ANCC FNP Exam Prep 2026 | 600+ Questions
Bank with Rationales | Pass Guarantee
Section 1: Assessment (Questions 1–25)
1. A 68-year-old woman presents with a 3-week history of progressive fatigue and dyspnea on
exertion. She has a history of hypertension and osteoarthritis. She takes lisinopril and
acetaminophen. Her vital signs are BP 138/82, HR 92, RR 18, SpO₂ 94% on room air. Physical
exam reveals conjunctival pallor and a soft systolic murmur at the apex. Which initial laboratory
assessment is most appropriate?
A. Ferritin, iron studies, and CBC with differential
B. BNP and transthoracic echocardiogram
C. TSH and free T4
D. Chest X-ray and pulse oximetry
Correct Answer: A
Rationale: Conjunctival pallor and exertional symptoms suggest anemia. The murmur at the
apex is likely a flow murmur secondary to anemia, not primary valvular disease. Initial
assessment for suspected iron-deficiency anemia includes CBC, ferritin, and iron studies.
BNP/echo would be appropriate if heart failure were suspected, but the pallor is a key clue
pointing away from that.
2. A 4-year-old boy is brought in by his mother for a 2-day history of fever (Tmax 102.1°F),
irritability, and decreased oral intake. He has been tugging at his right ear. Which physical
examination technique is most likely to reveal the diagnosis?
A. Otoscopic examination with pneumatic insufflation
B. Whispered voice test
C. Weber and Rinne tuning fork tests
D. Palpation of the mastoid process
Correct Answer: A
Rationale: Pneumatic otoscopy is the gold standard for diagnosing acute otitis media,
assessing for decreased mobility of the tympanic membrane (a key diagnostic criterion). Tuning
fork tests are unreliable in young children and assess hearing loss, not acute infection. Mastoid
tenderness would suggest mastoiditis, a complication.
,3. A 32-year-old woman presents with a 3-month history of intermittent palpitations, heat
intolerance, and a 10-pound weight loss despite normal appetite. Her HR is 108. Physical exam
reveals a fine tremor and mild lid lag. Which assessment finding would most support the
suspected diagnosis?
A. Bradycardia with hypotension
B. Diffuse, non-tender thyroid enlargement with a bruit
C. Cold intolerance with dry skin
D. A single, firm, non-tender thyroid nodule
Correct Answer: B
Rationale: The presentation suggests hyperthyroidism, most commonly Graves' disease. A
diffuse goiter with an audible bruit (from increased vascularity) is classic for Graves'. A solitary
nodule suggests a toxic adenoma. Cold intolerance and dry skin are hypothyroid features.
4. A 72-year-old man with a history of COPD presents with increased dyspnea, productive cough
with green sputum, and low-grade fever. His SpO₂ is 88% on room air (baseline 92%). Which
assessment finding would most strongly suggest impending respiratory failure?
A. Respiratory rate of 22
B. Use of accessory muscles with paradoxical abdominal movement
C. Coarse rhonchi on auscultation
D. Prolonged expiratory phase
Correct Answer: B
Rationale: Paradoxical abdominal movement (inward movement during inspiration) and
accessory muscle use indicate diaphragmatic fatigue and impending ventilatory failure.
Tachypnea, rhonchi, and prolonged expiration are expected in COPD exacerbation but do not
signal imminent failure as directly.
5. A 28-year-old woman presents for evaluation of a "lump" in her right breast that she noticed
while showering. She has no family history of breast cancer. On exam, you palpate a 2 cm,
smooth, mobile, non-tender mass in the upper outer quadrant. Which history question is most
important in guiding your next step?
A. "Have you had any recent trauma to the breast?"
B. "Does the mass change with your menstrual cycle?"
C. "Are you currently breastfeeding?"
D. "Have you had a mammogram before?"
Correct Answer: B
, Rationale: The characteristics of the mass (smooth, mobile, non-tender) are consistent with
a fibroadenoma or cyst. Cyclical variation strongly suggests a benign cyst or fibrocystic change. A
mass that does not vary with the cycle may warrant imaging. While the other questions have
some relevance, cyclical change is the most discriminating history feature in a young woman.
6. A 55-year-old man is being assessed for lower urinary tract symptoms. He reports nocturia,
hesitancy, and a weak stream. Which finding on digital rectal examination would most suggest
prostate cancer rather than benign prostatic hyperplasia?
A. Symmetrically enlarged, rubbery prostate
B. A firm, nodular, asymmetric prostate
C. A tender, boggy prostate
D. A small, atrophic prostate
Correct Answer: B
Rationale: A firm, nodular, asymmetric prostate is suspicious for malignancy. BPH typically
presents as a smooth, rubbery, symmetrically enlarged prostate. A tender, boggy prostate
suggests prostatitis. An atrophic prostate is not typical for either condition in a symptomatic 55-
year-old.
7. Which of the following questions is most critical when assessing fall risk in an 82-year-old
community-dwelling woman?
