2026 FNP-BC Exam Prep: Family Nurse
Practitioner Practice Questions, Answer
Rationales, Primary Care, Diagnosis,
Pharmacology, Health Promotion & Clinical
Management Study Guide
DOMAIN I: ASSESSMENT (Questions 1–19)
Question 1
A 52-year-old man with no risk factors presents for a routine visit. According to
the U.S. Preventive Services Task Force, at what age should he begin colorectal
cancer screening?
A) 40 years
B) 45 years
C) 50 years
D) 55 years
Rationale: The USPSTF recommends colorectal cancer screening for all adults
aged 45 to 75 years. This recommendation was updated in 2021 to lower the
starting age from 50 to 45 due to increasing incidence of colorectal cancer in
younger adults. Screening options include colonoscopy every 10 years, FIT
annually, or CT colonography every 5 years.
Question 2
A 55-year-old patient with no symptoms has a blood pressure of 138/88 mmHg on
two separate visits. How should this be classified?
A) Normal blood pressure
B) Elevated blood pressure
C) Stage 1 hypertension
D) Stage 2 hypertension
,Rationale: According to the 2017 ACC/AHA guidelines, stage 1 hypertension is
defined as systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg. This
patient's BP of 138/88 mmHg falls within this range. Normal BP is <120/<80,
elevated is 120–129/<80, and stage 2 is ≥140/≥90.
Question 3
A 45-year-old patient presents with persistent cough, fever, and malaise for 3
weeks. Chest auscultation reveals crackles in the right lower lobe. Which is the
most likely diagnosis?
A) Acute bronchitis
B) Community-acquired pneumonia
C) Asthma exacerbation
D) Pulmonary embolism
Rationale: The triad of persistent cough, fever, and malaise lasting 3 weeks,
combined with focal crackles on auscultation, is most consistent with community-
acquired pneumonia. Acute bronchitis typically presents with cough but without
fever or focal lung findings. Asthma presents with wheezing and reversible airflow
obstruction. Pulmonary embolism presents with sudden dyspnea, pleuritic chest
pain, and tachycardia.
Question 4
Which of the following is the first-line treatment for acute otitis media in children?
A) Azithromycin
B) Amoxicillin
C) Ciprofloxacin
D) Trimethoprim-sulfamethoxazole
Rationale: High-dose amoxicillin (80–90 mg/kg/day) is the first-line treatment for
acute otitis media in children, according to the American Academy of Pediatrics
guidelines. It provides excellent coverage for Streptococcus pneumoniae, the most
common bacterial pathogen. Azithromycin and TMP-SMX are alternatives for
penicillin-allergic patients. Ciprofloxacin is not typically used in children due to
concerns about cartilage development.
,Question 5
A 62-year-old female reports shortness of breath and a dry cough that has been
gradually worsening over the past 6 months. She has no smoking history. Which of
the following is the most appropriate initial diagnostic test?
A) Chest X-ray
B) Echocardiogram
C) Pulmonary function tests
D) CT angiography
Rationale: The insidious onset of dyspnea and dry cough in a non-smoker
suggests heart failure with preserved ejection fraction, which is common in older
adults. An echocardiogram is the most appropriate initial test to assess ejection
fraction and diastolic function. A chest X-ray may show cardiomegaly but does not
assess cardiac function. Pulmonary function tests assess obstructive or restrictive
lung disease. CT angiography is used for suspected pulmonary embolism.
Question 6
A 28-year-old female presents with a 2-day history of dysuria, frequency, and
urgency. She has no fever or flank pain. Which of the following is the most
appropriate initial management?
A) Empiric antibiotics for uncomplicated cystitis
B) Urine culture and sensitivity before treatment
C) Renal ultrasound
D) Hospital admission for IV antibiotics
Rationale: The presentation is classic for uncomplicated cystitis in a young,
healthy female. Empiric antibiotic therapy (e.g., nitrofurantoin, TMP-SMX, or
fosfomycin) is appropriate without waiting for culture results. Urine culture is
reserved for complicated cases, treatment failures, or recurrent infections. Renal
ultrasound and hospital admission are not indicated for uncomplicated cystitis.
Question 7
A 35-year-old male presents with a 3-day history of severe unilateral scrotal pain,
swelling, and nausea. Which of the following is the priority nursing action?
, A) Apply ice packs and administer analgesics
B) Immediate urology referral for suspected testicular torsion
C) Obtain a urine culture and treat for epididymitis
D) Order a scrotal ultrasound within 24 hours
Rationale: Testicular torsion is a surgical emergency requiring detorsion within 6
hours to prevent testicular loss. The sudden onset of severe unilateral scrotal pain,
swelling, and nausea in a young male is classic for torsion. Immediate urology
referral is essential; imaging should not delay treatment when torsion is suspected.
Epididymitis typically has a more gradual onset and is associated with dysuria and
fever.
Question 8
A 70-year-old patient with Alzheimer's disease presents with new-onset agitation,
hallucinations, and hitting caregivers over 2 days. He is afebrile. Which of the
following is the most likely cause?
A) Progression of Alzheimer's disease
B) Urinary tract infection
C) Medication side effect
D) Dehydration
Rationale: In older adults with dementia, an acute change in mental status
(delirium) with agitation and hallucinations is most commonly caused by an
underlying infection, with urinary tract infection being the most frequent
precipitant. Delirium is characterized by acute onset, fluctuating course, and
inattention. Progression of Alzheimer's is typically gradual, not sudden.
Medication side effects and dehydration are also possible but less common than
UTI in this population.
Question 9
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is elevated, and free T4 is normal. What is the most likely
diagnosis?
