ANCC Final Practice Exam |300 Expert
Questions and Answers with Rationales
Newest Update 2025/2026 |100%
Guaranteed Pass!!!
MULTIPLE CHOICES
Question 1
A 55-year-old male with hypertension and type 2 diabetes presents with a new-onset, non-healing
ulcer on his right great toe. The toe is cool to the touch with diminished pedal pulses. What is the
most likely etiology?
A) Venous insufficiency
B) Arterial insufficiency
C) Diabetic neuropathy without ischemia
D) Pressure injury
Answer: B
Rationale: Cool extremity, diminished pulses, and non-healing ulcer on a toe suggest arterial
insufficiency; diabetic neuropathy ulcers are painless but not typically cool with absent pulses.
Question 2
A nurse practitioner is considering a research study. Which element is essential for informed consent?
A) Assurance of compensation for injury
B) Detailed description of statistical analysis
C) Disclosure of potential risks and benefits
D) Guarantee of treatment benefit
Answer: C
1 SUCCESS!!!
, Rationale: Informed consent requires disclosure of potential risks, benefits, and alternatives;
guarantees of benefit or compensation are not required.
Question 3
A 28-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Labs: TSH
25 mIU/mL (normal 0.4–4.5), free T4 0.5 ng/dL (normal 0.8–1.8). What is the most appropriate initial
treatment?
A) Methimazole 5 mg daily
B) Levothyroxine 25–50 mcg daily
C) Radioactive iodine ablation
D) Observation with repeat labs in 6 months
Answer: B
Rationale: Primary hypothyroidism requires levothyroxine replacement; start low dose (25–50 mcg) in
young adults, titrate based on TSH.
Question 4 (Select all)
Which factors increase a patient’s risk for developing delirium in the hospital? (Select all)
A) Age >70 years
B) Preadmission dementia
C) Use of physical restraints
D) Early mobilization
E) Sensory impairment (hearing/vision loss)
Answers: A, B, C, E
Rationale: Risk factors for delirium include older age, baseline cognitive impairment, restraints,
sensory deficits; early mobilization is protective, not a risk factor.
Question 5
A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
nystagmus. Which vitamin deficiency is most likely?
A) Vitamin B12
B) Thiamine (B1)
2 SUCCESS!!!
, C) Vitamin D
D) Niacin (B3)
Answer: B
Rationale: Wernicke’s encephalopathy (confusion, ataxia, nystagmus/ophthalmoplegia) is caused by
thiamine deficiency, common in alcohol use disorder.
Question 6
A nurse practitioner is prescribing a medication that is metabolized by CYP3A4. Which concurrent
medication would most likely increase the risk of toxicity?
A) Rifampin
B) Carbamazepine
C) Ketoconazole
D) St. John’s wort
Answer: C
Rationale: Ketoconazole is a strong CYP3A4 inhibitor, decreasing metabolism and increasing toxicity;
rifampin, carbamazepine, and St. John’s wort are inducers.
Question 7
A 72-year-old female with osteoporosis is prescribed alendronate. Which instruction is most
important to prevent esophageal injury?
A) Take with orange juice
B) Take with a full glass of water and remain upright for 30 minutes
C) Take at bedtime with a small snack
D) Crush the tablet for easier swallowing
Answer: B
Rationale: Alendronate requires a full glass of water and upright position for 30 minutes to prevent
esophageal irritation and ulceration.
Question 8 (Select all)
Which clinical findings are consistent with right-sided heart failure? (Select all)
3 SUCCESS!!!
, A) Jugular venous distension
B) Peripheral edema
C) Hepatomegaly
D) Crackles in lung bases
E) Paroxysmal nocturnal dyspnea
Answers: A, B, C
Rationale: Right heart failure causes systemic congestion: JVD, peripheral edema, hepatomegaly.
Crackles and PND are left heart failure findings.
Question 9
A 60-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss, and
hoarseness for 3 months. What is the most appropriate next step?
A) Chest X-ray
B) CT chest with contrast
C) Bronchoscopy
D) Sputum cytology
Answer: A
Rationale: Chest X-ray is the initial imaging for suspected lung cancer; CT and bronchoscopy follow
based on findings.
Question 10
A nurse practitioner is evaluating a research article. The study reports a p-value of 0.03. This means:
A) There is a 3% chance the results are due to chance
B) The null hypothesis is true
C) The study has high clinical significance
D) The sample size was inadequate
Answer: A
Rationale: A p-value <0.05 indicates statistical significance; there is less than a 5% probability that the
results occurred by chance alone.
