ANCC FNP-BC Practice Exam – 260 Questions
with Rationales | Family Nurse Practitioner
2026 Test Content Outline | Updated for
October 30, 2026
TABLE OF CONTENTS
1. Domain 1: Assessment (Questions 1–50) – 19% of Exam
2. Domain 2: Diagnosis (Questions 51–100) – 17% of Exam
3. Domain 3: Planning (Questions 101–150) – 19% of Exam
4. Domain 4: Implementation (Questions 151–220) – 29% of Exam
5. Domain 5: Evaluation (Questions 221–260) – 15% of Exam
DOMAIN 1: ASSESSMENT (Questions 1–50)
Question 1 A 45-year-old female patient presents for a routine health maintenance visit. She has no
significant medical history. Which of the following screening tests should the nurse practitioner
recommend based on current USPSTF guidelines?
A. Mammogram every 2 years B. Colonoscopy starting at age 50 C. Pap smear every 3 years D. Lipid
panel starting at age 35
Correct Answer: A Rationale: For average-risk women aged 45-54, the USPSTF recommends
biennial screening mammography (A). Colonoscopy (B) is now recommended starting at age 45 for
average-risk individuals. Pap smears (C) for women aged 21-65 are recommended every 3 years, but
the question is focused on screening recommendations for a 45-year-old. Lipid screening (D) is
recommended for men starting at age 35 and women starting at age 45 if they have risk factors.
Question 2 (Select all that apply) A 68-year-old male patient presents for a geriatric assessment.
Which of the following are components of a functional assessment in the older adult? (Select all that
apply)
A. Instrumental Activities of Daily Living (IADLs) B. Basic Activities of Daily Living (BADLs) C.
Cognitive screening (e.g., Mini-Cog) D. Gait and balance assessment E. Serum creatinine level
,Correct Answers: A, B, C, D Rationale: Functional assessment includes BADLs (eating, bathing,
dressing, toileting, transferring) (B) and IADLs (managing finances, transportation, shopping, meal
preparation) (A). Cognitive screening (C) and gait/balance assessment (D) are also essential
components of geriatric functional assessment. Serum creatinine (E) is a laboratory test used to assess
renal function, not functional status.
Question 3 A 32-year-old female patient reports fatigue, weight gain, and cold intolerance. On
physical exam, you note bradycardia and dry, coarse skin. Which of the following is the most
appropriate initial screening test?
A. Complete blood count (CBC) B. Thyroid-stimulating hormone (TSH) C. Serum cortisol D. Fasting
blood glucose
Correct Answer: B Rationale: The patient's symptoms (fatigue, weight gain, cold intolerance,
bradycardia, dry skin) are classic for hypothyroidism. The most appropriate initial screening test is
TSH (B). A CBC (A) may show anemia but is not the primary screening test. Serum cortisol (C)
would be indicated for adrenal insufficiency. Fasting glucose (D) would be indicated for diabetes.
Question 4 A 55-year-old male patient with a 30-pack-year smoking history presents for a wellness
visit. According to USPSTF guidelines, which screening test should the nurse practitioner
recommend?
A. Annual low-dose computed tomography (LDCT) for lung cancer B. Chest x-ray annually C.
Sputum cytology D. Pulmonary function tests
Correct Answer: A Rationale: The USPSTF recommends annual lung cancer screening with low-
dose CT (LDCT) for adults aged 50-80 with a 20-pack-year smoking history who currently smoke or
have quit within the past 15 years (A). Chest x-ray (B) is not recommended for lung cancer screening.
Sputum cytology (C) is not an effective screening tool. Pulmonary function tests (D) are used to
diagnose COPD, not for lung cancer screening.
Question 5 (Select all that apply) A 70-year-old female patient has a history of osteoporosis. Which
of the following are risk factors for osteoporosis that should be assessed during a comprehensive
history? (Select all that apply)
A. Family history of hip fracture B. Tobacco use C. Early menopause (before age 45) D. Long-term
corticosteroid use E. High body mass index (BMI)
Correct Answers: A, B, C, D Rationale: Risk factors for osteoporosis include family history of hip
fracture (A), tobacco use (B), early menopause (C), and long-term corticosteroid use (D). High BMI
(E) is actually protective against osteoporosis (higher bone density).
,Question 6 A 28-year-old male patient reports frequent headaches. Which of the following findings
on history would suggest a migraine headache rather than a tension-type headache?
A. Bilateral, non-throbbing pain B. Unilateral, throbbing pain with nausea and photophobia C. Pain
that is constant and band-like D. Pain that worsens with activity
Correct Answers: B, D Rationale: Migraines typically present with unilateral, throbbing pain (B)
accompanied by nausea, photophobia, and phonophobia. Pain worsens with activity (D). Tension-type
headaches (A, C) are bilateral, non-throbbing (band-like) and do not worsen with activity.
