ANCC FNP
600+ QUESTIONS BANK
high-yield questions designed to mirror the
latest ANCC blueprint (2025)
Pass on the first attempt.
Features: Comprehensive ANCC domain coverage · Detailed rationales · Correct answers in red · Evidence-based ·
Expanded high-yield clinical items
PASS 100% GUARANTEED
Total Questions in this edition: 677 | Verified & Updated
, ANCC FNP Questions Bank — Expanded Edition
All 677 questions with Correct Answers and Rationales clearly marked
Correct answers in red | Rationales in green
Q1. A 16-year-old male presents for a sports physical. He has a harsh systolic ejection murmur at the left upper sternal border
that increases with Valsalva and decreases with squatting. What is the most likely diagnosis?
B) Hypertrophic cardiomyopathy
C) Mitral regurgitation
D) Ventricular septal defect
Correct Answer: B
Rationale: HCM murmur increases with Valsalva (decreased preload) and decreases with squatting (increased preload). It is the leading cause of sudden
cardiac death in young athletes.
Q2. A 42-year-old female presents with palpitations and lightheadedness. Her ECG shows an irregularly irregular rhythm with
no discernible P waves and a ventricular rate of 110 bpm. What is the most important immediate assessment?
B) TSH
D) Serum electrolytes
Correct Answer: C
Rationale: The ECG describes atrial fibrillation. Immediate hemodynamic assessment determines whether urgent cardioversion is needed.
Q3. A 58-year-old male with new-onset atrial fibrillation. Which finding most strongly indicates the need for urgent
cardioversion?
A) Heart rate of 110 bpm
C) Palpitations
D) Fatigue
Correct Answer: B
Rationale: Hemodynamic instability with atrial fibrillation requires urgent synchronized cardioversion.
Q4. A 62-year-old male presents with acute tearing chest pain radiating to the back. Which ECG finding is most consistent with
STEMI?
A) ST-segment depression
B) ST-segment elevation
C) T-wave inversion
D) Q waves
Correct Answer: B
Rationale: ST elevation is the hallmark of acute STEMI.
Q5. A 68-year-old male with a 40-pack-year smoking history presents for a routine visit with no respiratory symptoms. Which
screening is most appropriate?
C) Pulmonary function tests
D) Sputum cytology
Correct Answer: A
Rationale: USPSTF recommends annual low-dose CT for adults 50–80 with 20-pack-year history who currently smoke or quit within 15 years. 1.2
Respiratory Assessment
Q6. A 45-year-old male presents with progressive exertional dyspnea and chronic productive cough with a 30-pack-year
smoking history. Which finding is most consistent with COPD?
A) Inspiratory crackles at the bases
B) Prolonged expiratory phase with wheezing
C) Egophony over the right lower lobe
Correct Answer: B
Rationale: Prolonged expiration with wheezing is a hallmark of airflow obstruction in COPD.
Q7. A 68-year-old male with COPD, FEV1 45%. Which maintenance therapy is preferred?
D) Oral prednisone
Correct Answer: B
Rationale: LAMA + LABA is preferred for COPD with FEV1 <50% and frequent exacerbations.
Q8. A 28-year-old female with asthma and nighttime symptoms. What is the preferred controller medication?
C) Montelukast
D) Theophylline
Correct Answer: B
,Rationale: Low-dose ICS is first-line controller therapy for persistent asthma. 1.3 Neurological Assessment
Q9. A 55-year-old male presents with sudden severe headache described as "the worst of my life." What is the priority
diagnostic test?
A) Lumbar puncture
C) MRI brain
D) EEG
Correct Answer: B
Rationale: Thunderclap headache suggests SAH. Non-contrast CT is initial; if negative, LP for xanthochromia.
Q10. A 72-year-old female presents with sudden right-sided weakness and aphasia. What is the priority diagnostic test?
B) MRI brain
D) EEG
Correct Answer: A
Rationale: Non-contrast CT is initial to distinguish ischemic from hemorrhagic stroke before thrombolysis.
Q11. A 55-year-old male presents with a new-onset seizure. What is the most appropriate initial imaging?
B) MRI brain with contrast
C) EEG
D) Lumbar puncture
Correct Answer: A
Rationale: Non-contrast CT head is initial for new-onset seizure to rule out hemorrhage, mass, or structural lesion.
Q12. A 72-year-old male presents with a 6-month history of progressive memory loss and difficulty finding words. He has
difficulty with instrumental ADLs but is independent in basic ADLs. What is the most likely diagnosis?
A) Mild cognitive impairment
Correct Answer: B
Rationale: Progressive memory loss with impairment in instrumental but preserved basic ADLs suggests early Alzheimer disease.
Q13. A 65-year-old male presents with confusion, inattention, and fluctuating course over 2 days. What is the diagnosis?
