BARKLEY EXAM / ACTUAL CERTIFICATION
2026/2027 EXAM QUESTIONS FAMILY NURSE
PRACTITIONER (FNP) CERTIFICATION REVIEW /
ANCC: ACTUAL EXAM QUESTIONS AND ANSWERS
WI TH RATIONALES
CORE DOMAINS
Assessment (19%)
Diagnosis (17%)
Planning (19%)
Implementation (29%)
Evaluation (15%)
INTRODUCTION
The ANCC Family Nurse Practitioner Board Certification Examination assesses
the competency of graduate-prepared nurses seeking FNP-BC certification. This
comprehensive assessment evaluates knowledge across five critical domains
including assessment, diagnosis, planning, implementation, and evaluation. The
examination employs 175 questions (150 scored, 25 pretest) to be completed in 3.5
hours . Candidates must demonstrate applied clinical judgment and decision-
making skills essential for family practice. Emphasis is placed on evidence-based
practice, pharmacotherapeutics, and professional role implementation. Successful
completion validates the candidate's readiness to provide comprehensive primary
care across the lifespan.
SECTION ONE: QUESTIONS 1–100
Question 1
The ANCC FNP exam consists of 175 questions. How many of these questions are
pretest questions that do not count toward the candidate's score?
,A. 15
B. 20
C. 25
D. 30
C. 25
RATIONALE: The ANCC FNP exam has 175 total questions, of which 25 are
pretest questions that are not scored. The remaining 150 questions contribute to the
candidate's final score .
Question 2
According to the ANCC FNP-BC Test Content Outline effective October 2026,
which domain accounts for the largest percentage of the exam?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation
D. Implementation
RATIONALE: The Implementation domain comprises 29% of the exam (43
questions), making it the largest domain. Assessment is 19% (29 questions),
Diagnosis is 17% (26 questions), Planning is 19% (29 questions), and Evaluation is
15% (23 questions) .
Question 3
A 58-year-old male with metabolic syndrome and a recent diagnosis of
nonalcoholic steatohepatitis (NASH) presents with persistently elevated ALT (78
U/L) despite dietary counseling. His HbA1c is 7.2% on metformin. Which
pharmacological agent has the strongest evidence for simultaneously improving
glycemic control and reducing hepatic steatosis in this patient?
A. Pioglitazone 30 mg daily
B. Glipizide 5 mg daily
,C. Sitagliptin 100 mg daily
D. Empagliflozin 10 mg daily
A. Pioglitazone 30 mg daily
RATIONALE: Pioglitazone (thiazolidinedione) has demonstrated
improvement in hepatic steatosis and fibrosis in NASH patients with diabetes,
along with glycemic control. Glipizide does not affect steatosis. Sitagliptin and
empagliflozin have less robust evidence for NASH specifically compared to
pioglitazone .
Question 4
A 72-year-old female with a history of hypertension and paroxysmal atrial
fibrillation is started on dabigatran for stroke prophylaxis. She develops acute-
onset, severe dysphagia, odynophagia, and a sensation of a "mass" in her throat 4
days later. Which serious adverse effect of dabigatran should the FNP suspect and
evaluate immediately?
A. Esophageal injury (ulceration or esophagitis) due to the tartaric acid core
B. Angioedema from bradykinin accumulation
C. Pill-induced pill esophagitis from poor swallowing technique
D. Candida esophagitis from immunosuppression
A. Esophageal injury (ulceration or esophagitis) due to the tartaric acid core
RATIONALE: Dabigatran capsules contain tartaric acid to promote
absorption, which can cause esophageal mucosal injury, ulceration, or esophagitis
if the capsule dissolves in the esophagus. Patients should take it with a full glass of
water and remain upright .
Question 5
A 34-year-old male presents with a 2-week history of progressive, painless
bilateral visual blurring, headaches worse in the morning, and transient visual
"gray-outs" when bending over. He has a BMI of 38 and no known medical
history. Funduscopic examination reveals bilateral papilledema with hemorrhages.
, Which diagnostic test is most critical to confirm the suspected diagnosis and guide
immediate management?
A. Lumbar puncture with opening pressure measurement
B. MRI of the brain with and without contrast
C. CT venogram of the cerebral sinuses
D. Visual field testing by perimetry
A. Lumbar puncture with opening pressure measurement
RATIONALE: Idiopathic intracranial hypertension (IIH) is diagnosed by
elevated opening pressure (>250 mm H2O) on LP with normal CSF composition,
in the absence of a space-occupying lesion. MRI and CT venogram are used to rule
out other causes but LP is confirmatory .
Question 6
A 29-year-old G1P0 woman at 34 weeks gestation develops sudden-onset,
painless, bright red vaginal bleeding that is moderate in volume. She has a history
of placenta previa diagnosed at 20 weeks. Fetal heart tracing is reassuring. Which
management plan is most appropriate for this patient?
A. Immediate cesarean delivery due to ongoing bleeding
B. Admit to hospital, administer corticosteroids for fetal lung maturity, and prepare
for possible emergent delivery
C. Digital cervical examination to assess dilation and bleeding source
D. Discharge home with pelvic rest and close outpatient follow-up
B. Admit to hospital, administer corticosteroids for fetal lung maturity, and
prepare for possible emergent delivery
RATIONALE: In a patient with known placenta previa and bleeding at 34
weeks, admission, steroids, and monitoring are appropriate. Digital cervical
examination is contraindicated with placenta previa due to risk of severe
hemorrhage .