Question 7 A 62-year-old male patient presents with a complaint of "feeling dizzy" when standing
up. On exam, you measure his blood pressure supine and then after standing for 2 minutes. What
finding defines orthostatic hypotension?
A. Decrease in systolic BP of ≥20 mmHg and/or diastolic BP of ≥10 mmHg within 3 minutes of
standing B. Decrease in systolic BP of ≥10 mmHg and/or diastolic BP of ≥5 mmHg within 3 minutes
of standing C. Increase in heart rate of ≥30 bpm within 3 minutes of standing D. Decrease in systolic
BP of ≥20 mmHg within 5 minutes of standing
Correct Answer: A Rationale: Orthostatic hypotension is defined as a decrease in systolic BP of ≥20
mmHg and/or a decrease in diastolic BP of ≥10 mmHg within 3 minutes of standing (A). Option B is
incorrect (values are too low). Option C describes orthostatic tachycardia (not a definition of
orthostatic hypotension). Option D has an incorrect time frame.
Question 8 (Select all that apply) A 48-year-old female patient reports irregular menstrual cycles and
hot flashes. Which of the following should be included in the assessment for menopause? (Select all
that apply)
A. Last menstrual period date B. Symptoms (vasomotor, vaginal, sleep disturbance) C. Family history
of breast cancer D. Use of hormonal contraceptives E. Blood glucose level
Correct Answers: A, B, C, D Rationale: Menopause assessment includes the patient's last menstrual
period (A), symptom assessment (B), family history of breast cancer (C) (which affects hormone
therapy decisions), and current use of hormonal contraceptives (D) (which may mask menopausal
symptoms). Blood glucose (E) is not directly part of menopause assessment.
Question 9 A 2-year-old child is brought in for a well-child visit. The child has no history of
developmental delay. Which of the following developmental milestones would the nurse practitioner
expect to assess at this age?
A. Walking independently B. Saying 2-3 word sentences C. Riding a tricycle D. Tying shoelaces
, Correct Answer: A Rationale: By age 2, a child should be walking independently (A). Saying 2-3
word sentences (B) is expected by age 3. Riding a tricycle (C) is a 3-4 year milestone. Tying
shoelaces (D) is a 5-6 year milestone.
Question 10 A 55-year-old male patient reports difficulty sleeping and daytime fatigue. Which of the
following screening tools is most appropriate for sleep apnea?
A. Epworth Sleepiness Scale B. STOP-BANG questionnaire C. Pittsburgh Sleep Quality Index
(PSQI) D. Insomnia Severity Index (ISI)
Correct Answer: B Rationale: The STOP-BANG questionnaire (Snoring, Tiredness, Observed
apnea, Pressure (hypertension), BMI >35, Age >50, Neck circumference >40 cm, Gender male) (B) is
a validated screening tool for obstructive sleep apnea. The Epworth Sleepiness Scale (A) measures
daytime sleepiness but is not a specific screening tool for sleep apnea. The PSQI (C) assesses sleep
quality over a 1-month period. The ISI (D) screens for insomnia.
Question 11 (Select all that apply) A 30-year-old female patient of childbearing age reports a family
history of breast and ovarian cancer. Which of the following genetic risk assessments should the nurse
practitioner consider? (Select all that apply)
A. BRCA1/BRCA2 genetic testing B. Family history of breast cancer in first-degree relatives C.
Ashkenazi Jewish ancestry D. Personal history of breast cancer (none) E. History of radiation therapy
to the chest
Correct Answers: A, B, C, E Rationale: BRCA1/BRCA2 genetic testing (A) should be considered
in patients with a family history of breast or ovarian cancer. Family history (B), Ashkenazi Jewish
ancestry (C), and history of chest radiation (E) are risk factors for hereditary breast and ovarian
cancer syndrome. The patient does not have a personal history of breast cancer (D), but the question
is about risk assessment.
Question 12 A 72-year-old male patient presents with a complaint of "not remembering things as well
as I used to." Which of the following cognitive screening tools is most appropriate for a brief
assessment?
