, ANCC FNP Practice Questions (Education-Focused)
1. A 65-year-old patient with a history of type 2 diabetes and hypertension
presents for a routine physical. Their blood pressure today is 142/88 mmHg.
According to the most recent ACC/AHA guidelines, how should this reading be
classified?
A) Normal
B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C) Stage 1 hypertension
*Rationale: ACC/AHA 2017 guidelines define Stage 1 hypertension as systolic 130-
139 or diastolic 80-89. This patient has a comorbidity (diabetes), making tight
control important.*
2. During a well-child visit for a 4-month-old infant exclusively breastfed, the
mother asks about iron supplementation. What is the most appropriate
recommendation?
A) Start 1 mg/kg/day of elemental iron now
B) Start iron-fortified cereals at 6 months
C) No supplementation needed while exclusively breastfeeding
D) Check a hemoglobin level first
Answer: A) Start 1 mg/kg/day of elemental iron now
*Rationale: AAP recommends iron supplementation (1 mg/kg/day) starting at 4
months for exclusively breastfed infants to prevent deficiency.*
3. A 28-year-old female presents with a 2-day history of dysuria, frequency, and
urgency. She is afebrile with no flank pain. A urine dipstick is positive for nitrites
and leukocyte esterase. What is the first-line treatment?
A) Nitrofurantoin 100 mg BID for 5 days
B) Ciprofloxacin 250 mg BID for 3 days
C) Trimethoprim-sulfamethoxazole DS BID for 3 days
D) Amoxicillin 500 mg TID for 7 days
Answer: A) Nitrofurantoin 100 mg BID for 5 days
,*Rationale: For uncomplicated cystitis in women, nitrofurantoin or trimethoprim-
sulfamethoxazole (if local resistance <20%) are first-line. 5-day course of
nitrofurantoin is standard.*
4. When performing a depression screening using the PHQ-9, what score
typically indicates the need for active treatment intervention?
A) ≥5
B) ≥10
C) ≥15
D) ≥20
Answer: B) ≥10
*Rationale: PHQ-9 scores: 5-9 = mild; 10-14 = moderate; 15-19 = moderately
severe; 20-27 = severe. Scores ≥10 usually warrant treatment consideration.*
5. A postmenopausal woman not on HRT asks about osteoporosis screening. She
is 62 with no risk factors besides age and menopause. When should she have
her first DEXA scan?
A) Now
B) Age 65
C) Only if she fractures a bone
D) Age 70
Answer: B) Age 65
*Rationale: USPSTF recommends screening for osteoporosis with DEXA scan for
women 65+ or younger women with fracture risk equivalent to a 65-year-old.*
6. Which vaccine is contraindicated during pregnancy?
A) Tdap
B) Inactivated influenza
C) Hepatitis B
D) MMR
Answer: D) MMR
Rationale: MMR is a live attenuated vaccine and is contraindicated during
pregnancy due to theoretical risk to the fetus.
, 7. A patient with stable COPD on ipratropium bromide asks about the seasonal
influenza vaccine. The most appropriate advice is:
A) "You should get the live attenuated nasal spray vaccine."
B) "You should avoid all influenza vaccines due to your COPD."
C) "You should receive the inactivated injectable vaccine annually."
D) "You only need the vaccine if there's an outbreak in our area."
Answer: C) "You should receive the inactivated injectable vaccine annually."
Rationale: Patients with chronic lung disease like COPD are at high risk for
complications and should receive annual inactivated influenza vaccine. Live
vaccine is contraindicated.
8. During a sports physical, a 16-year-old male is found to have a blood pressure
of 136/82. Repeat measurement is 132/84. He is at the 90th percentile for
height and weight. What is the next appropriate step?
A) Diagnose hypertension and start medication
B) Recommend lifestyle changes and recheck in 6 months
C) Schedule a recheck in 1-2 weeks
D) Order renal ultrasound and echocardiogram
Answer: C) Schedule a recheck in 1-2 weeks
*Rationale: For pediatric BP readings >95th percentile, the recommendation is to
recheck in 1-2 weeks. If elevated on 3 separate occasions, then further evaluation
is warranted.*
9. Which of the following is considered a positive PPD (tuberculin skin test) for a
45-year-old healthcare worker with no known TB exposure?
A) ≥5 mm induration
B) ≥10 mm induration
C) ≥15 mm induration
D) Any induration with erythema
Answer: B) ≥10 mm induration
*Rationale: For healthcare workers with no other risk factors, ≥10 mm is positive.
