ANCC FNP ACTUAL EXAM VERSION 1 2026 | 200 Real Exam
Questions and 100% Correct Answers Graded A+ | Family
Nurse Practitioner | 2026/2027 New | Pass Guaranteed
Domain 1: Assessment (35 Questions)
Q1: A 68-year-old male presents with progressive dyspnea on exertion, orthopnea, and
bilateral lower extremity edema. On physical examination, an S3 gallop is auscultated.
Which additional finding on cardiac examination would most strongly support a
diagnosis of heart failure with reduced ejection fraction (HFrEF)?
A. Holosystolic murmur at the apex radiating to the axilla
B. Fixed split S2 with loud P2
C. Displaced point of maximal impulse (PMI) laterally to the mid-axillary line
D. High-pitched early diastolic decrescendo murmur at the left sternal border
Correct Answer: C
Rationale: A laterally displaced PMI beyond the midclavicular line indicates cardiac
enlargement and volume overload, characteristic of HFrEF. The S3 gallop represents
rapid ventricular filling into a dilated, non-compliant ventricle. Option A describes mitral
regurgitation, which can cause heart failure but is not the most specific finding for
HFrEF diagnosis. Option B suggests an atrial septal defect with pulmonary
hypertension. Option D indicates aortic regurgitation. The displaced PMI combined with
S3 provides the strongest evidence for ventricular dilation in HFrEF. [CORRECT]
Q2: A 4-year-old child is brought to the clinic for a well-child visit. The parents are
concerned about developmental milestones. Which developmental milestone is most
appropriate for a typically developing 4-year-old?
A. Copies a circle and names four colors
B. Rides a tricycle and speaks in three-word sentences
C. Ties shoelaces and prints some letters
D. Uses a fork and spoon and jumps in place
,Correct Answer: A
Rationale: By age 4 years, children typically copy circles and squares, name four colors,
and speak in complete sentences of 4-5 words. Option B describes 3-year-old
milestones (tricycle riding, 3-word sentences). Option C describes 5-6 year milestones
(tying shoes, printing letters). Option D describes 2-year-old milestones (utensil use,
jumping). Denver II and Bright Futures guidelines support these developmental
expectations. [CORRECT]
Q3: A 35-year-old female presents with fatigue, cold intolerance, constipation, and
weight gain. Laboratory studies reveal TSH 12.5 mIU/L (normal 0.4-4.0) and free T4 0.6
ng/dL (normal 0.8-1.8). Which physical examination finding would be most consistent
with this diagnosis?
A. Exophthalmos and lid lag
B. Fine tremor and warm, moist skin
C. Periorbital myxedema and delayed relaxation phase of deep tendon reflexes
D. Thyroid bruit and pretibial myxedema
Correct Answer: C
Rationale: The laboratory values indicate primary hypothyroidism (elevated TSH, low
free T4). Physical findings include periorbital myxedema (non-pitting edema), coarse dry
skin, brittle hair, and delayed relaxation phase of deep tendon reflexes (hung-up
reflexes). Options A, B, and D describe hyperthyroidism/Graves' disease findings
(exophthalmos, tremor, warm skin, thyroid bruit, pretibial myxedema). The delayed
reflexes result from decreased metabolic rate affecting muscle contraction and
relaxation. [CORRECT]
Q4: A 58-year-old male with a 40 pack-year smoking history presents for a routine
physical. Which screening test is recommended by the USPSTF for lung cancer in this
patient?
A. Annual chest X-ray
B. Annual low-dose CT (LDCT) of the chest
C. Annual sputum cytology
,D. No screening recommended at this time
Correct Answer: B
Rationale: The USPSTF recommends annual LDCT screening for lung cancer in adults
aged 50-80 years with a 20 pack-year smoking history who currently smoke or quit
within the past 15 years (Grade B recommendation). Chest X-ray (Option A) has poor
sensitivity for early lung cancer detection. Sputum cytology (Option C) is not
recommended for screening. Screening should be discontinued once a person has not
smoked for 15 years or develops health problems limiting life expectancy or curative
treatment. [CORRECT]
Q5: A 28-year-old pregnant female at 28 weeks gestation presents for a prenatal visit.
Which laboratory test is routinely recommended at this gestational age?
A. Group B Streptococcus (GBS) screening
B. Gestational diabetes screening (glucose challenge test)
C. Triple/Quad screen for aneuploidy
D. Repeat CBC and antibody screen
Correct Answer: B
Rationale: Gestational diabetes screening via 50g glucose challenge test is routinely
performed at 24-28 weeks gestation. GBS screening (Option A) occurs at 35-37 weeks.
