ANCC FNP EXAM VERSION 4 FAMILY NURSE PRACTITIONER 2026/2027 – 350 QUESTIONS AND
ANSWERS | 100% VERIFIED | DETAILED RATIONALES – PASS GUARANTEED – A+ GRADED
Course: ANCC FNP Family Nurse Practitioner Version 4 2026/2027 | 350 Questions Mixed: A=80 B=96 C=90 D=84 | 100%
Verified | Pass Guaranteed
TABLE OF CONTENT
1. I. Assessment & Physical Examination - HEENT, Cardiac, Respiratory, GI, GU, Musculoskeletal, Neuro
2. II. Health Promotion & Disease Prevention - USPSTF Screening Guidelines - Cervical, Breast, Prostate, Colorectal
3. III. Cardiovascular - HTN JNC 8, HF, Afib CHA2DS2-VASc, Chest Pain, Hyperlipidemia
4. IV. Respiratory - Asthma, COPD GOLD, Croup, Epiglottitis, Pneumonia, Centor Criteria Strep
5. V. Endocrine & Metabolic - DM2 Metformin, HHS vs DKA, Thyroid, PCOS Rotterdam, Obesity
6. VI. Pediatrics - Vaccines MMR Schedule, AOM Watchful Waiting, Lead Screening, Growth & Development
7. VII. Women's Health - Contraception OCP Contraindications, Menopause HRT, Pap Guidelines, STI Chlamydia Treatment
8. VIII. Geriatrics - Beers Criteria, Delirium vs Dementia, Polypharmacy, Falls
9. IX. Hematology & Anemia - Microcytic Differential Iron Deficiency vs Thalassemia, Labs
10. X. Genitourinary & Renal - UTI Uncomplicated First-Line, BPH, AKI, eGFR Metformin
11. XI. Psychiatric & Mental Health - Depression PHQ-9, Bipolar Maintenance, Anxiety, PHQ-9 Scoring
12. XII. Neurology - Headache, Seizures, Stroke, Dizziness
13. XIII. Musculoskeletal - Osteoarthritis, Rheumatoid, Back Pain, Gout
14. XIV. Pharmacology - Antibiotics, Antidepressants, Antihypertensives, Antidiabetics, Vaccines
15. XV. Practice Questions - 350 Verified Questions with Rationales - Each Question Asked Like Real ANCC Exam
16. XVI. Answer Key with Detailed Rationales & Guidelines JNC 8, GOLD, USPSTF, CDC
17. XVII. Study Guide - Currently Updated 2026/2027 - Pass Guaranteed - A+ Graded
,ANCC FNP EXAM - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM - 350 QUESTIONS
Based on ANCC FNP Blueprint 2026/2027 - Assessment, Diagnosis, Planning, Evaluation - JNC 8, GOLD, USPSTF, CDC Guidelines. 100% Verified.
1. [FNP V4] A 45yo with HTN, BP 160/95 on lisinopril. Next step per JNC 8?
A. Add thiazide diuretic or CCB, assess adherence, diet, check BMP/K+
B. Stop lisinopril
C. No action
D. Double lisinopril only
Answer: A
Rationale: JNC 8: If BP not at goal on ACE, add thiazide or CCB, check adherence, BMP for K+/creatinine.
2. [FNP V4] HTN emergency vs urgency?
A. Emergency BP high + acute target organ damage - need IV, Urgency high BP no organ damage - oral meds, close f/u
B. No difference
C. Same
D. Only emergency has high BP
Answer: A
Rationale: Emergency = organ damage (chest pain, neuro, AKI, pulmonary edema), Urgency = no organ damage.
3. [FNP V4] Geriatric - delirium vs dementia?
A. Both chronic
B. Delirium acute fluctuating inattention, altered LOC, reversible cause - dementia chronic progressive memory, normal LOC
C. Same
D. Both acute
Answer: B
Rationale: Delirium acute fluctuating, dementia chronic progressive.