A. Mini-Mental State Examination (MMSE) B. Montreal Cognitive Assessment (MoCA) C. Mini-
Cog D. Clock Drawing Test
Correct Answers: C Rationale: The Mini-Cog (C) is a brief, 3-minute screening tool that assesses
memory recall and clock drawing. The MMSE (A) and MoCA (B) are longer (10-15 minutes). The
Clock Drawing Test (D) is a component of other screening tools but is not a standalone
comprehensive screening.
with Rationales | Family Nurse Practitioner
2026 Test Content Outline | Updated for
October 30, 2026
TABLE OF CONTENTS
1. Domain 1: Assessment (Questions 1–50) – 19% of Exam
2. Domain 2: Diagnosis (Questions 51–100) – 17% of Exam
3. Domain 3: Planning (Questions 101–150) – 19% of Exam
4. Domain 4: Implementation (Questions 151–220) – 29% of Exam
5. Domain 5: Evaluation (Questions 221–260) – 15% of Exam
DOMAIN 1: ASSESSMENT (Questions 1–50)
Question 1 A 45-year-old female patient presents for a routine health maintenance visit. She has no
significant medical history. Which of the following screening tests should the nurse practitioner
recommend based on current USPSTF guidelines?
A. Mammogram every 2 years B. Colonoscopy starting at age 50 C. Pap smear every 3 years D. Lipid
panel starting at age 35
Correct Answer: A Rationale: For average-risk women aged 45-54, the USPSTF recommends
biennial screening mammography (A). Colonoscopy (B) is now recommended starting at age 45 for
average-risk individuals. Pap smears (C) for women aged 21-65 are recommended every 3 years, but
the question is focused on screening recommendations for a 45-year-old. Lipid screening (D) is
recommended for men starting at age 35 and women starting at age 45 if they have risk factors.
Question 2 (Select all that apply) A 68-year-old male patient presents for a geriatric assessment.
Which of the following are components of a functional assessment in the older adult? (Select all that
apply)
A. Instrumental Activities of Daily Living (IADLs) B. Basic Activities of Daily Living (BADLs) C.
Cognitive screening (e.g., Mini-Cog) D. Gait and balance assessment E. Serum creatinine level
,Correct Answers: A, B, C, D Rationale: Functional assessment includes BADLs (eating, bathing,
dressing, toileting, transferring) (B) and IADLs (managing finances, transportation, shopping, meal
preparation) (A). Cognitive screening (C) and gait/balance assessment (D) are also essential
components of geriatric functional assessment. Serum creatinine (E) is a laboratory test used to assess
renal function, not functional status.
Question 3 A 32-year-old female patient reports fatigue, weight gain, and cold intolerance. On
physical exam, you note bradycardia and dry, coarse skin. Which of the following is the most
appropriate initial screening test?
A. Complete blood count (CBC) B. Thyroid-stimulating hormone (TSH) C. Serum cortisol D. Fasting
blood glucose
Correct Answer: B Rationale: The patient's symptoms (fatigue, weight gain, cold intolerance,
bradycardia, dry skin) are classic for hypothyroidism. The most appropriate initial screening test is
TSH (B). A CBC (A) may show anemia but is not the primary screening test. Serum cortisol (C)
would be indicated for adrenal insufficiency. Fasting glucose (D) would be indicated for diabetes.
Question 4 A 55-year-old male patient with a 30-pack-year smoking history presents for a wellness
visit. According to USPSTF guidelines, which screening test should the nurse practitioner
recommend?
A. Annual low-dose computed tomography (LDCT) for lung cancer B. Chest x-ray annually C.
Sputum cytology D. Pulmonary function tests
Correct Answer: A Rationale: The USPSTF recommends annual lung cancer screening with low-
dose CT (LDCT) for adults aged 50-80 with a 20-pack-year smoking history who currently smoke or
have quit within the past 15 years (A). Chest x-ray (B) is not recommended for lung cancer screening.
Sputum cytology (C) is not an effective screening tool. Pulmonary function tests (D) are used to
diagnose COPD, not for lung cancer screening.
Question 5 (Select all that apply) A 70-year-old female patient has a history of osteoporosis. Which
of the following are risk factors for osteoporosis that should be assessed during a comprehensive
history? (Select all that apply)
A. Family history of hip fracture B. Tobacco use C. Early menopause (before age 45) D. Long-term
corticosteroid use E. High body mass index (BMI)
Correct Answers: A, B, C, D Rationale: Risk factors for osteoporosis include family history of hip
fracture (A), tobacco use (B), early menopause (C), and long-term corticosteroid use (D). High BMI
(E) is actually protective against osteoporosis (higher bone density).
,Question 6 A 28-year-old male patient reports frequent headaches. Which of the following findings
on history would suggest a migraine headache rather than a tension-type headache?
A. Bilateral, non-throbbing pain B. Unilateral, throbbing pain with nausea and photophobia C. Pain
that is constant and band-like D. Pain that worsens with activity
Correct Answers: B, D Rationale: Migraines typically present with unilateral, throbbing pain (B)
accompanied by nausea, photophobia, and phonophobia. Pain worsens with activity (D). Tension-type
headaches (A, C) are bilateral, non-throbbing (band-like) and do not worsen with activity.