D) Psychosis
Correct Answer: A
Rationale: Acute onset, inattention, and fluctuating course define delirium. Dementia is chronic and progressive.
Q14. A 68-year-old female presents with a 2-week history of unilateral throbbing headache, jaw claudication, and scalp
tenderness. ESR is 78 mm/hr. What is the priority action?
A) Start high-dose corticosteroids immediately
B) Order temporal artery biopsy and await results before treatment
C) Prescribe sumatriptan
D) Reassure and follow up in 2 weeks
Correct Answer: A
Rationale: Giant cell arteritis with visual symptoms is an emergency. High-dose corticosteroids must be started immediately to prevent irreversible vision
loss. 1.4 HEENT Assessment
Q15. A 55-year-old man presents with sudden onset of severe unilateral eye pain, blurred vision, and halos around lights. The
eye is red with a fixed, mid-dilated pupil. What is the most likely diagnosis?
B) Open-angle glaucoma
Correct Answer: A
Rationale: Acute angle-closure glaucoma presents with severe pain, halos, fixed mid-dilated pupil, and a red eye. It is an ophthalmologic emergency.
Q16. A 4-year-old girl cannot read letters on a Snellen chart. Which chart type is most appropriate?
A) Tumbling E chart
B) Number chart
C) Picture chart
Correct Answer: A
Rationale: The Tumbling E chart does not require literacy — the child indicates the direction of the E.
Q17. A 65-year-old male presents with sudden painless vision loss in one eye. Fundoscopy shows a "cherry-red spot" at the
macula. What is the diagnosis?
C) Retinal detachment
D) Vitreous hemorrhage
Correct Answer: A
Rationale: Cherry-red spot on a pale retina is classic for CRAO, an ophthalmologic emergency.
, Q18. A 55-year-old female presents with a "curtain" over her vision and flashes of light. What is the most likely diagnosis?
A) Retinal detachment
B) Vitreous hemorrhage
C) Migraine with aura
Correct Answer: A
Rationale: Flashes and floaters followed by a curtain-like visual field defect suggest retinal detachment.
Q19. A 70-year-old male presents with progressive painless vision loss and halos around lights. What is the most likely
diagnosis?
B) Open-angle glaucoma
C) Macular degeneration
Correct Answer: A
Rationale: Progressive painless vision loss with halos suggests cataract.
Q20. A 78-year-old female presents with central vision loss and metamorphopsia. Fundoscopy shows drusen. What is the
diagnosis?
A) Macular degeneration
C) Glaucoma
Correct Answer: A
Rationale: Central vision loss with metamorphopsia and drusen suggests age-related macular degeneration.
Q21. A 52-year-old male with diabetes presents with new floaters and vision loss. Fundoscopy shows neovascularization. What
is the diagnosis?
A) Proliferative diabetic retinopathy
B) Non-proliferative diabetic retinopathy
C) Macular edema
Correct Answer: A
Rationale: Neovascularization on fundoscopy indicates proliferative diabetic retinopathy.
Q22. A 6-year-old presents with fever, drooling, and tripod positioning. What is the priority action?
A) Inspect the throat with a tongue blade
B) Immediate airway management and ENT consultation
C) Prescribe amoxicillin
D) Obtain throat culture
Correct Answer: B
Rationale: Epiglottitis is a medical emergency. Airway management is the priority; inspecting the throat may precipitate obstruction.
Q23. A 72-year-old female presents with a 3-day history of unilateral ear pain, facial droop, and vesicles in the ear canal. What
is the diagnosis?
B) Ramsay Hunt syndrome
C) Trigeminal neuralgia
D) Otitis externa
Correct Answer: B
Rationale: Ramsay Hunt syndrome is herpes zoster of the geniculate ganglion, causing ear pain, facial palsy, and vesicles.
Q24. A 45-year-old female presents with a 6-month history of hoarseness and a feeling of a lump in the throat. She has a
20-pack-year smoking history. What is the priority action?
A) Reassurance
B) Laryngoscopy referral
C) PPI trial
D) Voice rest
Correct Answer: B
Rationale: Persistent hoarseness >4 weeks in a smoker requires laryngoscopy to rule out malignancy. 1.5 Dermatological Assessment
Q25. A 55-year-old female presents with a painless, pearly, translucent nodule with telangiectasias on the nose. What is the
most likely diagnosis?
B) Squamous cell carcinoma
C) Melanoma
Correct Answer: A
Rationale: Pearly, translucent nodule with telangiectasias on sun-exposed skin is classic for BCC.
Q26. A 45-year-old male presents with an asymmetric, irregularly bordered, multi-colored lesion on the back that has changed
in size. What is the priority action?
