ANCC FNP Exam Prep 2026
200 Questions with Answer key and Rationales
1. A 45-year-old female presents with a breast lump she discovered during
self-examination. Which finding in the history would be most concerning for
malignancy?
A. A fixed, non-tender mass with irregular borders
B. A tender, mobile, rubbery mass that changes with menses
C. A small, well-circumscribed mass that is easily movable
D. A painful lump that appeared after trauma to the breast
2. During a cardiovascular assessment of a 60-year-old male, the nurse
practitioner auscultates a systolic ejection murmur at the right upper sternal
border that radiates to the carotids. The murmur increases with Valsalva release.
What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Aortic regurgitation
3. A 32-year-old female presents for her annual well-woman examination. She
reports her last menstrual period was 6 weeks ago. She uses a combination oral
contraceptive pill but admits to missing several doses. Which finding on bimanual
examination would most strongly suggest an ectopic pregnancy?
A. Adnexal fullness and cervical motion tenderness
B. A closed cervical os with minimal discharge
C. Uterine enlargement consistent with 6 weeks gestation
D. Bilateral ovarian tenderness without palpable masses
4. The nurse practitioner is assessing a 70-year-old patient with suspected
dementia. Which screening tool is most appropriate for initial cognitive
assessment in the primary care setting?
A. Mini-Cog
B. Montreal Cognitive Assessment (MoCA)
C. Clock Drawing Test alone
, D. Mini-Mental State Examination (MMSE)
5. A 55-year-old male with a 30-pack-year smoking history presents with chronic
cough, weight loss, and hemoptysis. Chest X-ray reveals a 3 cm right upper lobe
mass. Which diagnostic procedure should the nurse practitioner order next?
A. CT-guided percutaneous needle biopsy
B. Sputum cytology
C. Bronchoscopy with biopsy
D. PET scan
6. Inassessing a newborn at 24 hours of life, the nurse practitioner notes the
infant has acrocyanosis, a heart rate of 145 bpm, and irregular respirations with
occasional periods of apnea lasting up to 10
,seconds. What is the most appropriate interpretation of these findings?
A. These are normal findings for a 24-hour-old newborn
B. The infant requires immediate oxygen supplementation
C. The infant should be evaluated for sepsis
D. The infant needs a cardiology referral for the irregular heart rate
7. A 28-year-old female presents with a 2-day history of dysuria, frequency,
and urgency. She has no fever or flank pain. A urine dipstick is positive for
leukocyte esterase and nitrites. What is the most likely diagnosis?
A. Uncomplicated acute bacterial cystitis
B. Pyelonephritis
C. Urethritis caused by Chlamydia trachomatis
D. Asymptomatic bacteriuria
8. A 65-year-old male presents for a routine physical examination. His blood
pressure is 168/95 mmHg on two separate visits. Laboratory tests reveal a serum
creatinine of 1.8 mg/dL (baseline 1.0 mg/dL), potassium of 5.1 mEq/L, and a
urinalysis showing 1+ protein. Which of the following would be most important
to order next?
A. Renal artery duplex ultrasound
B. 24-hour urine collection for microalbumin
C. Serum aldosterone and plasma renin activity
D. Echocardiogram
9. During a prenatal visit at 28 weeks, a nurse practitioner performs an oral
glucose tolerance test. The results show fasting glucose of 92 mg/dL, 1-hour
glucose of 195 mg/dL, and 2-hour glucose of 158 mg/dL. How should these results
be interpreted?
A. The patient has gestational diabetes mellitus
B. The results are within normal limits
C. The patient has impaired glucose tolerance but not gestational diabetes
D. The test needs to be repeated due to inadequate fasting
10. A 42-year-oldmale presents with severe right-sided flank pain that radiates to
the groin, nausea, and vomiting. The pain started suddenly 2 hours ago.
Urinalysis reveals gross hematuria. What is the most appropriate initial imaging
study?
, A. Non-contrast CT of the abdomen and pelvis
B. Renal ultrasound
C. IV pyelogram
D. MRI of the abdomen
11. A nurse practitioner is performing a well-child check on a 12-month-old infant.
Which developmental milestone is the infant expected to have achieved?