4. [FNP V4] Prostate screening PSA - shared decision?
A. All men screen
B. No screening
C. Screen at 40 all
D. Age 55-69 shared decision per USPSTF, high risk black men or family hx consider earlier
Answer: D
Rationale: PSA 55-69 shared decision.
5. [FNP V4] Anemia - microcytic differential?
A. Iron deficiency, thalassemia, anemia of chronic disease, lead - check ferritin, TIBC
B. B12 deficiency
C. No differential
D. Macrocytic only
Answer: A
Rationale: Microcytic: iron deficiency low ferritin high TIBC, thalassemia, ACD, sideroblastic.
6. [FNP V4] HTN emergency vs urgency?
A. Only emergency has high BP
B. Same
C. No difference
D. Emergency BP high + acute target organ damage - need IV, Urgency high BP no organ damage - oral meds, close f/u
Answer: D
Rationale: Emergency = organ damage (chest pain, neuro, AKI, pulmonary edema), Urgency = no organ damage.
7. [FNP V4] UTI in elderly woman - uncomplicated - first-line?
A. No treatment
B. Nitrofurantoin or TMP-SMX if susceptible - avoid cipro first-line per guidelines
C. Cipro always
D. IV antibiotics
Answer: B
Rationale: Uncomplicated cystitis first-line nitrofurantoin or TMP-SMX if local resistance <20%.
8. [FNP V4] Asthma - albuterol side effects?
A. Bradycardia
B. Tachycardia, tremor, nervousness
C. Weight gain
D. No effects
Answer: B
Rationale: Albuterol beta2 tachycardia tremor.
9. [FNP V4] Anemia - microcytic differential?
, A. B12 deficiency
B. Macrocytic only
C. Iron deficiency, thalassemia, anemia of chronic disease, lead - check ferritin, TIBC
D. No differential
Answer: C
Rationale: Microcytic: iron deficiency low ferritin high TIBC, thalassemia, ACD, sideroblastic.
10. [FNP V4] A 45yo with HTN, BP 160/95 on lisinopril. Next step per JNC 8?
A. Double lisinopril only
B. No action
C. Stop lisinopril
D. Add thiazide diuretic or CCB, assess adherence, diet, check BMP/K+
Answer: D
Rationale: JNC 8: If BP not at goal on ACE, add thiazide or CCB, check adherence, BMP for K+/creatinine.
11. [FNP V4] Depression screening - PHQ-9 score 20 means?
A. No depression
B. Mild
C. Severe depression - PHQ-9 20-27 severe, assess suicide, consider therapy + SSRI + referral
D. Minimal
Answer: C
Rationale: PHQ-9: 5-9 mild, 10-14 moderate, 15-19 mod-severe, 20-27 severe.
12. [FNP V4] Menopause - when to give HRT?
A. Moderate-severe vasomotor symptoms, <60yo and <10y since menopause, no contraindication - lowest dose shortest duration
B. All >60
C. No HRT ever
D. All women
Answer: A
Rationale: HRT for vasomotor symptoms <60 and <10y since menopause, no hx breast cancer/VTE.
13. [FNP V4] Pap screening guidelines USPSTF 2026?
A. Never screen
B. Every 5 years from 18
C. Every year from age 18
D. Age 21-29 cytology q3y, 30-65 HPV co-test q5y or cytology q3y, >65 stop if adequate prior
Answer: D
Rationale: USPSTF cervical: 21-29 cytology q3y, 30-65 co-test q5y or cytology q3y.
14. [FNP V4] DM2 - metformin contraindication?
A. No contraindication
B. No renal check
C. eGFR 90 contraindicated
D. eGFR <30 contraindicated, <45 caution, hold for contrast/AKI - lactic acidosis risk
Answer: D
Rationale: Metformin eGFR <30 contraindicated, 30-45 max 1000mg, hold contrast.
