ANCC FNP Certification 2025/2026 –
Verified Exam Questions with Correct
Answers
Advanced Assessment Questions
Question 1
A 45-year-old female presents with acute onset of severe headache, nausea, and photophobia. On
examination, she has nuchal rigidity and a positive Kernig's sign. What is the most likely
diagnosis?
A. Migraine headache
B. Tension headache
C. Bacterial meningitis
D. Subarachnoid hemorrhage
Correct Answer: C. Bacterial meningitis
Rationale: The classic triad of fever, headache, and neck stiffness (nuchal rigidity) with positive
Kernig's and Brudzinski's signs strongly suggests bacterial meningitis. Immediate lumbar
puncture and antibiotics are required. Migraines lack meningeal signs, tension headaches are
bilateral without nausea, and subarachnoid hemorrhage typically presents with thunderclap
headache without fever.
Question 2
During a routine physical exam, a 60-year-old male has a blood pressure of 160/100 mmHg.
What is the most appropriate initial assessment step?
A. Prescribe an antihypertensive immediately
B. Order a 24-hour urine collection for aldosterone
C. Repeat the blood pressure measurement after 5 minutes of rest
D. Refer to cardiology
Correct Answer: C. Repeat the blood pressure measurement after 5 minutes of rest
Rationale: White coat hypertension is common; guidelines recommend confirming elevated
readings with a repeat measurement in a rested state. If persistently elevated, further evaluation
for secondary causes may be needed, but initial confirmation is key.
Question 3
A 25-year-old pregnant woman at 32 weeks gestation reports decreased fetal movement. What is
the priority assessment?
,A. Non-stress test
B. Ultrasound for biophysical profile
C. Urinalysis for proteinuria
D. Blood glucose level
Correct Answer: A. Non-stress test
Rationale: Decreased fetal movement warrants immediate fetal heart rate monitoring via non-
stress test to assess for fetal well-being. Biophysical profile follows if NST is non-reactive, while
proteinuria and glucose relate to maternal conditions like preeclampsia or gestational diabetes.
Question 4
In assessing a patient with suspected acute coronary syndrome, which ECG finding is most
indicative of myocardial infarction?
A. Sinus tachycardia
B. ST-segment elevation in contiguous leads
C. First-degree AV block
D. Premature ventricular contractions
Correct Answer: B. ST-segment elevation in contiguous leads
Rationale: STEMI is diagnosed by ST elevation ≥1 mm in two contiguous leads, indicating
transmural ischemia requiring emergent reperfusion. Other findings may be present but are not
diagnostic alone.
Question 5
A 70-year-old with dementia presents with confusion and urinary incontinence. What assessment
tool is best for delirium?
A. Mini-Mental State Examination (MMSE)
B. Confusion Assessment Method (CAM)
C. Montreal Cognitive Assessment (MoCA)
D. Clock Drawing Test
Correct Answer: B. Confusion Assessment Method (CAM)
Rationale: CAM is the gold standard for rapid delirium screening, assessing acute onset,
inattention, altered consciousness, and disorganized thinking. MMSE and MoCA evaluate
chronic cognition, while clock drawing is adjunctive.
Question 6
A child with stridor at rest and drooling is suspected of epiglottitis. What is the most appropriate
initial assessment?
A. Throat inspection with tongue depressor
B. Lateral neck X-ray
, C. Nasopharyngeal swab
D. Secure airway in OR
Correct Answer: D. Secure airway in OR
Rationale: Epiglottitis is a medical emergency; manipulation like throat exam can precipitate
obstruction. Direct to OR for visualization and intubation. Imaging or swabs are secondary.
Question 7
During pelvic exam, a 30-year-old woman has a friable, red lesion on the cervix. What is the
next assessment step?
A. Colposcopy
B. Pap smear
C. Biopsy
D. HPV testing
Correct Answer: A. Colposcopy
Rationale: Suspicious cervical lesions require colposcopy for directed biopsy to rule out CIN or
cancer. Pap smear is screening, not diagnostic for visible lesions.
Question 8
A 50-year-old with rheumatoid arthritis reports morning stiffness >1 hour. What joint assessment
finding confirms active synovitis?
A. Heberden's nodes
B. Bouchard's nodes
C. Warm, boggy joints
D. Crepitus
Correct Answer: C. Warm, boggy joints
Rationale: Active RA features synovial inflammation causing warmth, swelling (boggy), and
tenderness. Nodes are in OA, crepitus in degenerative disease.
Question 9
In evaluating a neonate with jaundice on day 2 of life, what lab is priority?
