ANCC FNP BOARD EXAM PRACTICE EXAMINATION
2026–2027 — COMPREHENSIVE STUDY GUIDE |
LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A 45-year-old male presents with a blood pressure of 148/92 on two
separate occasions. He has no other medical conditions. What is the initial
management?
A) Start hydrochlorothiazide 25 mg daily
B) Recommend lifestyle modifications and reassess in 3–6 months
C) Start lisinopril 10 mg daily
D) Refer to cardiology
Correct Answer: B
For stage 1 hypertension without compelling indications, lifestyle modifications are
first-line for 3–6 months before initiating pharmacologic therapy. Medication is
initiated if BP remains elevated or if the patient has diabetes, CKD, or high
cardiovascular risk.
2. A 35-year-old female presents with fatigue, weight gain, and cold
intolerance. TSH is 8.5 mIU/L and free T4 is low. What is the most likely
diagnosis?
A) Secondary hypothyroidism
B) Primary hypothyroidism
C) Hyperthyroidism
D) Euthyroid sick syndrome
Correct Answer: B
Primary hypothyroidism is characterized by elevated TSH and low free T4 due to
,thyroid gland failure. Secondary hypothyroidism would have low or normal TSH
with low free T4. Hyperthyroidism has low TSH and high T4.
3. A 60-year-old male with type 2 diabetes has an HbA1c of 8.5% on
metformin 1000 mg twice daily. What is the most appropriate next step?
A) Continue metformin only
B) Add a GLP-1 receptor agonist or SGLT2 inhibitor
C) Discontinue metformin
D) Start insulin glargine only
Correct Answer: B
With an HbA1c above target (usually <7%), a second agent is needed. GLP-1 RAs or
SGLT2 inhibitors are preferred in patients with ASCVD, heart failure, or CKD.
Discontinuing metformin is not indicated. Insulin may be needed later if HbA1c
remains high.
4. A 24-year-old female presents with a 2-day history of dysuria, frequency,
and suprapubic tenderness. Urine dipstick is positive for leukocyte esterase
and nitrites. What is the first-line antibiotic?
A) Ciprofloxacin
B) Nitrofurantoin or trimethoprim-sulfamethoxazole
C) Amoxicillin
D) Azithromycin
Correct Answer: B
For uncomplicated cystitis, nitrofurantoin or TMP-SMX are first-line depending on
local resistance. Fluoroquinolones are reserved for complicated infections.
Amoxicillin has high resistance. Azithromycin is not for UTI.
5. A 50-year-old postmenopausal female reports vaginal dryness and
dyspareunia. What is the most appropriate first-line treatment?
A) Oral estrogen
B) Vaginal estrogen
C) Testosterone cream
D) Sildenafil
,Correct Answer: B
Vaginal estrogen is first-line for genitourinary syndrome of menopause, providing
local relief with minimal systemic absorption. Oral estrogen is for systemic
symptoms. Testosterone and sildenafil are not first-line for vaginal dryness.
6. A 2-year-old child presents with a barky cough, stridor, and low-grade fever.
What is the most likely diagnosis?
A) Epiglottitis
B) Croup
C) Bacterial tracheitis
D) Foreign body aspiration
Correct Answer: B
Croup (laryngotracheobronchitis) presents with barky cough, stridor, and low-
grade fever, often following a viral URI. Epiglottitis has high fever, drooling, and
toxic appearance. Bacterial tracheitis is more severe. Foreign body aspiration has
sudden onset without fever.
7. A 65-year-old male presents with sudden-onset severe headache, nausea,
and photophobia. CT shows blood in the subarachnoid space. What is the
most common cause?
A) Arteriovenous malformation
B) Berry aneurysm rupture
C) Ischemic stroke
D) Hypertensive hemorrhage
Correct Answer: B
Spontaneous subarachnoid hemorrhage is most commonly caused by rupture of a
berry (saccular) aneurysm. AVM is less common. Ischemic stroke does not cause
blood in subarachnoid space. Hypertensive hemorrhage is usually
intraparenchymal.
8. A 30-year-old female presents with a painful, swollen right knee after a
recent GI infection. Synovial fluid shows inflammatory cells, no crystals, and
no bacteria. What is the most likely diagnosis?
, A) Gout
B) Pseudogout
C) Reactive arthritis
D) Septic arthritis
Correct Answer: C
Reactive arthritis follows GI or genitourinary infection and causes sterile
inflammatory arthritis. Gout and pseudogout have crystals. Septic arthritis has
bacteria and is a medical emergency.
9. A 40-year-old male has a total cholesterol of 250 mg/dL, LDL 170 mg/dL,
HDL 40 mg/dL, and triglycerides 150 mg/dL. He has no other risk factors.
What is the initial treatment?
A) Start atorvastatin 20 mg daily
B) Lifestyle modifications and reassess
C) Start fenofibrate
D) Start niacin
Correct Answer: B
For primary prevention with LDL ≥190 mg/dL, statin therapy is indicated
regardless of risk. However, if LDL is 170 and no other risk factors, lifestyle
modifications may be tried first for 3–6 months, but guidelines now recommend
statin for LDL ≥190 only. With LDL 170, risk calculation may guide. The question
lacks ASCVD risk score. Best answer: B lifestyle for moderate elevation without
high risk? But guidelines for LDL 170: if 10-year risk <7.5%, lifestyle; if ≥7.5%,
statin. We'll assume low risk. So B.
10.A 28-year-old female with a history of asthma presents with wheezing,
cough, and shortness of breath. Peak flow is 70% of personal best. What is
the initial treatment?
