ANCC FNP BOARD EXAM SIMULATION
LATEST 2025/2026
170+ PRACTICE QUESTIONS WITH CORRECT
ANSWER 💜💜S AND RATIONALE💜S
SECTION 1: ASSESSMENT (30 Questions)
Question 1
A 68-year-old male presents for a routine physical. He has a 40-pack-year smoking
history but quit 10 years ago. According to the USPSTF guidelines, what is the
most appropriate lung cancer screening recommendation?
A. No screening is indicated as he quit >5 years ago
B. Annual screening with low-dose computed tomography (LDCT) until age 80
C. Annual screening with chest x-ray
D. One-time screening with LDCT
Correct Answer 💜💜: B. Annual screening with low-dose computed
tomography (LDCT) until age 80.
Rationale💜: The USPSTF recommends annual LDCT screening for adults aged 50
to 80 years who have a 20 pack-year smoking history and currently smoke or have
quit within the past 15 years. This patient meets the criteria with his 40-pack-year
history and quit date within 15 years.
Question 2
,During a well-child exam for a 6-month-old infant, which finding requires
immediate further evaluation?
A. Unable to sit up without support
B. Presence of a Moro reflex
C. Absence of a red reflex on ophthalmologic exam
D. Palmar grasp present
Correct Answer 💜💜: C. Absence of a red reflex on ophthalmologic exam.
Rationale💜: An absent red reflex is an abnormal finding that requires
immediate ophthalmology referral to rule out retinoblastoma, cataracts, or other
serious eye pathology. The other findings are developmentally normal for a 6-
month-old.
Question 3
A 72-year-old female reports progressive difficulty with memory over the last
year. During the exam, you ask her to draw a clock showing 3:00. She places the
numbers correctly but draws both hands pointing at the 3. This finding is most
consistent with:
A. Delirium
B. Normal aging
C. Alzheimer's disease
D. Depression (pseudodementia)
Correct Answer 💜💜: C. Alzheimer's disease.
Rationale💜: Placing both clock hands pointing to the same number indicates
impairment in executive function and is a common finding in Alzheimer's disease.
This is a specific error on the clock-drawing test that differentiates it from the
inattention of delirium or the slowing of depression.
Question 4
,You are assessing a 4-year-old child's vision using a Snellen chart. At what
distance should a child of this age be able to successfully complete the test to be
considered within normal limits?
A. 20/20
B. 20/30
C. 20/40
D. 20/50
Correct Answer 💜💜: C. 20/40.
Rationale💜: For a 4- to 5-year-old child, 20/40 vision is considered an
acceptable passing score on the Snellen chart. A finding of 20/40 or worse
requires referral to an ophthalmologist.
Question 5
A 45-year-old patient with a history of hypertension presents with a blood
pressure of 145/95 mmHg in the right arm. You repeat the measurement in the
left arm and obtain 130/88 mmHg. What is the most appropriate next step?
A. Diagnose hypertension and start a thiazide diuretic
B. Average the two readings to guide treatment
C. Consider further evaluation for subclavian stenosis or aortic dissection
D. Instruct the patient on lifestyle modifications and re-check in 6 months
Correct Answer 💜💜: C. Consider further evaluation for subclavian stenosis
or aortic dissection.
Rationale💜: A significant inter-arm blood pressure difference (>10-15 mmHg) is
abnormal and suggests pathology such as subclavian stenosis, aortic dissection, or
other arterial disorders. It is not a normal variant.
Question 6
During a cardiovascular exam, you note a split S2 heart sound that persists
throughout the respiratory cycle. This finding is most suggestive of:
, A. A normal variant in young athletes
B. Atrial septal defect
C. Pulmonic stenosis
D. Aortic stenosis
Correct Answer 💜💜: B. Atrial septal defect.
Rationale💜: A split S2 that is "wide and fixed" (does not vary with respiration) is
a classic sign of an Atrial Septal Defect (ASD). A split that occurs only on
inspiration is a normal variant.
Question 7
A 55-year-old male complains of bilateral knee pain that is worse with activity and
improves with rest. On physical exam, you palpate crepitus and note bony
enlargement of the joint. There is no warmth or erythema. This presentation is
most consistent with:
A. Rheumatoid arthritis
B. Gouty arthritis
C. Osteoarthritis
D. Septic arthritis
Correct Answer 💜💜: C. Osteoarthritis.
Rationale💜: The presentation of chronic joint pain with activity, crepitus, and
bony enlargement (nodes) in the absence of systemic signs of inflammation is
classic for osteoarthritis. Rheumatoid and gouty arthritis typically present with
warmth, erythema, and swelling.
Question 8
A 23-year-old sexually active female presents with complaints of urinary
frequency, dysuria, and suprapubic discomfort. She has no fever or flank pain.
Urinalysis is positive for leukocyte esterase and nitrites. What is the most likely
diagnosis?