A. Total bilirubin
B. Direct Coombs test
C. Blood type
D. G6PD screen
Correct Answer: A. Total bilirubin
Verified Exam Questions with Correct
Answers
Advanced Assessment Questions
Question 1
A 45-year-old female presents with acute onset of severe headache, nausea, and photophobia. On
examination, she has nuchal rigidity and a positive Kernig's sign. What is the most likely
diagnosis?
A. Migraine headache
B. Tension headache
C. Bacterial meningitis
D. Subarachnoid hemorrhage
Correct Answer: C. Bacterial meningitis
Rationale: The classic triad of fever, headache, and neck stiffness (nuchal rigidity) with positive
Kernig's and Brudzinski's signs strongly suggests bacterial meningitis. Immediate lumbar
puncture and antibiotics are required. Migraines lack meningeal signs, tension headaches are
bilateral without nausea, and subarachnoid hemorrhage typically presents with thunderclap
headache without fever.
Question 2
During a routine physical exam, a 60-year-old male has a blood pressure of 160/100 mmHg.
What is the most appropriate initial assessment step?
A. Prescribe an antihypertensive immediately
B. Order a 24-hour urine collection for aldosterone
C. Repeat the blood pressure measurement after 5 minutes of rest
D. Refer to cardiology
Correct Answer: C. Repeat the blood pressure measurement after 5 minutes of rest
Rationale: White coat hypertension is common; guidelines recommend confirming elevated
readings with a repeat measurement in a rested state. If persistently elevated, further evaluation
for secondary causes may be needed, but initial confirmation is key.
Question 3
A 25-year-old pregnant woman at 32 weeks gestation reports decreased fetal movement. What is
the priority assessment?
,A. Non-stress test
B. Ultrasound for biophysical profile
C. Urinalysis for proteinuria
D. Blood glucose level
Correct Answer: A. Non-stress test
Rationale: Decreased fetal movement warrants immediate fetal heart rate monitoring via non-
stress test to assess for fetal well-being. Biophysical profile follows if NST is non-reactive, while
proteinuria and glucose relate to maternal conditions like preeclampsia or gestational diabetes.
Question 4
In assessing a patient with suspected acute coronary syndrome, which ECG finding is most
indicative of myocardial infarction?
A. Sinus tachycardia
B. ST-segment elevation in contiguous leads
C. First-degree AV block
D. Premature ventricular contractions
Correct Answer: B. ST-segment elevation in contiguous leads
Rationale: STEMI is diagnosed by ST elevation ≥1 mm in two contiguous leads, indicating
transmural ischemia requiring emergent reperfusion. Other findings may be present but are not
diagnostic alone.
Question 5
A 70-year-old with dementia presents with confusion and urinary incontinence. What assessment
tool is best for delirium?
A. Mini-Mental State Examination (MMSE)
B. Confusion Assessment Method (CAM)
C. Montreal Cognitive Assessment (MoCA)
D. Clock Drawing Test
Correct Answer: B. Confusion Assessment Method (CAM)
Rationale: CAM is the gold standard for rapid delirium screening, assessing acute onset,
inattention, altered consciousness, and disorganized thinking. MMSE and MoCA evaluate
chronic cognition, while clock drawing is adjunctive.
Question 6
A child with stridor at rest and drooling is suspected of epiglottitis. What is the most appropriate
initial assessment?
A. Throat inspection with tongue depressor
B. Lateral neck X-ray
, C. Nasopharyngeal swab
D. Secure airway in OR
Correct Answer: D. Secure airway in OR
Rationale: Epiglottitis is a medical emergency; manipulation like throat exam can precipitate
obstruction. Direct to OR for visualization and intubation. Imaging or swabs are secondary.
Question 7
During pelvic exam, a 30-year-old woman has a friable, red lesion on the cervix. What is the
next assessment step?
A. Colposcopy
B. Pap smear
C. Biopsy
D. HPV testing
Correct Answer: A. Colposcopy
Rationale: Suspicious cervical lesions require colposcopy for directed biopsy to rule out CIN or
cancer. Pap smear is screening, not diagnostic for visible lesions.
Question 8
A 50-year-old with rheumatoid arthritis reports morning stiffness >1 hour. What joint assessment
finding confirms active synovitis?
A. Heberden's nodes
B. Bouchard's nodes
C. Warm, boggy joints
D. Crepitus
Correct Answer: C. Warm, boggy joints
Rationale: Active RA features synovial inflammation causing warmth, swelling (boggy), and
tenderness. Nodes are in OA, crepitus in degenerative disease.
Question 9
In evaluating a neonate with jaundice on day 2 of life, what lab is priority?
A. Total bilirubin
B. Direct Coombs test
C. Blood type
D. G6PD screen
Correct Answer: A. Total bilirubin