A. "How many times have you fallen in the past year?"
B. "Do you take any vitamins?"
C. "How many hours do you sleep at night?"
D. "What is your favorite type of exercise?"
Correct Answer: A
Rationale: A history of falls is the strongest single predictor of future falls. The ANCC
blueprint specifically lists fall risk assessment as a key functional assessment. While medication
review, vision, and gait are also important, prior falls remain the most critical screening
question.
8. A 16-year-old male presents with a 2-day history of sore throat, fever, and enlarged, tender
anterior cervical lymph nodes. He has no cough. Which clinical decision rule can guide the need
for rapid antigen detection testing?
A. Centor criteria
B. CURB-65
, C. Ottawa Ankle Rules
D. Wells criteria
Correct Answer: A
Rationale: The Centor criteria (fever, tonsillar exudates, tender anterior cervical
adenopathy, absence of cough) stratify the probability of group A streptococcal pharyngitis and
guide testing. CURB-65 is for pneumonia severity. Ottawa Ankle Rules are for ankle fractures.
Wells criteria are for DVT/PE.
9. A 45-year-old woman with a BMI of 34 presents for a routine visit. She has no known
diabetes. Which screening test is most appropriate for assessing her risk of type 2 diabetes?
A. Fasting plasma glucose
B. Random plasma glucose
C. Hemoglobin A1c
D. Oral glucose tolerance test
Correct Answer: C
Rationale: The American Diabetes Association recommends HbA1c as a convenient and
reliable screening test for diabetes and prediabetes in adults with risk factors (BMI ≥25 plus
additional risk factors). Fasting glucose is acceptable, but HbA1c does not require fasting. OGTT
is less practical for routine screening. Random glucose is not a screening test.
10. A 3-month-old infant is brought for a well-child visit. The mother reports the infant is
"always spitting up" after feeds but is gaining weight appropriately. Which assessment finding
would most concern you for pyloric stenosis rather than physiologic reflux?
A. Spitting up small amounts after every feeding
B. A palpable olive-shaped mass in the right upper quadrant
C. Happy spitter who is content between feeds
D. Spitting up that decreases when held upright after feeds
Correct Answer: B
Rationale: A palpable olive (the hypertrophied pylorus) is pathognomonic for pyloric
stenosis. Physiologic reflux typically presents with a "happy spitter" who is gaining weight.
Pyloric stenosis usually presents with projectile, non-bilious vomiting and a hungry infant who
fails to gain weight.
Bank with Rationales | Pass Guarantee
Section 1: Assessment (Questions 1–25)
1. A 68-year-old woman presents with a 3-week history of progressive fatigue and dyspnea on
exertion. She has a history of hypertension and osteoarthritis. She takes lisinopril and
acetaminophen. Her vital signs are BP 138/82, HR 92, RR 18, SpO₂ 94% on room air. Physical
exam reveals conjunctival pallor and a soft systolic murmur at the apex. Which initial laboratory
assessment is most appropriate?
A. Ferritin, iron studies, and CBC with differential
B. BNP and transthoracic echocardiogram
C. TSH and free T4
D. Chest X-ray and pulse oximetry
Correct Answer: A
Rationale: Conjunctival pallor and exertional symptoms suggest anemia. The murmur at the
apex is likely a flow murmur secondary to anemia, not primary valvular disease. Initial
assessment for suspected iron-deficiency anemia includes CBC, ferritin, and iron studies.
BNP/echo would be appropriate if heart failure were suspected, but the pallor is a key clue
pointing away from that.
2. A 4-year-old boy is brought in by his mother for a 2-day history of fever (Tmax 102.1°F),
irritability, and decreased oral intake. He has been tugging at his right ear. Which physical
examination technique is most likely to reveal the diagnosis?
A. Otoscopic examination with pneumatic insufflation
B. Whispered voice test
C. Weber and Rinne tuning fork tests
D. Palpation of the mastoid process
Correct Answer: A
Rationale: Pneumatic otoscopy is the gold standard for diagnosing acute otitis media,
assessing for decreased mobility of the tympanic membrane (a key diagnostic criterion). Tuning
fork tests are unreliable in young children and assess hearing loss, not acute infection. Mastoid
tenderness would suggest mastoiditis, a complication.
,3. A 32-year-old woman presents with a 3-month history of intermittent palpitations, heat
intolerance, and a 10-pound weight loss despite normal appetite. Her HR is 108. Physical exam
reveals a fine tremor and mild lid lag. Which assessment finding would most support the
suspected diagnosis?
A. Bradycardia with hypotension
B. Diffuse, non-tender thyroid enlargement with a bruit
C. Cold intolerance with dry skin
D. A single, firm, non-tender thyroid nodule
Correct Answer: B
Rationale: The presentation suggests hyperthyroidism, most commonly Graves' disease. A
diffuse goiter with an audible bruit (from increased vascularity) is classic for Graves'. A solitary
nodule suggests a toxic adenoma. Cold intolerance and dry skin are hypothyroid features.