A) Oral prednisone only
B) Inhaled short-acting beta-agonist and reassess
C) Long-acting beta-agonist monotherapy
D) Inhaled corticosteroid only
2026–2027 — COMPREHENSIVE STUDY GUIDE |
LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A 45-year-old male presents with a blood pressure of 148/92 on two
separate occasions. He has no other medical conditions. What is the initial
management?
A) Start hydrochlorothiazide 25 mg daily
B) Recommend lifestyle modifications and reassess in 3–6 months
C) Start lisinopril 10 mg daily
D) Refer to cardiology
Correct Answer: B
For stage 1 hypertension without compelling indications, lifestyle modifications are
first-line for 3–6 months before initiating pharmacologic therapy. Medication is
initiated if BP remains elevated or if the patient has diabetes, CKD, or high
cardiovascular risk.
2. A 35-year-old female presents with fatigue, weight gain, and cold
intolerance. TSH is 8.5 mIU/L and free T4 is low. What is the most likely
diagnosis?
A) Secondary hypothyroidism
B) Primary hypothyroidism
C) Hyperthyroidism
D) Euthyroid sick syndrome
Correct Answer: B
Primary hypothyroidism is characterized by elevated TSH and low free T4 due to
,thyroid gland failure. Secondary hypothyroidism would have low or normal TSH
with low free T4. Hyperthyroidism has low TSH and high T4.
3. A 60-year-old male with type 2 diabetes has an HbA1c of 8.5% on
metformin 1000 mg twice daily. What is the most appropriate next step?
A) Continue metformin only
B) Add a GLP-1 receptor agonist or SGLT2 inhibitor
C) Discontinue metformin
D) Start insulin glargine only
Correct Answer: B
With an HbA1c above target (usually <7%), a second agent is needed. GLP-1 RAs or
SGLT2 inhibitors are preferred in patients with ASCVD, heart failure, or CKD.
Discontinuing metformin is not indicated. Insulin may be needed later if HbA1c
remains high.
4. A 24-year-old female presents with a 2-day history of dysuria, frequency,
and suprapubic tenderness. Urine dipstick is positive for leukocyte esterase
and nitrites. What is the first-line antibiotic?
A) Ciprofloxacin
B) Nitrofurantoin or trimethoprim-sulfamethoxazole
C) Amoxicillin
D) Azithromycin
Correct Answer: B
For uncomplicated cystitis, nitrofurantoin or TMP-SMX are first-line depending on
local resistance. Fluoroquinolones are reserved for complicated infections.
Amoxicillin has high resistance. Azithromycin is not for UTI.
5. A 50-year-old postmenopausal female reports vaginal dryness and
dyspareunia. What is the most appropriate first-line treatment?
A) Oral estrogen
B) Vaginal estrogen
C) Testosterone cream
D) Sildenafil
,Correct Answer: B
Vaginal estrogen is first-line for genitourinary syndrome of menopause, providing
local relief with minimal systemic absorption. Oral estrogen is for systemic
symptoms. Testosterone and sildenafil are not first-line for vaginal dryness.
6. A 2-year-old child presents with a barky cough, stridor, and low-grade fever.
What is the most likely diagnosis?
A) Epiglottitis
B) Croup
C) Bacterial tracheitis
D) Foreign body aspiration
Correct Answer: B
Croup (laryngotracheobronchitis) presents with barky cough, stridor, and low-
grade fever, often following a viral URI. Epiglottitis has high fever, drooling, and
toxic appearance. Bacterial tracheitis is more severe. Foreign body aspiration has
sudden onset without fever.
7. A 65-year-old male presents with sudden-onset severe headache, nausea,
and photophobia. CT shows blood in the subarachnoid space. What is the
most common cause?
A) Arteriovenous malformation
B) Berry aneurysm rupture
C) Ischemic stroke
D) Hypertensive hemorrhage
Correct Answer: B
Spontaneous subarachnoid hemorrhage is most commonly caused by rupture of a
berry (saccular) aneurysm. AVM is less common. Ischemic stroke does not cause
blood in subarachnoid space. Hypertensive hemorrhage is usually
intraparenchymal.
8. A 30-year-old female presents with a painful, swollen right knee after a
recent GI infection. Synovial fluid shows inflammatory cells, no crystals, and
no bacteria. What is the most likely diagnosis?
, A) Gout
B) Pseudogout
C) Reactive arthritis
D) Septic arthritis
Correct Answer: C
Reactive arthritis follows GI or genitourinary infection and causes sterile
inflammatory arthritis. Gout and pseudogout have crystals. Septic arthritis has
bacteria and is a medical emergency.
9. A 40-year-old male has a total cholesterol of 250 mg/dL, LDL 170 mg/dL,
HDL 40 mg/dL, and triglycerides 150 mg/dL. He has no other risk factors.
What is the initial treatment?
A) Start atorvastatin 20 mg daily
B) Lifestyle modifications and reassess
C) Start fenofibrate
D) Start niacin
Correct Answer: B
For primary prevention with LDL ≥190 mg/dL, statin therapy is indicated
regardless of risk. However, if LDL is 170 and no other risk factors, lifestyle
modifications may be tried first for 3–6 months, but guidelines now recommend
statin for LDL ≥190 only. With LDL 170, risk calculation may guide. The question
lacks ASCVD risk score. Best answer: B lifestyle for moderate elevation without
high risk? But guidelines for LDL 170: if 10-year risk <7.5%, lifestyle; if ≥7.5%,
statin. We'll assume low risk. So B.
10.A 28-year-old female with a history of asthma presents with wheezing,
cough, and shortness of breath. Peak flow is 70% of personal best. What is
the initial treatment?
A) Oral prednisone only
B) Inhaled short-acting beta-agonist and reassess
C) Long-acting beta-agonist monotherapy
D) Inhaled corticosteroid only
