ANCC FNP Board Exam Prep with
Real Questions and Answers ACTUAL
EXAM 2026/2027 | ANCC FNP
Certification | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain 1: Assessment & Diagnosis Across the Lifespan (25 Questions)
Q1: A 4-month-old infant is brought to the clinic with episodes of sudden, inconsolable crying, drawing
the knees to the abdomen, and vomiting. The episodes last 15-20 minutes and are followed by periods
of lethargy. On exam, the abdomen is soft between episodes, but a sausage-shaped mass is palpable in
the right upper quadrant. Stool is guaiac-positive. What is the most likely diagnosis?
A. Volvulus B. Pyloric stenosis C. Intussusception [CORRECT] D. Incarcerated inguinal hernia
Correct Answer: C
Rationale: Intussusception classically presents in infants 3-12 months with intermittent, colicky
abdominal pain, vomiting, "currant jelly" stool, and a palpable "sausage-shaped" mass in the RUQ
(Dance sign). USPSTF does not screen for this condition; prompt diagnosis and air/contrast enema
reduction are critical.
Q2: A 2-year-old boy presents with a 3-day history of low-grade fever, barking cough, and inspiratory
stridor that worsens at night. He has no drooling and appears comfortable between coughing episodes.
What is the first-line management?
A. Nebulized racemic epinephrine and oral dexamethasone [CORRECT] B. Intramuscular ceftriaxone and
hospital admission C. Nebulized albuterol and chest physiotherapy D. Emergent intubation and ENT
consultation
Correct Answer: A
,Rationale: Croup (laryngotracheobronchitis) is managed with a single dose of oral dexamethasone (0.15-
0.6 mg/kg) and nebulized racemic epinephrine for moderate to severe cases; most cases are viral and
self-limited.
Q3: A 28-year-old woman presents with a 2-week history of fatigue, sore throat, and generalized
lymphadenopathy. Physical exam reveals posterior cervical lymphadenopathy and splenomegaly. CBC
shows atypical lymphocytes (15%). What is the most likely diagnosis?
A. Streptococcal pharyngitis B. Infectious mononucleosis [CORRECT] C. Acute lymphoblastic leukemia D.
Acute HIV infection
Correct Answer: B
Rationale: Infectious mononucleosis (EBV) presents with the classic triad of fever, pharyngitis, and
lymphadenopathy, with atypical lymphocytosis >10% and splenomegaly; avoid amoxicillin/ampicillin due
to risk of rash.
Q4: A 6-month-old infant presents with a 2-day history of rhinorrhea, low-grade fever, and wheezing. On
exam, there is tachypnea, nasal flaring, intercostal retractions, and diffuse wheezes and crackles. RSV
testing is positive. What is the most appropriate next step in management?
A. Initiate palivizumab prophylaxis B. Administer nebulized albuterol and oral corticosteroids C. Provide
supportive care with hydration and nasal suctioning [CORRECT] D. Admit for IV antibiotics and chest
physiotherapy
Correct Answer: C
Rationale: RSV bronchiolitis is managed supportively with hydration, nasal suctioning, and oxygen as
needed; bronchodilators and corticosteroids are not routinely recommended per AAP guidelines.
Q5: A 45-year-old man presents with sudden-onset severe headache described as "the worst headache
of my life," accompanied by nausea and photophobia. On exam, he has nuchal rigidity and a positive
Brudzinski sign. CT head is pending. What is the most likely diagnosis?
A. Migraine with aura B. Subarachnoid hemorrhage [CORRECT] C. Acute bacterial meningitis D. Cluster
headache
Correct Answer: B
Rationale: A thunderclap headache with meningeal signs is classic for subarachnoid hemorrhage; non-
contrast CT is the initial imaging of choice, followed by lumbar puncture if CT is negative.
,Q6: A 3-year-old girl is brought in with a fever of 103°F, irritability, and a stiff neck. She has a purpuric
rash on her lower extremities. Kernig and Brudzinski signs are positive. What is the most appropriate
immediate management?