B) Excisional biopsy
600+ QUESTIONS BANK
high-yield questions designed to mirror the
latest ANCC blueprint (2025)
Pass on the first attempt.
Features: Comprehensive ANCC domain coverage · Detailed rationales · Correct answers in red · Evidence-based ·
Expanded high-yield clinical items
PASS 100% GUARANTEED
Total Questions in this edition: 677 | Verified & Updated
, ANCC FNP Questions Bank — Expanded Edition
All 677 questions with Correct Answers and Rationales clearly marked
Correct answers in red | Rationales in green
Q1. A 16-year-old male presents for a sports physical. He has a harsh systolic ejection murmur at the left upper sternal border
that increases with Valsalva and decreases with squatting. What is the most likely diagnosis?
B) Hypertrophic cardiomyopathy
C) Mitral regurgitation
D) Ventricular septal defect
Correct Answer: B
Rationale: HCM murmur increases with Valsalva (decreased preload) and decreases with squatting (increased preload). It is the leading cause of sudden
cardiac death in young athletes.
Q2. A 42-year-old female presents with palpitations and lightheadedness. Her ECG shows an irregularly irregular rhythm with
no discernible P waves and a ventricular rate of 110 bpm. What is the most important immediate assessment?
B) TSH
D) Serum electrolytes
Correct Answer: C
Rationale: The ECG describes atrial fibrillation. Immediate hemodynamic assessment determines whether urgent cardioversion is needed.
Q3. A 58-year-old male with new-onset atrial fibrillation. Which finding most strongly indicates the need for urgent
cardioversion?
A) Heart rate of 110 bpm
C) Palpitations
D) Fatigue
Correct Answer: B
Rationale: Hemodynamic instability with atrial fibrillation requires urgent synchronized cardioversion.
Q4. A 62-year-old male presents with acute tearing chest pain radiating to the back. Which ECG finding is most consistent with
STEMI?
A) ST-segment depression
B) ST-segment elevation
C) T-wave inversion
D) Q waves
Correct Answer: B
Rationale: ST elevation is the hallmark of acute STEMI.
Q5. A 68-year-old male with a 40-pack-year smoking history presents for a routine visit with no respiratory symptoms. Which
screening is most appropriate?
C) Pulmonary function tests
D) Sputum cytology
Correct Answer: A
Rationale: USPSTF recommends annual low-dose CT for adults 50–80 with 20-pack-year history who currently smoke or quit within 15 years. 1.2
Respiratory Assessment
Q6. A 45-year-old male presents with progressive exertional dyspnea and chronic productive cough with a 30-pack-year
smoking history. Which finding is most consistent with COPD?
A) Inspiratory crackles at the bases
B) Prolonged expiratory phase with wheezing
C) Egophony over the right lower lobe
Correct Answer: B
Rationale: Prolonged expiration with wheezing is a hallmark of airflow obstruction in COPD.
Q7. A 68-year-old male with COPD, FEV1 45%. Which maintenance therapy is preferred?
D) Oral prednisone
Correct Answer: B
Rationale: LAMA + LABA is preferred for COPD with FEV1 <50% and frequent exacerbations.
Q8. A 28-year-old female with asthma and nighttime symptoms. What is the preferred controller medication?
C) Montelukast
D) Theophylline
Correct Answer: B
,Rationale: Low-dose ICS is first-line controller therapy for persistent asthma. 1.3 Neurological Assessment
Q9. A 55-year-old male presents with sudden severe headache described as "the worst of my life." What is the priority
diagnostic test?
A) Lumbar puncture
C) MRI brain
D) EEG
Correct Answer: B
Rationale: Thunderclap headache suggests SAH. Non-contrast CT is initial; if negative, LP for xanthochromia.
Q10. A 72-year-old female presents with sudden right-sided weakness and aphasia. What is the priority diagnostic test?
B) MRI brain
D) EEG
Correct Answer: A
Rationale: Non-contrast CT is initial to distinguish ischemic from hemorrhagic stroke before thrombolysis.
Q11. A 55-year-old male presents with a new-onset seizure. What is the most appropriate initial imaging?
B) MRI brain with contrast
C) EEG
D) Lumbar puncture
Correct Answer: A
Rationale: Non-contrast CT head is initial for new-onset seizure to rule out hemorrhage, mass, or structural lesion.
Q12. A 72-year-old male presents with a 6-month history of progressive memory loss and difficulty finding words. He has
difficulty with instrumental ADLs but is independent in basic ADLs. What is the most likely diagnosis?
A) Mild cognitive impairment
Correct Answer: B
Rationale: Progressive memory loss with impairment in instrumental but preserved basic ADLs suggests early Alzheimer disease.
Q13. A 65-year-old male presents with confusion, inattention, and fluctuating course over 2 days. What is the diagnosis?
