ANCC FNP Board - Comprehensive Family
Nurse Practitioner EXAM 2026-2027 LATEST
UPDATED VERSION 150 Q
SECTION 1: Comprehensive Health Assessment and Diagnostic Reasoning
(Questions 1–35)
1. A 52-year-old female presents with chest pain. The FNP uses the OLDCARTS
framework to structure the history. Which component of OLDCARTS addresses the
question "What makes the pain better or worse?"
A. Onset
B. Character
C. Relieving/Exacerbating factors
D. Timing
Correct Answer: C
Rationale: OLDCARTS = Onset, Location, Duration, Character,
Aggravating/Relieving factors, Radiation, Timing, Severity. "Relieving/Exacerbating
factors" (option C) addresses what makes the pain better or worse. Onset (A) is
when it started, Character (B) is the quality (sharp, dull), and Timing (D) is the
pattern. OLDCARTS is a standard HPI framework tested on the ANCC FNP exam.
2. A 45-year-old male presents with chronic abdominal pain. The FNP uses the
PQRST framework to further evaluate the pain. What does the "Q" in PQRST
represent?
A. Quality of pain
B. Quantity of pain
C. Quick onset
D. Questioning the patient
, Correct Answer: A
Rationale: PQRST = Provocation/Palliation, Quality, Region/Radiation, Severity,
Timing. "Q" represents Quality of pain (sharp, dull, burning, cramping). PQRST is
particularly useful for pain assessment and is tested as a key HPI framework on
the ANCC FNP exam. Options B, C, and D are incorrect interpretations of the
mnemonic.
3. A 58-year-old patient with hypertension and type 2 diabetes presents for
follow-up. Current medications include lisinopril and metformin. Blood pressure is
154/92 mm Hg on two separate visits. Laboratory results show an estimated GFR
of 58 mL/min/1.73m² and a urine albumin-to-creatinine ratio of 280 mg/g. Which
intervention is most appropriate?
A. Discontinue lisinopril because of the reduced eGFR
B. Increase antihypertensive therapy while continuing ACE inhibitor therapy
C. Begin chronic NSAID therapy
D. Stop metformin immediately because eGFR is below 60
Correct Answer: B
Rationale: This patient has hypertension and significant albuminuria, making
renin-angiotensin system blockade beneficial for renal and cardiovascular
protection. Because blood pressure remains above goal, additional
antihypertensive therapy should be considered while monitoring renal function
and potassium. Discontinuing the ACE inhibitor would remove renal protection,
and NSAIDs are contraindicated in CKD.
4. A 24-year-old woman presents with dysuria and urinary frequency for 2 days.
She has no fever, flank pain, nausea, vaginal discharge, or pregnancy risk.
Urinalysis is positive for leukocyte esterase and nitrites. Which diagnosis is most
likely?
,A. Acute pyelonephritis
B. Acute uncomplicated cystitis
C. Pelvic inflammatory disease
D. Vaginitis
Correct Answer: B
Rationale: Dysuria and frequency without systemic symptoms or flank pain
strongly suggest lower urinary tract infection. Positive leukocyte esterase and
nitrites further support bacterial cystitis, particularly infection caused by common
gram-negative organisms. Pyelonephritis would present with fever and flank pain;
PID and vaginitis typically present with vaginal symptoms.
5. A 45-year-old patient reports episodic headaches, palpitations, sweating, and
severe anxiety. During an episode, blood pressure is 210/118 mm Hg. Which
condition should be considered?
A. Pheochromocytoma
B. Hypothyroidism
C. Iron-deficiency anemia
D. Osteoarthritis
Correct Answer: A
Rationale: Episodic hypertension accompanied by headache, palpitations, and
diaphoresis is characteristic of catecholamine excess and should prompt
evaluation for pheochromocytoma. Other causes of paroxysmal hypertension
should also be considered, but this classic triad strongly suggests
pheochromocytoma.
6. A 67-year-old patient presents with sudden right-sided weakness and difficulty
speaking that began 45 minutes ago. What is the priority diagnostic study?
, A. Noncontrast CT of the head
B. MRI of the lumbar spine
C. Carotid ultrasound only
D. EEG
Correct Answer: A
Rationale: A patient with suspected acute stroke requires rapid brain imaging
to distinguish ischemic from hemorrhagic stroke. Noncontrast head CT is widely
used initially because it can rapidly identify intracranial hemorrhage and guide
urgent treatment decisions. MRI is more sensitive for acute ischemia but is not the
first-line emergency study.
7. A 32-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Examination reveals dry skin and a delayed relaxation phase of the
deep tendon reflexes. Which laboratory test is the best initial screening test?
A. Serum TSH
B. Serum cortisol
C. Serum aldosterone
D. Serum growth hormone
Correct Answer: A
Rationale: The clinical findings are consistent with hypothyroidism. Serum
thyroid-stimulating hormone is generally the initial screening test for primary
hypothyroidism because it is highly sensitive to changes in thyroid hormone levels.
Cortisol, aldosterone, and growth hormone are not indicated for this presentation.
