1
ANCC FNP Board Exam Prep with Real
Questions and Answers Actual Exam
2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: ASSESSMENT & DIAGNOSIS — Questions 1-20]
Q1. A 65-year-old male presents with progressive shortness of breath on exertion and orthopnea.
On auscultation, you hear a harsh, systolic ejection murmur best heard at the right upper sternal
border that radiates to the carotids. What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Aortic regurgitation
Correct Answer: B
Rationale: Aortic stenosis is characterized by a harsh, systolic ejection murmur heard best at the
right upper sternal border (RUSB) with radiation to the carotids, often associated with symptoms
like dyspnea on exertion, angina, and syncope. The classic "crescendo-decrescendo" quality
suggests obstruction of blood flow from the left ventricle. Mitral regurgitation typically presents
with a holosystolic murmur at the apex radiating to the axilla, while mitral stenosis presents with
a diastolic murmur. Aortic regurgitation presents with a diastolic decrescendo murmur.
Q2. A 28-year-old female presents with a "butterfly" rash across her nose and cheeks,
photosensitivity, and oral ulcers. She reports fatigue and joint pain in her hands. Which
autoimmune disease is most strongly suggested by these findings?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
,2
C. Sjögren's syndrome
D. Dermatomyositis
Correct Answer: B
Rationale: The malar rash ("butterfly" rash) across the nose and cheeks, combined with
photosensitivity, oral ulcers, fatigue, and arthralgia, is a classic presentation of Systemic Lupus
Erythematosus (SLE). SLE is a multisystem autoimmune disorder that often affects the skin,
joints, and kidneys. Rheumatoid arthritis primarily presents with symmetric joint inflammation
and deformity but not the characteristic malar rash. Sjögren's syndrome presents with dry eyes
and dry mouth (sicca symptoms), while dermatomyositis involves a heliotrope rash and proximal
muscle weakness.
Q3. A 4-year-old child is brought to the clinic with a "barking" cough, stridor, and inspiratory
wheezing that worsens at night. The child has a low-grade fever but appears alert. What is the
most appropriate initial diagnostic step?
A. Lateral neck X-ray
B. Chest X-ray
C. Clinical diagnosis based on history and physical exam
D. Throat culture
Correct Answer: C
Rationale: Croup (laryngotracheobronchitis) is primarily a clinical diagnosis based on the
characteristic history of a barking cough, stridor, and hoarseness, often preceded by upper
respiratory symptoms. Radiographs are generally not required for mild to moderate cases and can
cause unnecessary delay or radiation exposure. A lateral neck X-ray might show the "steeple
sign," but it is not essential for diagnosis unless epiglottitis is suspected (which presents with
high fever, toxic appearance, and drooling). Throat cultures are used for bacterial infections like
streptococcal pharyngitis, not viral croup.
Q4. You are evaluating a 52-year-old male with abdominal pain. On physical exam, you note that
when the patient lies supine and lifts his head, the pain increases. What is the name of this sign
and its implication?
,3
A. Murphy’s sign – Cholecystitis
B. Rovsing’s sign – Appendicitis
C. Carnett’s sign – Abdominal wall pain
D. Obturator sign – Appendicitis
Correct Answer: C
Rationale: Carnett’s sign is positive if abdominal pain increases when the patient tenses their
abdominal muscles (e.g., lifting the head while supine), indicating that the source of pain is
likely within the abdominal wall rather than the intra-abdominal cavity. Murphy’s sign (arrest of
inspiration upon palpation of the RUQ) suggests cholecystitis. Rovsing’s sign (palpation of the
LLQ causing pain in the RLQ) and the Obturator sign (pain on internal rotation of the hip) are
both indicators of appendicitis.
Q5. A patient presents with sudden onset of severe, unilateral eye pain, redness, blurred vision,
and seeing "halos" around lights. On exam, the pupil is mid-dilated and non-reactive to light, and
the eye feels hard to palpation. What is the priority intervention?
