ANCC Family Nurse Practitioner
Board Exam Prep · 100 Verified Items
American Nurses Credentialing Center (ANCC) | Family Nurse Practitioner (FNP-BC™) Board Certification |
2026/2027 Cycle
Assessment · Diagnosis · Planning · Implementation · Evaluation — the five ANCC content domains
Pharmacotherapeutics & Prescriptive Authority · Evidence-Based Guidelines · Professional Role & Legal-Ethical
Standards · Population Health & Health Equity
Entry-Level APRN Focus | Clinical Vignette, Application and Analysis Format | Guidelines Verified July 2026
Exam Structure
The ANCC FNP-BC™ board certification examination is a computer-based assessment
administered through Prometric. Per the current ANCC General Testing Handbook and Test
Content Outline, the examination comprises 175 total questions — 150 scored and 25 unscored
pretest items — with a 3.5-hour testing period. The passing standard is a scaled score of 350 on a
0–500 scale. Item formats include multiple-choice, multiple-response (select-all-that-apply), drag-
and-drop, and hotspot questions.
Correction to a Common Misstatement
A 150-question / 135-scored / Pearson VUE format is sometimes quoted for the ANCC FNP exam.
That describes the AANP FNP-C® examination, which has 150 questions (135 scored) and 3
hours. The ANCC FNP-BC™ exam has 175 questions (150 scored), runs 3.5 hours, and is delivered
through Prometric. This pack is built to the ANCC blueprint and domain weighting; the
distinction matters because the ANCC exam places materially greater emphasis on professional
role, systems, and policy content.
ANCC Domain Blueprint % Scored Items on This Pack
Exam
Domain 1 — Assessment 19% ~29 scored items Q1–Q14
Domain 2 — Diagnosis 17% ~26 scored items Q15–Q26
Domain 3 — Planning 19% ~29 scored items Q27–Q42
Domain 4 — Implementation 29% ~43 scored items Q43–Q64
Domain 5 — Evaluation 15% ~23 scored items Q65–Q80
Select-all-that-apply set — cross-domain Q81–Q86
Algorithm identification — cross-domain Q87–Q92
Clinical vignettes — cross-domain Q93–Q100
TOTAL IN THIS PACK 100% 100 items Q1–Q100
Introduction
This guide prepares entry-level Family Nurse Practitioners for national board certification. The
content emphasizes advanced clinical judgment, evidence-based diagnostic reasoning, safe
prescriptive authority, and patient-centered care aligned with the ANCC FNP Test Content Outline,
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
,AANP core competencies, and current clinical practice guidelines, ensuring learners can prioritize
differential diagnoses, formulate comprehensive management plans across the lifespan, and
demonstrate the critical thinking required for safe, entry-level advanced practice nursing.
Domain 1 · Assessment (Q1–Q14)
Question 1 (1 point · Multiple Choice)
A 52-year-old man presents for a routine visit. His office BP averages 134/84 mmHg across two
visits. He has no ASCVD, diabetes, or CKD, and his 10-year PREVENT risk is 5%. According to the
2025 AHA/ACC guideline, what is the MOST appropriate next step?
A. Begin a thiazide diuretic today
B. Initiate lifestyle therapy and reassess in 3–6 months, starting medication if BP
remains ≥130/80 ✓
C. No intervention; this BP is normal
D. Begin a two-drug single-pill combination
Correct Answer: B. Initiate lifestyle therapy and reassess in 3–6 months, starting
medication if BP remains ≥130/80
Rationale: This is stage 1 hypertension (130–139/80–89). The 2025 guideline directs pharmacotherapy for
stage 1 when the patient has ASCVD, diabetes, CKD, or a 10-year PREVENT risk ≥7.5%. With a PREVENT risk of
5% and no compelling indication, lifestyle therapy for 3–6 months is first-line; medication is then added if BP
remains at or above 130/80. Note the change from the 2017 guideline, which used a 10% ASCVD threshold —
PREVENT has replaced the Pooled Cohort Equations. Option D is reserved for stage 2 disease.
References: 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and Management of High Blood
Pressure in Adults; ANCC FNP Test Content Outline (2024/2026) Domain 1.
Question 2 (1 point · Multiple Choice)
Which finding on a diabetic foot examination is the STRONGEST predictor of future ulceration and
warrants the most urgent preventive intervention?