A) Overt hypothyroidism
B) Subclinical hypothyroidism
Practitioner Practice Questions, Answer
Rationales, Primary Care, Diagnosis,
Pharmacology, Health Promotion & Clinical
Management Study Guide
DOMAIN I: ASSESSMENT (Questions 1–19)
Question 1
A 52-year-old man with no risk factors presents for a routine visit. According to
the U.S. Preventive Services Task Force, at what age should he begin colorectal
cancer screening?
A) 40 years
B) 45 years
C) 50 years
D) 55 years
Rationale: The USPSTF recommends colorectal cancer screening for all adults
aged 45 to 75 years. This recommendation was updated in 2021 to lower the
starting age from 50 to 45 due to increasing incidence of colorectal cancer in
younger adults. Screening options include colonoscopy every 10 years, FIT
annually, or CT colonography every 5 years.
Question 2
A 55-year-old patient with no symptoms has a blood pressure of 138/88 mmHg on
two separate visits. How should this be classified?
A) Normal blood pressure
B) Elevated blood pressure
C) Stage 1 hypertension
D) Stage 2 hypertension
,Rationale: According to the 2017 ACC/AHA guidelines, stage 1 hypertension is
defined as systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg. This
patient's BP of 138/88 mmHg falls within this range. Normal BP is <120/<80,
elevated is 120–129/<80, and stage 2 is ≥140/≥90.
Question 3
A 45-year-old patient presents with persistent cough, fever, and malaise for 3
weeks. Chest auscultation reveals crackles in the right lower lobe. Which is the
most likely diagnosis?
A) Acute bronchitis
B) Community-acquired pneumonia
C) Asthma exacerbation
D) Pulmonary embolism
Rationale: The triad of persistent cough, fever, and malaise lasting 3 weeks,
combined with focal crackles on auscultation, is most consistent with community-
acquired pneumonia. Acute bronchitis typically presents with cough but without
fever or focal lung findings. Asthma presents with wheezing and reversible airflow
obstruction. Pulmonary embolism presents with sudden dyspnea, pleuritic chest
pain, and tachycardia.
Question 4
Which of the following is the first-line treatment for acute otitis media in children?
A) Azithromycin
B) Amoxicillin
C) Ciprofloxacin
D) Trimethoprim-sulfamethoxazole
Rationale: High-dose amoxicillin (80–90 mg/kg/day) is the first-line treatment for
acute otitis media in children, according to the American Academy of Pediatrics
guidelines. It provides excellent coverage for Streptococcus pneumoniae, the most
common bacterial pathogen. Azithromycin and TMP-SMX are alternatives for
penicillin-allergic patients. Ciprofloxacin is not typically used in children due to
concerns about cartilage development.
,Question 5
A 62-year-old female reports shortness of breath and a dry cough that has been
gradually worsening over the past 6 months. She has no smoking history. Which of
the following is the most appropriate initial diagnostic test?
A) Chest X-ray
B) Echocardiogram
C) Pulmonary function tests
D) CT angiography
Rationale: The insidious onset of dyspnea and dry cough in a non-smoker
suggests heart failure with preserved ejection fraction, which is common in older
adults. An echocardiogram is the most appropriate initial test to assess ejection
fraction and diastolic function. A chest X-ray may show cardiomegaly but does not
assess cardiac function. Pulmonary function tests assess obstructive or restrictive
lung disease. CT angiography is used for suspected pulmonary embolism.
Question 6
A 28-year-old female presents with a 2-day history of dysuria, frequency, and
urgency. She has no fever or flank pain. Which of the following is the most
appropriate initial management?
A) Empiric antibiotics for uncomplicated cystitis
B) Urine culture and sensitivity before treatment
C) Renal ultrasound
D) Hospital admission for IV antibiotics
Rationale: The presentation is classic for uncomplicated cystitis in a young,
healthy female. Empiric antibiotic therapy (e.g., nitrofurantoin, TMP-SMX, or
fosfomycin) is appropriate without waiting for culture results. Urine culture is
reserved for complicated cases, treatment failures, or recurrent infections. Renal
ultrasound and hospital admission are not indicated for uncomplicated cystitis.
Question 7
A 35-year-old male presents with a 3-day history of severe unilateral scrotal pain,
swelling, and nausea. Which of the following is the priority nursing action?
, A) Apply ice packs and administer analgesics
B) Immediate urology referral for suspected testicular torsion
C) Obtain a urine culture and treat for epididymitis
D) Order a scrotal ultrasound within 24 hours
Rationale: Testicular torsion is a surgical emergency requiring detorsion within 6
hours to prevent testicular loss. The sudden onset of severe unilateral scrotal pain,
swelling, and nausea in a young male is classic for torsion. Immediate urology
referral is essential; imaging should not delay treatment when torsion is suspected.
Epididymitis typically has a more gradual onset and is associated with dysuria and
fever.
Question 8
A 70-year-old patient with Alzheimer's disease presents with new-onset agitation,
hallucinations, and hitting caregivers over 2 days. He is afebrile. Which of the
following is the most likely cause?
A) Progression of Alzheimer's disease
B) Urinary tract infection
C) Medication side effect
D) Dehydration
Rationale: In older adults with dementia, an acute change in mental status
(delirium) with agitation and hallucinations is most commonly caused by an
underlying infection, with urinary tract infection being the most frequent
precipitant. Delirium is characterized by acute onset, fluctuating course, and
inattention. Progression of Alzheimer's is typically gradual, not sudden.
Medication side effects and dehydration are also possible but less common than
UTI in this population.
Question 9
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is elevated, and free T4 is normal. What is the most likely
diagnosis?
A) Overt hypothyroidism
B) Subclinical hypothyroidism