A. Oral amoxicillin and observation B. Immediate IV ceftriaxone and vancomycin [CORRECT] C. Lumbar
puncture before any antibiotics D. Acetaminophen and observation pending blood cultures
Correct Answer: B
Rationale: Suspected bacterial meningitis requires immediate empiric IV antibiotics (ceftriaxone +
vancomycin) before LP if the patient is unstable or has signs of increased ICP; delay in antibiotics
increases mortality.
Q7: A 55-year-old woman presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. On exam, she has an S3 gallop, jugular venous distension, and bibasilar crackles.
Echocardiogram shows an ejection fraction of 35%. What is the most appropriate first-line
pharmacotherapy?
A. Furosemide, lisinopril, and metoprolol succinate [CORRECT] B. Digoxin, hydralazine, and isosorbide
dinitrate C. Diltiazem, spironolactone, and losartan D. Amlodipine, hydrochlorothiazide, and carvedilol
Correct Answer: A
Rationale: HFrEF (EF <40%) is managed with guideline-directed medical therapy: ACE
inhibitor/ARB/ARNI, evidence-based beta-blocker (metoprolol succinate, carvedilol, or bisoprolol), and
loop diuretics for congestion; SGLT2 inhibitors are also now first-line per 2022 AHA/ACC/HFSA
guidelines.
Q8: A 62-year-old man with a 40 pack-year smoking history presents with a 3-month history of cough,
hemoptysis, and 15-pound weight loss. Chest X-ray reveals a 3 cm spiculated mass in the left upper lobe.
What is the next most appropriate diagnostic step?
A. Initiate broad-spectrum antibiotics and repeat CXR in 6 weeks B. CT chest with contrast and PET-CT,
followed by tissue biopsy [CORRECT] C. Start empiric anti-TB therapy D. Bronchoscopy with
transbronchial biopsy only
Correct Answer: B
Rationale: A spiculated lung mass in a heavy smoker is highly suspicious for lung cancer; staging with
CT/PET-CT and tissue biopsy (CT-guided or bronchoscopic) is required before treatment planning.
, Q9: A 35-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. Physical
exam reveals dry skin, coarse hair, and delayed deep tendon reflexes. TSH is 12.5 mIU/L (normal 0.4-
4.0). What is the first-line treatment?
A. Liothyronine (T3) replacement B. Levothyroxine (T4) 1.6 mcg/kg daily [CORRECT] C. Methimazole 10
mg daily D. Iodine supplementation
Correct Answer: B
Rationale: Primary hypothyroidism is treated with levothyroxine (T4) at 1.6 mcg/kg/day; TSH should be
rechecked in 6-8 weeks and dose adjusted accordingly.
Q10: A 16-year-old male athlete presents with anterior knee pain that worsens with running, jumping,
and climbing stairs. There is tenderness over the tibial tuberosity and a prominent bony bump. What is
the most likely diagnosis?
A. Patellar tendon rupture B. Osgood-Schlatter disease [CORRECT] C. Prepatellar bursitis D.
Osteochondritis dissecans
Correct Answer: B
Rationale: Osgood-Schlatter disease is traction apophysitis of the tibial tuberosity in adolescents during
growth spurts, exacerbated by repetitive jumping/running; managed with activity modification, ice, and
NSAIDs.
Q11: A 50-year-old man presents with progressive dysphagia to solids that is worse in the supine
position and associated with regurgitation of undigested food. He has halitosis and intermittent cough.
Barium swallow shows a dilated esophagus with a "bird's beak" appearance. What is the most likely
diagnosis?
A. Esophageal stricture from GERD B. Achalasia [CORRECT] C. Esophageal spasm D. Zenker diverticulum
Correct Answer: B
Rationale: Achalasia presents with progressive dysphagia to solids and liquids, regurgitation, and a
"bird's beak" appearance on barium swallow due to failure of the lower esophageal sphincter to relax;
confirmed with manometry.