15. [FNP V4] Child with barky cough, inspiratory stridor worse at night - diagnosis?
A. Epiglottitis
B. Asthma
C. Bronchiolitis
D. Croup (laryngotracheobronchitis) - racemic epi, steroids, humidified air
Answer: D
Rationale: Croup: barky cough, stridor, worse night, steeple sign. Treat racemic epi, dexamethasone.
16. [FNP V4] Strep pharyngitis Centor criteria - which needs testing?
A. No testing
B. Cough present treat
C. Centor 2-3 test with RADT, 4+ consider empiric + test - fever, tonsil exudates, tender anterior cervical nodes, no cough
D. All sore throats antibiotics
Answer: C
Rationale: Centor: fever, exudates, anterior cervical nodes, no cough. 0-1 no test, 2-3 RADT, 4 empiric.
17. [FNP V4] Child with barky cough, inspiratory stridor worse at night - diagnosis?
A. Bronchiolitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis) - racemic epi, steroids, humidified air
D. Asthma
, Answer: C
Rationale: Croup: barky cough, stridor, worse night, steeple sign. Treat racemic epi, dexamethasone.
18. [FNP V4] Geriatric - Beers criteria - avoid?
A. Acetaminophen
B. Lisinopril
C. Metformin
D. Meperidine, diphenhydramine, benzodiazepines, muscle relaxants - falls, cognitive
Answer: D
Rationale: Beers avoid anticholinergics, benzos, meperidine, muscle relaxants in elderly.
19. [FNP V4] COPD GOLD - when to add ICS?
A. Never
B. Frequent exacerbations >=2/year or 1 hospitalized, eosinophils >=300, or asthma-COPD overlap
C. All COPD
D. Only mild
Answer: B
Rationale: COPD add ICS if exacerbator phenotype, eosinophils high, or ACO.
20. [FNP V4] PCOS criteria Rotterdam?
A. Only hyperandrogenism
B. One criteria
C. Only US
D. 2 of 3: oligo/anovulation, hyperandrogenism clinical/lab, polycystic ovaries US - exclude other causes
Answer: D
Rationale: Rotterdam PCOS 2 of 3.
21. [FNP V4] STI - chlamydia treatment?
A. No treatment
B. No partner treatment
C. Doxycycline 100mg BID 7d first-line, or azithromycin - treat partners, retest 3 months
D. Only azithro
Answer: C
Rationale: Chlamydia doxycycline first-line 7d, partner treatment, retest 3mo.
22. [FNP V4] Auscultation - S3 in 70yo with HF means?
A. No significance
B. Volume overload, HF exacerbation - assess weight, crackles, JVD, edema, BNP
C. Healthy athlete
D. Normal
Answer: B
Rationale: S3 in older adult = volume overload HF, not normal like in young athlete.
23. [FNP V4] DM2 - metformin contraindication?
A. No renal check
B. eGFR 90 contraindicated
C. No contraindication
D. eGFR <30 contraindicated, <45 caution, hold for contrast/AKI - lactic acidosis risk
Answer: D
Rationale: Metformin eGFR <30 contraindicated, 30-45 max 1000mg, hold contrast.
24. [FNP V4] Anemia - microcytic differential?
A. Iron deficiency, thalassemia, anemia of chronic disease, lead - check ferritin, TIBC
B. B12 deficiency
C. No differential
D. Macrocytic only
Answer: A
Rationale: Microcytic: iron deficiency low ferritin high TIBC, thalassemia, ACD, sideroblastic.
25. [FNP V4] Bipolar mania - first-line maintenance?
A. Lithium, valproate, atypical antipsychotic - monitor levels, kidney/thyroid/metabolic
B. SSRI only
C. Benzos only
D. No meds
Answer: A
Rationale: Bipolar maintenance lithium gold standard, valproate, atypicals.
26. [FNP V4] Child vaccine - MMR schedule?