A. Onychomycosis of two toenails
B. Loss of protective sensation on 10-g monofilament testing ✓
C. Dry, scaling skin over the heels
D. A bunion at the first metatarsophalangeal joint
Correct Answer: B. Loss of protective sensation on 10-g monofilament testing
Rationale: Loss of protective sensation is the single strongest predictor of ulceration because the patient
can no longer perceive the repetitive trauma that produces tissue breakdown. The 10-g Semmes-Weinstein
monofilament, ideally combined with one other modality such as vibration or pinprick, is the standard
screening test and should be performed at least annually. The other findings warrant attention but confer far
lower risk. Patients with loss of protective sensation require education, appropriate footwear, and more
frequent surveillance.
References: ADA Standards of Care in Diabetes — 2026 Section 12; ANCC FNP Test Content Outline (2024/2026)
Domain 1.
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
,Question 3 (1 point · Multiple Choice)
A 3-week-old infant presents with a rectal temperature of 38.2 °C (100.8 °F). The infant is feeding
well and appears nontoxic. What is the MOST appropriate action?
A. Reassure the parents and follow up in 24 hours
B. Prescribe oral amoxicillin and arrange next-day follow-up
C. Refer immediately for emergency evaluation including full sepsis work-up ✓
D. Obtain a urinalysis in the office and treat if positive
Correct Answer: C. Refer immediately for emergency evaluation including full sepsis
work-up
Rationale: Any fever of 38.0 °C or higher in an infant under 28 days of age is a medical emergency
regardless of appearance, because neonates mount unreliable inflammatory responses and can harbor
invasive bacterial infection or HSV while looking well. Management requires immediate referral for blood,
urine, and CSF cultures with empiric parenteral antibiotics. A well appearance is explicitly NOT reassuring at
this age, which makes options A, B, and D unsafe.
References: AAP clinical practice guidelines febrile infant guideline; ANCC FNP Test Content Outline (2024/2026)
Domain 1.
Question 4 (1 point · Multiple Choice)
According to current USPSTF recommendations, at what age should average-risk adults BEGIN
screening for colorectal cancer?
A. 40 years
B. 45 years ✓
C. 50 years
D. 55 years
Correct Answer: B. 45 years
Rationale: The USPSTF lowered the starting age for average-risk colorectal cancer screening from 50 to 45
years (grade B for ages 45–49, grade A for 50–75), reflecting rising incidence in younger adults. Acceptable
strategies include colonoscopy every 10 years, annual FIT, FIT-DNA every 1–3 years, or CT colonography every
5 years. Screening from 76 to 85 is individualized based on health status and prior screening history.
References: U.S. Preventive Services Task Force recommendation statements, colorectal cancer screening; ANCC FNP
Test Content Outline (2024/2026) Domain 1.
Question 5 (1 point · Multiple Choice)
A 40-year-old woman with no personal or family history of breast cancer asks when she should
begin mammography. Based on the 2024 USPSTF recommendation, the FNP should advise:
A. Annual mammography beginning now
B. Biennial mammography beginning now, continuing through age 74 ✓
C. Biennial mammography beginning at age 50
D. No screening until age 45
Correct Answer: B. Biennial mammography beginning now, continuing through age 74
Rationale: In 2024 the USPSTF lowered the starting age for biennial screening mammography from 50 to
40 years (grade B), continuing through age 74. Evidence for screening at 75 and older is insufficient. Note that
this differs from the American Cancer Society, which offers annual screening from 45; when guidelines diverge,
shared decision-making that accounts for patient values is the appropriate approach.
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
, References: U.S. Preventive Services Task Force recommendation statements, breast cancer screening (2024); ANCC
FNP Test Content Outline (2024/2026) Domain 1.
Question 6 (1 point · Multiple Choice)
Which patient meets USPSTF criteria for annual low-dose CT lung cancer screening?
A. A 45-year-old with a 30 pack-year history who currently smokes
B. A 62-year-old with a 25 pack-year history who quit 8 years ago ✓
C. A 55-year-old with a 15 pack-year history who currently smokes
D. A 70-year-old with a 40 pack-year history who quit 20 years ago
Correct Answer: B. A 62-year-old with a 25 pack-year history who quit 8 years ago
Rationale: All three criteria must be met: age 50–80, at least a 20 pack-year history, and current smoking
or cessation within the past 15 years. Option B satisfies each. Option A fails on age, option C on pack-years, and
option D on the cessation interval, since risk declines substantially beyond 15 years of abstinence. Screening
should stop once a patient has not smoked for 15 years or develops a condition limiting life expectancy.
