ANCC Family Nurse Practitioner (FNP)
Certification Practice Exam (2026-27 Edition) –
Board Review & Comprehensive Assessment | A+
Predictor Questions
75 Questions | 100 % Board-Aligned Rationales
DOMAIN I – Assessment & Diagnosis (24 Q)
Q1
28-y/o G2P1 32 wk GA. BP 142/92 (baseline 110/70), urine dip 1+ protein, mild pedal
edema.
Next step?
A. Induce at 37 wk
B. Start labetalol 100 mg BID
C. 24-h urine & BP recheck 3-4 d
D. Admit for MgSO₄
Correct: C
Board Rationale
,Domain: I – Task: interpret diagnostics for hypertensive disorders.
ACOG 2026: preeclampsia requires sustained ≥140/90 ×2 ≥4 h apart AND ≥300 mg/24 h
protein (or P/Cr ≥0.3). Single BP + trace dipstick insufficient; quantify protein & confirm
persistence.
Errors: A premature diagnosis; B treats unconfirmed disease; D overtreatment.
Takeaway: Always confirm proteinuria quantitatively before preeclampsia label.
Q2
45-y/o man 3-mo fatigue, 10-lb weight gain, dry skin. TSH 6.8 mIU/L (nl 0.4-4.2), free T₄
1.1 ng/dL (nl).
Diagnosis?
A. Subclinical hypothyroidism
B. Primary overt hypothyroidism
C. Sick-euthyroid
D. Central hypothyroidism
Correct: A
Rationale
Elevated TSH + normal free T₄ = subclinical hypothyroidism (ATA 2025). No symptoms
mandate treatment unless TSH >10 or pregnancy.
Errors: B requires low free T₄; C usually low TSH; D low/low-normal TSH.
,Takeaway: Do not treat subclinical hypothyroidism with TSH <10 in non-pregnant adults
without compelling symptoms.
Q3
22-y/o woman acute dysuria, frequency, no vaginal discharge, no fever. UA: 15 WBCs,
positive leukocyte esterase, negative nitrite.
Most likely pathogen?
A. E. coli
B. Chlamydia trachomatis
C. Candida albicans
D. Staphylococcus saprophyticus
Correct: A
Rationale
Negative nitrite suggests non-E. coli coliform (e.g., Enterococcus, S. saprophyticus), but
E. coli remains most common overall (70-95 %).
Errors: B causes urethritis (pyuria only); C causes vaginitis; D less common.
Takeaway: Start empiric nitrofurantoin or TMP-SMX pending culture.
Q4
60-y/o man COPD GOLD C, 2 L O₂, now RR 32, using accessory muscles, ABG: pH 7.25,
PaCO₂ 75, PaO₂ 55, HCO₃ 34.
Acid-base disorder?
, A. Acute respiratory acidosis
B. Chronic respiratory acidosis with acute on chronic
C. Acute metabolic acidosis
D. Mixed respiratory & metabolic alkalosis
Correct: B
Rationale
pH <7.35 + ↑PaCO₂ + ↑HCO₃ (compensated) = acute exacerbation on chronic respiratory
acidosis (expected HCO₃ = 24 + (75-40)×0.4 ≈ 38).
Errors: A would show normal HCO₃; C low HCO₃; D opposite direction.
Takeaway: Calculate expected compensation to detect acute worsening.
Q5
35-y/o woman 4-wk low back pain, no trauma, night pain, morning stiffness >1 h,
negative straight-leg raise.
Red flag most suggests?
A. Disc herniation
B. Ankylosing spondylitis
C. Osteoporotic fracture
D. Mechanical strain
Correct: B
Certification Practice Exam (2026-27 Edition) –
Board Review & Comprehensive Assessment | A+
Predictor Questions
75 Questions | 100 % Board-Aligned Rationales
DOMAIN I – Assessment & Diagnosis (24 Q)
Q1
28-y/o G2P1 32 wk GA. BP 142/92 (baseline 110/70), urine dip 1+ protein, mild pedal
edema.
Next step?
A. Induce at 37 wk
B. Start labetalol 100 mg BID
C. 24-h urine & BP recheck 3-4 d
D. Admit for MgSO₄
Correct: C
Board Rationale
,Domain: I – Task: interpret diagnostics for hypertensive disorders.
ACOG 2026: preeclampsia requires sustained ≥140/90 ×2 ≥4 h apart AND ≥300 mg/24 h
protein (or P/Cr ≥0.3). Single BP + trace dipstick insufficient; quantify protein & confirm
persistence.
Errors: A premature diagnosis; B treats unconfirmed disease; D overtreatment.
Takeaway: Always confirm proteinuria quantitatively before preeclampsia label.
Q2
45-y/o man 3-mo fatigue, 10-lb weight gain, dry skin. TSH 6.8 mIU/L (nl 0.4-4.2), free T₄
1.1 ng/dL (nl).
Diagnosis?
A. Subclinical hypothyroidism
B. Primary overt hypothyroidism
C. Sick-euthyroid
D. Central hypothyroidism
Correct: A
Rationale
Elevated TSH + normal free T₄ = subclinical hypothyroidism (ATA 2025). No symptoms
mandate treatment unless TSH >10 or pregnancy.
Errors: B requires low free T₄; C usually low TSH; D low/low-normal TSH.
,Takeaway: Do not treat subclinical hypothyroidism with TSH <10 in non-pregnant adults
without compelling symptoms.
Q3
22-y/o woman acute dysuria, frequency, no vaginal discharge, no fever. UA: 15 WBCs,
positive leukocyte esterase, negative nitrite.
Most likely pathogen?
A. E. coli
B. Chlamydia trachomatis
C. Candida albicans
D. Staphylococcus saprophyticus
Correct: A
Rationale
Negative nitrite suggests non-E. coli coliform (e.g., Enterococcus, S. saprophyticus), but
E. coli remains most common overall (70-95 %).
Errors: B causes urethritis (pyuria only); C causes vaginitis; D less common.
Takeaway: Start empiric nitrofurantoin or TMP-SMX pending culture.
Q4
60-y/o man COPD GOLD C, 2 L O₂, now RR 32, using accessory muscles, ABG: pH 7.25,
PaCO₂ 75, PaO₂ 55, HCO₃ 34.
Acid-base disorder?
, A. Acute respiratory acidosis
B. Chronic respiratory acidosis with acute on chronic
C. Acute metabolic acidosis
D. Mixed respiratory & metabolic alkalosis
Correct: B
Rationale
pH <7.35 + ↑PaCO₂ + ↑HCO₃ (compensated) = acute exacerbation on chronic respiratory
acidosis (expected HCO₃ = 24 + (75-40)×0.4 ≈ 38).
Errors: A would show normal HCO₃; C low HCO₃; D opposite direction.
Takeaway: Calculate expected compensation to detect acute worsening.
Q5
35-y/o woman 4-wk low back pain, no trauma, night pain, morning stiffness >1 h,
negative straight-leg raise.
Red flag most suggests?
A. Disc herniation
B. Ankylosing spondylitis
C. Osteoporotic fracture
D. Mechanical strain
Correct: B
