ANCC FNP Exam Version 2 | Family Nurse
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Rationales 2026/27 (PDF) | Guaranteed
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SECTION 1: ASSESSMENT (Questions 1–29)
1. A 72-year-old woman with a history of hypertension presents with
progressive shortness of breath over the last few weeks. She reports
worsening symptoms at night when she lies flat and now needs to sleep on
three pillows. An echocardiogram demonstrates diffuse left ventricular
hypertrophy and an ejection fraction of 65%. In this patient population, which
of the following therapies has been proven to confer a mortality benefit?
A. Beta-blockers
B. Loop diuretics
C. Spironolactone
D. No agent has shown a definitive mortality benefit
Correct Answer: D
Rationale: This patient's presentation (exertional dyspnea, orthopnea,
preserved ejection fraction) is classic for heart failure with preserved ejection
fraction (HFpEF). Large-scale clinical trials have not consistently
demonstrated a mortality benefit for beta-blockers, ACE inhibitors, ARBs, or
spironolactone specifically in the HFpEF population. Current management
focuses on symptom control (e.g., diuretics for volume overload) and
aggressive treatment of comorbidities like hypertension and atrial
fibrillation.
,2. A 58-year-old male with a 20 pack-year smoking history presents for a
routine physical. According to USPSTF guidelines, what screening is
recommended?
A. Abdominal aortic aneurysm screening with ultrasound
B. Annual lung cancer screening with low-dose CT
C. Carotid artery stenosis screening with duplex ultrasound
D. Coronary artery disease screening with exercise stress test
Correct Answer: B
Rationale: The USPSTF recommends annual low-dose computed tomography
(LDCT) screening for lung cancer in adults aged 50–80 years with a 20 pack-
year smoking history who currently smoke or have quit within the past 15
years. This patient meets both the age and pack-year criteria. Abdominal
aortic aneurysm screening is recommended only for men aged 65–75 who
have ever smoked. Screening for carotid artery stenosis or CAD with stress
testing is not recommended for asymptomatic individuals at average risk.
3. A 72-year-old female scores 25/30 on the Montreal Cognitive Assessment
(MoCA). This finding most likely indicates:
A. Normal cognitive function for age
B. Mild cognitive impairment
C. Moderate dementia
D. Severe dementia
Correct Answer: B
Rationale: The MoCA is scored from 0–30, with a score of 26 or above
generally considered normal. Scores between 18–25 suggest mild cognitive
impairment, 10–17 suggest moderate dementia, and less than 10 suggests
severe dementia. Therefore, a score of 25/30 places this patient in the range
of mild cognitive impairment.
,4. A 28-year-old multipara at 32 weeks gestation presents with sudden onset
of small amounts of bright-red vaginal bleeding. Her uterus is soft to palpation.
What is the most likely diagnosis?
A. Placental abruption
B. Placenta previa
C. Acute cervicitis
D. Hydatidiform mole
Correct Answer: B
Rationale: Placenta previa classically presents with painless, bright-red
vaginal bleeding in the second or third trimester. The uterus remains soft on
palpation. Placental abruption typically presents with painful bleeding and a
firm, tender uterus. Acute cervicitis and hydatidiform mole have different
presentations and are less likely in this scenario.
5. A sexually active 30-year-old woman reports a large amount of milky vaginal
discharge for several weeks. Microscopy reveals numerous clue cells, few
white blood cells, and vaginal pH 6.0. What is the most likely diagnosis?
A. Trichomonas vaginalis
B. Bacterial vaginosis
C. Candidiasis
D. Atrophic vaginitis
Correct Answer: B
Rationale: Bacterial vaginosis is characterized by a thin, milky white or gray,
homogenous vaginal discharge with a pH > 4.5. The presence of clue cells
(epithelial cells with blurred margins) on wet mount is diagnostic. Few white
blood cells are typical. Trichomoniasis typically has a frothy, greenish
discharge with a fishy odor and motile trichomonads on microscopy.
Candidiasis presents with thick, white, curdlike discharge, hyphae on KOH
prep, and normal pH. Atrophic vaginitis is associated with menopause and
presents with thin, dry vaginal mucosa.
, 6. The Lachman maneuver is used to assess which of the following?
A. Instability of the knee
B. Integrity of the patellar tendon
C. Tears of the meniscus
D. Nerve damage of the knee
Correct Answer: A
Rationale: The Lachman maneuver is used to assess instability of the knee,
specifically for anterior cruciate ligament (ACL) integrity. It is performed with
the knee flexed 20–30 degrees, and the examiner stabilizes the femur while
pulling the tibia anteriorly. Excessive anterior translation indicates ACL laxity
or tear.
7. A 52-year-old male presents with "crushing" substernal chest pain radiating
to his left arm. He is diaphoretic and nauseous. What is the most appropriate
initial diagnostic test?
A. Exercise stress test
B. Chest X-ray
C. Computed Tomography (CT) Angiography of the chest
D. Electrocardiogram (ECG)
Correct Answer: D
Rationale: The patient's presentation is classic for Acute Coronary Syndrome
(ACS). The ECG is the immediate first-line diagnostic test to identify ST-
elevation myocardial infarction (STEMI), which dictates immediate
reperfusion therapy (PCI). Exercise stress testing is contraindicated in an
acute setting; CT Angiography is used for low-risk patients with negative
enzymes and ECGs to rule out pulmonary embolism or aortic dissection.
Chest X-ray will not diagnose ischemia.
