ANCC Family Nurse Practitioner (FNP) Board Exam 3rd edition Complete
Practice 100 Questions with answers and Detailed Rationales for exam
preparation 100 % guaranteed pass
Domain: Assessment (Questions 1-25)
1. A 68-year-old male presents with sudden onset of severe, tearing chest pain that radiates
to his back. His blood pressure is 160/90 in the right arm and 110/70 in the left arm. What is
the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Musculoskeletal pain
Answer: C ✔
Rationale: Aortic dissection presents with sudden, severe "tearing" chest pain and pulse/blood
pressure differential between arms. This is a vascular emergency requiring immediate imaging
(CT angiography).
2. A 28-year-old female presents with fatigue, joint pain, and a malar rash that worsens with
sun exposure. She also reports oral ulcers. What laboratory finding is most specific to her
likely diagnosis?
A) Positive rheumatoid factor
B) Positive anti-dsDNA antibody
C) Elevated ESR
D) Positive ANA
Answer: B ✔
Rationale: The presentation suggests systemic lupus erythematosus (SLE). Anti-dsDNA is highly
specific for SLE, while ANA is sensitive but not specific.
3. A 45-year-old male with a 30-pack-year smoking history presents with a new cough,
hemoptysis, and unintentional weight loss. What is the most appropriate initial diagnostic
test?
A) CT chest
B) Sputum cytology
C) Chest X-ray
D) Bronchoscopy
Answer: C ✔
Rationale: Chest X-ray is the initial imaging study of choice for evaluating a new cough with
hemoptysis in a high-risk patient. Further imaging is guided by X-ray findings.
,4. A 2-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever
that worsens at night. What is the most likely diagnosis?
A) Epiglottitis
B) Bacterial tracheitis
C) Bronchiolitis
D) Croup
Answer: D ✔
Rationale: Croup (laryngotracheobronchitis) is characterized by a barking cough, stridor, and
nocturnal worsening. It is typically viral in origin and common in children aged 6 months to 3
years.
5. A 55-year-old female reports a several-month history of progressive memory loss, difficulty
managing finances, and getting lost while driving. Her symptoms began gradually. What is the
most likely diagnosis?
A) Delirium
B) Major depressive disorder
C) Alzheimer's disease
D) Vitamin B12 deficiency
Answer: C ✔
Rationale: Alzheimer's disease presents with insidious onset and progressive decline in
cognitive function, including memory loss and impairment in instrumental activities of daily
living.
6. A 35-year-old pregnant patient at 30 weeks gestation reports headache, blurred vision, and
right upper quadrant pain. Her blood pressure is 160/100. What is the most appropriate next
step?
A) Prescribe acetaminophen and recommend bed rest
B) Order a liver ultrasound
C) Admit for immediate evaluation and magnesium sulfate
D) Schedule a follow-up in one week
Answer: C ✔
Rationale: This patient has signs of severe preeclampsia (BP ≥160/100 with end-organ
symptoms). Immediate hospitalization for maternal and fetal monitoring and magnesium
sulfate for seizure prophylaxis is required.
7. A 60-year-old male presents with a smooth, symmetrically enlarged prostate on digital
rectal exam. He reports nocturia, hesitancy, and weak stream. What is the most likely
diagnosis?
A) Prostate cancer
, B) Benign prostatic hyperplasia
C) Acute prostatitis
D) Urethral stricture
Answer: B ✔
Rationale: Benign prostatic hyperplasia (BPH) typically presents with lower urinary tract
symptoms and a smooth, symmetric enlargement. Prostate cancer often presents with a hard,
nodular, or irregular gland.
8. A 25-year-old male presents with acute onset of severe right scrotal pain, nausea, and
vomiting. The testis is tender and elevated. What is the priority diagnostic test?
A) Urinalysis
B) Scrotal ultrasound with Doppler
C) Testicular biopsy
D) CT abdomen
Answer: B ✔
Rationale: This presentation is concerning for testicular torsion, a surgical emergency. Doppler
ultrasound assesses blood flow; absence of flow confirms torsion.
9. A 3-year-old child presents with fever for 3 days that suddenly resolved, followed by a
diffuse maculopapular rash. What is the most likely diagnosis?
A) Measles
B) Scarlet fever
C) Roseola
D) Fifth disease
Answer: C ✔
Rationale: Roseola (HHV-6) is characterized by high fever for 3-5 days followed by a rapid
defervescence and onset of a maculopapular rash. It is common in children aged 6 months to 3
years.
10. A 72-year-old female reports a 2-day history of confusion, agitation, and hallucinations.
She has a urinary tract infection. What is the most likely diagnosis?
A) Vascular dementia
B) Delirium
C) Alzheimer's disease
D) Frontotemporal dementia
Answer: B ✔
Rationale: Delirium is an acute, fluctuating change in mental status often triggered by an
underlying medical condition such as infection, medication, or metabolic disturbance. It is
distinguished from dementia by its acute onset.
