ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
ANCC FNP Exam Version 1 - Newest 2026/2027
Complete 100 Questions and Correct Answers (Verified Answers) | Already Graded A+ | Brand New
American Nurses Credentialing Center (ANCC) Family Nurse Practitioner Certification
Total Questions: 100 (7 Sections)
Cognitive Levels: 25% Recall | 50% Application | 25% Analysis
Question Style: 75% Scenario-Based | 20% Direct Recall | 5% Calculation
Aligned with USPSTF, CDC, ACOG, AAP, ADA, AHA/ACC, GOLD, GINA 2026/2027 guidelines
SECTION 1: Assessment and Diagnosis
Health History, Physical Exam, & Diagnostic Testing (Q1-Q20)
Q1: A 52-year-old male presents with chest pain. Using the OLDCARTS acronym for the history of
present illness, which component is being assessed when the FNP asks, 'What were you doing when the
pain started?'
A. Onset [CORRECT]
B. Location
C. Duration
D. Character
Correct Answer: A
Rationale: Onset is being assessed when asking what the patient was doing when the pain started—this establishes
when and how symptoms began (sudden vs. gradual, activity vs. rest). OLDCARTS stands for Onset, Location,
Duration, Character, Aggravating factors, Relieving factors, Timing, Severity. Location (option B) asks where the pain
is. Duration (option C) asks how long it lasts. Character (option D) asks what the pain feels like (sharp, dull, pressure).
A comprehensive HPI is essential for accurate diagnosis and E/M coding documentation.
Q2: An FNP is evaluating a 28-year-old female with suspected group A streptococcal pharyngitis. Using
the Centor criteria, which combination of findings would warrant a rapid strep test or throat culture?
A. Fever, absent cough, tender anterior cervical adenopathy, tonsillar exudate (Centor score 4: test or
treat empirically) [CORRECT]
B. Cough, rhinorrhea, no fever, no exudate (Centor score 0: no testing)
C. Fever, cough, no exudate, no adenopathy (Centor score 1: no testing)
D. No fever, no cough, no exudate, no adenopathy (Centor score 0: no testing)
Correct Answer: A
Rationale: Centor criteria (modified McIsaac) assigns 1 point each for: fever, absence of cough, tender anterior
cervical adenopathy, and tonsillar exudate (plus 1 point for age 3-14, 0 for 15-44, -1 for 45+). A score of 4 warrants
testing or empiric treatment. A score of 0-1 requires no testing (options B, C, D). A score of 2-3 warrants testing with
rapid strep or culture. The Centor score helps FNPs make evidence-based decisions about testing, avoiding unnecessary
antibiotics for viral pharyngitis. ASO titer is not used for acute diagnosis.
ANCC FNP - Brand New Version 1 (100 Questions) Page 1
,ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
Q3: A 45-year-old female presents with dyspnea and pleuritic chest pain. Wells criteria score is 2
(moderate probability). Which diagnostic approach is most appropriate?
A. Immediate CT pulmonary angiography without D-dimer
B. D-dimer test; if positive, proceed to CT pulmonary angiography or V/Q scan [CORRECT]
C. Empiric anticoagulation without further testing
D. Lower extremity venous ultrasound only
Correct Answer: B
Rationale: For moderate pretest probability (Wells score 2-6), a D-dimer test is the appropriate first step. If D-dimer is
positive, proceed to CT pulmonary angiography (CTPA) or V/Q scan. If D-dimer is negative, PE is excluded. For high
probability (Wells >6), skip D-dimer and proceed directly to CTPA. Immediate CTPA without D-dimer (option A) is
for high probability. Empiric anticoagulation without testing (option C) is inappropriate. Lower extremity ultrasound
(option D) is useful if DVT is suspected, but PE workup requires CTPA/V/Q. The PERC rule can rule out PE without
D-dimer in low-risk patients.
Q4: A 35-year-old male presents with acute-onset chest pain. ECG shows ST-segment elevation in leads
II, III, aVF. Which area of the heart is affected, and what is the most likely diagnosis?
