ANCC FNP Board 2026/2027 | ANCC Family Nurse Practitioner FNP-BC Board
Certification Exam Study Guide, FNP Board Exam Prep, Family Nurse Practitioner
Review, Primary Care, Assessment, Diagnosis, Treatment, Pharmacology, Pediatrics,
Women's Health, Adult & Older Adult Care, Practice Questions, Answers & Rationales
Question 1: A 58-year-old woman with type 2 diabetes mellitus presents for a
routine visit. Her blood pressure is 148/92 mm Hg on two separate readings
taken today, and her urine albumin-to-creatinine ratio is 120 mg/g. She has no
history of heart failure. Which medication should be initiated as first-line
therapy for her blood pressure?
A. Hydrochlorothiazide 25 mg daily
B. Atenolol 50 mg daily
C. Lisinopril 10 mg daily
D. Amlodipine 5 mg daily
CORRECT ANSWER: C. Lisinopril 10 mg daily
Rationale: Lisinopril, an angiotensin-converting enzyme inhibitor, is the preferred
first-line agent for hypertensive patients with diabetes and albuminuria because it
reduces intraglomerular pressure and slows the progression of diabetic
nephropathy. Amlodipine and hydrochlorothiazide lower blood pressure
effectively but do not provide the same degree of renal protection. Beta blockers
such as atenolol are no longer recommended as first-line therapy for
uncomplicated hypertension because of weaker protection against stroke and
end-organ damage .
Question 2: A 72-year-old man reports episodes of exertional chest discomfort
and one recent episode of syncope while climbing stairs. On cardiac
examination, you auscultate a harsh crescendo-decrescendo systolic murmur at
the right upper sternal border that radiates to the carotids, with delayed and
diminished carotid upstrokes. Which condition best explains these findings?
A. Hypertrophic cardiomyopathy
B. Aortic stenosis
C. Tricuspid regurgitation
D. Mitral regurgitation
CORRECT ANSWER: B. Aortic stenosis
,Rationale: The combination of a systolic crescendo-decrescendo murmur at the
right upper sternal border radiating to the carotids, delayed carotid upstroke
(pulsus parvus et tardus), and the classic triad of angina, syncope, and dyspnea on
exertion is diagnostic of aortic stenosis. Mitral regurgitation produces a
holosystolic murmur at the apex radiating to the axilla. Hypertrophic
cardiomyopathy produces a systolic murmur that increases with Valsalva and
does not radiate to the carotids. Tricuspid regurgitation is a holosystolic murmur
heard at the left lower sternal border that increases with inspiration .
Question 3: A nurse practitioner is preparing a patient for an office-based
procedure. Which of the following is an essential element of valid informed
consent?
A. Consent is required only for procedures performed in an operating room
B. A signed consent form alone documents that consent is valid
C. Disclosure of the nature of the procedure, its risks and benefits, and reasonable
alternatives
D. Consent obtained from a family member whenever a procedure carries any risk
CORRECT ANSWER: C. Disclosure of the nature of the procedure, its risks and
benefits, and reasonable alternatives
Rationale: Valid informed consent requires that the patient receive and
understand information about the diagnosis, the nature of the proposed
procedure, the material risks and benefits, and reasonable alternatives, including
the option of no treatment. A signature merely documents that the conversation
occurred; it does not substitute for the disclosure and two-way exchange. Family
members cannot consent for a competent adult patient, and consent is required
for any invasive or risk-bearing procedure regardless of setting .
Question 4: A 52-year-old man is diagnosed with type 2 diabetes. His HbA1c is
7.8%. He has no significant comorbidities. According to the American Diabetes
Association, what is the recommended target HbA1c for this patient?
A. Less than 6.0%
B. Less than 6.5%
C. Less than 7.0%
D. Less than 8.0%
,CORRECT ANSWER: C. Less than 7.0%
Rationale: The American Diabetes Association recommends an HbA1c goal of less
than 7.0% for most nonpregnant adults with diabetes who have no significant
comorbidities and a reasonable life expectancy. More stringent goals (such as less
than 6.5%) may be appropriate for selected individual patients if they can be
achieved without significant hypoglycemia or other adverse effects. Less stringent
goals (such as less than 8.0%) are appropriate for patients with a history of severe
hypoglycemia, limited life expectancy, advanced complications, or extensive
comorbid conditions .
Question 5: A 34-year-old woman presents with a 2-day history of dysuria,
urinary frequency, and urgency. She has no fever, flank pain, or vaginal
discharge. Urinalysis is positive for leukocyte esterase and nitrites. What is the
most appropriate management?
