ANCC FNP EXAM 300 PRACTICE QUESTIONS AND
CORRECT ANSWERS WITH WELL EXPLAINED
RATIONALES
Domain 1: Assessment (Health History, Physical Exam, Diagnostic Testing)
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Question 1
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
dry skin. On examination, you note bradycardia and a delayed relaxation
phase of deep tendon reflexes. Which initial laboratory test is most
appropriate?
A) TSH and free T4
B) Complete blood count and comprehensive metabolic panel
C) Cortisol level and ACTH stimulation test
D) Thyroid peroxidase antibodies
Correct Answer: A
Rationale: The presentation is classic for hypothyroidism. TSH and free T4 are
the initial screening tests of choice. TSH is the most sensitive marker for
primary hypothyroidism. While TPO antibodies may be checked if
autoimmune etiology is suspected, they are not the initial diagnostic test. CBC
and CMP may be affected but are not specific. Cortisol and ACTH testing would
be appropriate if adrenal insufficiency were suspected.
,---
Question 2
A 6-month-old infant is brought in for a well-child visit. The mother reports
the infant has been rolling over and sitting with support. Which
developmental milestone should the nurse practitioner expect this infant to
have achieved?
A) Pincer grasp
B) Stranger anxiety
C) Walking independently
D) Saying single words
Correct Answer: B
Rationale: Stranger anxiety typically emerges around 6-8 months of age.
Pincer grasp develops around 9-10 months. Walking independently occurs
around 12-15 months. Single words typically emerge around 12 months.
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Question 3
A 68-year-old male with a 40-pack-year smoking history presents with a new
cough, hemoptysis, and weight loss. Chest X-ray shows a right hilar mass.
What is the most appropriate next step?
A) Start antibiotics and repeat chest X-ray in 2 weeks
,B) CT scan of the chest with contrast
C) Sputum cytology
D) PET scan
Correct Answer: B
Rationale: CT scan of the chest is the appropriate next step to further
characterize the hilar mass, assess for mediastinal involvement, and guide
potential biopsy. While sputum cytology may be helpful, CT provides better
anatomical detail. Antibiotics are not indicated without evidence of infection.
PET scan is typically obtained after tissue diagnosis for staging.
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Question 4
A 32-year-old pregnant woman at 28 weeks gestation presents with a blood
pressure of 148/94 mmHg and 2+ proteinuria on urine dipstick. She reports
headache and visual changes. Which diagnosis is most likely?
A) Gestational hypertension
B) Chronic hypertension
C) Preeclampsia with severe features
D) Eclampsia
Correct Answer: C
Rationale: Preeclampsia with severe features is diagnosed when a pregnant
patient has new-onset hypertension (≥140/90) after 20 weeks gestation with
proteinuria and severe features including headache, visual changes, and
, significant proteinuria. Gestational hypertension is hypertension without
proteinuria. Eclampsia includes seizures. Chronic hypertension is pre-existing.
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Question 5
A 55-year-old male with a history of type 2 diabetes presents with a non-
healing ulcer on the plantar aspect of his right foot. The ulcer is 2 cm in
diameter, extends to bone, and there is surrounding erythema. What is the
most appropriate next step?
A) Wound culture and start oral antibiotics
B) Referral to podiatry for debridement
C) MRI of the foot to evaluate for osteomyelitis
D) Tight glycemic control and offloading
Correct Answer: C
Rationale: Given the ulcer extends to bone with surrounding erythema in a
diabetic patient, osteomyelitis must be ruled out. MRI is the most sensitive
imaging modality for osteomyelitis. While wound culture, antibiotics,
debridement, and glycemic control are all important, determining the
presence of osteomyelitis guides the treatment approach.
---
Question 6
A 14-year-old adolescent presents with a 3-day history of sore throat, fever,
and headache. On examination, there is pharyngeal erythema, tonsillar
CORRECT ANSWERS WITH WELL EXPLAINED
RATIONALES
Domain 1: Assessment (Health History, Physical Exam, Diagnostic Testing)
---
Question 1
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
dry skin. On examination, you note bradycardia and a delayed relaxation
phase of deep tendon reflexes. Which initial laboratory test is most
appropriate?
A) TSH and free T4
B) Complete blood count and comprehensive metabolic panel
C) Cortisol level and ACTH stimulation test
D) Thyroid peroxidase antibodies
Correct Answer: A
Rationale: The presentation is classic for hypothyroidism. TSH and free T4 are
the initial screening tests of choice. TSH is the most sensitive marker for
primary hypothyroidism. While TPO antibodies may be checked if
autoimmune etiology is suspected, they are not the initial diagnostic test. CBC
and CMP may be affected but are not specific. Cortisol and ACTH testing would
be appropriate if adrenal insufficiency were suspected.
,---
Question 2
A 6-month-old infant is brought in for a well-child visit. The mother reports
the infant has been rolling over and sitting with support. Which
developmental milestone should the nurse practitioner expect this infant to
have achieved?
A) Pincer grasp
B) Stranger anxiety
C) Walking independently
D) Saying single words
Correct Answer: B
Rationale: Stranger anxiety typically emerges around 6-8 months of age.
Pincer grasp develops around 9-10 months. Walking independently occurs
around 12-15 months. Single words typically emerge around 12 months.
---
Question 3
A 68-year-old male with a 40-pack-year smoking history presents with a new
cough, hemoptysis, and weight loss. Chest X-ray shows a right hilar mass.
What is the most appropriate next step?
A) Start antibiotics and repeat chest X-ray in 2 weeks
,B) CT scan of the chest with contrast
C) Sputum cytology
D) PET scan
Correct Answer: B
Rationale: CT scan of the chest is the appropriate next step to further
characterize the hilar mass, assess for mediastinal involvement, and guide
potential biopsy. While sputum cytology may be helpful, CT provides better
anatomical detail. Antibiotics are not indicated without evidence of infection.
PET scan is typically obtained after tissue diagnosis for staging.
---
Question 4
A 32-year-old pregnant woman at 28 weeks gestation presents with a blood
pressure of 148/94 mmHg and 2+ proteinuria on urine dipstick. She reports
headache and visual changes. Which diagnosis is most likely?
A) Gestational hypertension
B) Chronic hypertension
C) Preeclampsia with severe features
D) Eclampsia
Correct Answer: C
Rationale: Preeclampsia with severe features is diagnosed when a pregnant
patient has new-onset hypertension (≥140/90) after 20 weeks gestation with
proteinuria and severe features including headache, visual changes, and
, significant proteinuria. Gestational hypertension is hypertension without
proteinuria. Eclampsia includes seizures. Chronic hypertension is pre-existing.
---
Question 5
A 55-year-old male with a history of type 2 diabetes presents with a non-
healing ulcer on the plantar aspect of his right foot. The ulcer is 2 cm in
diameter, extends to bone, and there is surrounding erythema. What is the
most appropriate next step?
A) Wound culture and start oral antibiotics
B) Referral to podiatry for debridement
C) MRI of the foot to evaluate for osteomyelitis
D) Tight glycemic control and offloading
Correct Answer: C
Rationale: Given the ulcer extends to bone with surrounding erythema in a
diabetic patient, osteomyelitis must be ruled out. MRI is the most sensitive
imaging modality for osteomyelitis. While wound culture, antibiotics,
debridement, and glycemic control are all important, determining the
presence of osteomyelitis guides the treatment approach.
---
Question 6
A 14-year-old adolescent presents with a 3-day history of sore throat, fever,
and headache. On examination, there is pharyngeal erythema, tonsillar