≥5 mm for HIV+, recent contacts, or immunosuppressed. ≥15 mm for low-risk
individuals.*
1. A 65-year-old patient with a history of type 2 diabetes and hypertension
presents for a routine physical. Their blood pressure today is 142/88 mmHg.
According to the most recent ACC/AHA guidelines, how should this reading be
classified?
A) Normal
B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C) Stage 1 hypertension
*Rationale: ACC/AHA 2017 guidelines define Stage 1 hypertension as systolic 130-
139 or diastolic 80-89. This patient has a comorbidity (diabetes), making tight
control important.*
2. During a well-child visit for a 4-month-old infant exclusively breastfed, the
mother asks about iron supplementation. What is the most appropriate
recommendation?
A) Start 1 mg/kg/day of elemental iron now
B) Start iron-fortified cereals at 6 months
C) No supplementation needed while exclusively breastfeeding
D) Check a hemoglobin level first
Answer: A) Start 1 mg/kg/day of elemental iron now
*Rationale: AAP recommends iron supplementation (1 mg/kg/day) starting at 4
months for exclusively breastfed infants to prevent deficiency.*
3. A 28-year-old female presents with a 2-day history of dysuria, frequency, and
urgency. She is afebrile with no flank pain. A urine dipstick is positive for nitrites
and leukocyte esterase. What is the first-line treatment?
A) Nitrofurantoin 100 mg BID for 5 days
B) Ciprofloxacin 250 mg BID for 3 days
C) Trimethoprim-sulfamethoxazole DS BID for 3 days
D) Amoxicillin 500 mg TID for 7 days
Answer: A) Nitrofurantoin 100 mg BID for 5 days
,*Rationale: For uncomplicated cystitis in women, nitrofurantoin or trimethoprim-
sulfamethoxazole (if local resistance <20%) are first-line. 5-day course of
nitrofurantoin is standard.*
4. When performing a depression screening using the PHQ-9, what score
typically indicates the need for active treatment intervention?
A) ≥5
B) ≥10
C) ≥15
D) ≥20
Answer: B) ≥10
*Rationale: PHQ-9 scores: 5-9 = mild; 10-14 = moderate; 15-19 = moderately
severe; 20-27 = severe. Scores ≥10 usually warrant treatment consideration.*
5. A postmenopausal woman not on HRT asks about osteoporosis screening. She
is 62 with no risk factors besides age and menopause. When should she have
her first DEXA scan?
A) Now
B) Age 65
C) Only if she fractures a bone
D) Age 70
Answer: B) Age 65
*Rationale: USPSTF recommends screening for osteoporosis with DEXA scan for
women 65+ or younger women with fracture risk equivalent to a 65-year-old.*
6. Which vaccine is contraindicated during pregnancy?
A) Tdap
B) Inactivated influenza
C) Hepatitis B
D) MMR
Answer: D) MMR
Rationale: MMR is a live attenuated vaccine and is contraindicated during
pregnancy due to theoretical risk to the fetus.
, 7. A patient with stable COPD on ipratropium bromide asks about the seasonal
influenza vaccine. The most appropriate advice is:
A) "You should get the live attenuated nasal spray vaccine."
B) "You should avoid all influenza vaccines due to your COPD."
C) "You should receive the inactivated injectable vaccine annually."
D) "You only need the vaccine if there's an outbreak in our area."
Answer: C) "You should receive the inactivated injectable vaccine annually."
Rationale: Patients with chronic lung disease like COPD are at high risk for
complications and should receive annual inactivated influenza vaccine. Live
vaccine is contraindicated.
8. During a sports physical, a 16-year-old male is found to have a blood pressure
of 136/82. Repeat measurement is 132/84. He is at the 90th percentile for
height and weight. What is the next appropriate step?
A) Diagnose hypertension and start medication
B) Recommend lifestyle changes and recheck in 6 months
C) Schedule a recheck in 1-2 weeks
D) Order renal ultrasound and echocardiogram
Answer: C) Schedule a recheck in 1-2 weeks
*Rationale: For pediatric BP readings >95th percentile, the recommendation is to
recheck in 1-2 weeks. If elevated on 3 separate occasions, then further evaluation
is warranted.*
9. Which of the following is considered a positive PPD (tuberculin skin test) for a
45-year-old healthcare worker with no known TB exposure?
A) ≥5 mm induration
B) ≥10 mm induration
C) ≥15 mm induration
D) Any induration with erythema
Answer: B) ≥10 mm induration
*Rationale: For healthcare workers with no other risk factors, ≥10 mm is positive.
≥5 mm for HIV+, recent contacts, or immunosuppressed. ≥15 mm for low-risk
individuals.*
