ANCC Family Nurse Practitioner (FNP) Exam
Guide – WGU D120 OBJECTIVE ASSESSMENT
ACTUAL EXAM STUDY GUIDE 2025/2026
COMPLETE QUESTIONS AND CORRECT
DETAILED
ANCC Family Nurse Practitioner (FNP) Exam Practice Questions & Answers
Health Promotion & Disease Prevention
1. A 45-year-old patient with no significant past medical history presents for a routine
physical. They have no complaints. Which of the following screening recommendations is
most appropriate according to the US Preventive Services Task Force (USPSTF)?
A. Annual serum creatinine for chronic kidney disease.
B. Screening for abdominal aortic aneurysm with ultrasonography.
C. Annual chest X-ray for lung cancer.
D. Screening for vitamin D deficiency.
Answer: B
Rationale: The USPSTF recommends a one-time screening for abdominal aortic aneurysm (AAA)
with ultrasonography in men aged 65 to 75 years who have ever smoked. However, for this 45-
year-old, no routine screening for AAA, creatinine, or vitamin D is recommended without risk
factors. The USPSTF recommends low-dose CT scans for lung cancer only in high-risk adults (age
50-80, 20 pack-year history, current smoker or quit within last 15 years). This question tests
knowledge of age and risk-factor-specific screening.
2. The parents of a 2-week-old newborn are concerned about Sudden Infant Death Syndrome
(SIDS). Which of the following is the most effective advice to reduce the risk?
A. Place the infant to sleep in a prone position.
B. Share a bed with the infant.
C. Use a firm sleep surface with no soft bedding.
D. Offer a pacifier dipped in honey at bedtime.
Answer: C
Rationale: The "Back to Sleep" campaign recommends placing infants supine (on their back) to
sleep, on a firm surface without soft bedding, pillows, or stuffed animals to reduce the risk of
,SIDS. Bed-sharing increases risk. Honey is contraindicated in infants under 1 year due to the risk
of botulism.
3. A 55-year-old female requests a "bone density test." She is healthy, post-menopausal, and
has no risk factors for osteoporosis other than her age and gender. What is the most
appropriate initial action?
A. Order a dual-energy X-ray absorptiometry (DEXA) scan.
B. Prescribe calcium and vitamin D and re-evaluate in one year.
C. Use the FRAX® tool to assess her 10-year fracture probability.
D. Reassure her that screening is not indicated until age 65.
Answer: D
Rationale: The USPSTF recommends routine screening for osteoporosis with DEXA for women
aged 65 and older and for younger women whose fracture risk is equal to or greater than that of
a 65-year-old white woman with no additional risk factors. For a healthy 55-year-old with no
additional risk factors, screening is not yet recommended. The FRAX tool is used when risk
factors are present.
4. A 30-year-old patient is preparing for international travel to a region with endemic hepatitis
A. What is the best prophylactic measure?
A. Hepatitis A immune globulin only.
B. Hepatitis A vaccine only.
C. Both hepatitis A vaccine and immune globulin.
D. No prophylaxis is needed for this age group.
Answer: B
Rationale: The hepatitis A vaccine is the preferred pre-exposure prophylaxis for all eligible
persons aged ≥12 months. Immune globulin is an alternative for those who are
immunocompromised, have chronic liver disease, or are allergic to the vaccine.
5. During a well-child visit for a 5-year-old, the parent expresses concern about lead exposure
from old paint in their home. The child is asymptomatic. What is the best initial step?
A. Order a venous blood lead level.
B. Provide educational materials on nutrition to mitigate lead absorption.
C. Prescribe chelation therapy prophylactically.
D. Reassure the parent that the risk is low.
Answer: A
Rationale: For children at risk of exposure (e.g., living in a home built before 1978), screening
with a blood lead level is indicated, even if asymptomatic. Education is important but does not
replace objective testing. Chelation is only for confirmed high levels.