First/second trimester aneuploidy screening (Option C) occurs earlier (11-13 weeks or
15-22 weeks). Routine CBC and antibody screening (Option D) typically occurs at initial
prenatal visit and 28 weeks for Rh-negative women only. Early detection of gestational
diabetes reduces risks of macrosomia, birth injury, and maternal complications.
[CORRECT]
Q6: A 72-year-old female presents with confusion, urinary incontinence, and gait
instability over the past 3 days. Her family reports she had a minor fall 1 week ago.
Which diagnostic study is most appropriate as the initial evaluation?
A. Non-contrast head CT
, B. Lumbar puncture
C. MRI brain with contrast
D. EEG
Correct Answer: A
Rationale: This classic triad (confusion, incontinence, gait ataxia) suggests normal
pressure hydrocephalus (NPH) or chronic subdural hematoma, both common in elderly
patients with falls. Non-contrast head CT is the appropriate initial study to evaluate for
subdural hematoma, hydrocephalus, mass lesions, or stroke. It is rapid, widely available,
and sufficient for initial assessment. MRI (Option C) provides better detail but CT is
first-line for acute changes. Lumbar puncture (Option B) is contraindicated until mass
effect is excluded. EEG (Option D) evaluates seizures, not structural lesions. [CORRECT]
Q7: A 45-year-old male presents with epigastric pain radiating to the back, nausea, and
vomiting. Laboratory studies show lipase 850 U/L (normal 10-140). Which physical
examination finding would suggest severe acute pancreatitis requiring immediate
intervention?
A. Epigastric tenderness with guarding
B. Grey Turner's sign (flank ecchymosis)
C. Positive Murphy's sign
D. Rebound tenderness in the right lower quadrant
Correct Answer: B
Rationale: Grey Turner's sign (flank ecchymosis) indicates retroperitoneal hemorrhage
and severe necrotizing pancreatitis, associated with high mortality requiring ICU-level
care. Cullen's sign (periumbilical ecchymosis) is similarly ominous. While epigastric
tenderness (Option A) is expected in all pancreatitis cases, Grey Turner's sign
specifically indicates severe disease with vascular complications. Murphy's sign (Option
C) suggests cholecystitis. RLQ rebound (Option D) suggests appendicitis. Severe
pancreatitis requires aggressive fluid resuscitation and monitoring for organ failure.
[CORRECT]
Questions and 100% Correct Answers Graded A+ | Family
Nurse Practitioner | 2026/2027 New | Pass Guaranteed
Domain 1: Assessment (35 Questions)
Q1: A 68-year-old male presents with progressive dyspnea on exertion, orthopnea, and
bilateral lower extremity edema. On physical examination, an S3 gallop is auscultated.
Which additional finding on cardiac examination would most strongly support a
diagnosis of heart failure with reduced ejection fraction (HFrEF)?
A. Holosystolic murmur at the apex radiating to the axilla
B. Fixed split S2 with loud P2
C. Displaced point of maximal impulse (PMI) laterally to the mid-axillary line
D. High-pitched early diastolic decrescendo murmur at the left sternal border
Correct Answer: C
Rationale: A laterally displaced PMI beyond the midclavicular line indicates cardiac
enlargement and volume overload, characteristic of HFrEF. The S3 gallop represents
rapid ventricular filling into a dilated, non-compliant ventricle. Option A describes mitral
regurgitation, which can cause heart failure but is not the most specific finding for
HFrEF diagnosis. Option B suggests an atrial septal defect with pulmonary
hypertension. Option D indicates aortic regurgitation. The displaced PMI combined with
S3 provides the strongest evidence for ventricular dilation in HFrEF. [CORRECT]
Q2: A 4-year-old child is brought to the clinic for a well-child visit. The parents are
concerned about developmental milestones. Which developmental milestone is most
appropriate for a typically developing 4-year-old?
A. Copies a circle and names four colors
B. Rides a tricycle and speaks in three-word sentences
C. Ties shoelaces and prints some letters
D. Uses a fork and spoon and jumps in place
,Correct Answer: A
Rationale: By age 4 years, children typically copy circles and squares, name four colors,
and speak in complete sentences of 4-5 words. Option B describes 3-year-old
milestones (tricycle riding, 3-word sentences). Option C describes 5-6 year milestones
(tying shoes, printing letters). Option D describes 2-year-old milestones (utensil use,
jumping). Denver II and Bright Futures guidelines support these developmental
expectations. [CORRECT]
Q3: A 35-year-old female presents with fatigue, cold intolerance, constipation, and
weight gain. Laboratory studies reveal TSH 12.5 mIU/L (normal 0.4-4.0) and free T4 0.6
ng/dL (normal 0.8-1.8). Which physical examination finding would be most consistent
with this diagnosis?