D) Psychosis
Correct Answer: A
Rationale: Acute onset, inattention, and fluctuating course define delirium. Dementia is chronic and progressive.
Q14. A 68-year-old female presents with a 2-week history of unilateral throbbing headache, jaw claudication, and scalp
tenderness. ESR is 78 mm/hr. What is the priority action?
A) Start high-dose corticosteroids immediately
B) Order temporal artery biopsy and await results before treatment
C) Prescribe sumatriptan
D) Reassure and follow up in 2 weeks
Correct Answer: A
Rationale: Giant cell arteritis with visual symptoms is an emergency. High-dose corticosteroids must be started immediately to prevent irreversible vision
loss. 1.4 HEENT Assessment
Q15. A 55-year-old man presents with sudden onset of severe unilateral eye pain, blurred vision, and halos around lights. The
eye is red with a fixed, mid-dilated pupil. What is the most likely diagnosis?
B) Open-angle glaucoma
Correct Answer: A
Rationale: Acute angle-closure glaucoma presents with severe pain, halos, fixed mid-dilated pupil, and a red eye. It is an ophthalmologic emergency.
Q16. A 4-year-old girl cannot read letters on a Snellen chart. Which chart type is most appropriate?
A) Tumbling E chart
B) Number chart
C) Picture chart
Correct Answer: A
Rationale: The Tumbling E chart does not require literacy — the child indicates the direction of the E.
Q17. A 65-year-old male presents with sudden painless vision loss in one eye. Fundoscopy shows a "cherry-red spot" at the
macula. What is the diagnosis?
C) Retinal detachment
D) Vitreous hemorrhage
Correct Answer: A
Rationale: Cherry-red spot on a pale retina is classic for CRAO, an ophthalmologic emergency.
, Q18. A 55-year-old female presents with a "curtain" over her vision and flashes of light. What is the most likely diagnosis?
A) Retinal detachment
B) Vitreous hemorrhage
C) Migraine with aura
Correct Answer: A
Rationale: Flashes and floaters followed by a curtain-like visual field defect suggest retinal detachment.
Q19. A 70-year-old male presents with progressive painless vision loss and halos around lights. What is the most likely
diagnosis?
B) Open-angle glaucoma
C) Macular degeneration
Correct Answer: A
Rationale: Progressive painless vision loss with halos suggests cataract.
Q20. A 78-year-old female presents with central vision loss and metamorphopsia. Fundoscopy shows drusen. What is the
diagnosis?
A) Macular degeneration
C) Glaucoma
Correct Answer: A
Rationale: Central vision loss with metamorphopsia and drusen suggests age-related macular degeneration.
Q21. A 52-year-old male with diabetes presents with new floaters and vision loss. Fundoscopy shows neovascularization. What
is the diagnosis?
A) Proliferative diabetic retinopathy
B) Non-proliferative diabetic retinopathy
C) Macular edema
Correct Answer: A
Rationale: Neovascularization on fundoscopy indicates proliferative diabetic retinopathy.
Q22. A 6-year-old presents with fever, drooling, and tripod positioning. What is the priority action?
A) Inspect the throat with a tongue blade
B) Immediate airway management and ENT consultation
C) Prescribe amoxicillin
D) Obtain throat culture
Correct Answer: B
Rationale: Epiglottitis is a medical emergency. Airway management is the priority; inspecting the throat may precipitate obstruction.
Q23. A 72-year-old female presents with a 3-day history of unilateral ear pain, facial droop, and vesicles in the ear canal. What
is the diagnosis?
B) Ramsay Hunt syndrome
C) Trigeminal neuralgia
D) Otitis externa
Correct Answer: B
Rationale: Ramsay Hunt syndrome is herpes zoster of the geniculate ganglion, causing ear pain, facial palsy, and vesicles.
Q24. A 45-year-old female presents with a 6-month history of hoarseness and a feeling of a lump in the throat. She has a
20-pack-year smoking history. What is the priority action?
A) Reassurance
B) Laryngoscopy referral
C) PPI trial
D) Voice rest
Correct Answer: B
Rationale: Persistent hoarseness >4 weeks in a smoker requires laryngoscopy to rule out malignancy. 1.5 Dermatological Assessment
Q25. A 55-year-old female presents with a painless, pearly, translucent nodule with telangiectasias on the nose. What is the
most likely diagnosis?
B) Squamous cell carcinoma
C) Melanoma
Correct Answer: A
Rationale: Pearly, translucent nodule with telangiectasias on sun-exposed skin is classic for BCC.
Q26. A 45-year-old male presents with an asymmetric, irregularly bordered, multi-colored lesion on the back that has changed
in size. What is the priority action?
B) Excisional biopsy