A. 12-15 months first, 4-6 years second
ANSWERS | 100% VERIFIED | DETAILED RATIONALES – PASS GUARANTEED – A+ GRADED
Course: ANCC FNP Family Nurse Practitioner Version 4 2026/2027 | 350 Questions Mixed: A=80 B=96 C=90 D=84 | 100%
Verified | Pass Guaranteed
TABLE OF CONTENT
1. I. Assessment & Physical Examination - HEENT, Cardiac, Respiratory, GI, GU, Musculoskeletal, Neuro
2. II. Health Promotion & Disease Prevention - USPSTF Screening Guidelines - Cervical, Breast, Prostate, Colorectal
3. III. Cardiovascular - HTN JNC 8, HF, Afib CHA2DS2-VASc, Chest Pain, Hyperlipidemia
4. IV. Respiratory - Asthma, COPD GOLD, Croup, Epiglottitis, Pneumonia, Centor Criteria Strep
5. V. Endocrine & Metabolic - DM2 Metformin, HHS vs DKA, Thyroid, PCOS Rotterdam, Obesity
6. VI. Pediatrics - Vaccines MMR Schedule, AOM Watchful Waiting, Lead Screening, Growth & Development
7. VII. Women's Health - Contraception OCP Contraindications, Menopause HRT, Pap Guidelines, STI Chlamydia Treatment
8. VIII. Geriatrics - Beers Criteria, Delirium vs Dementia, Polypharmacy, Falls
9. IX. Hematology & Anemia - Microcytic Differential Iron Deficiency vs Thalassemia, Labs
10. X. Genitourinary & Renal - UTI Uncomplicated First-Line, BPH, AKI, eGFR Metformin
11. XI. Psychiatric & Mental Health - Depression PHQ-9, Bipolar Maintenance, Anxiety, PHQ-9 Scoring
12. XII. Neurology - Headache, Seizures, Stroke, Dizziness
13. XIII. Musculoskeletal - Osteoarthritis, Rheumatoid, Back Pain, Gout
14. XIV. Pharmacology - Antibiotics, Antidepressants, Antihypertensives, Antidiabetics, Vaccines
15. XV. Practice Questions - 350 Verified Questions with Rationales - Each Question Asked Like Real ANCC Exam
16. XVI. Answer Key with Detailed Rationales & Guidelines JNC 8, GOLD, USPSTF, CDC
17. XVII. Study Guide - Currently Updated 2026/2027 - Pass Guaranteed - A+ Graded
,ANCC FNP EXAM - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM - 350 QUESTIONS
Based on ANCC FNP Blueprint 2026/2027 - Assessment, Diagnosis, Planning, Evaluation - JNC 8, GOLD, USPSTF, CDC Guidelines. 100% Verified.
1. [FNP V4] A 45yo with HTN, BP 160/95 on lisinopril. Next step per JNC 8?
A. Add thiazide diuretic or CCB, assess adherence, diet, check BMP/K+
B. Stop lisinopril
C. No action
D. Double lisinopril only
Answer: A
Rationale: JNC 8: If BP not at goal on ACE, add thiazide or CCB, check adherence, BMP for K+/creatinine.
2. [FNP V4] HTN emergency vs urgency?
A. Emergency BP high + acute target organ damage - need IV, Urgency high BP no organ damage - oral meds, close f/u
B. No difference
C. Same
D. Only emergency has high BP
Answer: A
Rationale: Emergency = organ damage (chest pain, neuro, AKI, pulmonary edema), Urgency = no organ damage.
3. [FNP V4] Geriatric - delirium vs dementia?
A. Both chronic
B. Delirium acute fluctuating inattention, altered LOC, reversible cause - dementia chronic progressive memory, normal LOC
C. Same
D. Both acute
Answer: B
Rationale: Delirium acute fluctuating, dementia chronic progressive.
