ANCC FNP Certification exam (Family Nurse Practitioner
(FNP) Exam) by ANCC Actual Past Exam with 175
Questions with 100% Correct Answers and Rationale
Question 1
A 6-year-old child presents with a fever, sore throat, and white patches on the tonsils. What is the
most likely diagnosis?
A) Viral pharyngitis
B) Streptococcal pharyngitis
C) Mononucleosis
D) Allergic rhinitis
Correct Answer: B) Streptococcal pharyngitis
Rationale: White patches on the tonsils with fever and sore throat strongly suggest streptococcal
pharyngitis (strep throat), commonly caused by Streptococcus pyogenes. Viral pharyngitis
typically lacks exudate, mononucleosis may include fatigue and lymphadenopathy, and allergic
rhinitis involves nasal symptoms.
Question 2
Which medication is first-line treatment for hypertension in a 45-year-old patient with no
comorbidities?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Losartan
Correct Answer: A) Lisinopril
Rationale: ACE inhibitors like lisinopril are first-line for uncomplicated hypertension per JNC 8
guidelines, especially in patients under 60. Beta-blockers (metoprolol) and calcium channel
blockers (amlodipine) are alternatives, and losartan (an ARB) is similar but less commonly first-
line.
Question 3
A 30-year-old female reports irregular menstrual cycles and excessive hair growth. What is the
most likely diagnosis?
A) Hypothyroidism
B) Polycystic ovary syndrome (PCOS)
C) Cushing’s syndrome
D) Hyperprolactinemia
Correct Answer: B) Polycystic ovary syndrome (PCOS)
Rationale: Irregular cycles and hirsutism are hallmark signs of PCOS, often due to androgen
excess. Hypothyroidism may cause irregular cycles but not hirsutism, Cushing’s includes central
obesity, and hyperprolactinemia typically causes galactorrhea.
Question 4
What is the recommended screening frequency for colorectal cancer in a 50-year-old with no risk
,factors?
A) Every 2 years
B) Every 5 years
C) Every 10 years
D) Annually
Correct Answer: C) Every 10 years
Rationale: The USPSTF recommends colonoscopy every 10 years starting at age 45–50 for
average-risk individuals. Shorter intervals apply to higher-risk patients.
Question 5
A 65-year-old male with type 2 diabetes has an A1C of 8.5%. What is the next step in
management?
A) Continue current therapy
B) Add metformin
C) Initiate insulin
D) Increase physical activity alone
Correct Answer: C) Initiate insulin
Rationale: An A1C > 8% despite therapy suggests poor control. Insulin is appropriate when oral
agents (e.g., metformin) fail. Adding metformin assumes it’s not already used, and exercise alone
won’t suffice.
Question 6
Which vaccine is recommended annually for all patients over 6 months of age?
A) Pneumococcal
B) Influenza
C) Tdap
D) Hepatitis B
Correct Answer: B) Influenza
Rationale: The CDC recommends annual influenza vaccination for everyone over 6 months.
Pneumococcal and Tdap have different schedules, and hepatitis B is a series.
Question 7
A 12-year-old presents with wheezing and a history of allergies. What is the most appropriate
initial treatment?
A) Albuterol inhaler
B) Oral prednisone
C) Montelukast
D) Epinephrine injection
Correct Answer: A) Albuterol inhaler
Rationale: Albuterol, a short-acting beta-agonist, is first-line for acute asthma symptoms like
wheezing. Prednisone is for exacerbations, montelukast is preventive, and epinephrine is for
anaphylaxis.
Question 8
What is the most common cause of community-acquired pneumonia in adults?
A) Streptococcus pneumoniae
,B) Mycoplasma pneumoniae
C) Haemophilus influenzae
D) Legionella pneumophila
Correct Answer: A) Streptococcus pneumoniae
Rationale: S. pneumoniae is the leading cause of community-acquired pneumonia in adults.
Mycoplasma is common in younger patients, and Legionella and H. influenzae are less frequent.
Question 9
A 25-year-old female presents with dysuria and frequency. What is the most likely diagnosis?
A) Pyelonephritis
B) Uncomplicated UTI
C) Vaginitis
D) Kidney stones
Correct Answer: B) Uncomplicated UTI
Rationale: Dysuria and frequency in a young female suggest a urinary tract infection (UTI).
Pyelonephritis includes fever and flank pain, vaginitis causes discharge, and stones cause severe
pain.
Question 10
Which lab value indicates iron-deficiency anemia in a 40-year-old female?
A) Elevated ferritin
B) Decreased TIBC
C) Low serum iron
D) High hemoglobin
Correct Answer: C) Low serum iron
Rationale: Iron-deficiency anemia features low serum iron, low ferritin, and high TIBC due to
reduced iron stores. High hemoglobin indicates normal oxygen-carrying capacity.