References: U.S. Preventive Services Task Force recommendation statements, lung cancer screening; ANCC FNP Test
Content Outline (2024/2026) Domain 1.
Question 7 (1 point · Multiple Choice)
A 30-year-old woman reports that her partner monitors her phone, controls the household
finances, and has threatened her twice. What is the FNP's PRIORITY action?
A. Provide a shelter brochure and schedule a 3-month follow-up
B. Assess immediate safety, including lethality risk, and develop a safety plan ✓
C. Notify law enforcement without the patient's consent
D. Recommend couples counseling
Correct Answer: B. Assess immediate safety, including lethality risk, and develop a safety
plan
Rationale: The priority in intimate partner violence is immediate safety assessment: presence of weapons,
escalation, threats to kill, strangulation history, and whether it is safe to go home tonight. Strangulation and
threats with a weapon are especially strong predictors of homicide. Couples counseling is contraindicated
because it can escalate danger. Reporting requirements vary by state and generally respect the competent
adult's autonomy; overriding consent may increase risk and destroy trust.
References: U.S. Preventive Services Task Force recommendation statements, IPV screening; ANCC FNP Test Content
Outline (2024/2026) Domain 1.
Question 8 (1 point · Multiple Choice)
A 78-year-old woman reports two falls in the past six months. Which assessment finding most
warrants a medication review as the initial intervention?
A. She uses a cane outdoors
B. She takes zolpidem nightly and oxybutynin for urinary urgency ✓
C. She walks 20 minutes three times weekly
D. Her vitamin D level is 42 ng/mL
Correct Answer: B. She takes zolpidem nightly and oxybutynin for urinary urgency
Rationale: Both agents appear on the AGS Beers Criteria as potentially inappropriate in older adults.
Sedative-hypnotics such as zolpidem impair balance and psychomotor function, and anticholinergics such as
oxybutynin cause sedation, confusion, and orthostasis. Polypharmacy involving these classes is among the most
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
Board Exam Prep · 100 Verified Items
American Nurses Credentialing Center (ANCC) | Family Nurse Practitioner (FNP-BC™) Board Certification |
2026/2027 Cycle
Assessment · Diagnosis · Planning · Implementation · Evaluation — the five ANCC content domains
Pharmacotherapeutics & Prescriptive Authority · Evidence-Based Guidelines · Professional Role & Legal-Ethical
Standards · Population Health & Health Equity
Entry-Level APRN Focus | Clinical Vignette, Application and Analysis Format | Guidelines Verified July 2026
Exam Structure
The ANCC FNP-BC™ board certification examination is a computer-based assessment
administered through Prometric. Per the current ANCC General Testing Handbook and Test
Content Outline, the examination comprises 175 total questions — 150 scored and 25 unscored
pretest items — with a 3.5-hour testing period. The passing standard is a scaled score of 350 on a
0–500 scale. Item formats include multiple-choice, multiple-response (select-all-that-apply), drag-
and-drop, and hotspot questions.
Correction to a Common Misstatement
A 150-question / 135-scored / Pearson VUE format is sometimes quoted for the ANCC FNP exam.
That describes the AANP FNP-C® examination, which has 150 questions (135 scored) and 3
hours. The ANCC FNP-BC™ exam has 175 questions (150 scored), runs 3.5 hours, and is delivered
through Prometric. This pack is built to the ANCC blueprint and domain weighting; the
distinction matters because the ANCC exam places materially greater emphasis on professional
role, systems, and policy content.
ANCC Domain Blueprint % Scored Items on This Pack
Exam
Domain 1 — Assessment 19% ~29 scored items Q1–Q14
Domain 2 — Diagnosis 17% ~26 scored items Q15–Q26
Domain 3 — Planning 19% ~29 scored items Q27–Q42
Domain 4 — Implementation 29% ~43 scored items Q43–Q64
Domain 5 — Evaluation 15% ~23 scored items Q65–Q80
Select-all-that-apply set — cross-domain Q81–Q86
Algorithm identification — cross-domain Q87–Q92
Clinical vignettes — cross-domain Q93–Q100
TOTAL IN THIS PACK 100% 100 items Q1–Q100
Introduction
This guide prepares entry-level Family Nurse Practitioners for national board certification. The
content emphasizes advanced clinical judgment, evidence-based diagnostic reasoning, safe
prescriptive authority, and patient-centered care aligned with the ANCC FNP Test Content Outline,
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
,AANP core competencies, and current clinical practice guidelines, ensuring learners can prioritize
differential diagnoses, formulate comprehensive management plans across the lifespan, and
demonstrate the critical thinking required for safe, entry-level advanced practice nursing.
