ANCC FNP Exam Prep 2026 |
Questions Bank with
Rationales | Pass Guarantee
1. A 58-year-old male with a history of hypertension presents for a routine visit.
His current blood pressure is 152/94 mmHg. According to the 2017 ACC/AHA
guidelines, his blood pressure is classified as:
A. Elevated
B. Stage 1 Hypertension
C. Stage 2 Hypertension
D. Hypertensive Crisis
Correct Answer: C. Stage 2 Hypertension
Rationale: The 2017 ACC/AHA guidelines define Stage 2 Hypertension as a
systolic BP ≥140 mmHg or a diastolic BP ≥90 mmHg. This patient's BP of 152/94
mmHg falls into this category. Stage 1 is 130-139/80-89 mmHg.
2. Which of the following is the most common cause of community-acquired
pneumonia (CAP) in adults?
A. Haemophilus influenzae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Correct Answer: C. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most frequently identified
bacterial cause of community-acquired pneumonia across all adult age groups.
While atypical bacteria like Mycoplasma are common, pneumococcus is the
classic and most prevalent pathogen.
,3. A 24-year-old female presents with a 3-day history of dysuria, urinary
frequency, and urgency. She has no fever or flank pain. A urinalysis is positive for
leukocyte esterase and nitrites. The most appropriate initial management is:
A. Obtain a urine culture and await results.
B. Prescribe a 3-day course of trimethoprim-sulfamethoxazole.
C. Prescribe a 7-day course of amoxicillin.
D. Refer to urology for cystoscopy.
Correct Answer: B. Prescribe a 3-day course of trimethoprim-
sulfamethoxazole.
Rationale: This presentation is classic for uncomplicated acute cystitis. First-
line treatment includes a short course (3 days) of trimethoprim-sulfamethoxazole,
nitrofurantoin, or fosfomycin. A culture is not routinely required for
uncomplicated cases.
4. A 6-year-old child is brought in by his mother for a rash. She describes it as
starting on his face and spreading downwards. On exam, you note a "slapped
cheek" appearance on his face and a lacy, reticular rash on his trunk and
extremities. The most likely diagnosis is:
A. Rubella
B. Measles
C. Fifth Disease (Erythema Infectiosum)
D. Roseola Infantum
Correct Answer: C. Fifth Disease (Erythema Infectiosum)
Rationale: Erythema infectiosum, caused by Parvovirus B19, is characterized
by a distinctive "slapped cheek" rash on the face, followed by a lacy, reticular rash
on the body. It is a common, generally benign childhood illness.
5. Which of the following is a non-modifiable risk factor for the development of
osteoporosis?
A. Low calcium intake
B. Sedentary lifestyle
,C. Family history
D. Smoking
Correct Answer: C. Family history
Rationale: Non-modifiable risk factors are those that cannot be changed.
These include genetics (family history), age, gender (female), and ethnicity
(Caucasian or Asian). Low calcium intake, sedentary lifestyle, and smoking are all
modifiable risk factors.
6. A 45-year-old male with type 2 diabetes presents with an A1c of 8.5%. He is
currently on metformin 1000 mg BID. According to the ADA guidelines, the most
appropriate next step in his pharmacologic management is to:
A. Continue metformin and recheck A1c in 6 months.
B. Add a sulfonylurea.
C. Add an SGLT2 inhibitor or GLP-1 receptor agonist.
D. Start basal insulin.
Correct Answer: C. Add an SGLT2 inhibitor or GLP-1 receptor agonist.
Rationale: For patients with type 2 diabetes and an A1c above their target
(generally <7%), adding an agent from a different class is recommended. The ADA
guidelines now favor adding an SGLT2 inhibitor or GLP-1 receptor agonist in
patients with established atherosclerotic cardiovascular disease, heart failure, or
chronic kidney disease due to their proven cardiovascular and renal benefits.