Question 7
2026/2027 EXAM QUESTIONS FAMILY NURSE
PRACTITIONER (FNP) CERTIFICATION REVIEW /
ANCC: ACTUAL EXAM QUESTIONS AND ANSWERS
WI TH RATIONALES
CORE DOMAINS
Assessment (19%)
Diagnosis (17%)
Planning (19%)
Implementation (29%)
Evaluation (15%)
INTRODUCTION
The ANCC Family Nurse Practitioner Board Certification Examination assesses
the competency of graduate-prepared nurses seeking FNP-BC certification. This
comprehensive assessment evaluates knowledge across five critical domains
including assessment, diagnosis, planning, implementation, and evaluation. The
examination employs 175 questions (150 scored, 25 pretest) to be completed in 3.5
hours . Candidates must demonstrate applied clinical judgment and decision-
making skills essential for family practice. Emphasis is placed on evidence-based
practice, pharmacotherapeutics, and professional role implementation. Successful
completion validates the candidate's readiness to provide comprehensive primary
care across the lifespan.
SECTION ONE: QUESTIONS 1–100
Question 1
The ANCC FNP exam consists of 175 questions. How many of these questions are
pretest questions that do not count toward the candidate's score?
,A. 15
B. 20
C. 25
D. 30
C. 25
RATIONALE: The ANCC FNP exam has 175 total questions, of which 25 are
pretest questions that are not scored. The remaining 150 questions contribute to the
candidate's final score .
Question 2
According to the ANCC FNP-BC Test Content Outline effective October 2026,
which domain accounts for the largest percentage of the exam?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation
D. Implementation
RATIONALE: The Implementation domain comprises 29% of the exam (43
questions), making it the largest domain. Assessment is 19% (29 questions),
Diagnosis is 17% (26 questions), Planning is 19% (29 questions), and Evaluation is
15% (23 questions) .
Question 3
A 58-year-old male with metabolic syndrome and a recent diagnosis of
nonalcoholic steatohepatitis (NASH) presents with persistently elevated ALT (78
U/L) despite dietary counseling. His HbA1c is 7.2% on metformin. Which
pharmacological agent has the strongest evidence for simultaneously improving
glycemic control and reducing hepatic steatosis in this patient?
A. Pioglitazone 30 mg daily
B. Glipizide 5 mg daily
,C. Sitagliptin 100 mg daily
D. Empagliflozin 10 mg daily
A. Pioglitazone 30 mg daily
RATIONALE: Pioglitazone (thiazolidinedione) has demonstrated
improvement in hepatic steatosis and fibrosis in NASH patients with diabetes,
along with glycemic control. Glipizide does not affect steatosis. Sitagliptin and
empagliflozin have less robust evidence for NASH specifically compared to
pioglitazone .
Question 4
A 72-year-old female with a history of hypertension and paroxysmal atrial
fibrillation is started on dabigatran for stroke prophylaxis. She develops acute-
onset, severe dysphagia, odynophagia, and a sensation of a "mass" in her throat 4
days later. Which serious adverse effect of dabigatran should the FNP suspect and
evaluate immediately?
A. Esophageal injury (ulceration or esophagitis) due to the tartaric acid core
B. Angioedema from bradykinin accumulation
C. Pill-induced pill esophagitis from poor swallowing technique
D. Candida esophagitis from immunosuppression
A. Esophageal injury (ulceration or esophagitis) due to the tartaric acid core
RATIONALE: Dabigatran capsules contain tartaric acid to promote
absorption, which can cause esophageal mucosal injury, ulceration, or esophagitis
if the capsule dissolves in the esophagus. Patients should take it with a full glass of
water and remain upright .
Question 5
A 34-year-old male presents with a 2-week history of progressive, painless
bilateral visual blurring, headaches worse in the morning, and transient visual
"gray-outs" when bending over. He has a BMI of 38 and no known medical
history. Funduscopic examination reveals bilateral papilledema with hemorrhages.
, Which diagnostic test is most critical to confirm the suspected diagnosis and guide
immediate management?
A. Lumbar puncture with opening pressure measurement
B. MRI of the brain with and without contrast
C. CT venogram of the cerebral sinuses
D. Visual field testing by perimetry
A. Lumbar puncture with opening pressure measurement
RATIONALE: Idiopathic intracranial hypertension (IIH) is diagnosed by
elevated opening pressure (>250 mm H2O) on LP with normal CSF composition,
in the absence of a space-occupying lesion. MRI and CT venogram are used to rule
out other causes but LP is confirmatory .
Question 6
A 29-year-old G1P0 woman at 34 weeks gestation develops sudden-onset,
painless, bright red vaginal bleeding that is moderate in volume. She has a history
of placenta previa diagnosed at 20 weeks. Fetal heart tracing is reassuring. Which
management plan is most appropriate for this patient?
A. Immediate cesarean delivery due to ongoing bleeding
B. Admit to hospital, administer corticosteroids for fetal lung maturity, and prepare
for possible emergent delivery
C. Digital cervical examination to assess dilation and bleeding source
D. Discharge home with pelvic rest and close outpatient follow-up
B. Admit to hospital, administer corticosteroids for fetal lung maturity, and
prepare for possible emergent delivery
RATIONALE: In a patient with known placenta previa and bleeding at 34
weeks, admission, steroids, and monitoring are appropriate. Digital cervical
examination is contraindicated with placenta previa due to risk of severe
hemorrhage .
Question 7