A. Exophthalmos and lid lag
B. Fine tremor and warm, moist skin
C. Periorbital myxedema and delayed relaxation phase of deep tendon reflexes
D. Thyroid bruit and pretibial myxedema
Correct Answer: C
Rationale: The laboratory values indicate primary hypothyroidism (elevated TSH, low
free T4). Physical findings include periorbital myxedema (non-pitting edema), coarse dry
skin, brittle hair, and delayed relaxation phase of deep tendon reflexes (hung-up
reflexes). Options A, B, and D describe hyperthyroidism/Graves' disease findings
(exophthalmos, tremor, warm skin, thyroid bruit, pretibial myxedema). The delayed
reflexes result from decreased metabolic rate affecting muscle contraction and
relaxation. [CORRECT]
Q4: A 58-year-old male with a 40 pack-year smoking history presents for a routine
physical. Which screening test is recommended by the USPSTF for lung cancer in this
patient?
A. Annual chest X-ray
B. Annual low-dose CT (LDCT) of the chest
C. Annual sputum cytology
,D. No screening recommended at this time
Correct Answer: B
Rationale: The USPSTF recommends annual LDCT screening for lung cancer in adults
aged 50-80 years with a 20 pack-year smoking history who currently smoke or quit
within the past 15 years (Grade B recommendation). Chest X-ray (Option A) has poor
sensitivity for early lung cancer detection. Sputum cytology (Option C) is not
recommended for screening. Screening should be discontinued once a person has not
smoked for 15 years or develops health problems limiting life expectancy or curative
treatment. [CORRECT]
Q5: A 28-year-old pregnant female at 28 weeks gestation presents for a prenatal visit.
Which laboratory test is routinely recommended at this gestational age?
A. Group B Streptococcus (GBS) screening
B. Gestational diabetes screening (glucose challenge test)
C. Triple/Quad screen for aneuploidy
D. Repeat CBC and antibody screen
Correct Answer: B
Rationale: Gestational diabetes screening via 50g glucose challenge test is routinely
performed at 24-28 weeks gestation. GBS screening (Option A) occurs at 35-37 weeks.
First/second trimester aneuploidy screening (Option C) occurs earlier (11-13 weeks or
15-22 weeks). Routine CBC and antibody screening (Option D) typically occurs at initial
prenatal visit and 28 weeks for Rh-negative women only. Early detection of gestational
diabetes reduces risks of macrosomia, birth injury, and maternal complications.
[CORRECT]
Q6: A 72-year-old female presents with confusion, urinary incontinence, and gait
instability over the past 3 days. Her family reports she had a minor fall 1 week ago.
Which diagnostic study is most appropriate as the initial evaluation?
A. Non-contrast head CT
, B. Lumbar puncture
C. MRI brain with contrast
D. EEG
Correct Answer: A
Rationale: This classic triad (confusion, incontinence, gait ataxia) suggests normal
pressure hydrocephalus (NPH) or chronic subdural hematoma, both common in elderly
patients with falls. Non-contrast head CT is the appropriate initial study to evaluate for
subdural hematoma, hydrocephalus, mass lesions, or stroke. It is rapid, widely available,
and sufficient for initial assessment. MRI (Option C) provides better detail but CT is
first-line for acute changes. Lumbar puncture (Option B) is contraindicated until mass
effect is excluded. EEG (Option D) evaluates seizures, not structural lesions. [CORRECT]
Q7: A 45-year-old male presents with epigastric pain radiating to the back, nausea, and
vomiting. Laboratory studies show lipase 850 U/L (normal 10-140). Which physical
examination finding would suggest severe acute pancreatitis requiring immediate
intervention?
A. Epigastric tenderness with guarding
B. Grey Turner's sign (flank ecchymosis)
C. Positive Murphy's sign
D. Rebound tenderness in the right lower quadrant
Correct Answer: B
Rationale: Grey Turner's sign (flank ecchymosis) indicates retroperitoneal hemorrhage
and severe necrotizing pancreatitis, associated with high mortality requiring ICU-level
care. Cullen's sign (periumbilical ecchymosis) is similarly ominous. While epigastric
tenderness (Option A) is expected in all pancreatitis cases, Grey Turner's sign
specifically indicates severe disease with vascular complications. Murphy's sign (Option
C) suggests cholecystitis. RLQ rebound (Option D) suggests appendicitis. Severe
pancreatitis requires aggressive fluid resuscitation and monitoring for organ failure.
[CORRECT]
