ANCC FNP BOARD EXAM LATEST 2025/2026
COMPREHENSIVE PRACTICE TEST BANK
160 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALE💜
SECTION 1: ASSESSMENT (36-38 Questions)
1. A 55-year-old male presents for a routine physical. He has no significant past medical
history. According to the USPSTF, what is the recommended screening for colorectal cancer?
A. Fecal occult blood test annually starting at age 40
B. Colonoscopy every 5 years starting at age 50
C. Colonoscopy every 10 years starting at age 45
D. Flexible sigmoidoscopy every 10 years starting at age 45
Rationale💜: The USPSTF recommends screening for colorectal cancer starting at age 45 and
continuing through age 75. Colonoscopy every 10 years is one of the recommended strategies.
The age was lowered from 50 to 45 in recent years due to increasing incidence in younger
adults .
2. During a sports physical for a 14-year-old athlete, you auscultate a split S2 heart sound that
varies with respiration (widens on inspiration, disappears on expiration). There are no
murmurs. What is your assessment?
,A. This is suspicious for an atrial septal defect and requires an echocardiogram
B. This is a normal physiological finding in children and young adults
C. This indicates pulmonic stenosis and requires cardiology referral
D. This is an expected finding of hypertrophic cardiomyopathy
Rationale💜: A split S2 that varies with respiration (physiological splitting) is a normal finding.
The aortic valve closes slightly before the pulmonic valve. During inspiration, increased venous
return delays pulmonic closure, widening the split. This disappears on expiration .
3. A 68-year-old female with a history of hypertension and heart failure with preserved
ejection fraction (HFpEF) presents with worsening dyspnea on exertion and orthopnea. An
echocardiogram shows an ejection fraction of 60% and left ventricular hypertrophy. Which
finding on physical exam is most specific for heart failure?
A. Bibasilar crackles that clear with coughing
B. An S3 gallop
C. Pedal edema
D. Jugular venous distention
Rationale💜: While JVD and edema are signs of volume overload, an S3 gallop is the most
specific physical exam finding for heart failure, indicating increased ventricular filling pressures
and volume overload. Crackles that clear with coughing may simply be atelectasis .
4. A 45-year-old administrative assistant presents with right wrist pain and numbness in the
thumb and index finger. Which test involves tapping on the volar surface of the wrist to
reproduce symptoms?
,A. Phalen's test
B. Finkelstein's test
C. Tinel's sign
D. Hoffmann's sign
Rationale💜: Tinel's sign is performed by percussing over the median nerve at the carpal
tunnel. A positive test is indicated by tingling or paresthesia in the median nerve distribution
(thumb, index, middle fingers), suggesting carpal tunnel syndrome .
5. When assessing a patient's visual acuity with a Snellen chart, you record 20/50. What does
this mean?
A. The patient has 20/50 vision in one eye and 20/20 in the other
B. The patient can see at 20 feet what a person with normal vision can see at 50 feet
C. The patient has a 50% reduction in visual acuity
D. The patient is legally blind
Rationale💜: The Snellen fraction represents the patient's distance from the chart
(numerator) over the distance at which a normal eye can read that line (denominator). 20/50
means the patient must be at 20 feet to read what a normal eye can read at 50 feet .
6. A 6-month-old infant is brought in for a well-child check. Which gross motor skill should the
nurse practitioner expect to observe?
A. Standing independently
B. Sitting without support
, C. Walking while holding onto furniture (cruising)
D. Rolling from back to stomach
Rationale💜: By 6 months, an infant should be able to sit with minimal support or briefly
without support. Cruising and standing independently are skills closer to 10-12 months. Rolling
over is usually achieved by 4-5 months .
7. A 35-year-old female with a family history of breast cancer in her mother (diagnosed at age
48) asks about screening. What is the most appropriate next step?
A. Order an immediate mammogram
B. Assess her risk using a formal tool like the Gail model
C. Refer her for genetic testing
D. Recommend breast self-exams only
Rationale💜: Before ordering additional screening or genetic testing, a formal risk assessment
should be performed using a tool like the Gail model or Tyrer-Cuzick. This helps determine if
she is high-risk and needs earlier or more frequent screening (e.g., MRI) vs. standard screening .
8. A 72-year-old male with a 60 pack-year smoking history (quit 10 years ago) asks about lung
cancer screening. What is the appropriate response?
