ANCC Family Nurse Practitioner Exam Questions and
Answers with Rationales 2026/2027 Update
1. A 52-year-old patient has a blood pressure of 168/102 mmHg on two
separate visits. Which classification best describes this reading?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: D. Stage 2 hypertension
Rationale: A BP ≥140 systolic or ≥90 diastolic is stage 2 hypertension
under current ACC/AHA classification.
2. Which lifestyle intervention has the strongest evidence for reducing
blood pressure?
A. Increasing sodium intake
B. Following a DASH-style eating pattern
C. Avoiding all carbohydrates
D. Increasing saturated fat
Answer: B. Following a DASH-style eating pattern
Rationale: The DASH dietary pattern emphasizes fruits, vegetables,
whole grains, and low-fat dairy and can meaningfully lower BP.
3. A patient taking lisinopril develops facial swelling and difficulty
breathing. What is the priority action?
A. Give the next dose
B. Discontinue lisinopril and provide emergency evaluation
C. Add hydrochlorothiazide
D. Recheck the BP in one week
Answer: B. Discontinue lisinopril and provide emergency evaluation
Rationale: Angioedema is a potentially life-threatening ACE-inhibitor
adverse effect requiring immediate treatment.
,4. Which laboratory abnormality is most concerning in a patient taking
an ACE inhibitor?
A. Mildly increased HDL
B. Hyperkalemia
C. Low uric acid
D. Mild hypoglycemia
Answer: B. Hyperkalemia
Rationale: ACE inhibitors reduce aldosterone activity and can increase
serum potassium.
5. A 45-year-old patient has LDL cholesterol of 210 mg/dL. What is the
preferred initial pharmacologic approach?
A. No medication
B. High-intensity statin therapy
C. Niacin alone
D. Fibrate alone
Answer: B. High-intensity statin therapy
Rationale: Severe primary hypercholesterolemia with LDL ≥190 mg/dL
generally warrants high-intensity statin treatment regardless of
calculated risk.
6. Which finding is most characteristic of hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Bradycardia
D. Hyperreflexia
Answer: C. Bradycardia
Rationale: Hypothyroidism commonly causes fatigue, cold intolerance,
weight gain, constipation, dry skin, and bradycardia.
7. The most appropriate initial laboratory test for suspected primary
hypothyroidism is:
,A. TSH
B. ACTH
C. Cortisol
D. Growth hormone
Answer: A. TSH
Rationale: TSH is the standard initial screening test for primary thyroid
dysfunction.
8. A patient with Graves disease is most likely to report:
A. Cold intolerance
B. Weight gain
C. Heat intolerance and palpitations
D. Bradycardia
Answer: C. Heat intolerance and palpitations
Rationale: Hyperthyroidism increases metabolic and sympathetic
activity, producing heat intolerance, tachycardia, anxiety, and weight
loss.
9. Which test is preferred for diagnosing diabetes in an asymptomatic
adult when no unequivocal hyperglycemia is present?
A. Random urine glucose
B. Hemoglobin A1c
C. Urine ketones
D. Serum insulin
Answer: B. Hemoglobin A1c
Rationale: A1c is an accepted diagnostic test for diabetes and reflects
average glycemia over approximately 2–3 months.
10. Which A1c result is in the diabetes diagnostic range?
A. 5.2%
B. 5.6%
C. 6.0%
, D. 6.5%
Answer: D. 6.5%
Rationale: An A1c ≥6.5% is diagnostic of diabetes when appropriately
confirmed in an asymptomatic patient.
11. Which medication is generally first-line pharmacologic therapy for
many patients with newly diagnosed type 2 diabetes?
A. Metformin
B. Glyburide exclusively
C. Regular insulin in every patient
D. Acarbose exclusively
Answer: A. Metformin
Rationale: Metformin is commonly used as initial therapy when
appropriate, alongside lifestyle intervention, although newer glucose-
lowering agents may be prioritized for patients with specific
cardiovascular, renal, or weight-related indications.
12. Which symptom suggests hypoglycemia?
A. Dry skin
B. Tremor and diaphoresis
C. Polyuria only
D. Slow wound healing
Answer: B. Tremor and diaphoresis
Rationale: Adrenergic symptoms of hypoglycemia include sweating,
tremor, palpitations, hunger, and anxiety.