Assessment & Diagnosis
,6. A 68-year-old male presents with acute onset of "the worst headache of my life" that began
suddenly during exertion. He has nuchal rigidity. What is the most likely diagnosis?
A. Tension headache.
B. Migraine with aura.
C. Subarachnoid hemorrhage.
D. Temporal arteritis.
Answer: C
Rationale: The classic presentation of a subarachnoid hemorrhage (often from a ruptured
cerebral aneurysm) is a sudden, severe "thunderclap" headache, often associated with neck
stiffness (nuchal rigidity).
7. A 25-year-old female presents with malar rash, photosensitivity, and painful, swollen joints
in her hands. Which laboratory test is most specific for the suspected diagnosis?
A. Antinuclear antibody (ANA).
B. Anti-double-stranded DNA (anti-dsDNA).
C. Erythrocyte sedimentation rate (ESR).
D. Rheumatoid factor (RF).
Answer: B
Rationale: While ANA is highly sensitive for Systemic Lupus Erythematosus (SLE), anti-dsDNA is
highly specific for SLE and correlates with disease activity, especially lupus nephritis. RF is more
associated with Rheumatoid Arthritis.
8. A 60-year-old patient with a history of COPD presents with increased shortness of breath,
purulent sputum, and wheezing. Vital signs: Temp 100.8°F, HR 102, RR 26, SpO2 88% on room
air. What is the most appropriate initial diagnosis?
A. Pulmonary embolism.
B. Acute COPD exacerbation.
C. Spontaneous pneumothorax.
D. Congestive heart failure.
Answer: B
Rationale: This presentation (increased dyspnea, sputum purulence, and wheezing in a COPD
patient) is the classic triad for an acute exacerbation of COPD, often triggered by infection.
9. A 4-year-old child is brought in with a 2-day history of barking cough, stridor, and mild
fever. Symptoms are worse at night. The child is alert and has moderate respiratory distress.
What is the most likely diagnosis?
A. Epiglottitis.
B. Bacterial tracheitis.
C. Foreign body aspiration.
, D. Viral croup.
Answer: D
Rationale: Viral croup (laryngotracheobronchitis) typically affects children 6 months to 3 years
and presents with a barking cough, stridor, and hoarseness, often preceded by a URI. Symptoms
often have a diurnal pattern, worsening at night. Epiglottitis is more acute and severe with a
high fever, toxic appearance, and drooling.
10. A 50-year-old male presents with colicky right upper quadrant pain that radiates to the
right scapula and is associated with nausea and fatty food intolerance. What is the most likely
finding on ultrasound?
A. Gallstones (cholelithiasis).
B. Thickened gallbladder wall.
C. Stones in the common bile duct.
D. Stones in the gallbladder with sonographic Murphy's sign.
Answer: D
Rationale: The symptoms are classic for acute cholecystitis. While gallstones (A) are common,
the presence of sonographic Murphy's sign (pain when the transducer presses on the
gallbladder) confirms acute inflammation, distinguishing it from simple cholelithiasis.
Pharmacology & Therapeutics
11. A patient with Type 2 Diabetes is started on Metformin. What is the most important
patient education point regarding a serious adverse effect?
A. Report any metallic taste, as it indicates toxicity.
B. The medication must be stopped before procedures with IV contrast.
C. Always take with a full glass of water to prevent esophageal ulceration.
D. Avoid direct sunlight due to photosensitivity.
Answer: B
Rationale: Metformin carries a risk of Lactic Acidosis, which is rare but fatal. The risk is
significantly increased in the setting of acute kidney injury from IV contrast dye. It must be held
before and after such procedures until renal function is confirmed to be normal.
12. Which class of antihypertensive is considered first-line for a patient with diabetes and
proteinuria?
