ANCC FNP-BC Certification Exam 2026 |
Practice Questions with Answers & Detailed
Explanations | Family Nurse Practitioner
Board Review | Latest Update
📚 Section 1: Assessment (29 Questions)
1. A 67-year-old male presents with a 3-month history of progressive difficulty
swallowing, first with solids and now with liquids. He reports unintentional weight
loss of 15 pounds over the same period. He has no history of GERD or smoking.
Which assessment finding is most concerning for a serious underlying condition?
A) Dysphagia to solids only
B) Weight loss of 5% of body weight
C) Progressive dysphagia from solids to liquids
D) Absence of GERD symptoms
Answer: C
Explanation: Progressive dysphagia that begins with solids and advances to liquids
(esophageal dysphagia) is a red flag for an obstructive lesion such as esophageal
malignancy. This progressive pattern suggests a growing mechanical obstruction that is
narrowing the esophageal lumen over time. While weight loss is concerning, the
progression from solids to liquids is the hallmark of structural esophageal disease that
requires urgent evaluation, including endoscopy. Patients with oropharyngeal dysphagia
typically have difficulty initiating a swallow and may experience nasal regurgitation or
, coughing during meals. The absence of GERD does not rule out malignancy—esophageal
adenocarcinoma can occur without preceding GERD symptoms. This patient requires
prompt referral for endoscopy with biopsy .
2. A 72-year-old female presents with a 2-month history of gradually worsening
shortness of breath on exertion. She reports being able to walk only one block before
needing to stop. She has a 30-pack-year smoking history and a chronic cough that
produces small amounts of clear sputum. She has not seen a healthcare provider in
over 10 years. Physical examination reveals decreased breath sounds in the lung
bases with faint expiratory wheezes. Which is the most appropriate next step in
evaluation?
A) Chest X-ray
B) Spirometry before and after bronchodilator administration
C) Referral for pulmonary rehabilitation
D) Empiric treatment with an inhaled corticosteroid
Answer: B
Explanation: This patient's presentation of progressive exertional dyspnea, chronic cough,
and smoking history with decreased breath sounds and wheezing is suggestive of COPD.
Spirometry is the most appropriate next step to confirm the diagnosis and assess severity.
Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) should be
measured before and after bronchodilator administration. A post-bronchodilator FEV1/FVC
ratio of less than 0.70 confirms airflow limitation consistent with COPD. Chest X-ray may be
useful later to rule out other conditions, but spirometry is the gold standard for diagnosis.
Empiric treatment without a diagnosis is inappropriate. Pulmonary rehabilitation is a
management strategy, not a diagnostic tool, and should only be initiated after diagnosis .
3. A 35-year-old female presents with a 6-week history of fatigue, joint pain, and a
facial rash that worsens with sun exposure. She also reports hair loss and
intermittent fevers. Physical examination reveals malar erythema, oral ulcers, and
synovitis of the metacarpophalangeal joints. Which of the following findings is most
specific for the suspected diagnosis?
, A) Positive antinuclear antibody (ANA) titer of 1:160
B) Positive anti-double-stranded DNA (anti-dsDNA) antibody
C) Normocytic anemia
D) Elevated erythrocyte sedimentation rate (ESR)
Answer: B
Explanation: This patient's presentation of malar rash, oral ulcers, arthritis, and
photosensitivity is consistent with systemic lupus erythematosus (SLE). Anti-dsDNA
antibodies are highly specific for SLE (approximately 95% specificity) and are associated
with disease activity, particularly lupus nephritis. While a positive ANA is a sensitive
screening test for SLE (about 98% of SLE patients are ANA-positive), it is not specific—
ANA positivity can be seen in many autoimmune and non-autoimmune conditions.
Normocytic anemia and elevated ESR are non-specific inflammatory findings that may be
present in SLE but are not diagnostic. The American College of Rheumatology criteria for
SLE require fulfillment of at least 4 of 11 criteria, including laboratory findings such as anti-
dsDNA antibodies .
4. A 58-year-old male with a history of type 2 diabetes and hypertension presents for
a routine physical examination. He reports feeling well and has no specific
complaints. His current medications include metformin 1,000 mg BID, lisinopril 20 mg
daily, and atorvastatin 20 mg daily. His blood pressure is 138/86 mm Hg, heart rate is
72/min, and BMI is 31. Laboratory results show a hemoglobin A1c of 7.8% (previously
7.2% six months ago), eGFR of 58 mL/min/1.73 m², and urine albumin-to-creatinine
ratio (UACR) of 120 mg/g. Which of the following represents the most appropriate
adjustment to his medication regimen?
