ANCC FNP BOARD EXAM LATEST 2025/
2026 ACTUAL EXAM TEST BANK| FAMILY
NURSING PRACTITIONER ANCC
BOARD EXAM PREP WITH COMPLETE
100 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+ (MOST RECENT!!)
1. A 45-year-old male presents with episodic palpitations,
sweating, and headache. His blood pressure is 180/100 mm Hg
during one episode but normal between episodes. What is the
most likely diagnosis?
A) Essential hypertension
B) Panic disorder
C) Pheochromocytoma
D) Hyperthyroidism
Answer: C) Pheochromocytoma
Rationale: Pheochromocytoma presents with paroxysmal hypertension, palpitations,
diaphoresis, and headache. Episodic symptoms with normal inter-episode BP are classic.
Panic disorder can mimic this but is a diagnosis of exclusion after ruling out organic
causes.
,2. A 68-year-old female reports several weeks of generalized
weakness, unintentional weight loss, and low-grade fevers. On
exam, you palpate a painless, non-tender, pulsatile mass in the
mid-abdomen. What is the most appropriate next step?
A) Abdominal ultrasound
B) CBC with differential
C) Colonoscopy
D) Empiric antibiotics
Answer: A) Abdominal ultrasound
Rationale: A pulsatile abdominal mass in an older patient suggests abdominal aortic
aneurysm (AAA). Ultrasound is the initial imaging modality to confirm diagnosis and
measure size. Symptomatic or large AAA requires surgical referral.
3. A 32-year-old G2P1 at 28 weeks gestation presents with a
blood pressure of 150/95 mm Hg and 2+ proteinuria on dipstick.
She denies headache or visual changes. What is the most
appropriate next step?
A) Diagnose gestational hypertension and schedule follow-up in 1 week
B) Order 24-hour urine protein and initiate labetalol
C) Admit for magnesium sulfate and delivery
D) Diagnose preeclampsia without severe features and monitor with twice-weekly
testing
Answer: D) Diagnose preeclampsia without severe features and monitor with twice-
weekly testing
Rationale: New-onset hypertension after 20 weeks with proteinuria defines
preeclampsia. Without severe features (no CNS symptoms, no thrombocytopenia,
normal LFTs, no pulmonary edema), outpatient monitoring with fetal surveillance and BP
checks is appropriate. Admission and delivery are for severe features or term gestation.
,4. A 55-year-old male with a 30-pack-year smoking history
presents with new hoarseness for 3 weeks. He denies sore throat
or URI symptoms. Laryngoscopy shows a left vocal cord lesion.
What is the most important next step?
A) Reassure and re-evaluate in 4 weeks
B) Start proton pump inhibitor for possible reflux
C) Refer for biopsy
D) Prescribe voice rest and hydration
Answer: C) Refer for biopsy
Rationale: Hoarseness lasting >2 weeks in a smoker warrants direct visualization and
biopsy to rule out laryngeal cancer. Delay can affect staging and prognosis.
5. A 7-year-old boy presents with limping and right hip pain for 2
days. He is afebrile and refuses to bear weight. What physical
exam finding is most suggestive of transient synovitis versus
septic arthritis?
A) Pain with internal rotation of the hip
B) Erythema and warmth over the hip
C) Ability to bear weight when distracted
D) Flexion, abduction, external rotation positioning
Answer: C) Ability to bear weight when distracted
Rationale: Transient synovitis typically allows weight-bearing once the child is
distracted, whereas septic arthritis causes refusal to bear weight regardless. Fever,
marked elevation in ESR/CRP, and severe pain with any hip motion favor septic arthritis.
, Domain: Diagnosis & Pathophysiology
6. A 24-year-old female presents with fatigue, diffuse joint pain,
and a malar rash. Labs show ANA positive, anti-dsDNA positive,
and hypocomplementemia. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Sjögren’s syndrome
D) Fibromyalgia
Answer: B) Systemic lupus erythematosus
Rationale: Malar rash, arthritis, ANA positivity, anti-dsDNA (highly specific), and low
complement are diagnostic for SLE. Anti-dsDNA correlates with disease activity and
lupus nephritis.
7. A 60-year-old female presents with progressive dyspnea on
exertion and a nonproductive cough. She has never smoked.
Chest X-ray shows bilateral interstitial infiltrates with
honeycombing in the lung bases. What is the most likely
diagnosis?
A) Sarcoidosis
B) Idiopathic pulmonary fibrosis
C) Congestive heart failure
D) Hypersensitivity pneumonitis
Answer: B) Idiopathic pulmonary fibrosis
Rationale: IPF presents with insidious dyspnea, dry cough, basal predominant interstitial
changes with honeycombing on HRCT. Sarcoidosis typically has upper lobe involvement
and hilar adenopathy.