Domain 1 · Assessment (Q1–Q14)
Question 1 (1 point · Multiple Choice)
A 52-year-old man presents for a routine visit. His office BP averages 134/84 mmHg across two
visits. He has no ASCVD, diabetes, or CKD, and his 10-year PREVENT risk is 5%. According to the
2025 AHA/ACC guideline, what is the MOST appropriate next step?
A. Begin a thiazide diuretic today
B. Initiate lifestyle therapy and reassess in 3–6 months, starting medication if BP
remains ≥130/80 ✓
C. No intervention; this BP is normal
D. Begin a two-drug single-pill combination
Correct Answer: B. Initiate lifestyle therapy and reassess in 3–6 months, starting
medication if BP remains ≥130/80
Rationale: This is stage 1 hypertension (130–139/80–89). The 2025 guideline directs pharmacotherapy for
stage 1 when the patient has ASCVD, diabetes, CKD, or a 10-year PREVENT risk ≥7.5%. With a PREVENT risk of
5% and no compelling indication, lifestyle therapy for 3–6 months is first-line; medication is then added if BP
remains at or above 130/80. Note the change from the 2017 guideline, which used a 10% ASCVD threshold —
PREVENT has replaced the Pooled Cohort Equations. Option D is reserved for stage 2 disease.
References: 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and Management of High Blood
Pressure in Adults; ANCC FNP Test Content Outline (2024/2026) Domain 1.
Question 2 (1 point · Multiple Choice)
Which finding on a diabetic foot examination is the STRONGEST predictor of future ulceration and
warrants the most urgent preventive intervention?
A. Onychomycosis of two toenails
B. Loss of protective sensation on 10-g monofilament testing ✓
C. Dry, scaling skin over the heels
D. A bunion at the first metatarsophalangeal joint
Correct Answer: B. Loss of protective sensation on 10-g monofilament testing
Rationale: Loss of protective sensation is the single strongest predictor of ulceration because the patient
can no longer perceive the repetitive trauma that produces tissue breakdown. The 10-g Semmes-Weinstein
monofilament, ideally combined with one other modality such as vibration or pinprick, is the standard
screening test and should be performed at least annually. The other findings warrant attention but confer far
lower risk. Patients with loss of protective sensation require education, appropriate footwear, and more
frequent surveillance.
References: ADA Standards of Care in Diabetes — 2026 Section 12; ANCC FNP Test Content Outline (2024/2026)
Domain 1.
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
,Question 3 (1 point · Multiple Choice)
A 3-week-old infant presents with a rectal temperature of 38.2 °C (100.8 °F). The infant is feeding
well and appears nontoxic. What is the MOST appropriate action?
A. Reassure the parents and follow up in 24 hours
B. Prescribe oral amoxicillin and arrange next-day follow-up
C. Refer immediately for emergency evaluation including full sepsis work-up ✓
D. Obtain a urinalysis in the office and treat if positive
Correct Answer: C. Refer immediately for emergency evaluation including full sepsis
work-up
Rationale: Any fever of 38.0 °C or higher in an infant under 28 days of age is a medical emergency
regardless of appearance, because neonates mount unreliable inflammatory responses and can harbor
invasive bacterial infection or HSV while looking well. Management requires immediate referral for blood,
urine, and CSF cultures with empiric parenteral antibiotics. A well appearance is explicitly NOT reassuring at
this age, which makes options A, B, and D unsafe.
References: AAP clinical practice guidelines febrile infant guideline; ANCC FNP Test Content Outline (2024/2026)
Domain 1.
Question 4 (1 point · Multiple Choice)
According to current USPSTF recommendations, at what age should average-risk adults BEGIN
screening for colorectal cancer?