LATEST 2025/2026
170+ PRACTICE QUESTIONS WITH CORRECT
ANSWER 💜💜S AND RATIONALE💜S
SECTION 1: ASSESSMENT (30 Questions)
Question 1
A 68-year-old male presents for a routine physical. He has a 40-pack-year smoking
history but quit 10 years ago. According to the USPSTF guidelines, what is the
most appropriate lung cancer screening recommendation?
A. No screening is indicated as he quit >5 years ago
B. Annual screening with low-dose computed tomography (LDCT) until age 80
C. Annual screening with chest x-ray
D. One-time screening with LDCT
Correct Answer 💜💜: B. Annual screening with low-dose computed
tomography (LDCT) until age 80.
Rationale💜: The USPSTF recommends annual LDCT screening for adults aged 50
to 80 years who have a 20 pack-year smoking history and currently smoke or have
quit within the past 15 years. This patient meets the criteria with his 40-pack-year
history and quit date within 15 years.
Question 2
,During a well-child exam for a 6-month-old infant, which finding requires
immediate further evaluation?
A. Unable to sit up without support
B. Presence of a Moro reflex
C. Absence of a red reflex on ophthalmologic exam
D. Palmar grasp present
Correct Answer 💜💜: C. Absence of a red reflex on ophthalmologic exam.
Rationale💜: An absent red reflex is an abnormal finding that requires
immediate ophthalmology referral to rule out retinoblastoma, cataracts, or other
serious eye pathology. The other findings are developmentally normal for a 6-
month-old.
Question 3
A 72-year-old female reports progressive difficulty with memory over the last
year. During the exam, you ask her to draw a clock showing 3:00. She places the
numbers correctly but draws both hands pointing at the 3. This finding is most
consistent with:
A. Delirium
B. Normal aging
C. Alzheimer's disease
D. Depression (pseudodementia)
Correct Answer 💜💜: C. Alzheimer's disease.
Rationale💜: Placing both clock hands pointing to the same number indicates
impairment in executive function and is a common finding in Alzheimer's disease.
This is a specific error on the clock-drawing test that differentiates it from the
inattention of delirium or the slowing of depression.
Question 4
,You are assessing a 4-year-old child's vision using a Snellen chart. At what
distance should a child of this age be able to successfully complete the test to be
considered within normal limits?
A. 20/20
B. 20/30
C. 20/40
D. 20/50
Correct Answer 💜💜: C. 20/40.
Rationale💜: For a 4- to 5-year-old child, 20/40 vision is considered an
acceptable passing score on the Snellen chart. A finding of 20/40 or worse
requires referral to an ophthalmologist.
Question 5
A 45-year-old patient with a history of hypertension presents with a blood
pressure of 145/95 mmHg in the right arm. You repeat the measurement in the
left arm and obtain 130/88 mmHg. What is the most appropriate next step?
A. Diagnose hypertension and start a thiazide diuretic
B. Average the two readings to guide treatment
C. Consider further evaluation for subclavian stenosis or aortic dissection
D. Instruct the patient on lifestyle modifications and re-check in 6 months
Correct Answer 💜💜: C. Consider further evaluation for subclavian stenosis
or aortic dissection.
Rationale💜: A significant inter-arm blood pressure difference (>10-15 mmHg) is
abnormal and suggests pathology such as subclavian stenosis, aortic dissection, or
other arterial disorders. It is not a normal variant.
Question 6
During a cardiovascular exam, you note a split S2 heart sound that persists
throughout the respiratory cycle. This finding is most suggestive of:
, A. A normal variant in young athletes
B. Atrial septal defect
C. Pulmonic stenosis
D. Aortic stenosis
Correct Answer 💜💜: B. Atrial septal defect.
Rationale💜: A split S2 that is "wide and fixed" (does not vary with respiration) is
a classic sign of an Atrial Septal Defect (ASD). A split that occurs only on
inspiration is a normal variant.
Question 7
A 55-year-old male complains of bilateral knee pain that is worse with activity and
improves with rest. On physical exam, you palpate crepitus and note bony
enlargement of the joint. There is no warmth or erythema. This presentation is
most consistent with:
A. Rheumatoid arthritis
B. Gouty arthritis
C. Osteoarthritis
D. Septic arthritis
Correct Answer 💜💜: C. Osteoarthritis.
Rationale💜: The presentation of chronic joint pain with activity, crepitus, and
bony enlargement (nodes) in the absence of systemic signs of inflammation is
classic for osteoarthritis. Rheumatoid and gouty arthritis typically present with
warmth, erythema, and swelling.
Question 8
A 23-year-old sexually active female presents with complaints of urinary
frequency, dysuria, and suprapubic discomfort. She has no fever or flank pain.
Urinalysis is positive for leukocyte esterase and nitrites. What is the most likely
diagnosis?