8. A 65-year-old female patient reports difficulty sleeping, low energy, and a
loss of interest in her hobbies for the past two months. She has lost 10 pounds
Practitioner | | Questions & Answers Plus
Rationales 2026/27 (PDF) | Guaranteed
Pass | A+ Graded | Instant FeedBack
SECTION 1: ASSESSMENT (Questions 1–29)
1. A 72-year-old woman with a history of hypertension presents with
progressive shortness of breath over the last few weeks. She reports
worsening symptoms at night when she lies flat and now needs to sleep on
three pillows. An echocardiogram demonstrates diffuse left ventricular
hypertrophy and an ejection fraction of 65%. In this patient population, which
of the following therapies has been proven to confer a mortality benefit?
A. Beta-blockers
B. Loop diuretics
C. Spironolactone
D. No agent has shown a definitive mortality benefit
Correct Answer: D
Rationale: This patient's presentation (exertional dyspnea, orthopnea,
preserved ejection fraction) is classic for heart failure with preserved ejection
fraction (HFpEF). Large-scale clinical trials have not consistently
demonstrated a mortality benefit for beta-blockers, ACE inhibitors, ARBs, or
spironolactone specifically in the HFpEF population. Current management
focuses on symptom control (e.g., diuretics for volume overload) and
aggressive treatment of comorbidities like hypertension and atrial
fibrillation.
,2. A 58-year-old male with a 20 pack-year smoking history presents for a
routine physical. According to USPSTF guidelines, what screening is
recommended?
A. Abdominal aortic aneurysm screening with ultrasound
B. Annual lung cancer screening with low-dose CT
C. Carotid artery stenosis screening with duplex ultrasound
D. Coronary artery disease screening with exercise stress test
Correct Answer: B
Rationale: The USPSTF recommends annual low-dose computed tomography
(LDCT) screening for lung cancer in adults aged 50–80 years with a 20 pack-
year smoking history who currently smoke or have quit within the past 15
years. This patient meets both the age and pack-year criteria. Abdominal
aortic aneurysm screening is recommended only for men aged 65–75 who
have ever smoked. Screening for carotid artery stenosis or CAD with stress
testing is not recommended for asymptomatic individuals at average risk.
3. A 72-year-old female scores 25/30 on the Montreal Cognitive Assessment
(MoCA). This finding most likely indicates:
A. Normal cognitive function for age
B. Mild cognitive impairment
C. Moderate dementia
D. Severe dementia
Correct Answer: B
Rationale: The MoCA is scored from 0–30, with a score of 26 or above
generally considered normal. Scores between 18–25 suggest mild cognitive
impairment, 10–17 suggest moderate dementia, and less than 10 suggests
severe dementia. Therefore, a score of 25/30 places this patient in the range
of mild cognitive impairment.
,4. A 28-year-old multipara at 32 weeks gestation presents with sudden onset
of small amounts of bright-red vaginal bleeding. Her uterus is soft to palpation.
What is the most likely diagnosis?
A. Placental abruption
B. Placenta previa
C. Acute cervicitis
D. Hydatidiform mole
Correct Answer: B
Rationale: Placenta previa classically presents with painless, bright-red
vaginal bleeding in the second or third trimester. The uterus remains soft on
palpation. Placental abruption typically presents with painful bleeding and a
firm, tender uterus. Acute cervicitis and hydatidiform mole have different
presentations and are less likely in this scenario.
5. A sexually active 30-year-old woman reports a large amount of milky vaginal
discharge for several weeks. Microscopy reveals numerous clue cells, few
white blood cells, and vaginal pH 6.0. What is the most likely diagnosis?
A. Trichomonas vaginalis
B. Bacterial vaginosis
C. Candidiasis
D. Atrophic vaginitis
Correct Answer: B
Rationale: Bacterial vaginosis is characterized by a thin, milky white or gray,
homogenous vaginal discharge with a pH > 4.5. The presence of clue cells
(epithelial cells with blurred margins) on wet mount is diagnostic. Few white
blood cells are typical. Trichomoniasis typically has a frothy, greenish
discharge with a fishy odor and motile trichomonads on microscopy.
Candidiasis presents with thick, white, curdlike discharge, hyphae on KOH
prep, and normal pH. Atrophic vaginitis is associated with menopause and
presents with thin, dry vaginal mucosa.
, 6. The Lachman maneuver is used to assess which of the following?
A. Instability of the knee
B. Integrity of the patellar tendon
C. Tears of the meniscus
D. Nerve damage of the knee
Correct Answer: A
Rationale: The Lachman maneuver is used to assess instability of the knee,
specifically for anterior cruciate ligament (ACL) integrity. It is performed with
the knee flexed 20–30 degrees, and the examiner stabilizes the femur while
pulling the tibia anteriorly. Excessive anterior translation indicates ACL laxity
or tear.
7. A 52-year-old male presents with "crushing" substernal chest pain radiating
to his left arm. He is diaphoretic and nauseous. What is the most appropriate
initial diagnostic test?
A. Exercise stress test
B. Chest X-ray
C. Computed Tomography (CT) Angiography of the chest
D. Electrocardiogram (ECG)
Correct Answer: D
Rationale: The patient's presentation is classic for Acute Coronary Syndrome
(ACS). The ECG is the immediate first-line diagnostic test to identify ST-
elevation myocardial infarction (STEMI), which dictates immediate
reperfusion therapy (PCI). Exercise stress testing is contraindicated in an
acute setting; CT Angiography is used for low-risk patients with negative
enzymes and ECGs to rule out pulmonary embolism or aortic dissection.
Chest X-ray will not diagnose ischemia.
8. A 65-year-old female patient reports difficulty sleeping, low energy, and a
loss of interest in her hobbies for the past two months. She has lost 10 pounds