4 SUCCESS!!!
Questions and Answers with Rationales
Newest Update 2025/2026 |100%
Guaranteed Pass!!!
MULTIPLE CHOICES
Question 1
A 55-year-old male with hypertension and type 2 diabetes presents with a new-onset, non-healing
ulcer on his right great toe. The toe is cool to the touch with diminished pedal pulses. What is the
most likely etiology?
A) Venous insufficiency
B) Arterial insufficiency
C) Diabetic neuropathy without ischemia
D) Pressure injury
Answer: B
Rationale: Cool extremity, diminished pulses, and non-healing ulcer on a toe suggest arterial
insufficiency; diabetic neuropathy ulcers are painless but not typically cool with absent pulses.
Question 2
A nurse practitioner is considering a research study. Which element is essential for informed consent?
A) Assurance of compensation for injury
B) Detailed description of statistical analysis
C) Disclosure of potential risks and benefits
D) Guarantee of treatment benefit
Answer: C
1 SUCCESS!!!
, Rationale: Informed consent requires disclosure of potential risks, benefits, and alternatives;
guarantees of benefit or compensation are not required.
Question 3
A 28-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Labs: TSH
25 mIU/mL (normal 0.4–4.5), free T4 0.5 ng/dL (normal 0.8–1.8). What is the most appropriate initial
treatment?
A) Methimazole 5 mg daily
B) Levothyroxine 25–50 mcg daily
C) Radioactive iodine ablation
D) Observation with repeat labs in 6 months
Answer: B
Rationale: Primary hypothyroidism requires levothyroxine replacement; start low dose (25–50 mcg) in
young adults, titrate based on TSH.
Question 4 (Select all)
Which factors increase a patient’s risk for developing delirium in the hospital? (Select all)
A) Age >70 years
B) Preadmission dementia
C) Use of physical restraints
D) Early mobilization
E) Sensory impairment (hearing/vision loss)
Answers: A, B, C, E
Rationale: Risk factors for delirium include older age, baseline cognitive impairment, restraints,
sensory deficits; early mobilization is protective, not a risk factor.
Question 5
A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
nystagmus. Which vitamin deficiency is most likely?
A) Vitamin B12
B) Thiamine (B1)
2 SUCCESS!!!
, C) Vitamin D
D) Niacin (B3)
Answer: B
Rationale: Wernicke’s encephalopathy (confusion, ataxia, nystagmus/ophthalmoplegia) is caused by
thiamine deficiency, common in alcohol use disorder.
Question 6
A nurse practitioner is prescribing a medication that is metabolized by CYP3A4. Which concurrent
medication would most likely increase the risk of toxicity?
A) Rifampin
B) Carbamazepine
C) Ketoconazole
D) St. John’s wort
Answer: C
Rationale: Ketoconazole is a strong CYP3A4 inhibitor, decreasing metabolism and increasing toxicity;
rifampin, carbamazepine, and St. John’s wort are inducers.
Question 7
A 72-year-old female with osteoporosis is prescribed alendronate. Which instruction is most
important to prevent esophageal injury?
A) Take with orange juice
B) Take with a full glass of water and remain upright for 30 minutes
C) Take at bedtime with a small snack
D) Crush the tablet for easier swallowing
Answer: B
Rationale: Alendronate requires a full glass of water and upright position for 30 minutes to prevent
esophageal irritation and ulceration.
Question 8 (Select all)
Which clinical findings are consistent with right-sided heart failure? (Select all)
3 SUCCESS!!!
, A) Jugular venous distension
B) Peripheral edema
C) Hepatomegaly
D) Crackles in lung bases
E) Paroxysmal nocturnal dyspnea
Answers: A, B, C
Rationale: Right heart failure causes systemic congestion: JVD, peripheral edema, hepatomegaly.
Crackles and PND are left heart failure findings.
Question 9
A 60-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss, and
hoarseness for 3 months. What is the most appropriate next step?
A) Chest X-ray
B) CT chest with contrast
C) Bronchoscopy
D) Sputum cytology
Answer: A
Rationale: Chest X-ray is the initial imaging for suspected lung cancer; CT and bronchoscopy follow
based on findings.
Question 10
A nurse practitioner is evaluating a research article. The study reports a p-value of 0.03. This means:
A) There is a 3% chance the results are due to chance
B) The null hypothesis is true
C) The study has high clinical significance
D) The sample size was inadequate
Answer: A
Rationale: A p-value <0.05 indicates statistical significance; there is less than a 5% probability that the
results occurred by chance alone.
4 SUCCESS!!!