A. Obtain a urine culture and await results before treatment
B. Prescribe nitrofurantoin monohydrate/macrocrystals for 5 days
C. Prescribe ciprofloxacin for 7 days
D. Recommend increased fluid intake and follow up in 1 week
CORRECT ANSWER: B. Prescribe nitrofurantoin monohydrate/macrocrystals for
5 days
Rationale: This patient has uncomplicated acute cystitis, characterized by dysuria,
frequency, and urgency without fever or flank pain in a healthy nonpregnant
woman. First-line treatment options include nitrofurantoin
monohydrate/macrocrystals for 5 days, trimethoprim-sulfamethoxazole for 3
days, or fosfomycin in a single dose. Urine culture is not required for
uncomplicated cystitis before initiating treatment. Fluoroquinolones such as
ciprofloxacin are reserved for more complicated infections due to collateral
damage concerns .
Question 6: A 68-year-old man with a history of hypertension and atrial
fibrillation presents with sudden onset of right-sided weakness and aphasia that
began 45 minutes ago. Non-contrast CT of the head is negative for hemorrhage.
Which intervention is most appropriate?
, A. Administer aspirin 325 mg orally
B. Administer intravenous alteplase
C. Administer intravenous heparin infusion
D. Observe and repeat CT in 24 hours
CORRECT ANSWER: B. Administer intravenous alteplase
Rationale: This patient presents with acute ischemic stroke within the therapeutic
window (within 3 to 4.5 hours of symptom onset) with no evidence of
hemorrhage on CT. Intravenous alteplase is the standard of care for eligible
patients. Aspirin is recommended for secondary prevention but is not the acute
treatment of choice. Heparin has not been shown to improve outcomes in acute
ischemic stroke. Observation without intervention would risk further neurological
damage .
Question 7: A 28-year-old woman at 10 weeks gestation presents with a blood
pressure of 148/92 mm Hg. She has no proteinuria and no signs of end-organ
damage. Her blood pressure was normal at her 8-week visit. What is the most
appropriate management?
A. Start labetalol 100 mg twice daily
B. Start methyldopa 250 mg twice daily
C. Monitor blood pressure at home and follow up in 1 week
D. Start nifedipine ER 30 mg daily
CORRECT ANSWER: C. Monitor blood pressure at home and follow up in 1 week
Rationale: Gestational hypertension is defined as new-onset hypertension after
20 weeks gestation without proteinuria. Before 20 weeks, hypertension is
considered chronic. At 10 weeks, this is likely chronic hypertension and should be
monitored. Antihypertensive therapy should be initiated at sustained BP
≥160/105 mmHg or when there is evidence of end-organ damage .
Question 8: A 45-year-old woman presents with a 3-week history of progressive
weakness in her proximal muscles, difficulty rising from a chair, and a heliotrope
rash over her upper eyelids. She also notes a scaly rash over her knuckles.
Which diagnostic test is most specific for this condition?
Certification Exam Study Guide, FNP Board Exam Prep, Family Nurse Practitioner
Review, Primary Care, Assessment, Diagnosis, Treatment, Pharmacology, Pediatrics,
Women's Health, Adult & Older Adult Care, Practice Questions, Answers & Rationales
Question 1: A 58-year-old woman with type 2 diabetes mellitus presents for a
routine visit. Her blood pressure is 148/92 mm Hg on two separate readings
taken today, and her urine albumin-to-creatinine ratio is 120 mg/g. She has no
history of heart failure. Which medication should be initiated as first-line
therapy for her blood pressure?
A. Hydrochlorothiazide 25 mg daily
B. Atenolol 50 mg daily
C. Lisinopril 10 mg daily
D. Amlodipine 5 mg daily
CORRECT ANSWER: C. Lisinopril 10 mg daily
Rationale: Lisinopril, an angiotensin-converting enzyme inhibitor, is the preferred
first-line agent for hypertensive patients with diabetes and albuminuria because it
reduces intraglomerular pressure and slows the progression of diabetic
nephropathy. Amlodipine and hydrochlorothiazide lower blood pressure
effectively but do not provide the same degree of renal protection. Beta blockers
such as atenolol are no longer recommended as first-line therapy for
uncomplicated hypertension because of weaker protection against stroke and
end-organ damage .
Question 2: A 72-year-old man reports episodes of exertional chest discomfort
and one recent episode of syncope while climbing stairs. On cardiac
examination, you auscultate a harsh crescendo-decrescendo systolic murmur at
the right upper sternal border that radiates to the carotids, with delayed and
diminished carotid upstrokes. Which condition best explains these findings?
A. Hypertrophic cardiomyopathy
B. Aortic stenosis
C. Tricuspid regurgitation
D. Mitral regurgitation
CORRECT ANSWER: B. Aortic stenosis
,Rationale: The combination of a systolic crescendo-decrescendo murmur at the
right upper sternal border radiating to the carotids, delayed carotid upstroke
(pulsus parvus et tardus), and the classic triad of angina, syncope, and dyspnea on
exertion is diagnostic of aortic stenosis. Mitral regurgitation produces a
holosystolic murmur at the apex radiating to the axilla. Hypertrophic
cardiomyopathy produces a systolic murmur that increases with Valsalva and
does not radiate to the carotids. Tricuspid regurgitation is a holosystolic murmur
heard at the left lower sternal border that increases with inspiration .