A) Add a sodium-glucose cotransporter-2 (SGLT-2) inhibitor
B) Increase the lisinopril dose to 40 mg daily
C) Add a glucagon-like peptide-1 (GLP-1) receptor agonist
D) Increase the atorvastatin to 40 mg daily
Answer: A
Explanation: This patient has multiple indications for an SGLT-2 inhibitor. He has type 2
diabetes with an elevated A1c (7.8% above goal of <7.0%), is at high cardiovascular risk
given hypertension, obesity, and dyslipidemia, and most importantly, has chronic kidney
disease with an eGFR of 58 mL/min and microalbuminuria (UACR 120 mg/g). SGLT-2
inhibitors have been shown to reduce cardiovascular events, slow the progression of
, chronic kidney disease, and reduce albuminuria in patients with type 2 diabetes,
independent of their glycemic effects. The DAPA-CKD and EMPA-KIDNEY trials
demonstrated renal and cardiovascular benefits in patients with and without diabetes. The
American Diabetes Association recommends SGLT-2 inhibitors for patients with type 2
diabetes and established atherosclerotic cardiovascular disease, heart failure, or chronic
kidney disease. While increasing the ACE inhibitor may help reduce albuminuria, the
addition of an SGLT-2 inhibitor provides additive benefits and is a guideline-recommended
therapy in this scenario .
5. A 28-year-old G2P1 female at 36 weeks gestation presents with a 2-day history of
headache, blurred vision, and epigastric pain. Her blood pressure is 158/96 mm Hg,
and she has 2+ protein on urine dipstick. She has no history of hypertension. Which
of the following is the priority intervention?
A) Administer oral labetalol 200 mg
B) Obtain a complete blood count and liver function tests
C) Administer magnesium sulfate IV
D) Prepare for induction of labor
Answer: C
Explanation: This patient's presentation of new-onset hypertension (>140/90 mm Hg) with
proteinuria after 20 weeks of gestation is consistent with preeclampsia with severe features,
given the presence of severe hypertension, headache, visual changes, and epigastric
pain—all signs of severe preeclampsia. Magnesium sulfate is the priority intervention for
seizure prophylaxis in patients with preeclampsia with severe features, as it reduces the risk
of eclampsia by over 50%. The American College of Obstetricians and Gynecologists
recommends initiating magnesium sulfate for seizure prophylaxis in patients with
preeclampsia with severe features. While blood pressure control with antihypertensives is
important, magnesium sulfate takes precedence for prevention of maternal seizures.
Labetalol can be given for blood pressure control, but the immediate concern is eclamptic
seizures. Laboratory evaluation, including CBC, liver function tests, and creatinine, is
important to assess for HELLP syndrome but should not delay magnesium sulfate
administration. Delivery is the definitive treatment for preeclampsia, but the timing of
delivery depends on gestational age, severity of disease, and maternal/fetal status .
Practice Questions with Answers & Detailed
Explanations | Family Nurse Practitioner
Board Review | Latest Update
📚 Section 1: Assessment (29 Questions)
1. A 67-year-old male presents with a 3-month history of progressive difficulty
swallowing, first with solids and now with liquids. He reports unintentional weight
loss of 15 pounds over the same period. He has no history of GERD or smoking.
Which assessment finding is most concerning for a serious underlying condition?
A) Dysphagia to solids only
B) Weight loss of 5% of body weight
C) Progressive dysphagia from solids to liquids
D) Absence of GERD symptoms
Answer: C
Explanation: Progressive dysphagia that begins with solids and advances to liquids
(esophageal dysphagia) is a red flag for an obstructive lesion such as esophageal
malignancy. This progressive pattern suggests a growing mechanical obstruction that is
narrowing the esophageal lumen over time. While weight loss is concerning, the
progression from solids to liquids is the hallmark of structural esophageal disease that
requires urgent evaluation, including endoscopy. Patients with oropharyngeal dysphagia
typically have difficulty initiating a swallow and may experience nasal regurgitation or
, coughing during meals. The absence of GERD does not rule out malignancy—esophageal
adenocarcinoma can occur without preceding GERD symptoms. This patient requires
prompt referral for endoscopy with biopsy .
2. A 72-year-old female presents with a 2-month history of gradually worsening
shortness of breath on exertion. She reports being able to walk only one block before
needing to stop. She has a 30-pack-year smoking history and a chronic cough that
produces small amounts of clear sputum. She has not seen a healthcare provider in
over 10 years. Physical examination reveals decreased breath sounds in the lung
bases with faint expiratory wheezes. Which is the most appropriate next step in
evaluation?
A) Chest X-ray
B) Spirometry before and after bronchodilator administration
C) Referral for pulmonary rehabilitation
D) Empiric treatment with an inhaled corticosteroid
Answer: B
Explanation: This patient's presentation of progressive exertional dyspnea, chronic cough,
and smoking history with decreased breath sounds and wheezing is suggestive of COPD.
Spirometry is the most appropriate next step to confirm the diagnosis and assess severity.
Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) should be
measured before and after bronchodilator administration. A post-bronchodilator FEV1/FVC
ratio of less than 0.70 confirms airflow limitation consistent with COPD. Chest X-ray may be
useful later to rule out other conditions, but spirometry is the gold standard for diagnosis.
