ANCC FNP BOARDS EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
2025/2026 | ALREADY GRADED A+
Dose of Tetanus Immune Globulin (TIG) --PRECISE ANS---250 units IM
How many doses of Tdap or Td IM needed for protection after clean minor wounds. --
PRECISE ANS---Three doses needed. If <3, unknown, or >10 years since last dose give dose
of Tdap or Td for clean minor wounds. No need to give TIG.
Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of Tdap/Td. -
-PRECISE ANS---Tdap or Td IM & TIG
Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles, burns, frostbite)
--PRECISE ANS---If <3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses in
past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or > doses in
the past
When to switch from DTap to Tdap in children --PRECISE ANS---Age 7 or > given Tdap
A woman becomes pregnant and received Tdap during her last pregnancy 1 year ago. When
should she receive her next dose. --PRECISE ANS---Tdap is recommended for each
pregnancy. "Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? -
-PRECISE ANS---IPV, MMR, varicella
A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? -
-PRECISE ANS---IPV, vaccinia (smallpox)
A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations (IZ)? -
-PRECISE ANS---Hepatitis B
A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? -
-PRECISE ANS---varicella zoster (zostavax) and MMR
Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What other
interventions/meds should be considered during anaphylaxis? --PRECISE ANS---Supine,
911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
,15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
>30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
s/s anaphylaxis --PRECISE ANS---Skin: pruritus, urticaria,
angioedema Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
PCV-13 --PRECISE ANS---Prevnar. Greater protection, Narrower coverage. Pneumococcal
conjugate. PCV23 --PRECISE ANS---lesser protection, broader coverage
Which type of vaccine boosts immune response better? conjugate vs. polysaccharide -
-PRECISE ANS---conjugate (example: prevnar)
Live attenuated (weaned) vaccines --PRECISE ANS---MMR, Varicella and intranasal Flu-
mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? --PRECISE ANS---SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus --PRECISE ANS---hand washing!; viral shed in stool in first week
post- vaccination
Shingrix: timing and dosing --PRECISE ANS---=/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? --PRECISE ANS---Feb
What s/s are associated with leukemia? --PRECISE ANS---fever, wt loss, fatigue, bone pain,
bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? --PRECISE ANS---WBCs >20,000
(think through common causes of leukocytosis: infection, stress, inflammation) --> get a
peripheral smear (AKA manual diff)
, if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis; enlarged
liver, spleen, or lymph nodes; or constitutional symptoms.
Which 2 chronic childhood diagnoses are associated with ALL and AML? --PRECISE ANS---
Downs syndrome and neurofibromatosis
What are 3 main risk factors for leukemia --PRECISE ANS---radiation (equivalent to 2 to 3 CTs),
toxin
/household pesticide exposure in utero/early childhood.
Acute Leukemia: ALL or AML cancer and symptoms/PE findings --PRECISE ANS---2 types: Acute
Lymphoblastic Leukemia or Acute Myelogenous Leukemia.
BLASTs on peripheral smear/bone aspiration in both ALL and AML.
AML also presents with
Auer rods on peripheral smear.
Acute leukemia can also present with leukopenia, combined with anemia or thrombocytopenia
Children: fever, lethargy, bleeding, potentially spinal or long bone pain. enlarged spleen, liver,
lymphandenopathy.
Adults (typically young): fever, fatigue, wt loss. May have anemia related symptoms (chest pain,
SOB)
Chronic Leukemia --PRECISE ANS---Presents in adulthood. predominant cell is mature but
does not function normally, CML (chronic myelogenous leukemia) and CLL (chronic
lymphocytic leukemia)
Look for hepatosplenomegaly and splenomegaly. ; some adults are asymptomatic. WBCs 20,000
to 100,000
Which type of leukemia presents with the Philadelphia chromosome (BCR-ABL1 fusion gene)? -
-PRECISE ANS---Chronic myelogenous leukemia
Which type of leukemia is most likely to present in older adults >/= 65y/o? --PRECISE ANS---
CLL (chronic lymphocytic leukemia)
In suspected leukemia, what lab work other than CBC should you obtain? --PRECISE ANS---Serum
electrolyte and creatinine levels, LFTs, and coagulation studies.
If the patient appears ill or is febrile, the physician should evaluate for infection with urinalysis,
urine culture, blood cultures, and chest radiography.
The next step in diagnosis involves a peripheral blood smear and usually a bone marrow
specimen (an aspirate or core biopsy).