8. The FNP asks a patient to perform rapid, alternating movements of the hands to
evaluate:
A. Cerebellar function
B. Cognitive function
Nurse Practitioner EXAM 2026-2027 LATEST
UPDATED VERSION 150 Q
SECTION 1: Comprehensive Health Assessment and Diagnostic Reasoning
(Questions 1–35)
1. A 52-year-old female presents with chest pain. The FNP uses the OLDCARTS
framework to structure the history. Which component of OLDCARTS addresses the
question "What makes the pain better or worse?"
A. Onset
B. Character
C. Relieving/Exacerbating factors
D. Timing
Correct Answer: C
Rationale: OLDCARTS = Onset, Location, Duration, Character,
Aggravating/Relieving factors, Radiation, Timing, Severity. "Relieving/Exacerbating
factors" (option C) addresses what makes the pain better or worse. Onset (A) is
when it started, Character (B) is the quality (sharp, dull), and Timing (D) is the
pattern. OLDCARTS is a standard HPI framework tested on the ANCC FNP exam.
2. A 45-year-old male presents with chronic abdominal pain. The FNP uses the
PQRST framework to further evaluate the pain. What does the "Q" in PQRST
represent?
A. Quality of pain
B. Quantity of pain
C. Quick onset
D. Questioning the patient
, Correct Answer: A
Rationale: PQRST = Provocation/Palliation, Quality, Region/Radiation, Severity,
Timing. "Q" represents Quality of pain (sharp, dull, burning, cramping). PQRST is
particularly useful for pain assessment and is tested as a key HPI framework on
the ANCC FNP exam. Options B, C, and D are incorrect interpretations of the
mnemonic.
3. A 58-year-old patient with hypertension and type 2 diabetes presents for
follow-up. Current medications include lisinopril and metformin. Blood pressure is
154/92 mm Hg on two separate visits. Laboratory results show an estimated GFR
of 58 mL/min/1.73m² and a urine albumin-to-creatinine ratio of 280 mg/g. Which
intervention is most appropriate?
A. Discontinue lisinopril because of the reduced eGFR
B. Increase antihypertensive therapy while continuing ACE inhibitor therapy
C. Begin chronic NSAID therapy
D. Stop metformin immediately because eGFR is below 60
Correct Answer: B
Rationale: This patient has hypertension and significant albuminuria, making
renin-angiotensin system blockade beneficial for renal and cardiovascular
protection. Because blood pressure remains above goal, additional
antihypertensive therapy should be considered while monitoring renal function
and potassium. Discontinuing the ACE inhibitor would remove renal protection,
and NSAIDs are contraindicated in CKD.
4. A 24-year-old woman presents with dysuria and urinary frequency for 2 days.
She has no fever, flank pain, nausea, vaginal discharge, or pregnancy risk.
Urinalysis is positive for leukocyte esterase and nitrites. Which diagnosis is most
likely?
,A. Acute pyelonephritis
B. Acute uncomplicated cystitis
C. Pelvic inflammatory disease
D. Vaginitis
Correct Answer: B
Rationale: Dysuria and frequency without systemic symptoms or flank pain
strongly suggest lower urinary tract infection. Positive leukocyte esterase and
nitrites further support bacterial cystitis, particularly infection caused by common
gram-negative organisms. Pyelonephritis would present with fever and flank pain;
PID and vaginitis typically present with vaginal symptoms.
5. A 45-year-old patient reports episodic headaches, palpitations, sweating, and
severe anxiety. During an episode, blood pressure is 210/118 mm Hg. Which
condition should be considered?
A. Pheochromocytoma
B. Hypothyroidism
C. Iron-deficiency anemia
D. Osteoarthritis
Correct Answer: A
Rationale: Episodic hypertension accompanied by headache, palpitations, and
diaphoresis is characteristic of catecholamine excess and should prompt
evaluation for pheochromocytoma. Other causes of paroxysmal hypertension
should also be considered, but this classic triad strongly suggests
pheochromocytoma.
6. A 67-year-old patient presents with sudden right-sided weakness and difficulty
speaking that began 45 minutes ago. What is the priority diagnostic study?
, A. Noncontrast CT of the head
B. MRI of the lumbar spine
C. Carotid ultrasound only
D. EEG
Correct Answer: A
Rationale: A patient with suspected acute stroke requires rapid brain imaging
to distinguish ischemic from hemorrhagic stroke. Noncontrast head CT is widely
used initially because it can rapidly identify intracranial hemorrhage and guide
urgent treatment decisions. MRI is more sensitive for acute ischemia but is not the
first-line emergency study.
7. A 32-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Examination reveals dry skin and a delayed relaxation phase of the
deep tendon reflexes. Which laboratory test is the best initial screening test?
A. Serum TSH
B. Serum cortisol
C. Serum aldosterone
D. Serum growth hormone
Correct Answer: A
Rationale: The clinical findings are consistent with hypothyroidism. Serum
thyroid-stimulating hormone is generally the initial screening test for primary
hypothyroidism because it is highly sensitive to changes in thyroid hormone levels.
Cortisol, aldosterone, and growth hormone are not indicated for this presentation.
8. The FNP asks a patient to perform rapid, alternating movements of the hands to
evaluate:
A. Cerebellar function
B. Cognitive function