A. Walking independently
B. Using two-word phrases
C. Building a tower of 6-7 cubes
200 Questions with Answer key and Rationales
1. A 45-year-old female presents with a breast lump she discovered during
self-examination. Which finding in the history would be most concerning for
malignancy?
A. A fixed, non-tender mass with irregular borders
B. A tender, mobile, rubbery mass that changes with menses
C. A small, well-circumscribed mass that is easily movable
D. A painful lump that appeared after trauma to the breast
2. During a cardiovascular assessment of a 60-year-old male, the nurse
practitioner auscultates a systolic ejection murmur at the right upper sternal
border that radiates to the carotids. The murmur increases with Valsalva release.
What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Aortic regurgitation
3. A 32-year-old female presents for her annual well-woman examination. She
reports her last menstrual period was 6 weeks ago. She uses a combination oral
contraceptive pill but admits to missing several doses. Which finding on bimanual
examination would most strongly suggest an ectopic pregnancy?
A. Adnexal fullness and cervical motion tenderness
B. A closed cervical os with minimal discharge
C. Uterine enlargement consistent with 6 weeks gestation
D. Bilateral ovarian tenderness without palpable masses
4. The nurse practitioner is assessing a 70-year-old patient with suspected
dementia. Which screening tool is most appropriate for initial cognitive
assessment in the primary care setting?
A. Mini-Cog
B. Montreal Cognitive Assessment (MoCA)
C. Clock Drawing Test alone
, D. Mini-Mental State Examination (MMSE)
5. A 55-year-old male with a 30-pack-year smoking history presents with chronic
cough, weight loss, and hemoptysis. Chest X-ray reveals a 3 cm right upper lobe
mass. Which diagnostic procedure should the nurse practitioner order next?
A. CT-guided percutaneous needle biopsy
B. Sputum cytology
C. Bronchoscopy with biopsy
D. PET scan
6. Inassessing a newborn at 24 hours of life, the nurse practitioner notes the
infant has acrocyanosis, a heart rate of 145 bpm, and irregular respirations with
occasional periods of apnea lasting up to 10
,seconds. What is the most appropriate interpretation of these findings?
A. These are normal findings for a 24-hour-old newborn
B. The infant requires immediate oxygen supplementation
C. The infant should be evaluated for sepsis
D. The infant needs a cardiology referral for the irregular heart rate
7. A 28-year-old female presents with a 2-day history of dysuria, frequency,
and urgency. She has no fever or flank pain. A urine dipstick is positive for
leukocyte esterase and nitrites. What is the most likely diagnosis?
A. Uncomplicated acute bacterial cystitis
B. Pyelonephritis
C. Urethritis caused by Chlamydia trachomatis
D. Asymptomatic bacteriuria
8. A 65-year-old male presents for a routine physical examination. His blood
pressure is 168/95 mmHg on two separate visits. Laboratory tests reveal a serum
creatinine of 1.8 mg/dL (baseline 1.0 mg/dL), potassium of 5.1 mEq/L, and a
urinalysis showing 1+ protein. Which of the following would be most important
to order next?
A. Renal artery duplex ultrasound
B. 24-hour urine collection for microalbumin
C. Serum aldosterone and plasma renin activity
D. Echocardiogram
9. During a prenatal visit at 28 weeks, a nurse practitioner performs an oral
glucose tolerance test. The results show fasting glucose of 92 mg/dL, 1-hour
glucose of 195 mg/dL, and 2-hour glucose of 158 mg/dL. How should these results
be interpreted?
A. The patient has gestational diabetes mellitus
B. The results are within normal limits
C. The patient has impaired glucose tolerance but not gestational diabetes
D. The test needs to be repeated due to inadequate fasting
10. A 42-year-oldmale presents with severe right-sided flank pain that radiates to
the groin, nausea, and vomiting. The pain started suddenly 2 hours ago.
Urinalysis reveals gross hematuria. What is the most appropriate initial imaging
study?
, A. Non-contrast CT of the abdomen and pelvis
B. Renal ultrasound
C. IV pyelogram
D. MRI of the abdomen
11. A nurse practitioner is performing a well-child check on a 12-month-old infant.
Which developmental milestone is the infant expected to have achieved?
A. Walking independently
B. Using two-word phrases
C. Building a tower of 6-7 cubes