A. Anterior wall STEMI (LAD occlusion)
B. Inferior wall STEMI (RCA occlusion) [CORRECT]
C. Lateral wall STEMI (LCx occlusion)
D. Posterior wall STEMI (PDA occlusion)
Correct Answer: B
Rationale: ST elevation in leads II, III, aVF indicates inferior wall STEMI, typically from right coronary artery (RCA)
occlusion. Anterior STEMI (option A) shows ST elevation in V1-V4 (LAD territory). Lateral STEMI (option C) shows
ST elevation in I, aVL, V5-V6 (LCx territory). Posterior STEMI (option D) shows ST depression in V1-V3 with tall R
waves. This patient requires immediate aspirin, P2Y12 inhibitor, heparin, and activation of PCI pathway
(door-to-balloon time <90 minutes). Time is muscle—immediate recognition of STEMI is essential for FNP practice.
Q5: An FNP is caring for a 6-month-old infant with fever of 39°C (102.2°F) without an obvious source.
Which is the appropriate workup according to current guidelines?
A. Observation only, as the infant is older than 3 months
B. Urinalysis and urine culture, CBC with differential, CRP or procalcitonin; consider chest X-ray and
lumbar puncture based on clinical findings [CORRECT]
C. Empiric antibiotics without any workup
D. CBC only and discharge home with follow-up
Correct Answer: B
Rationale: For infants 3-6 months with fever ≥39°C without source, the workup includes urinalysis and urine culture
(UTI is most common bacterial infection), CBC with differential, CRP or procalcitonin (inflammatory markers), and
consideration of chest X-ray (if respiratory findings) and lumbar puncture (if irritability, bulging fontanelle, or
petechiae). Urine must be obtained by catheterization or suprapubic aspirate (bag specimens have high contamination).
Observation only (option A) is for low-risk older infants. Empiric antibiotics without workup (option C) is
inappropriate. CBC only (option D) is insufficient.
ANCC FNP - Brand New Version 1 (100 Questions) Page 2
,ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
Q6: A 62-year-old male presents with acute onset of right-sided weakness and slurred speech that began
45 minutes ago. Blood pressure is 180/105 mmHg. What is the most appropriate immediate action?
A. Lower blood pressure to <140/90 immediately, then transfer
B. Activate stroke code; determine eligibility for IV thrombolytics (tPA) within 4.5-hour window; do not
lower BP unless >220/120 if tPA candidate [CORRECT]
C. Administer aspirin 325 mg orally and arrange outpatient follow-up
D. Obtain MRI brain before any intervention
Correct Answer: B
Rationale: This patient has acute ischemic stroke (FAST positive: Face, Arm, Speech, Time). Activate stroke code
immediately and determine tPA eligibility within 4.5-hour window. BP should NOT be lowered unless >220/120 mmHg
(or >185/110 if tPA candidate) to maintain cerebral perfusion. Lowering BP aggressively (option A) can worsen stroke.
Aspirin is given after hemorrhage is ruled out (option C). MRI (option D) delays treatment—CT without contrast is the
initial imaging to rule out hemorrhage. Time is brain—every minute of delay loses 1.9 million neurons.
Q7: An FNP is evaluating a 28-year-old female with fatigue, pallor, and shortness of breath. CBC reveals
hemoglobin 9.2 g/dL, MCV 72 fL, ferritin 8 ng/mL. What is the most likely diagnosis and underlying
cause to investigate?
A. Macrocytic anemia from B12 deficiency; check intrinsic factor antibodies
B. Microcytic anemia from iron deficiency; investigate menstrual blood loss and GI bleeding
[CORRECT]
C. Normocytic anemia from chronic kidney disease; check renal function
D. Hemolytic anemia from autoimmune destruction; check reticulocyte count
Correct Answer: B
Rationale: Low hemoglobin (9.2 g/dL) with low MCV (72 fL, microcytic) and low ferritin (8 ng/mL, iron stores
depleted) indicates iron deficiency anemia. In a 28-year-old female, the most common cause is menstrual blood loss; GI
bleeding should also be investigated (especially in older patients or those with GI symptoms). Macrocytic anemia
(option A) has high MCV (>100). Normocytic anemia (option C) has normal MCV. Hemolytic anemia (option D)
shows high reticulocytes. Treatment: oral iron sulfate 325 mg every other day with vitamin C, investigate and treat
underlying cause.
ANCC FNP - Brand New Version 1 (100 Questions) Page 3
, ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
Q8: A 55-year-old male with diabetes presents for routine follow-up. Which combination of monitoring
tests is appropriate for diabetic complication screening?