4. [FNP V4] Prostate screening PSA - shared decision?
A. All men screen
B. No screening
C. Screen at 40 all
D. Age 55-69 shared decision per USPSTF, high risk black men or family hx consider earlier
Answer: D
Rationale: PSA 55-69 shared decision.
5. [FNP V4] Anemia - microcytic differential?
A. Iron deficiency, thalassemia, anemia of chronic disease, lead - check ferritin, TIBC
B. B12 deficiency
C. No differential
D. Macrocytic only
Answer: A
Rationale: Microcytic: iron deficiency low ferritin high TIBC, thalassemia, ACD, sideroblastic.
6. [FNP V4] HTN emergency vs urgency?
A. Only emergency has high BP
B. Same
C. No difference
D. Emergency BP high + acute target organ damage - need IV, Urgency high BP no organ damage - oral meds, close f/u
Answer: D
Rationale: Emergency = organ damage (chest pain, neuro, AKI, pulmonary edema), Urgency = no organ damage.
7. [FNP V4] UTI in elderly woman - uncomplicated - first-line?
A. No treatment
B. Nitrofurantoin or TMP-SMX if susceptible - avoid cipro first-line per guidelines
C. Cipro always
D. IV antibiotics
Answer: B
Rationale: Uncomplicated cystitis first-line nitrofurantoin or TMP-SMX if local resistance <20%.
8. [FNP V4] Asthma - albuterol side effects?
A. Bradycardia
B. Tachycardia, tremor, nervousness
C. Weight gain
D. No effects
Answer: B
Rationale: Albuterol beta2 tachycardia tremor.
9. [FNP V4] Anemia - microcytic differential?
, A. B12 deficiency
B. Macrocytic only
C. Iron deficiency, thalassemia, anemia of chronic disease, lead - check ferritin, TIBC
D. No differential
Answer: C
Rationale: Microcytic: iron deficiency low ferritin high TIBC, thalassemia, ACD, sideroblastic.
10. [FNP V4] A 45yo with HTN, BP 160/95 on lisinopril. Next step per JNC 8?
A. Double lisinopril only
B. No action
C. Stop lisinopril
D. Add thiazide diuretic or CCB, assess adherence, diet, check BMP/K+
Answer: D
Rationale: JNC 8: If BP not at goal on ACE, add thiazide or CCB, check adherence, BMP for K+/creatinine.
11. [FNP V4] Depression screening - PHQ-9 score 20 means?
A. No depression
B. Mild
C. Severe depression - PHQ-9 20-27 severe, assess suicide, consider therapy + SSRI + referral
D. Minimal
Answer: C
Rationale: PHQ-9: 5-9 mild, 10-14 moderate, 15-19 mod-severe, 20-27 severe.
12. [FNP V4] Menopause - when to give HRT?
A. Moderate-severe vasomotor symptoms, <60yo and <10y since menopause, no contraindication - lowest dose shortest duration
B. All >60
C. No HRT ever
D. All women
Answer: A
Rationale: HRT for vasomotor symptoms <60 and <10y since menopause, no hx breast cancer/VTE.
13. [FNP V4] Pap screening guidelines USPSTF 2026?
A. Never screen
B. Every 5 years from 18
C. Every year from age 18
D. Age 21-29 cytology q3y, 30-65 HPV co-test q5y or cytology q3y, >65 stop if adequate prior
Answer: D
Rationale: USPSTF cervical: 21-29 cytology q3y, 30-65 co-test q5y or cytology q3y.
14. [FNP V4] DM2 - metformin contraindication?
A. No contraindication
B. No renal check
C. eGFR 90 contraindicated
D. eGFR <30 contraindicated, <45 caution, hold for contrast/AKI - lactic acidosis risk
Answer: D
Rationale: Metformin eGFR <30 contraindicated, 30-45 max 1000mg, hold contrast.