Practice 100 Questions with answers and Detailed Rationales for exam
preparation 100 % guaranteed pass
Domain: Assessment (Questions 1-25)
1. A 68-year-old male presents with sudden onset of severe, tearing chest pain that radiates
to his back. His blood pressure is 160/90 in the right arm and 110/70 in the left arm. What is
the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Musculoskeletal pain
Answer: C ✔
Rationale: Aortic dissection presents with sudden, severe "tearing" chest pain and pulse/blood
pressure differential between arms. This is a vascular emergency requiring immediate imaging
(CT angiography).
2. A 28-year-old female presents with fatigue, joint pain, and a malar rash that worsens with
sun exposure. She also reports oral ulcers. What laboratory finding is most specific to her
likely diagnosis?
A) Positive rheumatoid factor
B) Positive anti-dsDNA antibody
C) Elevated ESR
D) Positive ANA
Answer: B ✔
Rationale: The presentation suggests systemic lupus erythematosus (SLE). Anti-dsDNA is highly
specific for SLE, while ANA is sensitive but not specific.
3. A 45-year-old male with a 30-pack-year smoking history presents with a new cough,
hemoptysis, and unintentional weight loss. What is the most appropriate initial diagnostic
test?
A) CT chest
B) Sputum cytology
C) Chest X-ray
D) Bronchoscopy
Answer: C ✔
Rationale: Chest X-ray is the initial imaging study of choice for evaluating a new cough with
hemoptysis in a high-risk patient. Further imaging is guided by X-ray findings.
,4. A 2-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever
that worsens at night. What is the most likely diagnosis?
A) Epiglottitis
B) Bacterial tracheitis
C) Bronchiolitis
D) Croup
Answer: D ✔
Rationale: Croup (laryngotracheobronchitis) is characterized by a barking cough, stridor, and
nocturnal worsening. It is typically viral in origin and common in children aged 6 months to 3
years.
5. A 55-year-old female reports a several-month history of progressive memory loss, difficulty
managing finances, and getting lost while driving. Her symptoms began gradually. What is the
most likely diagnosis?
A) Delirium
B) Major depressive disorder
C) Alzheimer's disease
D) Vitamin B12 deficiency
Answer: C ✔
Rationale: Alzheimer's disease presents with insidious onset and progressive decline in
cognitive function, including memory loss and impairment in instrumental activities of daily
living.
6. A 35-year-old pregnant patient at 30 weeks gestation reports headache, blurred vision, and
right upper quadrant pain. Her blood pressure is 160/100. What is the most appropriate next
step?
A) Prescribe acetaminophen and recommend bed rest
B) Order a liver ultrasound
C) Admit for immediate evaluation and magnesium sulfate
D) Schedule a follow-up in one week
Answer: C ✔
Rationale: This patient has signs of severe preeclampsia (BP ≥160/100 with end-organ
symptoms). Immediate hospitalization for maternal and fetal monitoring and magnesium
sulfate for seizure prophylaxis is required.
7. A 60-year-old male presents with a smooth, symmetrically enlarged prostate on digital
rectal exam. He reports nocturia, hesitancy, and weak stream. What is the most likely
diagnosis?
A) Prostate cancer
, B) Benign prostatic hyperplasia
C) Acute prostatitis
D) Urethral stricture
Answer: B ✔
Rationale: Benign prostatic hyperplasia (BPH) typically presents with lower urinary tract
symptoms and a smooth, symmetric enlargement. Prostate cancer often presents with a hard,
nodular, or irregular gland.
8. A 25-year-old male presents with acute onset of severe right scrotal pain, nausea, and
vomiting. The testis is tender and elevated. What is the priority diagnostic test?
A) Urinalysis
B) Scrotal ultrasound with Doppler
C) Testicular biopsy
D) CT abdomen
Answer: B ✔
Rationale: This presentation is concerning for testicular torsion, a surgical emergency. Doppler
ultrasound assesses blood flow; absence of flow confirms torsion.
9. A 3-year-old child presents with fever for 3 days that suddenly resolved, followed by a
diffuse maculopapular rash. What is the most likely diagnosis?
A) Measles
B) Scarlet fever
C) Roseola
D) Fifth disease
Answer: C ✔
Rationale: Roseola (HHV-6) is characterized by high fever for 3-5 days followed by a rapid
defervescence and onset of a maculopapular rash. It is common in children aged 6 months to 3
years.
10. A 72-year-old female reports a 2-day history of confusion, agitation, and hallucinations.
She has a urinary tract infection. What is the most likely diagnosis?
A) Vascular dementia
B) Delirium
C) Alzheimer's disease
D) Frontotemporal dementia
Answer: B ✔
Rationale: Delirium is an acute, fluctuating change in mental status often triggered by an
underlying medical condition such as infection, medication, or metabolic disturbance. It is
distinguished from dementia by its acute onset.