Question 7 A 62-year-old male patient presents with a complaint of "feeling dizzy" when standing
up. On exam, you measure his blood pressure supine and then after standing for 2 minutes. What
finding defines orthostatic hypotension?
A. Decrease in systolic BP of ≥20 mmHg and/or diastolic BP of ≥10 mmHg within 3 minutes of
standing B. Decrease in systolic BP of ≥10 mmHg and/or diastolic BP of ≥5 mmHg within 3 minutes
of standing C. Increase in heart rate of ≥30 bpm within 3 minutes of standing D. Decrease in systolic
BP of ≥20 mmHg within 5 minutes of standing
Correct Answer: A Rationale: Orthostatic hypotension is defined as a decrease in systolic BP of ≥20
mmHg and/or a decrease in diastolic BP of ≥10 mmHg within 3 minutes of standing (A). Option B is
incorrect (values are too low). Option C describes orthostatic tachycardia (not a definition of
orthostatic hypotension). Option D has an incorrect time frame.
Question 8 (Select all that apply) A 48-year-old female patient reports irregular menstrual cycles and
hot flashes. Which of the following should be included in the assessment for menopause? (Select all
that apply)
A. Last menstrual period date B. Symptoms (vasomotor, vaginal, sleep disturbance) C. Family history
of breast cancer D. Use of hormonal contraceptives E. Blood glucose level
Correct Answers: A, B, C, D Rationale: Menopause assessment includes the patient's last menstrual
period (A), symptom assessment (B), family history of breast cancer (C) (which affects hormone
therapy decisions), and current use of hormonal contraceptives (D) (which may mask menopausal
symptoms). Blood glucose (E) is not directly part of menopause assessment.
Question 9 A 2-year-old child is brought in for a well-child visit. The child has no history of
developmental delay. Which of the following developmental milestones would the nurse practitioner
expect to assess at this age?
A. Walking independently B. Saying 2-3 word sentences C. Riding a tricycle D. Tying shoelaces
, Correct Answer: A Rationale: By age 2, a child should be walking independently (A). Saying 2-3
word sentences (B) is expected by age 3. Riding a tricycle (C) is a 3-4 year milestone. Tying
shoelaces (D) is a 5-6 year milestone.
Question 10 A 55-year-old male patient reports difficulty sleeping and daytime fatigue. Which of the
following screening tools is most appropriate for sleep apnea?
A. Epworth Sleepiness Scale B. STOP-BANG questionnaire C. Pittsburgh Sleep Quality Index
(PSQI) D. Insomnia Severity Index (ISI)
Correct Answer: B Rationale: The STOP-BANG questionnaire (Snoring, Tiredness, Observed
apnea, Pressure (hypertension), BMI >35, Age >50, Neck circumference >40 cm, Gender male) (B) is
a validated screening tool for obstructive sleep apnea. The Epworth Sleepiness Scale (A) measures
daytime sleepiness but is not a specific screening tool for sleep apnea. The PSQI (C) assesses sleep
quality over a 1-month period. The ISI (D) screens for insomnia.
Question 11 (Select all that apply) A 30-year-old female patient of childbearing age reports a family
history of breast and ovarian cancer. Which of the following genetic risk assessments should the nurse
practitioner consider? (Select all that apply)
A. BRCA1/BRCA2 genetic testing B. Family history of breast cancer in first-degree relatives C.
Ashkenazi Jewish ancestry D. Personal history of breast cancer (none) E. History of radiation therapy
to the chest
Correct Answers: A, B, C, E Rationale: BRCA1/BRCA2 genetic testing (A) should be considered
in patients with a family history of breast or ovarian cancer. Family history (B), Ashkenazi Jewish
ancestry (C), and history of chest radiation (E) are risk factors for hereditary breast and ovarian
cancer syndrome. The patient does not have a personal history of breast cancer (D), but the question
is about risk assessment.
Question 12 A 72-year-old male patient presents with a complaint of "not remembering things as well
as I used to." Which of the following cognitive screening tools is most appropriate for a brief
assessment?
A. Mini-Mental State Examination (MMSE) B. Montreal Cognitive Assessment (MoCA) C. Mini-
Cog D. Clock Drawing Test
Correct Answers: C Rationale: The Mini-Cog (C) is a brief, 3-minute screening tool that assesses
memory recall and clock drawing. The MMSE (A) and MoCA (B) are longer (10-15 minutes). The
Clock Drawing Test (D) is a component of other screening tools but is not a standalone
comprehensive screening.