Empiric treatment without a diagnosis is inappropriate. Pulmonary rehabilitation is a
management strategy, not a diagnostic tool, and should only be initiated after diagnosis .
3. A 35-year-old female presents with a 6-week history of fatigue, joint pain, and a
facial rash that worsens with sun exposure. She also reports hair loss and
intermittent fevers. Physical examination reveals malar erythema, oral ulcers, and
synovitis of the metacarpophalangeal joints. Which of the following findings is most
specific for the suspected diagnosis?
, A) Positive antinuclear antibody (ANA) titer of 1:160
B) Positive anti-double-stranded DNA (anti-dsDNA) antibody
C) Normocytic anemia
D) Elevated erythrocyte sedimentation rate (ESR)
Answer: B
Explanation: This patient's presentation of malar rash, oral ulcers, arthritis, and
photosensitivity is consistent with systemic lupus erythematosus (SLE). Anti-dsDNA
antibodies are highly specific for SLE (approximately 95% specificity) and are associated
with disease activity, particularly lupus nephritis. While a positive ANA is a sensitive
screening test for SLE (about 98% of SLE patients are ANA-positive), it is not specific—
ANA positivity can be seen in many autoimmune and non-autoimmune conditions.
Normocytic anemia and elevated ESR are non-specific inflammatory findings that may be
present in SLE but are not diagnostic. The American College of Rheumatology criteria for
SLE require fulfillment of at least 4 of 11 criteria, including laboratory findings such as anti-
dsDNA antibodies .
4. A 58-year-old male with a history of type 2 diabetes and hypertension presents for
a routine physical examination. He reports feeling well and has no specific
complaints. His current medications include metformin 1,000 mg BID, lisinopril 20 mg
daily, and atorvastatin 20 mg daily. His blood pressure is 138/86 mm Hg, heart rate is
72/min, and BMI is 31. Laboratory results show a hemoglobin A1c of 7.8% (previously
7.2% six months ago), eGFR of 58 mL/min/1.73 m², and urine albumin-to-creatinine
ratio (UACR) of 120 mg/g. Which of the following represents the most appropriate
adjustment to his medication regimen?
A) Add a sodium-glucose cotransporter-2 (SGLT-2) inhibitor
B) Increase the lisinopril dose to 40 mg daily
C) Add a glucagon-like peptide-1 (GLP-1) receptor agonist
D) Increase the atorvastatin to 40 mg daily
Answer: A
Explanation: This patient has multiple indications for an SGLT-2 inhibitor. He has type 2
diabetes with an elevated A1c (7.8% above goal of <7.0%), is at high cardiovascular risk
given hypertension, obesity, and dyslipidemia, and most importantly, has chronic kidney
disease with an eGFR of 58 mL/min and microalbuminuria (UACR 120 mg/g). SGLT-2
inhibitors have been shown to reduce cardiovascular events, slow the progression of
, chronic kidney disease, and reduce albuminuria in patients with type 2 diabetes,
independent of their glycemic effects. The DAPA-CKD and EMPA-KIDNEY trials
demonstrated renal and cardiovascular benefits in patients with and without diabetes. The
American Diabetes Association recommends SGLT-2 inhibitors for patients with type 2
diabetes and established atherosclerotic cardiovascular disease, heart failure, or chronic
kidney disease. While increasing the ACE inhibitor may help reduce albuminuria, the
addition of an SGLT-2 inhibitor provides additive benefits and is a guideline-recommended
therapy in this scenario .
5. A 28-year-old G2P1 female at 36 weeks gestation presents with a 2-day history of
headache, blurred vision, and epigastric pain. Her blood pressure is 158/96 mm Hg,
and she has 2+ protein on urine dipstick. She has no history of hypertension. Which
of the following is the priority intervention?
A) Administer oral labetalol 200 mg
B) Obtain a complete blood count and liver function tests
C) Administer magnesium sulfate IV
D) Prepare for induction of labor
Answer: C
Explanation: This patient's presentation of new-onset hypertension (>140/90 mm Hg) with
proteinuria after 20 weeks of gestation is consistent with preeclampsia with severe features,
given the presence of severe hypertension, headache, visual changes, and epigastric
pain—all signs of severe preeclampsia. Magnesium sulfate is the priority intervention for
seizure prophylaxis in patients with preeclampsia with severe features, as it reduces the risk
of eclampsia by over 50%. The American College of Obstetricians and Gynecologists
recommends initiating magnesium sulfate for seizure prophylaxis in patients with
preeclampsia with severe features. While blood pressure control with antihypertensives is
important, magnesium sulfate takes precedence for prevention of maternal seizures.
Labetalol can be given for blood pressure control, but the immediate concern is eclamptic
seizures. Laboratory evaluation, including CBC, liver function tests, and creatinine, is
important to assess for HELLP syndrome but should not delay magnesium sulfate
administration. Delivery is the definitive treatment for preeclampsia, but the timing of
delivery depends on gestational age, severity of disease, and maternal/fetal status .