7. A 30-year-old female presents with a 2-week history of palpitations, heat
intolerance, and a 10-pound weight loss despite a normal appetite. Her physical
exam is notable for a fine tremor and a diffusely enlarged, non-tender thyroid
gland. The most likely diagnosis is:
A. Hashimoto's thyroiditis
B. Graves' disease
C. Subacute thyroiditis
D. Thyroid cancer
Correct Answer: B. Graves' disease
Rationale: The symptoms of palpitations, heat intolerance, weight loss, and
, tremor are classic for hyperthyroidism. A diffusely enlarged, non-tender gland in a
young female strongly suggests Graves' disease, an autoimmune condition that is
the most common cause of hyperthyroidism.
8. A 68-year-old male presents for a Medicare Annual Wellness Visit. Which of
the following screening tests is recommended for this patient?
A. Prostate-specific antigen (PSA) test
B. One-time screening for abdominal aortic aneurysm (AAA) by ultrasonography
C. Annual screening for lung cancer with low-dose CT
D. Routine screening for testicular cancer
Correct Answer: B. One-time screening for abdominal aortic aneurysm (AAA)
by ultrasonography
Rationale: The USPSTF recommends a one-time screening for AAA with
ultrasonography in men aged 65 to 75 years who have ever smoked. PSA
screening is a shared decision-making process. Lung cancer screening is for high-
risk individuals (e.g., 50-80 years, 20 pack-year history, currently smoke or quit
within 15 years). Testicular cancer screening is not recommended.
9. A 2-month-old infant is brought in for a well-child visit. Which of the following
immunizations are scheduled to be administered at this visit?
A. Hepatitis B (HepB), Rotavirus (RV), Diphtheria, Tetanus, acellular Pertussis
(DTaP), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV13),
Inactivated Poliovirus (IPV)
B. Measles, Mumps, Rubella (MMR), Varicella (VAR)
C. DTaP, IPV, MMR, VAR
D. HepB, Hib, PCV13
Correct Answer: A. Hepatitis B (HepB), Rotavirus (RV), Diphtheria, Tetanus,
acellular Pertussis (DTaP), Haemophilus influenzae type b (Hib), Pneumococcal
conjugate (PCV13), Inactivated Poliovirus (IPV)
Rationale: According to the CDC immunization schedule, at 2 months of age,
infants should receive their second dose of HepB (if not given at 1 month), and
Questions Bank with
Rationales | Pass Guarantee
1. A 58-year-old male with a history of hypertension presents for a routine visit.
His current blood pressure is 152/94 mmHg. According to the 2017 ACC/AHA
guidelines, his blood pressure is classified as:
A. Elevated
B. Stage 1 Hypertension
C. Stage 2 Hypertension
D. Hypertensive Crisis
Correct Answer: C. Stage 2 Hypertension
Rationale: The 2017 ACC/AHA guidelines define Stage 2 Hypertension as a
systolic BP ≥140 mmHg or a diastolic BP ≥90 mmHg. This patient's BP of 152/94
mmHg falls into this category. Stage 1 is 130-139/80-89 mmHg.
2. Which of the following is the most common cause of community-acquired
pneumonia (CAP) in adults?
A. Haemophilus influenzae
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Correct Answer: C. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae remains the most frequently identified
bacterial cause of community-acquired pneumonia across all adult age groups.
While atypical bacteria like Mycoplasma are common, pneumococcus is the
classic and most prevalent pathogen.
,3. A 24-year-old female presents with a 3-day history of dysuria, urinary
frequency, and urgency. She has no fever or flank pain. A urinalysis is positive for
leukocyte esterase and nitrites. The most appropriate initial management is:
A. Obtain a urine culture and await results.
B. Prescribe a 3-day course of trimethoprim-sulfamethoxazole.
C. Prescribe a 7-day course of amoxicillin.
D. Refer to urology for cystoscopy.
Correct Answer: B. Prescribe a 3-day course of trimethoprim-
sulfamethoxazole.
Rationale: This presentation is classic for uncomplicated acute cystitis. First-
line treatment includes a short course (3 days) of trimethoprim-sulfamethoxazole,
nitrofurantoin, or fosfomycin. A culture is not routinely required for
uncomplicated cases.