13. A patient with diabetes reports burning pain in both feet. This is
most consistent with:
A. Peripheral neuropathy
B. Cellulitis
C. Gout
D. Deep-vein thrombosis
Answers with Rationales 2026/2027 Update
1. A 52-year-old patient has a blood pressure of 168/102 mmHg on two
separate visits. Which classification best describes this reading?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: D. Stage 2 hypertension
Rationale: A BP ≥140 systolic or ≥90 diastolic is stage 2 hypertension
under current ACC/AHA classification.
2. Which lifestyle intervention has the strongest evidence for reducing
blood pressure?
A. Increasing sodium intake
B. Following a DASH-style eating pattern
C. Avoiding all carbohydrates
D. Increasing saturated fat
Answer: B. Following a DASH-style eating pattern
Rationale: The DASH dietary pattern emphasizes fruits, vegetables,
whole grains, and low-fat dairy and can meaningfully lower BP.
3. A patient taking lisinopril develops facial swelling and difficulty
breathing. What is the priority action?
A. Give the next dose
B. Discontinue lisinopril and provide emergency evaluation
C. Add hydrochlorothiazide
D. Recheck the BP in one week
Answer: B. Discontinue lisinopril and provide emergency evaluation
Rationale: Angioedema is a potentially life-threatening ACE-inhibitor
adverse effect requiring immediate treatment.
,4. Which laboratory abnormality is most concerning in a patient taking
an ACE inhibitor?
A. Mildly increased HDL
B. Hyperkalemia
C. Low uric acid
D. Mild hypoglycemia
Answer: B. Hyperkalemia
Rationale: ACE inhibitors reduce aldosterone activity and can increase
serum potassium.
5. A 45-year-old patient has LDL cholesterol of 210 mg/dL. What is the
preferred initial pharmacologic approach?
A. No medication
B. High-intensity statin therapy
C. Niacin alone
D. Fibrate alone
Answer: B. High-intensity statin therapy
Rationale: Severe primary hypercholesterolemia with LDL ≥190 mg/dL
generally warrants high-intensity statin treatment regardless of
calculated risk.
6. Which finding is most characteristic of hypothyroidism?
A. Heat intolerance
B. Weight loss
C. Bradycardia
D. Hyperreflexia
Answer: C. Bradycardia
Rationale: Hypothyroidism commonly causes fatigue, cold intolerance,
weight gain, constipation, dry skin, and bradycardia.
7. The most appropriate initial laboratory test for suspected primary
hypothyroidism is:
,A. TSH
B. ACTH
C. Cortisol
D. Growth hormone
Answer: A. TSH
Rationale: TSH is the standard initial screening test for primary thyroid
dysfunction.
8. A patient with Graves disease is most likely to report:
A. Cold intolerance
B. Weight gain
C. Heat intolerance and palpitations
D. Bradycardia
Answer: C. Heat intolerance and palpitations
Rationale: Hyperthyroidism increases metabolic and sympathetic
activity, producing heat intolerance, tachycardia, anxiety, and weight
loss.
9. Which test is preferred for diagnosing diabetes in an asymptomatic
adult when no unequivocal hyperglycemia is present?
A. Random urine glucose
B. Hemoglobin A1c
C. Urine ketones
D. Serum insulin
Answer: B. Hemoglobin A1c
Rationale: A1c is an accepted diagnostic test for diabetes and reflects
average glycemia over approximately 2–3 months.
10. Which A1c result is in the diabetes diagnostic range?
A. 5.2%
B. 5.6%
C. 6.0%
, D. 6.5%
Answer: D. 6.5%
Rationale: An A1c ≥6.5% is diagnostic of diabetes when appropriately
confirmed in an asymptomatic patient.
11. Which medication is generally first-line pharmacologic therapy for
many patients with newly diagnosed type 2 diabetes?
A. Metformin
B. Glyburide exclusively
C. Regular insulin in every patient
D. Acarbose exclusively
Answer: A. Metformin
Rationale: Metformin is commonly used as initial therapy when
appropriate, alongside lifestyle intervention, although newer glucose-
lowering agents may be prioritized for patients with specific
cardiovascular, renal, or weight-related indications.
12. Which symptom suggests hypoglycemia?
A. Dry skin
B. Tremor and diaphoresis
C. Polyuria only
D. Slow wound healing
Answer: B. Tremor and diaphoresis
Rationale: Adrenergic symptoms of hypoglycemia include sweating,
tremor, palpitations, hunger, and anxiety.
13. A patient with diabetes reports burning pain in both feet. This is
most consistent with:
A. Peripheral neuropathy
B. Cellulitis
C. Gout
D. Deep-vein thrombosis