A. 40 years
B. 45 years ✓
C. 50 years
D. 55 years
Correct Answer: B. 45 years
Rationale: The USPSTF lowered the starting age for average-risk colorectal cancer screening from 50 to 45
years (grade B for ages 45–49, grade A for 50–75), reflecting rising incidence in younger adults. Acceptable
strategies include colonoscopy every 10 years, annual FIT, FIT-DNA every 1–3 years, or CT colonography every
5 years. Screening from 76 to 85 is individualized based on health status and prior screening history.
References: U.S. Preventive Services Task Force recommendation statements, colorectal cancer screening; ANCC FNP
Test Content Outline (2024/2026) Domain 1.
Question 5 (1 point · Multiple Choice)
A 40-year-old woman with no personal or family history of breast cancer asks when she should
begin mammography. Based on the 2024 USPSTF recommendation, the FNP should advise:
A. Annual mammography beginning now
B. Biennial mammography beginning now, continuing through age 74 ✓
C. Biennial mammography beginning at age 50
D. No screening until age 45
Correct Answer: B. Biennial mammography beginning now, continuing through age 74
Rationale: In 2024 the USPSTF lowered the starting age for biennial screening mammography from 50 to
40 years (grade B), continuing through age 74. Evidence for screening at 75 and older is insufficient. Note that
this differs from the American Cancer Society, which offers annual screening from 45; when guidelines diverge,
shared decision-making that accounts for patient values is the appropriate approach.
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
, References: U.S. Preventive Services Task Force recommendation statements, breast cancer screening (2024); ANCC
FNP Test Content Outline (2024/2026) Domain 1.
Question 6 (1 point · Multiple Choice)
Which patient meets USPSTF criteria for annual low-dose CT lung cancer screening?
A. A 45-year-old with a 30 pack-year history who currently smokes
B. A 62-year-old with a 25 pack-year history who quit 8 years ago ✓
C. A 55-year-old with a 15 pack-year history who currently smokes
D. A 70-year-old with a 40 pack-year history who quit 20 years ago
Correct Answer: B. A 62-year-old with a 25 pack-year history who quit 8 years ago
Rationale: All three criteria must be met: age 50–80, at least a 20 pack-year history, and current smoking
or cessation within the past 15 years. Option B satisfies each. Option A fails on age, option C on pack-years, and
option D on the cessation interval, since risk declines substantially beyond 15 years of abstinence. Screening
should stop once a patient has not smoked for 15 years or develops a condition limiting life expectancy.
References: U.S. Preventive Services Task Force recommendation statements, lung cancer screening; ANCC FNP Test
Content Outline (2024/2026) Domain 1.
Question 7 (1 point · Multiple Choice)
A 30-year-old woman reports that her partner monitors her phone, controls the household
finances, and has threatened her twice. What is the FNP's PRIORITY action?
A. Provide a shelter brochure and schedule a 3-month follow-up
B. Assess immediate safety, including lethality risk, and develop a safety plan ✓
C. Notify law enforcement without the patient's consent
D. Recommend couples counseling
Correct Answer: B. Assess immediate safety, including lethality risk, and develop a safety
plan
Rationale: The priority in intimate partner violence is immediate safety assessment: presence of weapons,
escalation, threats to kill, strangulation history, and whether it is safe to go home tonight. Strangulation and
threats with a weapon are especially strong predictors of homicide. Couples counseling is contraindicated
because it can escalate danger. Reporting requirements vary by state and generally respect the competent
adult's autonomy; overriding consent may increase risk and destroy trust.
References: U.S. Preventive Services Task Force recommendation statements, IPV screening; ANCC FNP Test Content
Outline (2024/2026) Domain 1.
Question 8 (1 point · Multiple Choice)
A 78-year-old woman reports two falls in the past six months. Which assessment finding most
warrants a medication review as the initial intervention?
A. She uses a cane outdoors
B. She takes zolpidem nightly and oxybutynin for urinary urgency ✓
C. She walks 20 minutes three times weekly
D. Her vitamin D level is 42 ng/mL
Correct Answer: B. She takes zolpidem nightly and oxybutynin for urinary urgency
Rationale: Both agents appear on the AGS Beers Criteria as potentially inappropriate in older adults.
Sedative-hypnotics such as zolpidem impair balance and psychomotor function, and anticholinergics such as
oxybutynin cause sedation, confusion, and orthostasis. Polypharmacy involving these classes is among the most
ANCC Family Nurse Practitioner Board Certification · Complete Exam Prep · 2026–2027