A. Annual eye exam, annual urine microalbumin, annual foot exam, daily glucose logs, quarterly A1C
[CORRECT]
B. Eye exam every 5 years, urinalysis as needed, foot exam when symptomatic, glucose monthly, A1C annually
C. No monitoring needed if asymptomatic
D. Eye exam only if visual symptoms, no urine testing, foot exam annually, A1C semi-annually
Correct Answer: A
Rationale: ADA-recommended monitoring for diabetic complications: annual dilated eye exam (retinopathy), annual
urine microalbumin (nephropathy), annual comprehensive foot exam (neuropathy), daily glucose self-monitoring, A1C
quarterly if not at goal or semi-annually if at goal. Also: BP every visit, annual lipid panel, annual dental exam, annual
flu vaccine. Tertiary prevention aims to detect complications early when treatment can prevent progression.
Proliferative retinopathy requires ophthalmology referral for laser photostatin. ACEi/ARB for microalbuminuria
prevents nephropathy progression.
Q9: A 70-year-old female presents with acute confusion over 2 days. She was recently started on a new
medication. Which medication class is most likely to cause delirium in elderly patients per Beers
Criteria?
A. Statin
B. Anticholinergic medication (e.g., diphenhydramine, oxybutynin, tricyclic antidepressants)
[CORRECT]
C. Beta-blocker
D. ACE inhibitor
Correct Answer: B
Rationale: Anticholinergic medications are high-risk for delirium in elderly per Beers Criteria. Common culprits:
diphenhydramine (Benadryl), oxybutynin, TCAs (amitriptyline), hydroxyzine, promethazine. Anticholinergic effects
cause confusion, dry mouth, urinary retention, constipation, blurred vision. Cumulative anticholinergic burden increases
dementia risk. Statins (option A), beta-blockers (option C), and ACE inhibitors (option D) are not typically deliriogenic.
Delirium workup: review medications (especially anticholinergics, benzodiazepines, opioids), evaluate for infection
(UTI, pneumonia), metabolic abnormalities, hypoxia, dehydration.
ANCC FNP - Brand New Version 1 (100 Questions) Page 4
ANCC FNP Exam Version 1 - Newest 2026/2027
Complete 100 Questions and Correct Answers (Verified Answers) | Already Graded A+ | Brand New
American Nurses Credentialing Center (ANCC) Family Nurse Practitioner Certification
Total Questions: 100 (7 Sections)
Cognitive Levels: 25% Recall | 50% Application | 25% Analysis
Question Style: 75% Scenario-Based | 20% Direct Recall | 5% Calculation
Aligned with USPSTF, CDC, ACOG, AAP, ADA, AHA/ACC, GOLD, GINA 2026/2027 guidelines
SECTION 1: Assessment and Diagnosis
Health History, Physical Exam, & Diagnostic Testing (Q1-Q20)
Q1: A 52-year-old male presents with chest pain. Using the OLDCARTS acronym for the history of
present illness, which component is being assessed when the FNP asks, 'What were you doing when the
pain started?'
A. Onset [CORRECT]
B. Location
C. Duration
D. Character
Correct Answer: A
Rationale: Onset is being assessed when asking what the patient was doing when the pain started—this establishes
when and how symptoms began (sudden vs. gradual, activity vs. rest). OLDCARTS stands for Onset, Location,
Duration, Character, Aggravating factors, Relieving factors, Timing, Severity. Location (option B) asks where the pain
is. Duration (option C) asks how long it lasts. Character (option D) asks what the pain feels like (sharp, dull, pressure).
A comprehensive HPI is essential for accurate diagnosis and E/M coding documentation.
Q2: An FNP is evaluating a 28-year-old female with suspected group A streptococcal pharyngitis. Using
the Centor criteria, which combination of findings would warrant a rapid strep test or throat culture?
A. Fever, absent cough, tender anterior cervical adenopathy, tonsillar exudate (Centor score 4: test or
treat empirically) [CORRECT]
B. Cough, rhinorrhea, no fever, no exudate (Centor score 0: no testing)
C. Fever, cough, no exudate, no adenopathy (Centor score 1: no testing)
D. No fever, no cough, no exudate, no adenopathy (Centor score 0: no testing)
Correct Answer: A
Rationale: Centor criteria (modified McIsaac) assigns 1 point each for: fever, absence of cough, tender anterior
cervical adenopathy, and tonsillar exudate (plus 1 point for age 3-14, 0 for 15-44, -1 for 45+). A score of 4 warrants
testing or empiric treatment. A score of 0-1 requires no testing (options B, C, D). A score of 2-3 warrants testing with
rapid strep or culture. The Centor score helps FNPs make evidence-based decisions about testing, avoiding unnecessary
antibiotics for viral pharyngitis. ASO titer is not used for acute diagnosis.