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
2025/2026 | ALREADY GRADED A+
Dose of Tetanus Immune Globulin (TIG) --PRECISE ANS---250 units IM
How many doses of Tdap or Td IM needed for protection after clean minor wounds. --
PRECISE ANS---Three doses needed. If <3, unknown, or >10 years since last dose give dose
of Tdap or Td for clean minor wounds. No need to give TIG.
Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of Tdap/Td. -
-PRECISE ANS---Tdap or Td IM & TIG
Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles, burns, frostbite)
--PRECISE ANS---If <3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses in
past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or > doses in
the past
When to switch from DTap to Tdap in children --PRECISE ANS---Age 7 or > given Tdap
A woman becomes pregnant and received Tdap during her last pregnancy 1 year ago. When
should she receive her next dose. --PRECISE ANS---Tdap is recommended for each
pregnancy. "Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? -
-PRECISE ANS---IPV, MMR, varicella
A person with a hx of anaphylaxis to neomycin should avoid which immunizations (IZ)? -
-PRECISE ANS---IPV, vaccinia (smallpox)
A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations (IZ)? -
-PRECISE ANS---Hepatitis B
A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? -
-PRECISE ANS---varicella zoster (zostavax) and MMR
Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What other
interventions/meds should be considered during anaphylaxis? --PRECISE ANS---Supine,
911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
,15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
>30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
s/s anaphylaxis --PRECISE ANS---Skin: pruritus, urticaria,
angioedema Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
PCV-13 --PRECISE ANS---Prevnar. Greater protection, Narrower coverage. Pneumococcal
conjugate. PCV23 --PRECISE ANS---lesser protection, broader coverage
Which type of vaccine boosts immune response better? conjugate vs. polysaccharide -
-PRECISE ANS---conjugate (example: prevnar)
Live attenuated (weaned) vaccines --PRECISE ANS---MMR, Varicella and intranasal Flu-
mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? --PRECISE ANS---SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus --PRECISE ANS---hand washing!; viral shed in stool in first week
post- vaccination
Shingrix: timing and dosing --PRECISE ANS---=/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? --PRECISE ANS---Feb
What s/s are associated with leukemia? --PRECISE ANS---fever, wt loss, fatigue, bone pain,
bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? --PRECISE ANS---WBCs >20,000
(think through common causes of leukocytosis: infection, stress, inflammation) --> get a
peripheral smear (AKA manual diff)
, if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis; enlarged
liver, spleen, or lymph nodes; or constitutional symptoms.
Which 2 chronic childhood diagnoses are associated with ALL and AML? --PRECISE ANS---
Downs syndrome and neurofibromatosis
What are 3 main risk factors for leukemia --PRECISE ANS---radiation (equivalent to 2 to 3 CTs),
toxin
/household pesticide exposure in utero/early childhood.
Acute Leukemia: ALL or AML cancer and symptoms/PE findings --PRECISE ANS---2 types: Acute
Lymphoblastic Leukemia or Acute Myelogenous Leukemia.
BLASTs on peripheral smear/bone aspiration in both ALL and AML.
AML also presents with
Auer rods on peripheral smear.
Acute leukemia can also present with leukopenia, combined with anemia or thrombocytopenia
Children: fever, lethargy, bleeding, potentially spinal or long bone pain. enlarged spleen, liver,
lymphandenopathy.
Adults (typically young): fever, fatigue, wt loss. May have anemia related symptoms (chest pain,
SOB)
Chronic Leukemia --PRECISE ANS---Presents in adulthood. predominant cell is mature but
does not function normally, CML (chronic myelogenous leukemia) and CLL (chronic
lymphocytic leukemia)
Look for hepatosplenomegaly and splenomegaly. ; some adults are asymptomatic. WBCs 20,000
to 100,000
Which type of leukemia presents with the Philadelphia chromosome (BCR-ABL1 fusion gene)? -
-PRECISE ANS---Chronic myelogenous leukemia
Which type of leukemia is most likely to present in older adults >/= 65y/o? --PRECISE ANS---
CLL (chronic lymphocytic leukemia)
In suspected leukemia, what lab work other than CBC should you obtain? --PRECISE ANS---Serum
electrolyte and creatinine levels, LFTs, and coagulation studies.
If the patient appears ill or is febrile, the physician should evaluate for infection with urinalysis,
urine culture, blood cultures, and chest radiography.
The next step in diagnosis involves a peripheral blood smear and usually a bone marrow
specimen (an aspirate or core biopsy).