A. Administer topical dilating drops
B. Refer to ophthalmology immediately for measurement of intraocular pressure
C. Prescribe oral antibiotics
D. Perform a slit-lamp exam and irrigate the eye
Correct Answer: B
Rationale: These symptoms (pain, redness, halos, hard eye, mid-dilated fixed pupil) are classic
for acute angle-closure glaucoma, a medical emergency requiring immediate reduction of
intraocular pressure (IOP) to prevent permanent optic nerve damage. The priority is immediate
referral to an ophthalmology specialist for IOP measurement and treatment (often with
acetazolamide, topical beta-blockers, or pilocarpine). Dilating drops can further worsen the angle
closure. Antibiotics are not indicated for glaucoma. While a slit-lamp exam is useful, the
immediate need is specialist intervention to lower pressure.
Q6. A 22-year-old female presents with a diffuse, throbbing headache that is unilateral and
accompanied by nausea, photophobia, and phonophobia. The headache lasts approximately 12
, 4
hours if untreated. She reports a family history of similar headaches. What is the most likely
diagnosis?
A. Tension headache
B. Migraine without aura
C. Cluster headache
D. Sinusitis
Correct Answer: B
Rationale: Migraine without aura is characterized by unilateral, throbbing headache pain of
moderate to severe intensity, aggravated by physical activity, and associated with nausea,
vomiting, photophobia, and phonophobia. Tension headaches are typically bilateral,
pressing/tightening in quality, and mild to moderate, without nausea or photophobia. Cluster
headaches are strictly unilateral, excruciating, short-lasting (15-180 mins), and associated with
autonomic symptoms like lacrimation and nasal congestion. Sinusitis usually presents with
purulent nasal discharge and facial pain.
Q7. An 8-month-old infant is assessed for developmental milestones. The infant can sit without
support, babbles, and transfers objects from hand to hand, but cannot crawl or pull to stand. How
do you interpret these findings?
A. Significant developmental delay requiring immediate neurology referral
B. Normal development for age
C. Gross motor delay only
D. Fine motor delay only
Correct Answer: B
Rationale: By 8 months, infants typically can sit without support, transfer objects hand-to-hand,
and babble. Crawling and pulling to stand are usually expected around 9-12 months, so the
absence of these skills at 8 months is within the range of normal variation. There is no indication
of global delay or specific isolated delays based on the information provided. Reassurance and
continued monitoring are appropriate.
ANCC FNP Board Exam Prep with Real
Questions and Answers Actual Exam
2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: ASSESSMENT & DIAGNOSIS — Questions 1-20]
Q1. A 65-year-old male presents with progressive shortness of breath on exertion and orthopnea.
On auscultation, you hear a harsh, systolic ejection murmur best heard at the right upper sternal
border that radiates to the carotids. What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Aortic regurgitation
Correct Answer: B
Rationale: Aortic stenosis is characterized by a harsh, systolic ejection murmur heard best at the
right upper sternal border (RUSB) with radiation to the carotids, often associated with symptoms
like dyspnea on exertion, angina, and syncope. The classic "crescendo-decrescendo" quality
suggests obstruction of blood flow from the left ventricle. Mitral regurgitation typically presents
with a holosystolic murmur at the apex radiating to the axilla, while mitral stenosis presents with
a diastolic murmur. Aortic regurgitation presents with a diastolic decrescendo murmur.
Q2. A 28-year-old female presents with a "butterfly" rash across her nose and cheeks,
photosensitivity, and oral ulcers. She reports fatigue and joint pain in her hands. Which
autoimmune disease is most strongly suggested by these findings?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
,2
C. Sjögren's syndrome
D. Dermatomyositis
Correct Answer: B
Rationale: The malar rash ("butterfly" rash) across the nose and cheeks, combined with
photosensitivity, oral ulcers, fatigue, and arthralgia, is a classic presentation of Systemic Lupus
Erythematosus (SLE). SLE is a multisystem autoimmune disorder that often affects the skin,
joints, and kidneys. Rheumatoid arthritis primarily presents with symmetric joint inflammation
and deformity but not the characteristic malar rash. Sjögren's syndrome presents with dry eyes
and dry mouth (sicca symptoms), while dermatomyositis involves a heliotrope rash and proximal
muscle weakness.
Q3. A 4-year-old child is brought to the clinic with a "barking" cough, stridor, and inspiratory
wheezing that worsens at night. The child has a low-grade fever but appears alert. What is the
most appropriate initial diagnostic step?