ANCC FNP - Brand New Version 1 (100 Questions) Page 1
,ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
Q3: A 45-year-old female presents with dyspnea and pleuritic chest pain. Wells criteria score is 2
(moderate probability). Which diagnostic approach is most appropriate?
A. Immediate CT pulmonary angiography without D-dimer
B. D-dimer test; if positive, proceed to CT pulmonary angiography or V/Q scan [CORRECT]
C. Empiric anticoagulation without further testing
D. Lower extremity venous ultrasound only
Correct Answer: B
Rationale: For moderate pretest probability (Wells score 2-6), a D-dimer test is the appropriate first step. If D-dimer is
positive, proceed to CT pulmonary angiography (CTPA) or V/Q scan. If D-dimer is negative, PE is excluded. For high
probability (Wells >6), skip D-dimer and proceed directly to CTPA. Immediate CTPA without D-dimer (option A) is
for high probability. Empiric anticoagulation without testing (option C) is inappropriate. Lower extremity ultrasound
(option D) is useful if DVT is suspected, but PE workup requires CTPA/V/Q. The PERC rule can rule out PE without
D-dimer in low-risk patients.
Q4: A 35-year-old male presents with acute-onset chest pain. ECG shows ST-segment elevation in leads
II, III, aVF. Which area of the heart is affected, and what is the most likely diagnosis?
A. Anterior wall STEMI (LAD occlusion)
B. Inferior wall STEMI (RCA occlusion) [CORRECT]
C. Lateral wall STEMI (LCx occlusion)
D. Posterior wall STEMI (PDA occlusion)
Correct Answer: B
Rationale: ST elevation in leads II, III, aVF indicates inferior wall STEMI, typically from right coronary artery (RCA)
occlusion. Anterior STEMI (option A) shows ST elevation in V1-V4 (LAD territory). Lateral STEMI (option C) shows
ST elevation in I, aVL, V5-V6 (LCx territory). Posterior STEMI (option D) shows ST depression in V1-V3 with tall R
waves. This patient requires immediate aspirin, P2Y12 inhibitor, heparin, and activation of PCI pathway
(door-to-balloon time <90 minutes). Time is muscle—immediate recognition of STEMI is essential for FNP practice.
Q5: An FNP is caring for a 6-month-old infant with fever of 39°C (102.2°F) without an obvious source.
Which is the appropriate workup according to current guidelines?
A. Observation only, as the infant is older than 3 months
B. Urinalysis and urine culture, CBC with differential, CRP or procalcitonin; consider chest X-ray and
lumbar puncture based on clinical findings [CORRECT]
C. Empiric antibiotics without any workup
D. CBC only and discharge home with follow-up
Correct Answer: B
Rationale: For infants 3-6 months with fever ≥39°C without source, the workup includes urinalysis and urine culture
(UTI is most common bacterial infection), CBC with differential, CRP or procalcitonin (inflammatory markers), and
consideration of chest X-ray (if respiratory findings) and lumbar puncture (if irritability, bulging fontanelle, or
petechiae). Urine must be obtained by catheterization or suprapubic aspirate (bag specimens have high contamination).
Observation only (option A) is for low-risk older infants. Empiric antibiotics without workup (option C) is
inappropriate. CBC only (option D) is insufficient.
ANCC FNP - Brand New Version 1 (100 Questions) Page 2
,ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
Q6: A 62-year-old male presents with acute onset of right-sided weakness and slurred speech that began
45 minutes ago. Blood pressure is 180/105 mmHg. What is the most appropriate immediate action?