4. A 72-year-old man with a history of COPD presents with increased dyspnea, productive cough
with green sputum, and low-grade fever. His SpO₂ is 88% on room air (baseline 92%). Which
assessment finding would most strongly suggest impending respiratory failure?
A. Respiratory rate of 22
B. Use of accessory muscles with paradoxical abdominal movement
C. Coarse rhonchi on auscultation
D. Prolonged expiratory phase
Correct Answer: B
Rationale: Paradoxical abdominal movement (inward movement during inspiration) and
accessory muscle use indicate diaphragmatic fatigue and impending ventilatory failure.
Tachypnea, rhonchi, and prolonged expiration are expected in COPD exacerbation but do not
signal imminent failure as directly.
5. A 28-year-old woman presents for evaluation of a "lump" in her right breast that she noticed
while showering. She has no family history of breast cancer. On exam, you palpate a 2 cm,
smooth, mobile, non-tender mass in the upper outer quadrant. Which history question is most
important in guiding your next step?
A. "Have you had any recent trauma to the breast?"
B. "Does the mass change with your menstrual cycle?"
C. "Are you currently breastfeeding?"
D. "Have you had a mammogram before?"
Correct Answer: B
, Rationale: The characteristics of the mass (smooth, mobile, non-tender) are consistent with
a fibroadenoma or cyst. Cyclical variation strongly suggests a benign cyst or fibrocystic change. A
mass that does not vary with the cycle may warrant imaging. While the other questions have
some relevance, cyclical change is the most discriminating history feature in a young woman.
6. A 55-year-old man is being assessed for lower urinary tract symptoms. He reports nocturia,
hesitancy, and a weak stream. Which finding on digital rectal examination would most suggest
prostate cancer rather than benign prostatic hyperplasia?
A. Symmetrically enlarged, rubbery prostate
B. A firm, nodular, asymmetric prostate
C. A tender, boggy prostate
D. A small, atrophic prostate
Correct Answer: B
Rationale: A firm, nodular, asymmetric prostate is suspicious for malignancy. BPH typically
presents as a smooth, rubbery, symmetrically enlarged prostate. A tender, boggy prostate
suggests prostatitis. An atrophic prostate is not typical for either condition in a symptomatic 55-
year-old.
7. Which of the following questions is most critical when assessing fall risk in an 82-year-old
community-dwelling woman?
A. "How many times have you fallen in the past year?"
B. "Do you take any vitamins?"
C. "How many hours do you sleep at night?"
D. "What is your favorite type of exercise?"
Correct Answer: A
Rationale: A history of falls is the strongest single predictor of future falls. The ANCC
blueprint specifically lists fall risk assessment as a key functional assessment. While medication
review, vision, and gait are also important, prior falls remain the most critical screening
question.
8. A 16-year-old male presents with a 2-day history of sore throat, fever, and enlarged, tender
anterior cervical lymph nodes. He has no cough. Which clinical decision rule can guide the need
for rapid antigen detection testing?
A. Centor criteria
B. CURB-65
, C. Ottawa Ankle Rules
D. Wells criteria
Correct Answer: A
Rationale: The Centor criteria (fever, tonsillar exudates, tender anterior cervical
adenopathy, absence of cough) stratify the probability of group A streptococcal pharyngitis and
guide testing. CURB-65 is for pneumonia severity. Ottawa Ankle Rules are for ankle fractures.
Wells criteria are for DVT/PE.
9. A 45-year-old woman with a BMI of 34 presents for a routine visit. She has no known
diabetes. Which screening test is most appropriate for assessing her risk of type 2 diabetes?
A. Fasting plasma glucose
B. Random plasma glucose
C. Hemoglobin A1c
D. Oral glucose tolerance test
Correct Answer: C
Rationale: The American Diabetes Association recommends HbA1c as a convenient and
reliable screening test for diabetes and prediabetes in adults with risk factors (BMI ≥25 plus
additional risk factors). Fasting glucose is acceptable, but HbA1c does not require fasting. OGTT
is less practical for routine screening. Random glucose is not a screening test.
10. A 3-month-old infant is brought for a well-child visit. The mother reports the infant is
"always spitting up" after feeds but is gaining weight appropriately. Which assessment finding
would most concern you for pyloric stenosis rather than physiologic reflux?
A. Spitting up small amounts after every feeding
B. A palpable olive-shaped mass in the right upper quadrant
C. Happy spitter who is content between feeds
D. Spitting up that decreases when held upright after feeds
Correct Answer: B
Rationale: A palpable olive (the hypertrophied pylorus) is pathognomonic for pyloric
stenosis. Physiologic reflux typically presents with a "happy spitter" who is gaining weight.
Pyloric stenosis usually presents with projectile, non-bilious vomiting and a hungry infant who
fails to gain weight.
