ANCC FNP BOARD EXAM LATEST REAL EXAM 100+
UPDATED 2027 QUESTIONS AND CORRECT
ANSWERS WITH
RATIONALES ALREDY GRADED A+
1. How many doses of Tdap or Td IM needed for protection after clean
minor wounds. - ANSWER>>Three doses needed. If <3, unknown, or
>10 years since last dose give dose of Tdap or Td for clean minor
wounds. No need to give TIG.
2. Non-"clean" minor wounds given both of these if unknown tetanus hx
or <3 doses of Tdap/Td. - ANSWER>>Tdap or Td IM & TIG
3. Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions,
missiles, burns, frostbite) - ANSWER>>If <3 doses Tdap or Td give
both Tdap and TIG 250 units. If 3 doses in past, but none in the last 5
years then given Tdap or Td. No need to give TIG If 3 or > doses in the
past
4. When to switch from DTap to Tdap in children - ANSWER>>Age 7 or >
given Tdap
5. A woman becomes pregnant and received Tdap during her last
pregnancy 1 year ago. When should she receive her next dose. -
ANSWER>>Tdap is recommended for each pregnancy.
6. "Getting Tdap between 27 through 36 weeks of pregnancy is 78%
more effective at preventing whooping cough in babies younger
than 2 months old (CDC)".
7. A person with a hx of anaphylaxis to neomycin should avoid which
immunizations (IZ)? - ANSWER>>IPV, MMR, varicella
8. A person with a hx of anaphylaxis to neomycin should avoid which
immunizations (IZ)? - ANSWER>>IPV, vaccinia (smallpox)
9. A person with a hx of anaphylaxis to bakers yeast should avoid which
immunizations (IZ)? - ANSWER>>Hepatitis B
10. A person with a hx of anaphylaxis to gelatin should avoid which
immunizations (IZ)? - ANSWER>>varicella zoster (zostavax) and MMR
,Epinephrine needs to be on hand for potential anaphylaxis r/t immunization
rxn. What other interventions/meds should be considered during
anaphylaxis? - ANSWER>>Supine, 911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
>30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic
corticosteroids, bronchodilators
s/s anaphylaxis - ANSWER>>Skin: pruritus, urticaria, angioedema
Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
PCV-13 - ANSWER>>Prevnar. Greater protection, Narrower coverage.
Pneumococcal conjugate.
PCV23 - ANSWER>>lesser protection, broader coverage
Which type of vaccine boosts immune response better? conjugate vs.
polysaccharide - ANSWER>>conjugate (example: prevnar)
Live attenuated (weaned) vaccines - ANSWER>>MMR, Varicella and
intranasal Flu- mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER>>SCID (severe
combined immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER>>hand washing!; viral shed in stool
in first week post-vaccination
, Shingrix: timing and dosing - ANSWER>>=/> 50 y/o, 2 doses, 2nd dose two
to six months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? -
ANSWER>>Feb
What s/s are associated with leukemia? - ANSWER>>fever, wt loss, fatigue,
bone pain, bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? -
ANSWER>>WBCs
>20,000 (think through common causes of leukocytosis: infection, stress,
inflammation)
--> get a peripheral smear (AKA manual diff)
if WBCs >20,000 and with associated anemia; thrombocytopenia;
thrombocytosis; enlarged liver, spleen, or lymph nodes; or constitutional
symptoms.
Which 2 chronic childhood diagnoses are associated with ALL and AML? -
ANSWER>>Downs syndrome and neurofibromatosis
What are 3 main risk factors for leukemia - ANSWER>>radiation (equivalent
to 2 to 3 CTs), toxin /household pesticide exposure in utero/early childhood.
Acute Leukemia: ALL or AML cancer and symptoms/PE findings -
ANSWER>>2 types: Acute Lymphoblastic Leukemia or Acute Myelogenous
Leukemia.
BLASTs on peripheral smear/bone aspiration in both ALL and AML.
AML also presents with
Auer rods on peripheral smear.
Acute leukemia can also present with leukopenia, combined with anemia or
thrombocytopenia
Children: fever, lethargy, bleeding, potentially spinal or long bone pain.
enlarged spleen, liver, lymphandenopathy.