A. Thiazide diuretic.
B. Beta-blocker.
C. Angiotensin-Converting Enzyme Inhibitor (ACE-I).
D. Dihydropyridine calcium channel blocker.
Answer: C
Rationale: ACE-Inhibitors (and ARBs) are first-line in patients with diabetes and proteinuria
Guide – WGU D120 OBJECTIVE ASSESSMENT
ACTUAL EXAM STUDY GUIDE 2025/2026
COMPLETE QUESTIONS AND CORRECT
DETAILED
ANCC Family Nurse Practitioner (FNP) Exam Practice Questions & Answers
Health Promotion & Disease Prevention
1. A 45-year-old patient with no significant past medical history presents for a routine
physical. They have no complaints. Which of the following screening recommendations is
most appropriate according to the US Preventive Services Task Force (USPSTF)?
A. Annual serum creatinine for chronic kidney disease.
B. Screening for abdominal aortic aneurysm with ultrasonography.
C. Annual chest X-ray for lung cancer.
D. Screening for vitamin D deficiency.
Answer: B
Rationale: The USPSTF recommends a one-time screening for abdominal aortic aneurysm (AAA)
with ultrasonography in men aged 65 to 75 years who have ever smoked. However, for this 45-
year-old, no routine screening for AAA, creatinine, or vitamin D is recommended without risk
factors. The USPSTF recommends low-dose CT scans for lung cancer only in high-risk adults (age
50-80, 20 pack-year history, current smoker or quit within last 15 years). This question tests
knowledge of age and risk-factor-specific screening.
2. The parents of a 2-week-old newborn are concerned about Sudden Infant Death Syndrome
(SIDS). Which of the following is the most effective advice to reduce the risk?
A. Place the infant to sleep in a prone position.
B. Share a bed with the infant.
C. Use a firm sleep surface with no soft bedding.
D. Offer a pacifier dipped in honey at bedtime.
Answer: C
Rationale: The "Back to Sleep" campaign recommends placing infants supine (on their back) to
sleep, on a firm surface without soft bedding, pillows, or stuffed animals to reduce the risk of
,SIDS. Bed-sharing increases risk. Honey is contraindicated in infants under 1 year due to the risk
of botulism.
3. A 55-year-old female requests a "bone density test." She is healthy, post-menopausal, and
has no risk factors for osteoporosis other than her age and gender. What is the most
appropriate initial action?
A. Order a dual-energy X-ray absorptiometry (DEXA) scan.
B. Prescribe calcium and vitamin D and re-evaluate in one year.
C. Use the FRAX® tool to assess her 10-year fracture probability.
D. Reassure her that screening is not indicated until age 65.
Answer: D
Rationale: The USPSTF recommends routine screening for osteoporosis with DEXA for women
aged 65 and older and for younger women whose fracture risk is equal to or greater than that of
a 65-year-old white woman with no additional risk factors. For a healthy 55-year-old with no
additional risk factors, screening is not yet recommended. The FRAX tool is used when risk
factors are present.
4. A 30-year-old patient is preparing for international travel to a region with endemic hepatitis
A. What is the best prophylactic measure?
A. Hepatitis A immune globulin only.
B. Hepatitis A vaccine only.
C. Both hepatitis A vaccine and immune globulin.
D. No prophylaxis is needed for this age group.
Answer: B
Rationale: The hepatitis A vaccine is the preferred pre-exposure prophylaxis for all eligible
persons aged ≥12 months. Immune globulin is an alternative for those who are
immunocompromised, have chronic liver disease, or are allergic to the vaccine.
5. During a well-child visit for a 5-year-old, the parent expresses concern about lead exposure
from old paint in their home. The child is asymptomatic. What is the best initial step?
A. Order a venous blood lead level.
B. Provide educational materials on nutrition to mitigate lead absorption.
C. Prescribe chelation therapy prophylactically.
D. Reassure the parent that the risk is low.
Answer: A
Rationale: For children at risk of exposure (e.g., living in a home built before 1978), screening
with a blood lead level is indicated, even if asymptomatic. Education is important but does not
replace objective testing. Chelation is only for confirmed high levels.