Real Questions and Answers ACTUAL
EXAM 2026/2027 | ANCC FNP
Certification | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain 1: Assessment & Diagnosis Across the Lifespan (25 Questions)
Q1: A 4-month-old infant is brought to the clinic with episodes of sudden, inconsolable crying, drawing
the knees to the abdomen, and vomiting. The episodes last 15-20 minutes and are followed by periods
of lethargy. On exam, the abdomen is soft between episodes, but a sausage-shaped mass is palpable in
the right upper quadrant. Stool is guaiac-positive. What is the most likely diagnosis?
A. Volvulus B. Pyloric stenosis C. Intussusception [CORRECT] D. Incarcerated inguinal hernia
Correct Answer: C
Rationale: Intussusception classically presents in infants 3-12 months with intermittent, colicky
abdominal pain, vomiting, "currant jelly" stool, and a palpable "sausage-shaped" mass in the RUQ
(Dance sign). USPSTF does not screen for this condition; prompt diagnosis and air/contrast enema
reduction are critical.
Q2: A 2-year-old boy presents with a 3-day history of low-grade fever, barking cough, and inspiratory
stridor that worsens at night. He has no drooling and appears comfortable between coughing episodes.
What is the first-line management?
A. Nebulized racemic epinephrine and oral dexamethasone [CORRECT] B. Intramuscular ceftriaxone and
hospital admission C. Nebulized albuterol and chest physiotherapy D. Emergent intubation and ENT
consultation
Correct Answer: A
,Rationale: Croup (laryngotracheobronchitis) is managed with a single dose of oral dexamethasone (0.15-
0.6 mg/kg) and nebulized racemic epinephrine for moderate to severe cases; most cases are viral and
self-limited.
Q3: A 28-year-old woman presents with a 2-week history of fatigue, sore throat, and generalized
lymphadenopathy. Physical exam reveals posterior cervical lymphadenopathy and splenomegaly. CBC
shows atypical lymphocytes (15%). What is the most likely diagnosis?
A. Streptococcal pharyngitis B. Infectious mononucleosis [CORRECT] C. Acute lymphoblastic leukemia D.
Acute HIV infection
Correct Answer: B
Rationale: Infectious mononucleosis (EBV) presents with the classic triad of fever, pharyngitis, and
lymphadenopathy, with atypical lymphocytosis >10% and splenomegaly; avoid amoxicillin/ampicillin due
to risk of rash.
Q4: A 6-month-old infant presents with a 2-day history of rhinorrhea, low-grade fever, and wheezing. On
exam, there is tachypnea, nasal flaring, intercostal retractions, and diffuse wheezes and crackles. RSV
testing is positive. What is the most appropriate next step in management?
A. Initiate palivizumab prophylaxis B. Administer nebulized albuterol and oral corticosteroids C. Provide
supportive care with hydration and nasal suctioning [CORRECT] D. Admit for IV antibiotics and chest
physiotherapy
Correct Answer: C
Rationale: RSV bronchiolitis is managed supportively with hydration, nasal suctioning, and oxygen as
needed; bronchodilators and corticosteroids are not routinely recommended per AAP guidelines.
Q5: A 45-year-old man presents with sudden-onset severe headache described as "the worst headache
of my life," accompanied by nausea and photophobia. On exam, he has nuchal rigidity and a positive
Brudzinski sign. CT head is pending. What is the most likely diagnosis?
A. Migraine with aura B. Subarachnoid hemorrhage [CORRECT] C. Acute bacterial meningitis D. Cluster
headache
Correct Answer: B
Rationale: A thunderclap headache with meningeal signs is classic for subarachnoid hemorrhage; non-
contrast CT is the initial imaging of choice, followed by lumbar puncture if CT is negative.
,Q6: A 3-year-old girl is brought in with a fever of 103°F, irritability, and a stiff neck. She has a purpuric
rash on her lower extremities. Kernig and Brudzinski signs are positive. What is the most appropriate
immediate management?
