getting lost in familiar places. Her Mini-Mental State Examination
(MMSE) score is 22/30. The MoCA score is 18/30. What is the most appropriate initial diagnostic
step?
A. Order brain MRI without contrast
B. Prescribe donepezil immediately
C. Check TSH, B12, and CMP [CORRECT]
D. Refer for lumbar puncture
Correct Answer: C
Rationale: The initial step in evaluating suspected dementia is to rule out reversible causes through
laboratory testing including TSH (hypothyroidism), vitamin B12 (deficiency), and CMP (electrolyte
abnormalities, renal/liver dysfunction). Brain MRI (A) is important but is a secondary step after reversible
causes are excluded. Donepezil (B) should not be prescribed until a diagnosis is confirmed. Lumbar
puncture (D) is not part of the initial dementia workup.
Q13: A 42-year-old male presents with a 3-day history of epigastric pain that worsens after
eating, melena, and fatigue. He takes ibuprofen 800 mg three times daily for chronic back pain.
What is the most likely diagnosis?
A. Gastric ulcer [CORRECT]
B. Duodenal ulcer
C. Gastroesophageal reflux disease
D. Gastritis
Correct Answer: A
Rationale: This patient's chronic NSAID use with epigastric pain worsening after eating and melena
(indicating upper GI bleeding) is most consistent with a gastric ulcer. Gastric ulcers typically cause pain
that worsens with eating, unlike duodenal ulcers (B) which improve with eating. GERD (C) presents with
heartburn and regurgitation, not melena. Gastritis (D) can cause epigastric pain but melena suggests