Question 11
What is the first-line treatment for generalized anxiety disorder in adults?
A) Lorazepam
B) Sertraline
C) Buspirone
D) Propranolol
Correct Answer: B) Sertraline
Rationale: SSRIs like sertraline are first-line for GAD due to efficacy and safety. Lorazepam
(benzodiazepine) is short-term, buspirone is an alternative, and propranolol treats physical
symptoms.
Question 12
A 70-year-old male reports progressive memory loss. What is the most likely diagnosis?
A) Depression
B) Alzheimer’s disease
C) Vitamin B12 deficiency
D) Normal aging
Correct Answer: B) Alzheimer’s disease
, Rationale: Progressive memory loss in an older adult suggests Alzheimer’s, the most common
dementia. Depression may mimic it, B12 deficiency is reversible, and normal aging involves
milder changes.
Question 13
Which finding is most concerning in a patient with chest pain?
A) Pain relieved by rest
B) Pain with deep breathing
C) Pain radiating to the jaw
D) Pain after eating
Correct Answer: C) Pain radiating to the jaw
Rationale: Chest pain radiating to the jaw suggests myocardial infarction (MI), a medical
emergency. Pain with rest or eating may be musculoskeletal or GI-related, and pleuritic pain
indicates lung issues.
Question 14
What is the target LDL cholesterol level for a patient with coronary artery disease?
A) < 130 mg/dL
B) < 100 mg/dL
C) < 70 mg/dL
D) < 160 mg/dL
Correct Answer: C) < 70 mg/dL
Rationale: For high-risk patients with CAD, the AHA recommends LDL < 70 mg/dL to reduce
further cardiovascular events.
Question 15
A 3-year-old has a rash with a "slapped cheek" appearance. What is the most likely diagnosis?
A) Measles
B) Fifth disease
C) Roseola
D) Scarlet fever
Correct Answer: B) Fifth disease
Rationale: Fifth disease (parvovirus B19) causes a "slapped cheek" rash. Measles has a diffuse
rash, roseola follows fever, and scarlet fever features a sandpaper texture.
Question 16
Which medication should be avoided in a patient with a sulfa allergy?
A) Amoxicillin
B) Sulfamethoxazole
C) Azithromycin
D) Doxycycline
Correct Answer: B) Sulfamethoxazole
Rationale: Sulfamethoxazole is a sulfonamide, contraindicated in sulfa allergies. The others are
not sulfa-based antibiotics.
Question 17
(FNP) Exam) by ANCC Actual Past Exam with 175
Questions with 100% Correct Answers and Rationale
Question 1
A 6-year-old child presents with a fever, sore throat, and white patches on the tonsils. What is the
most likely diagnosis?
A) Viral pharyngitis
B) Streptococcal pharyngitis
C) Mononucleosis
D) Allergic rhinitis
Correct Answer: B) Streptococcal pharyngitis
Rationale: White patches on the tonsils with fever and sore throat strongly suggest streptococcal
pharyngitis (strep throat), commonly caused by Streptococcus pyogenes. Viral pharyngitis
typically lacks exudate, mononucleosis may include fatigue and lymphadenopathy, and allergic
rhinitis involves nasal symptoms.
Question 2
Which medication is first-line treatment for hypertension in a 45-year-old patient with no
comorbidities?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Losartan
Correct Answer: A) Lisinopril
Rationale: ACE inhibitors like lisinopril are first-line for uncomplicated hypertension per JNC 8
guidelines, especially in patients under 60. Beta-blockers (metoprolol) and calcium channel
blockers (amlodipine) are alternatives, and losartan (an ARB) is similar but less commonly first-
line.
Question 3
A 30-year-old female reports irregular menstrual cycles and excessive hair growth. What is the
most likely diagnosis?
A) Hypothyroidism
B) Polycystic ovary syndrome (PCOS)
C) Cushing’s syndrome
D) Hyperprolactinemia
Correct Answer: B) Polycystic ovary syndrome (PCOS)
Rationale: Irregular cycles and hirsutism are hallmark signs of PCOS, often due to androgen
excess. Hypothyroidism may cause irregular cycles but not hirsutism, Cushing’s includes central
obesity, and hyperprolactinemia typically causes galactorrhea.
Question 4
What is the recommended screening frequency for colorectal cancer in a 50-year-old with no risk
,factors?
A) Every 2 years
B) Every 5 years
C) Every 10 years
D) Annually
Correct Answer: C) Every 10 years
Rationale: The USPSTF recommends colonoscopy every 10 years starting at age 45–50 for
average-risk individuals. Shorter intervals apply to higher-risk patients.
Question 5
A 65-year-old male with type 2 diabetes has an A1C of 8.5%. What is the next step in
management?