4. A 6-year-old child is brought in by his mother for a rash. She describes it as
starting on his face and spreading downwards. On exam, you note a "slapped
cheek" appearance on his face and a lacy, reticular rash on his trunk and
extremities. The most likely diagnosis is:
A. Rubella
B. Measles
C. Fifth Disease (Erythema Infectiosum)
D. Roseola Infantum
Correct Answer: C. Fifth Disease (Erythema Infectiosum)
Rationale: Erythema infectiosum, caused by Parvovirus B19, is characterized
by a distinctive "slapped cheek" rash on the face, followed by a lacy, reticular rash
on the body. It is a common, generally benign childhood illness.
5. Which of the following is a non-modifiable risk factor for the development of
osteoporosis?
A. Low calcium intake
B. Sedentary lifestyle
,C. Family history
D. Smoking
Correct Answer: C. Family history
Rationale: Non-modifiable risk factors are those that cannot be changed.
These include genetics (family history), age, gender (female), and ethnicity
(Caucasian or Asian). Low calcium intake, sedentary lifestyle, and smoking are all
modifiable risk factors.
6. A 45-year-old male with type 2 diabetes presents with an A1c of 8.5%. He is
currently on metformin 1000 mg BID. According to the ADA guidelines, the most
appropriate next step in his pharmacologic management is to:
A. Continue metformin and recheck A1c in 6 months.
B. Add a sulfonylurea.
C. Add an SGLT2 inhibitor or GLP-1 receptor agonist.
D. Start basal insulin.
Correct Answer: C. Add an SGLT2 inhibitor or GLP-1 receptor agonist.
Rationale: For patients with type 2 diabetes and an A1c above their target
(generally <7%), adding an agent from a different class is recommended. The ADA
guidelines now favor adding an SGLT2 inhibitor or GLP-1 receptor agonist in
patients with established atherosclerotic cardiovascular disease, heart failure, or
chronic kidney disease due to their proven cardiovascular and renal benefits.
7. A 30-year-old female presents with a 2-week history of palpitations, heat
intolerance, and a 10-pound weight loss despite a normal appetite. Her physical
exam is notable for a fine tremor and a diffusely enlarged, non-tender thyroid
gland. The most likely diagnosis is:
A. Hashimoto's thyroiditis
B. Graves' disease
C. Subacute thyroiditis
D. Thyroid cancer
Correct Answer: B. Graves' disease
Rationale: The symptoms of palpitations, heat intolerance, weight loss, and
, tremor are classic for hyperthyroidism. A diffusely enlarged, non-tender gland in a
young female strongly suggests Graves' disease, an autoimmune condition that is
the most common cause of hyperthyroidism.
8. A 68-year-old male presents for a Medicare Annual Wellness Visit. Which of
the following screening tests is recommended for this patient?
A. Prostate-specific antigen (PSA) test
B. One-time screening for abdominal aortic aneurysm (AAA) by ultrasonography
C. Annual screening for lung cancer with low-dose CT
D. Routine screening for testicular cancer
Correct Answer: B. One-time screening for abdominal aortic aneurysm (AAA)
by ultrasonography
Rationale: The USPSTF recommends a one-time screening for AAA with
ultrasonography in men aged 65 to 75 years who have ever smoked. PSA
screening is a shared decision-making process. Lung cancer screening is for high-
risk individuals (e.g., 50-80 years, 20 pack-year history, currently smoke or quit
within 15 years). Testicular cancer screening is not recommended.
9. A 2-month-old infant is brought in for a well-child visit. Which of the following
immunizations are scheduled to be administered at this visit?
A. Hepatitis B (HepB), Rotavirus (RV), Diphtheria, Tetanus, acellular Pertussis
(DTaP), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV13),
Inactivated Poliovirus (IPV)
B. Measles, Mumps, Rubella (MMR), Varicella (VAR)
C. DTaP, IPV, MMR, VAR
D. HepB, Hib, PCV13
Correct Answer: A. Hepatitis B (HepB), Rotavirus (RV), Diphtheria, Tetanus,
acellular Pertussis (DTaP), Haemophilus influenzae type b (Hib), Pneumococcal
conjugate (PCV13), Inactivated Poliovirus (IPV)
Rationale: According to the CDC immunization schedule, at 2 months of age,
infants should receive their second dose of HepB (if not given at 1 month), and
