ANCC FNP Exam Prep
(PDF) Questions and Ansẉers with
rationales 2026\2027 update
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Questions and Ansẉers
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,───────────────────────────────────────────────────────
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1. A 55-year-old male with a history of hypertension and type 2
diabetes presents for a follow-up. His blood pressure is 148/92
mmHg, and his HbA1c is 7.8%. He is currently on lisinopril 20 mg
daily and metformin 1000 mg twice daily. What is the most
appropriate next step in management?
A) Increase lisinopril to 40 mg daily
B) Add amlodipine 5 mg daily
C) Add hydrochlorothiazide 25 mg daily
D) Switch lisinopril to losartan 50 mg daily
Answer: B
Rationale: According to the ACC/AHA guidelines, for a patient with
diabetes and a blood pressure goal of <130/80 mmHg who is not at
goal on an ACE inhibitor, the most appropriate next step is to add a
calcium channel blocker (like amlodipine) or a thiazide diuretic.
However, because the patient has diabetes, adding amlodipine is
often preferred over a thiazide diuretic due to the metabolic side
effects of thiazides (hyperglycemia, hyperlipidemia). Increasing the
ACE inhibitor to max dose is an option, but adding a second agent
from a different class provides better BP reduction and target organ
protection.
2. Which of the following is an absolute contraindication to the use
of combined oral contraceptive pills (COCPs)?
A) History of gestational diabetes
B) Migraine with aura
C) Age older than 35 years
D) Unexplained vaginal bleeding
Answer: B
Rationale: Migraine with aura is an absolute contraindication (WHO
Category 4) for COCPs due to the significantly increased risk of
,ischemic stroke. Unexplained vaginal bleeding is a relative
contraindication (Category 2/3) until the cause is identified. Age
>35 alone is not a contraindication unless combined with smoking.
A history of gestational diabetes is not a contraindication.
3. A 24-year-old female presents with a 2-day history of dysuria,
urinary frequency, and suprapubic tenderness. A urinalysis shows
positive leukocyte esterase and nitrites. She has no fever or flank
pain. What is the most appropriate treatment?
A) Ciprofloxacin 500 mg twice daily for 7 days
B) Nitrofurantoin 100 mg twice daily for 5 days
C) Amoxicillin 500 mg twice daily for 10 days
D) TMP-SMX 1 DS tablet twice daily for 3 days
Answer: B
Rationale: This patient presents with an uncomplicated cystitis.
First-line treatments include nitrofurantoin for 5 days or TMP-SMX
for 3 days (if local E. coli resistance is <20%). Fluoroquinolones (like
ciprofloxacin) are reserved for complicated UTIs or pyelonephritis
due to severe side effects. Amoxicillin is not recommended due to
high resistance rates. Nitrofurantoin is highly effective and
concentrates in the bladder.
4. A 65-year-old male presents with progressive difficulty initiating
his urine stream, dribbling, and nocturia. His PSA is 2.5 ng/mL.
Digital rectal exam reveals an enlarged, smooth, non-tender
prostate. What is the most likely diagnosis?
A) Prostate cancer
B) Acute prostatitis
C) Benign prostatic hyperplasia (BPH)
D) Urethral stricture
Answer: C
Rationale: The patient presents with classic lower urinary tract
symptoms (LUTS) and an enlarged, smooth, non-tender prostate on
DRE, which is characteristic of BPH. A normal PSA for his age and a
, smooth prostate make prostate cancer less likely. Acute prostatitis
presents with a tender, warm prostate and systemic symptoms
(fever). Urethral stricture would not cause an enlarged prostate.
5. A 30-year-old female presents with a 3-week history of profound
fatigue, weight gain, constipation, and menorrhagia. Her TSH is 45
mIU/L (normal 0.4-4.0) and free T4 is low. What is the most likely
etiology of her condition?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subacute thyroiditis
D) Iodine deficiency
Answer: B
Rationale: The patient has primary hypothyroidism (elevated TSH,
low free T4). In the US, the most common cause of primary
hypothyroidism is Hashimoto's thyroiditis, an autoimmune
condition. Graves' disease causes hyperthyroidism. Subacute
thyroiditis often presents with a tender thyroid and transient
hyperthyroidism followed by hypothyroidism. Iodine deficiency is
rare in the US due to iodized salt.
6. A 10-month-old infant presents with a 3-day history of fever up to
103°F, irritability, and poor feeding. Today, the fever abruptly
resolved, and the infant developed a maculopapular rash on the
trunk. What is the most likely diagnosis?
A) Measles
B) Rubella
C) Roseola infantum
D) Fifth disease
Answer: C
Rationale: Roseola infantum (Exanthem subitum), caused by Human
Herpesvirus 6, classically presents with 3-5 days of high fever in a
child aged 6 months to 3 years, followed by an abrupt drop in fever
and the appearance of a maculopapular rash as the fever breaks.