A. Annual chest x-ray is recommended
B. No screening is recommended as he quit >5 years ago
C. He is eligible for annual low-dose CT scan
D. Screening with sputum cytology is recommended
COMPREHENSIVE PRACTICE TEST BANK
160 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALE💜
SECTION 1: ASSESSMENT (36-38 Questions)
1. A 55-year-old male presents for a routine physical. He has no significant past medical
history. According to the USPSTF, what is the recommended screening for colorectal cancer?
A. Fecal occult blood test annually starting at age 40
B. Colonoscopy every 5 years starting at age 50
C. Colonoscopy every 10 years starting at age 45
D. Flexible sigmoidoscopy every 10 years starting at age 45
Rationale💜: The USPSTF recommends screening for colorectal cancer starting at age 45 and
continuing through age 75. Colonoscopy every 10 years is one of the recommended strategies.
The age was lowered from 50 to 45 in recent years due to increasing incidence in younger
adults .
2. During a sports physical for a 14-year-old athlete, you auscultate a split S2 heart sound that
varies with respiration (widens on inspiration, disappears on expiration). There are no
murmurs. What is your assessment?
,A. This is suspicious for an atrial septal defect and requires an echocardiogram
B. This is a normal physiological finding in children and young adults
C. This indicates pulmonic stenosis and requires cardiology referral
D. This is an expected finding of hypertrophic cardiomyopathy
Rationale💜: A split S2 that varies with respiration (physiological splitting) is a normal finding.
The aortic valve closes slightly before the pulmonic valve. During inspiration, increased venous
return delays pulmonic closure, widening the split. This disappears on expiration .
3. A 68-year-old female with a history of hypertension and heart failure with preserved
ejection fraction (HFpEF) presents with worsening dyspnea on exertion and orthopnea. An
echocardiogram shows an ejection fraction of 60% and left ventricular hypertrophy. Which
finding on physical exam is most specific for heart failure?
A. Bibasilar crackles that clear with coughing
B. An S3 gallop
C. Pedal edema
D. Jugular venous distention
Rationale💜: While JVD and edema are signs of volume overload, an S3 gallop is the most
specific physical exam finding for heart failure, indicating increased ventricular filling pressures
and volume overload. Crackles that clear with coughing may simply be atelectasis .
4. A 45-year-old administrative assistant presents with right wrist pain and numbness in the
thumb and index finger. Which test involves tapping on the volar surface of the wrist to
reproduce symptoms?
,A. Phalen's test
B. Finkelstein's test
C. Tinel's sign
D. Hoffmann's sign
Rationale💜: Tinel's sign is performed by percussing over the median nerve at the carpal
tunnel. A positive test is indicated by tingling or paresthesia in the median nerve distribution
(thumb, index, middle fingers), suggesting carpal tunnel syndrome .
5. When assessing a patient's visual acuity with a Snellen chart, you record 20/50. What does
this mean?
A. The patient has 20/50 vision in one eye and 20/20 in the other
B. The patient can see at 20 feet what a person with normal vision can see at 50 feet
C. The patient has a 50% reduction in visual acuity
D. The patient is legally blind
Rationale💜: The Snellen fraction represents the patient's distance from the chart
(numerator) over the distance at which a normal eye can read that line (denominator). 20/50
means the patient must be at 20 feet to read what a normal eye can read at 50 feet .
6. A 6-month-old infant is brought in for a well-child check. Which gross motor skill should the
nurse practitioner expect to observe?
A. Standing independently
B. Sitting without support
, C. Walking while holding onto furniture (cruising)
D. Rolling from back to stomach
Rationale💜: By 6 months, an infant should be able to sit with minimal support or briefly
without support. Cruising and standing independently are skills closer to 10-12 months. Rolling
over is usually achieved by 4-5 months .
7. A 35-year-old female with a family history of breast cancer in her mother (diagnosed at age
48) asks about screening. What is the most appropriate next step?
A. Order an immediate mammogram
B. Assess her risk using a formal tool like the Gail model
C. Refer her for genetic testing
D. Recommend breast self-exams only
Rationale💜: Before ordering additional screening or genetic testing, a formal risk assessment
should be performed using a tool like the Gail model or Tyrer-Cuzick. This helps determine if
she is high-risk and needs earlier or more frequent screening (e.g., MRI) vs. standard screening .
8. A 72-year-old male with a 60 pack-year smoking history (quit 10 years ago) asks about lung
cancer screening. What is the appropriate response?
A. Annual chest x-ray is recommended
B. No screening is recommended as he quit >5 years ago
C. He is eligible for annual low-dose CT scan
D. Screening with sputum cytology is recommended