2026 ACTUAL EXAM TEST BANK| FAMILY
NURSING PRACTITIONER ANCC
BOARD EXAM PREP WITH COMPLETE
100 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+ (MOST RECENT!!)
1. A 45-year-old male presents with episodic palpitations,
sweating, and headache. His blood pressure is 180/100 mm Hg
during one episode but normal between episodes. What is the
most likely diagnosis?
A) Essential hypertension
B) Panic disorder
C) Pheochromocytoma
D) Hyperthyroidism
Answer: C) Pheochromocytoma
Rationale: Pheochromocytoma presents with paroxysmal hypertension, palpitations,
diaphoresis, and headache. Episodic symptoms with normal inter-episode BP are classic.
Panic disorder can mimic this but is a diagnosis of exclusion after ruling out organic
causes.
,2. A 68-year-old female reports several weeks of generalized
weakness, unintentional weight loss, and low-grade fevers. On
exam, you palpate a painless, non-tender, pulsatile mass in the
mid-abdomen. What is the most appropriate next step?
A) Abdominal ultrasound
B) CBC with differential
C) Colonoscopy
D) Empiric antibiotics
Answer: A) Abdominal ultrasound
Rationale: A pulsatile abdominal mass in an older patient suggests abdominal aortic
aneurysm (AAA). Ultrasound is the initial imaging modality to confirm diagnosis and
measure size. Symptomatic or large AAA requires surgical referral.
3. A 32-year-old G2P1 at 28 weeks gestation presents with a
blood pressure of 150/95 mm Hg and 2+ proteinuria on dipstick.
She denies headache or visual changes. What is the most
appropriate next step?
A) Diagnose gestational hypertension and schedule follow-up in 1 week
B) Order 24-hour urine protein and initiate labetalol
C) Admit for magnesium sulfate and delivery
D) Diagnose preeclampsia without severe features and monitor with twice-weekly
testing
Answer: D) Diagnose preeclampsia without severe features and monitor with twice-
weekly testing
Rationale: New-onset hypertension after 20 weeks with proteinuria defines
preeclampsia. Without severe features (no CNS symptoms, no thrombocytopenia,
normal LFTs, no pulmonary edema), outpatient monitoring with fetal surveillance and BP
checks is appropriate. Admission and delivery are for severe features or term gestation.
,4. A 55-year-old male with a 30-pack-year smoking history
presents with new hoarseness for 3 weeks. He denies sore throat
or URI symptoms. Laryngoscopy shows a left vocal cord lesion.
What is the most important next step?
A) Reassure and re-evaluate in 4 weeks
B) Start proton pump inhibitor for possible reflux
C) Refer for biopsy
D) Prescribe voice rest and hydration
Answer: C) Refer for biopsy
Rationale: Hoarseness lasting >2 weeks in a smoker warrants direct visualization and
biopsy to rule out laryngeal cancer. Delay can affect staging and prognosis.
5. A 7-year-old boy presents with limping and right hip pain for 2
days. He is afebrile and refuses to bear weight. What physical
exam finding is most suggestive of transient synovitis versus
septic arthritis?
A) Pain with internal rotation of the hip
B) Erythema and warmth over the hip
C) Ability to bear weight when distracted
D) Flexion, abduction, external rotation positioning
Answer: C) Ability to bear weight when distracted
Rationale: Transient synovitis typically allows weight-bearing once the child is
distracted, whereas septic arthritis causes refusal to bear weight regardless. Fever,
marked elevation in ESR/CRP, and severe pain with any hip motion favor septic arthritis.
, Domain: Diagnosis & Pathophysiology
6. A 24-year-old female presents with fatigue, diffuse joint pain,
and a malar rash. Labs show ANA positive, anti-dsDNA positive,
and hypocomplementemia. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Sjögren’s syndrome
D) Fibromyalgia
Answer: B) Systemic lupus erythematosus
Rationale: Malar rash, arthritis, ANA positivity, anti-dsDNA (highly specific), and low
complement are diagnostic for SLE. Anti-dsDNA correlates with disease activity and
lupus nephritis.
7. A 60-year-old female presents with progressive dyspnea on
exertion and a nonproductive cough. She has never smoked.
Chest X-ray shows bilateral interstitial infiltrates with
honeycombing in the lung bases. What is the most likely
diagnosis?
A) Sarcoidosis
B) Idiopathic pulmonary fibrosis
C) Congestive heart failure
D) Hypersensitivity pneumonitis
Answer: B) Idiopathic pulmonary fibrosis
Rationale: IPF presents with insidious dyspnea, dry cough, basal predominant interstitial
changes with honeycombing on HRCT. Sarcoidosis typically has upper lobe involvement
and hilar adenopathy.