Question 3: A nurse practitioner is preparing a patient for an office-based
procedure. Which of the following is an essential element of valid informed
consent?
A. Consent is required only for procedures performed in an operating room
B. A signed consent form alone documents that consent is valid
C. Disclosure of the nature of the procedure, its risks and benefits, and reasonable
alternatives
D. Consent obtained from a family member whenever a procedure carries any risk
CORRECT ANSWER: C. Disclosure of the nature of the procedure, its risks and
benefits, and reasonable alternatives
Rationale: Valid informed consent requires that the patient receive and
understand information about the diagnosis, the nature of the proposed
procedure, the material risks and benefits, and reasonable alternatives, including
the option of no treatment. A signature merely documents that the conversation
occurred; it does not substitute for the disclosure and two-way exchange. Family
members cannot consent for a competent adult patient, and consent is required
for any invasive or risk-bearing procedure regardless of setting .
Question 4: A 52-year-old man is diagnosed with type 2 diabetes. His HbA1c is
7.8%. He has no significant comorbidities. According to the American Diabetes
Association, what is the recommended target HbA1c for this patient?
A. Less than 6.0%
B. Less than 6.5%
C. Less than 7.0%
D. Less than 8.0%
,CORRECT ANSWER: C. Less than 7.0%
Rationale: The American Diabetes Association recommends an HbA1c goal of less
than 7.0% for most nonpregnant adults with diabetes who have no significant
comorbidities and a reasonable life expectancy. More stringent goals (such as less
than 6.5%) may be appropriate for selected individual patients if they can be
achieved without significant hypoglycemia or other adverse effects. Less stringent
goals (such as less than 8.0%) are appropriate for patients with a history of severe
hypoglycemia, limited life expectancy, advanced complications, or extensive
comorbid conditions .
Question 5: A 34-year-old woman presents with a 2-day history of dysuria,
urinary frequency, and urgency. She has no fever, flank pain, or vaginal
discharge. Urinalysis is positive for leukocyte esterase and nitrites. What is the
most appropriate management?
A. Obtain a urine culture and await results before treatment
B. Prescribe nitrofurantoin monohydrate/macrocrystals for 5 days
C. Prescribe ciprofloxacin for 7 days
D. Recommend increased fluid intake and follow up in 1 week
CORRECT ANSWER: B. Prescribe nitrofurantoin monohydrate/macrocrystals for
5 days
Rationale: This patient has uncomplicated acute cystitis, characterized by dysuria,
frequency, and urgency without fever or flank pain in a healthy nonpregnant
woman. First-line treatment options include nitrofurantoin
monohydrate/macrocrystals for 5 days, trimethoprim-sulfamethoxazole for 3
days, or fosfomycin in a single dose. Urine culture is not required for
uncomplicated cystitis before initiating treatment. Fluoroquinolones such as
ciprofloxacin are reserved for more complicated infections due to collateral
damage concerns .
Question 6: A 68-year-old man with a history of hypertension and atrial
fibrillation presents with sudden onset of right-sided weakness and aphasia that
began 45 minutes ago. Non-contrast CT of the head is negative for hemorrhage.
Which intervention is most appropriate?
, A. Administer aspirin 325 mg orally
B. Administer intravenous alteplase
C. Administer intravenous heparin infusion
D. Observe and repeat CT in 24 hours
CORRECT ANSWER: B. Administer intravenous alteplase
Rationale: This patient presents with acute ischemic stroke within the therapeutic
window (within 3 to 4.5 hours of symptom onset) with no evidence of
hemorrhage on CT. Intravenous alteplase is the standard of care for eligible
patients. Aspirin is recommended for secondary prevention but is not the acute
treatment of choice. Heparin has not been shown to improve outcomes in acute
ischemic stroke. Observation without intervention would risk further neurological
damage .
Question 7: A 28-year-old woman at 10 weeks gestation presents with a blood
pressure of 148/92 mm Hg. She has no proteinuria and no signs of end-organ
damage. Her blood pressure was normal at her 8-week visit. What is the most
appropriate management?
A. Start labetalol 100 mg twice daily
B. Start methyldopa 250 mg twice daily
C. Monitor blood pressure at home and follow up in 1 week
D. Start nifedipine ER 30 mg daily
CORRECT ANSWER: C. Monitor blood pressure at home and follow up in 1 week
Rationale: Gestational hypertension is defined as new-onset hypertension after
20 weeks gestation without proteinuria. Before 20 weeks, hypertension is
considered chronic. At 10 weeks, this is likely chronic hypertension and should be
monitored. Antihypertensive therapy should be initiated at sustained BP
≥160/105 mmHg or when there is evidence of end-organ damage .
Question 8: A 45-year-old woman presents with a 3-week history of progressive
weakness in her proximal muscles, difficulty rising from a chair, and a heliotrope
rash over her upper eyelids. She also notes a scaly rash over her knuckles.
Which diagnostic test is most specific for this condition?