Adults (typically young): fever, fatigue, wt loss. May have anemia related
symptoms (chest pain, SOB)
UPDATED 2027 QUESTIONS AND CORRECT
ANSWERS WITH
RATIONALES ALREDY GRADED A+
1. How many doses of Tdap or Td IM needed for protection after clean
minor wounds. - ANSWER>>Three doses needed. If <3, unknown, or
>10 years since last dose give dose of Tdap or Td for clean minor
wounds. No need to give TIG.
2. Non-"clean" minor wounds given both of these if unknown tetanus hx
or <3 doses of Tdap/Td. - ANSWER>>Tdap or Td IM & TIG
3. Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions,
missiles, burns, frostbite) - ANSWER>>If <3 doses Tdap or Td give
both Tdap and TIG 250 units. If 3 doses in past, but none in the last 5
years then given Tdap or Td. No need to give TIG If 3 or > doses in the
past
4. When to switch from DTap to Tdap in children - ANSWER>>Age 7 or >
given Tdap
5. A woman becomes pregnant and received Tdap during her last
pregnancy 1 year ago. When should she receive her next dose. -
ANSWER>>Tdap is recommended for each pregnancy.
6. "Getting Tdap between 27 through 36 weeks of pregnancy is 78%
more effective at preventing whooping cough in babies younger
than 2 months old (CDC)".
7. A person with a hx of anaphylaxis to neomycin should avoid which
immunizations (IZ)? - ANSWER>>IPV, MMR, varicella
8. A person with a hx of anaphylaxis to neomycin should avoid which
immunizations (IZ)? - ANSWER>>IPV, vaccinia (smallpox)
9. A person with a hx of anaphylaxis to bakers yeast should avoid which
immunizations (IZ)? - ANSWER>>Hepatitis B
10. A person with a hx of anaphylaxis to gelatin should avoid which
immunizations (IZ)? - ANSWER>>varicella zoster (zostavax) and MMR
,Epinephrine needs to be on hand for potential anaphylaxis r/t immunization
rxn. What other interventions/meds should be considered during
anaphylaxis? - ANSWER>>Supine, 911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
>30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic
corticosteroids, bronchodilators
s/s anaphylaxis - ANSWER>>Skin: pruritus, urticaria, angioedema
Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
PCV-13 - ANSWER>>Prevnar. Greater protection, Narrower coverage.
Pneumococcal conjugate.
PCV23 - ANSWER>>lesser protection, broader coverage
Which type of vaccine boosts immune response better? conjugate vs.
polysaccharide - ANSWER>>conjugate (example: prevnar)
Live attenuated (weaned) vaccines - ANSWER>>MMR, Varicella and
intranasal Flu- mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER>>SCID (severe
combined immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER>>hand washing!; viral shed in stool
in first week post-vaccination
, Shingrix: timing and dosing - ANSWER>>=/> 50 y/o, 2 doses, 2nd dose two
to six months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? -
ANSWER>>Feb
What s/s are associated with leukemia? - ANSWER>>fever, wt loss, fatigue,
bone pain, bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? -
ANSWER>>WBCs
>20,000 (think through common causes of leukocytosis: infection, stress,
inflammation)
--> get a peripheral smear (AKA manual diff)
if WBCs >20,000 and with associated anemia; thrombocytopenia;
thrombocytosis; enlarged liver, spleen, or lymph nodes; or constitutional
symptoms.
Which 2 chronic childhood diagnoses are associated with ALL and AML? -
ANSWER>>Downs syndrome and neurofibromatosis
What are 3 main risk factors for leukemia - ANSWER>>radiation (equivalent
to 2 to 3 CTs), toxin /household pesticide exposure in utero/early childhood.
Acute Leukemia: ALL or AML cancer and symptoms/PE findings -
ANSWER>>2 types: Acute Lymphoblastic Leukemia or Acute Myelogenous
Leukemia.
BLASTs on peripheral smear/bone aspiration in both ALL and AML.
AML also presents with
Auer rods on peripheral smear.
Acute leukemia can also present with leukopenia, combined with anemia or
thrombocytopenia
Children: fever, lethargy, bleeding, potentially spinal or long bone pain.
enlarged spleen, liver, lymphandenopathy.
Adults (typically young): fever, fatigue, wt loss. May have anemia related
symptoms (chest pain, SOB)