A) Continue current therapy
B) Add metformin
C) Initiate insulin
D) Increase physical activity alone
Correct Answer: C) Initiate insulin
Rationale: An A1C > 8% despite therapy suggests poor control. Insulin is appropriate when oral
agents (e.g., metformin) fail. Adding metformin assumes it’s not already used, and exercise alone
won’t suffice.
Question 6
Which vaccine is recommended annually for all patients over 6 months of age?
A) Pneumococcal
B) Influenza
C) Tdap
D) Hepatitis B
Correct Answer: B) Influenza
Rationale: The CDC recommends annual influenza vaccination for everyone over 6 months.
Pneumococcal and Tdap have different schedules, and hepatitis B is a series.
Question 7
A 12-year-old presents with wheezing and a history of allergies. What is the most appropriate
initial treatment?
A) Albuterol inhaler
B) Oral prednisone
C) Montelukast
D) Epinephrine injection
Correct Answer: A) Albuterol inhaler
Rationale: Albuterol, a short-acting beta-agonist, is first-line for acute asthma symptoms like
wheezing. Prednisone is for exacerbations, montelukast is preventive, and epinephrine is for
anaphylaxis.
Question 8
What is the most common cause of community-acquired pneumonia in adults?
A) Streptococcus pneumoniae
,B) Mycoplasma pneumoniae
C) Haemophilus influenzae
D) Legionella pneumophila
Correct Answer: A) Streptococcus pneumoniae
Rationale: S. pneumoniae is the leading cause of community-acquired pneumonia in adults.
Mycoplasma is common in younger patients, and Legionella and H. influenzae are less frequent.
Question 9
A 25-year-old female presents with dysuria and frequency. What is the most likely diagnosis?
A) Pyelonephritis
B) Uncomplicated UTI
C) Vaginitis
D) Kidney stones
Correct Answer: B) Uncomplicated UTI
Rationale: Dysuria and frequency in a young female suggest a urinary tract infection (UTI).
Pyelonephritis includes fever and flank pain, vaginitis causes discharge, and stones cause severe
pain.
Question 10
Which lab value indicates iron-deficiency anemia in a 40-year-old female?
A) Elevated ferritin
B) Decreased TIBC
C) Low serum iron
D) High hemoglobin
Correct Answer: C) Low serum iron
Rationale: Iron-deficiency anemia features low serum iron, low ferritin, and high TIBC due to
reduced iron stores. High hemoglobin indicates normal oxygen-carrying capacity.
Question 11
What is the first-line treatment for generalized anxiety disorder in adults?
A) Lorazepam
B) Sertraline
C) Buspirone
D) Propranolol
Correct Answer: B) Sertraline
Rationale: SSRIs like sertraline are first-line for GAD due to efficacy and safety. Lorazepam
(benzodiazepine) is short-term, buspirone is an alternative, and propranolol treats physical
symptoms.
Question 12
A 70-year-old male reports progressive memory loss. What is the most likely diagnosis?
A) Depression
B) Alzheimer’s disease
C) Vitamin B12 deficiency
D) Normal aging
Correct Answer: B) Alzheimer’s disease
, Rationale: Progressive memory loss in an older adult suggests Alzheimer’s, the most common
dementia. Depression may mimic it, B12 deficiency is reversible, and normal aging involves
milder changes.
Question 13
Which finding is most concerning in a patient with chest pain?
A) Pain relieved by rest
B) Pain with deep breathing
C) Pain radiating to the jaw
D) Pain after eating
Correct Answer: C) Pain radiating to the jaw
Rationale: Chest pain radiating to the jaw suggests myocardial infarction (MI), a medical
emergency. Pain with rest or eating may be musculoskeletal or GI-related, and pleuritic pain
indicates lung issues.
Question 14
What is the target LDL cholesterol level for a patient with coronary artery disease?
A) < 130 mg/dL
B) < 100 mg/dL
C) < 70 mg/dL
D) < 160 mg/dL
Correct Answer: C) < 70 mg/dL
Rationale: For high-risk patients with CAD, the AHA recommends LDL < 70 mg/dL to reduce
further cardiovascular events.
Question 15
A 3-year-old has a rash with a "slapped cheek" appearance. What is the most likely diagnosis?
A) Measles
B) Fifth disease
C) Roseola
D) Scarlet fever
Correct Answer: B) Fifth disease
Rationale: Fifth disease (parvovirus B19) causes a "slapped cheek" rash. Measles has a diffuse
rash, roseola follows fever, and scarlet fever features a sandpaper texture.
Question 16
Which medication should be avoided in a patient with a sulfa allergy?
A) Amoxicillin
B) Sulfamethoxazole
C) Azithromycin
D) Doxycycline
Correct Answer: B) Sulfamethoxazole
Rationale: Sulfamethoxazole is a sulfonamide, contraindicated in sulfa allergies. The others are
not sulfa-based antibiotics.
Question 17