A. Lateral neck X-ray
B. Chest X-ray
C. Clinical diagnosis based on history and physical exam
D. Throat culture
Correct Answer: C
Rationale: Croup (laryngotracheobronchitis) is primarily a clinical diagnosis based on the
characteristic history of a barking cough, stridor, and hoarseness, often preceded by upper
respiratory symptoms. Radiographs are generally not required for mild to moderate cases and can
cause unnecessary delay or radiation exposure. A lateral neck X-ray might show the "steeple
sign," but it is not essential for diagnosis unless epiglottitis is suspected (which presents with
high fever, toxic appearance, and drooling). Throat cultures are used for bacterial infections like
streptococcal pharyngitis, not viral croup.
Q4. You are evaluating a 52-year-old male with abdominal pain. On physical exam, you note that
when the patient lies supine and lifts his head, the pain increases. What is the name of this sign
and its implication?
,3
A. Murphy’s sign – Cholecystitis
B. Rovsing’s sign – Appendicitis
C. Carnett’s sign – Abdominal wall pain
D. Obturator sign – Appendicitis
Correct Answer: C
Rationale: Carnett’s sign is positive if abdominal pain increases when the patient tenses their
abdominal muscles (e.g., lifting the head while supine), indicating that the source of pain is
likely within the abdominal wall rather than the intra-abdominal cavity. Murphy’s sign (arrest of
inspiration upon palpation of the RUQ) suggests cholecystitis. Rovsing’s sign (palpation of the
LLQ causing pain in the RLQ) and the Obturator sign (pain on internal rotation of the hip) are
both indicators of appendicitis.
Q5. A patient presents with sudden onset of severe, unilateral eye pain, redness, blurred vision,
and seeing "halos" around lights. On exam, the pupil is mid-dilated and non-reactive to light, and
the eye feels hard to palpation. What is the priority intervention?
A. Administer topical dilating drops
B. Refer to ophthalmology immediately for measurement of intraocular pressure
C. Prescribe oral antibiotics
D. Perform a slit-lamp exam and irrigate the eye
Correct Answer: B
Rationale: These symptoms (pain, redness, halos, hard eye, mid-dilated fixed pupil) are classic
for acute angle-closure glaucoma, a medical emergency requiring immediate reduction of
intraocular pressure (IOP) to prevent permanent optic nerve damage. The priority is immediate
referral to an ophthalmology specialist for IOP measurement and treatment (often with
acetazolamide, topical beta-blockers, or pilocarpine). Dilating drops can further worsen the angle
closure. Antibiotics are not indicated for glaucoma. While a slit-lamp exam is useful, the
immediate need is specialist intervention to lower pressure.
Q6. A 22-year-old female presents with a diffuse, throbbing headache that is unilateral and
accompanied by nausea, photophobia, and phonophobia. The headache lasts approximately 12
, 4
hours if untreated. She reports a family history of similar headaches. What is the most likely
diagnosis?
A. Tension headache
B. Migraine without aura
C. Cluster headache
D. Sinusitis
Correct Answer: B
Rationale: Migraine without aura is characterized by unilateral, throbbing headache pain of
moderate to severe intensity, aggravated by physical activity, and associated with nausea,
vomiting, photophobia, and phonophobia. Tension headaches are typically bilateral,
pressing/tightening in quality, and mild to moderate, without nausea or photophobia. Cluster
headaches are strictly unilateral, excruciating, short-lasting (15-180 mins), and associated with
autonomic symptoms like lacrimation and nasal congestion. Sinusitis usually presents with
purulent nasal discharge and facial pain.
Q7. An 8-month-old infant is assessed for developmental milestones. The infant can sit without
support, babbles, and transfers objects from hand to hand, but cannot crawl or pull to stand. How
do you interpret these findings?
A. Significant developmental delay requiring immediate neurology referral
B. Normal development for age
C. Gross motor delay only
D. Fine motor delay only
Correct Answer: B
Rationale: By 8 months, infants typically can sit without support, transfer objects hand-to-hand,
and babble. Crawling and pulling to stand are usually expected around 9-12 months, so the
absence of these skills at 8 months is within the range of normal variation. There is no indication
of global delay or specific isolated delays based on the information provided. Reassurance and
continued monitoring are appropriate.