Assessment & Diagnosis
,6. A 68-year-old male presents with acute onset of "the worst headache of my life" that began
suddenly during exertion. He has nuchal rigidity. What is the most likely diagnosis?
A. Tension headache.
B. Migraine with aura.
C. Subarachnoid hemorrhage.
D. Temporal arteritis.
Answer: C
Rationale: The classic presentation of a subarachnoid hemorrhage (often from a ruptured
cerebral aneurysm) is a sudden, severe "thunderclap" headache, often associated with neck
stiffness (nuchal rigidity).
7. A 25-year-old female presents with malar rash, photosensitivity, and painful, swollen joints
in her hands. Which laboratory test is most specific for the suspected diagnosis?
A. Antinuclear antibody (ANA).
B. Anti-double-stranded DNA (anti-dsDNA).
C. Erythrocyte sedimentation rate (ESR).
D. Rheumatoid factor (RF).
Answer: B
Rationale: While ANA is highly sensitive for Systemic Lupus Erythematosus (SLE), anti-dsDNA is
highly specific for SLE and correlates with disease activity, especially lupus nephritis. RF is more
associated with Rheumatoid Arthritis.
8. A 60-year-old patient with a history of COPD presents with increased shortness of breath,
purulent sputum, and wheezing. Vital signs: Temp 100.8°F, HR 102, RR 26, SpO2 88% on room
air. What is the most appropriate initial diagnosis?
A. Pulmonary embolism.
B. Acute COPD exacerbation.
C. Spontaneous pneumothorax.
D. Congestive heart failure.
Answer: B
Rationale: This presentation (increased dyspnea, sputum purulence, and wheezing in a COPD
patient) is the classic triad for an acute exacerbation of COPD, often triggered by infection.
9. A 4-year-old child is brought in with a 2-day history of barking cough, stridor, and mild
fever. Symptoms are worse at night. The child is alert and has moderate respiratory distress.
What is the most likely diagnosis?
A. Epiglottitis.
B. Bacterial tracheitis.
C. Foreign body aspiration.
, D. Viral croup.
Answer: D
Rationale: Viral croup (laryngotracheobronchitis) typically affects children 6 months to 3 years
and presents with a barking cough, stridor, and hoarseness, often preceded by a URI. Symptoms
often have a diurnal pattern, worsening at night. Epiglottitis is more acute and severe with a
high fever, toxic appearance, and drooling.
10. A 50-year-old male presents with colicky right upper quadrant pain that radiates to the
right scapula and is associated with nausea and fatty food intolerance. What is the most likely
finding on ultrasound?
A. Gallstones (cholelithiasis).
B. Thickened gallbladder wall.
C. Stones in the common bile duct.
D. Stones in the gallbladder with sonographic Murphy's sign.
Answer: D
Rationale: The symptoms are classic for acute cholecystitis. While gallstones (A) are common,
the presence of sonographic Murphy's sign (pain when the transducer presses on the
gallbladder) confirms acute inflammation, distinguishing it from simple cholelithiasis.
Pharmacology & Therapeutics
11. A patient with Type 2 Diabetes is started on Metformin. What is the most important
patient education point regarding a serious adverse effect?
A. Report any metallic taste, as it indicates toxicity.
B. The medication must be stopped before procedures with IV contrast.
C. Always take with a full glass of water to prevent esophageal ulceration.
D. Avoid direct sunlight due to photosensitivity.
Answer: B
Rationale: Metformin carries a risk of Lactic Acidosis, which is rare but fatal. The risk is
significantly increased in the setting of acute kidney injury from IV contrast dye. It must be held
before and after such procedures until renal function is confirmed to be normal.
12. Which class of antihypertensive is considered first-line for a patient with diabetes and
proteinuria?
A. Thiazide diuretic.
B. Beta-blocker.
C. Angiotensin-Converting Enzyme Inhibitor (ACE-I).
D. Dihydropyridine calcium channel blocker.
Answer: C
Rationale: ACE-Inhibitors (and ARBs) are first-line in patients with diabetes and proteinuria