A. Oral amoxicillin and observation B. Immediate IV ceftriaxone and vancomycin [CORRECT] C. Lumbar
puncture before any antibiotics D. Acetaminophen and observation pending blood cultures
Correct Answer: B
Rationale: Suspected bacterial meningitis requires immediate empiric IV antibiotics (ceftriaxone +
vancomycin) before LP if the patient is unstable or has signs of increased ICP; delay in antibiotics
increases mortality.
Q7: A 55-year-old woman presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. On exam, she has an S3 gallop, jugular venous distension, and bibasilar crackles.
Echocardiogram shows an ejection fraction of 35%. What is the most appropriate first-line
pharmacotherapy?
A. Furosemide, lisinopril, and metoprolol succinate [CORRECT] B. Digoxin, hydralazine, and isosorbide
dinitrate C. Diltiazem, spironolactone, and losartan D. Amlodipine, hydrochlorothiazide, and carvedilol
Correct Answer: A
Rationale: HFrEF (EF <40%) is managed with guideline-directed medical therapy: ACE
inhibitor/ARB/ARNI, evidence-based beta-blocker (metoprolol succinate, carvedilol, or bisoprolol), and
loop diuretics for congestion; SGLT2 inhibitors are also now first-line per 2022 AHA/ACC/HFSA
guidelines.
Q8: A 62-year-old man with a 40 pack-year smoking history presents with a 3-month history of cough,
hemoptysis, and 15-pound weight loss. Chest X-ray reveals a 3 cm spiculated mass in the left upper lobe.
What is the next most appropriate diagnostic step?
A. Initiate broad-spectrum antibiotics and repeat CXR in 6 weeks B. CT chest with contrast and PET-CT,
followed by tissue biopsy [CORRECT] C. Start empiric anti-TB therapy D. Bronchoscopy with
transbronchial biopsy only
Correct Answer: B
Rationale: A spiculated lung mass in a heavy smoker is highly suspicious for lung cancer; staging with
CT/PET-CT and tissue biopsy (CT-guided or bronchoscopic) is required before treatment planning.
, Q9: A 35-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. Physical
exam reveals dry skin, coarse hair, and delayed deep tendon reflexes. TSH is 12.5 mIU/L (normal 0.4-
4.0). What is the first-line treatment?
A. Liothyronine (T3) replacement B. Levothyroxine (T4) 1.6 mcg/kg daily [CORRECT] C. Methimazole 10
mg daily D. Iodine supplementation
Correct Answer: B
Rationale: Primary hypothyroidism is treated with levothyroxine (T4) at 1.6 mcg/kg/day; TSH should be
rechecked in 6-8 weeks and dose adjusted accordingly.
Q10: A 16-year-old male athlete presents with anterior knee pain that worsens with running, jumping,
and climbing stairs. There is tenderness over the tibial tuberosity and a prominent bony bump. What is
the most likely diagnosis?
A. Patellar tendon rupture B. Osgood-Schlatter disease [CORRECT] C. Prepatellar bursitis D.
Osteochondritis dissecans
Correct Answer: B
Rationale: Osgood-Schlatter disease is traction apophysitis of the tibial tuberosity in adolescents during
growth spurts, exacerbated by repetitive jumping/running; managed with activity modification, ice, and
NSAIDs.
Q11: A 50-year-old man presents with progressive dysphagia to solids that is worse in the supine
position and associated with regurgitation of undigested food. He has halitosis and intermittent cough.
Barium swallow shows a dilated esophagus with a "bird's beak" appearance. What is the most likely
diagnosis?
A. Esophageal stricture from GERD B. Achalasia [CORRECT] C. Esophageal spasm D. Zenker diverticulum
Correct Answer: B
Rationale: Achalasia presents with progressive dysphagia to solids and liquids, regurgitation, and a
"bird's beak" appearance on barium swallow due to failure of the lower esophageal sphincter to relax;
confirmed with manometry.