(PDF) Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
1. A 55-year-old male with a history of hypertension and type 2
diabetes presents for a follow-up. His blood pressure is 148/92
mmHg, and his HbA1c is 7.8%. He is currently on lisinopril 20 mg
daily and metformin 1000 mg twice daily. What is the most
appropriate next step in management?
A) Increase lisinopril to 40 mg daily
B) Add amlodipine 5 mg daily
C) Add hydrochlorothiazide 25 mg daily
D) Switch lisinopril to losartan 50 mg daily
Answer: B
Rationale: According to the ACC/AHA guidelines, for a patient with
diabetes and a blood pressure goal of <130/80 mmHg who is not at
goal on an ACE inhibitor, the most appropriate next step is to add a
calcium channel blocker (like amlodipine) or a thiazide diuretic.
However, because the patient has diabetes, adding amlodipine is
often preferred over a thiazide diuretic due to the metabolic side
effects of thiazides (hyperglycemia, hyperlipidemia). Increasing the
ACE inhibitor to max dose is an option, but adding a second agent
from a different class provides better BP reduction and target organ
protection.
2. Which of the following is an absolute contraindication to the use
of combined oral contraceptive pills (COCPs)?
A) History of gestational diabetes
B) Migraine with aura
C) Age older than 35 years
D) Unexplained vaginal bleeding
Answer: B
Rationale: Migraine with aura is an absolute contraindication (WHO
Category 4) for COCPs due to the significantly increased risk of
,ischemic stroke. Unexplained vaginal bleeding is a relative
contraindication (Category 2/3) until the cause is identified. Age
>35 alone is not a contraindication unless combined with smoking.
A history of gestational diabetes is not a contraindication.
3. A 24-year-old female presents with a 2-day history of dysuria,
urinary frequency, and suprapubic tenderness. A urinalysis shows
positive leukocyte esterase and nitrites. She has no fever or flank
pain. What is the most appropriate treatment?
A) Ciprofloxacin 500 mg twice daily for 7 days
B) Nitrofurantoin 100 mg twice daily for 5 days
C) Amoxicillin 500 mg twice daily for 10 days
D) TMP-SMX 1 DS tablet twice daily for 3 days
Answer: B
Rationale: This patient presents with an uncomplicated cystitis.
First-line treatments include nitrofurantoin for 5 days or TMP-SMX
for 3 days (if local E. coli resistance is <20%). Fluoroquinolones (like
ciprofloxacin) are reserved for complicated UTIs or pyelonephritis
due to severe side effects. Amoxicillin is not recommended due to
high resistance rates. Nitrofurantoin is highly effective and
concentrates in the bladder.
4. A 65-year-old male presents with progressive difficulty initiating
his urine stream, dribbling, and nocturia. His PSA is 2.5 ng/mL.
Digital rectal exam reveals an enlarged, smooth, non-tender
prostate. What is the most likely diagnosis?
A) Prostate cancer
B) Acute prostatitis
C) Benign prostatic hyperplasia (BPH)
D) Urethral stricture
Answer: C
Rationale: The patient presents with classic lower urinary tract
symptoms (LUTS) and an enlarged, smooth, non-tender prostate on
DRE, which is characteristic of BPH. A normal PSA for his age and a
, smooth prostate make prostate cancer less likely. Acute prostatitis
presents with a tender, warm prostate and systemic symptoms
(fever). Urethral stricture would not cause an enlarged prostate.
5. A 30-year-old female presents with a 3-week history of profound
fatigue, weight gain, constipation, and menorrhagia. Her TSH is 45
mIU/L (normal 0.4-4.0) and free T4 is low. What is the most likely
etiology of her condition?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subacute thyroiditis
D) Iodine deficiency
Answer: B
Rationale: The patient has primary hypothyroidism (elevated TSH,
low free T4). In the US, the most common cause of primary
hypothyroidism is Hashimoto's thyroiditis, an autoimmune
condition. Graves' disease causes hyperthyroidism. Subacute
thyroiditis often presents with a tender thyroid and transient
hyperthyroidism followed by hypothyroidism. Iodine deficiency is
rare in the US due to iodized salt.
6. A 10-month-old infant presents with a 3-day history of fever up to
103°F, irritability, and poor feeding. Today, the fever abruptly
resolved, and the infant developed a maculopapular rash on the
trunk. What is the most likely diagnosis?
A) Measles
B) Rubella
C) Roseola infantum
D) Fifth disease
Answer: C
Rationale: Roseola infantum (Exanthem subitum), caused by Human
Herpesvirus 6, classically presents with 3-5 days of high fever in a
child aged 6 months to 3 years, followed by an abrupt drop in fever
and the appearance of a maculopapular rash as the fever breaks.