A. Lower blood pressure to <140/90 immediately, then transfer
B. Activate stroke code; determine eligibility for IV thrombolytics (tPA) within 4.5-hour window; do not
lower BP unless >220/120 if tPA candidate [CORRECT]
C. Administer aspirin 325 mg orally and arrange outpatient follow-up
D. Obtain MRI brain before any intervention
Correct Answer: B
Rationale: This patient has acute ischemic stroke (FAST positive: Face, Arm, Speech, Time). Activate stroke code
immediately and determine tPA eligibility within 4.5-hour window. BP should NOT be lowered unless >220/120 mmHg
(or >185/110 if tPA candidate) to maintain cerebral perfusion. Lowering BP aggressively (option A) can worsen stroke.
Aspirin is given after hemorrhage is ruled out (option C). MRI (option D) delays treatment—CT without contrast is the
initial imaging to rule out hemorrhage. Time is brain—every minute of delay loses 1.9 million neurons.
Q7: An FNP is evaluating a 28-year-old female with fatigue, pallor, and shortness of breath. CBC reveals
hemoglobin 9.2 g/dL, MCV 72 fL, ferritin 8 ng/mL. What is the most likely diagnosis and underlying
cause to investigate?
A. Macrocytic anemia from B12 deficiency; check intrinsic factor antibodies
B. Microcytic anemia from iron deficiency; investigate menstrual blood loss and GI bleeding
[CORRECT]
C. Normocytic anemia from chronic kidney disease; check renal function
D. Hemolytic anemia from autoimmune destruction; check reticulocyte count
Correct Answer: B
Rationale: Low hemoglobin (9.2 g/dL) with low MCV (72 fL, microcytic) and low ferritin (8 ng/mL, iron stores
depleted) indicates iron deficiency anemia. In a 28-year-old female, the most common cause is menstrual blood loss; GI
bleeding should also be investigated (especially in older patients or those with GI symptoms). Macrocytic anemia
(option A) has high MCV (>100). Normocytic anemia (option C) has normal MCV. Hemolytic anemia (option D)
shows high reticulocytes. Treatment: oral iron sulfate 325 mg every other day with vitamin C, investigate and treat
underlying cause.
ANCC FNP - Brand New Version 1 (100 Questions) Page 3
, ANCC FNP Exam Version 1 - 2026/2027 | Complete 100 Q&A Verified | A+ Graded Family Nurse Practitioner Certification
Q8: A 55-year-old male with diabetes presents for routine follow-up. Which combination of monitoring
tests is appropriate for diabetic complication screening?
A. Annual eye exam, annual urine microalbumin, annual foot exam, daily glucose logs, quarterly A1C
[CORRECT]
B. Eye exam every 5 years, urinalysis as needed, foot exam when symptomatic, glucose monthly, A1C annually
C. No monitoring needed if asymptomatic
D. Eye exam only if visual symptoms, no urine testing, foot exam annually, A1C semi-annually
Correct Answer: A
Rationale: ADA-recommended monitoring for diabetic complications: annual dilated eye exam (retinopathy), annual
urine microalbumin (nephropathy), annual comprehensive foot exam (neuropathy), daily glucose self-monitoring, A1C
quarterly if not at goal or semi-annually if at goal. Also: BP every visit, annual lipid panel, annual dental exam, annual
flu vaccine. Tertiary prevention aims to detect complications early when treatment can prevent progression.
Proliferative retinopathy requires ophthalmology referral for laser photostatin. ACEi/ARB for microalbuminuria
prevents nephropathy progression.
Q9: A 70-year-old female presents with acute confusion over 2 days. She was recently started on a new
medication. Which medication class is most likely to cause delirium in elderly patients per Beers
Criteria?
A. Statin
B. Anticholinergic medication (e.g., diphenhydramine, oxybutynin, tricyclic antidepressants)
[CORRECT]
C. Beta-blocker
D. ACE inhibitor
Correct Answer: B
Rationale: Anticholinergic medications are high-risk for delirium in elderly per Beers Criteria. Common culprits:
diphenhydramine (Benadryl), oxybutynin, TCAs (amitriptyline), hydroxyzine, promethazine. Anticholinergic effects
cause confusion, dry mouth, urinary retention, constipation, blurred vision. Cumulative anticholinergic burden increases
dementia risk. Statins (option A), beta-blockers (option C), and ACE inhibitors (option D) are not typically deliriogenic.
Delirium workup: review medications (especially anticholinergics, benzodiazepines, opioids), evaluate for infection
(UTI, pneumonia), metabolic abnormalities, hypoxia, dehydration.
ANCC FNP - Brand New Version 1 (100 Questions) Page 4