15. [FNP V4] Child with barky cough, inspiratory stridor worse at night - diagnosis?
A. Epiglottitis
B. Asthma
C. Bronchiolitis
D. Croup (laryngotracheobronchitis) - racemic epi, steroids, humidified air
Answer: D
Rationale: Croup: barky cough, stridor, worse night, steeple sign. Treat racemic epi, dexamethasone.
16. [FNP V4] Strep pharyngitis Centor criteria - which needs testing?
A. No testing
B. Cough present treat
C. Centor 2-3 test with RADT, 4+ consider empiric + test - fever, tonsil exudates, tender anterior cervical nodes, no cough
D. All sore throats antibiotics
Answer: C
Rationale: Centor: fever, exudates, anterior cervical nodes, no cough. 0-1 no test, 2-3 RADT, 4 empiric.
17. [FNP V4] Child with barky cough, inspiratory stridor worse at night - diagnosis?
A. Bronchiolitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis) - racemic epi, steroids, humidified air
D. Asthma
, Answer: C
Rationale: Croup: barky cough, stridor, worse night, steeple sign. Treat racemic epi, dexamethasone.
18. [FNP V4] Geriatric - Beers criteria - avoid?
A. Acetaminophen
B. Lisinopril
C. Metformin
D. Meperidine, diphenhydramine, benzodiazepines, muscle relaxants - falls, cognitive
Answer: D
Rationale: Beers avoid anticholinergics, benzos, meperidine, muscle relaxants in elderly.
19. [FNP V4] COPD GOLD - when to add ICS?
A. Never
B. Frequent exacerbations >=2/year or 1 hospitalized, eosinophils >=300, or asthma-COPD overlap
C. All COPD
D. Only mild
Answer: B
Rationale: COPD add ICS if exacerbator phenotype, eosinophils high, or ACO.
20. [FNP V4] PCOS criteria Rotterdam?
A. Only hyperandrogenism
B. One criteria
C. Only US
D. 2 of 3: oligo/anovulation, hyperandrogenism clinical/lab, polycystic ovaries US - exclude other causes
Answer: D
Rationale: Rotterdam PCOS 2 of 3.
21. [FNP V4] STI - chlamydia treatment?
A. No treatment
B. No partner treatment
C. Doxycycline 100mg BID 7d first-line, or azithromycin - treat partners, retest 3 months
D. Only azithro
Answer: C
Rationale: Chlamydia doxycycline first-line 7d, partner treatment, retest 3mo.
22. [FNP V4] Auscultation - S3 in 70yo with HF means?
A. No significance
B. Volume overload, HF exacerbation - assess weight, crackles, JVD, edema, BNP
C. Healthy athlete
D. Normal
Answer: B
Rationale: S3 in older adult = volume overload HF, not normal like in young athlete.
23. [FNP V4] DM2 - metformin contraindication?
A. No renal check
B. eGFR 90 contraindicated
C. No contraindication
D. eGFR <30 contraindicated, <45 caution, hold for contrast/AKI - lactic acidosis risk
Answer: D
Rationale: Metformin eGFR <30 contraindicated, 30-45 max 1000mg, hold contrast.
24. [FNP V4] Anemia - microcytic differential?
A. Iron deficiency, thalassemia, anemia of chronic disease, lead - check ferritin, TIBC
B. B12 deficiency
C. No differential
D. Macrocytic only
Answer: A
Rationale: Microcytic: iron deficiency low ferritin high TIBC, thalassemia, ACD, sideroblastic.
25. [FNP V4] Bipolar mania - first-line maintenance?
A. Lithium, valproate, atypical antipsychotic - monitor levels, kidney/thyroid/metabolic
B. SSRI only
C. Benzos only
D. No meds
Answer: A
Rationale: Bipolar maintenance lithium gold standard, valproate, atypicals.
26. [FNP V4] Child vaccine - MMR schedule?
A. 12-15 months first, 4-6 years second
