ANCC FNP ACTUAL EXAM VERSION 2 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 62-year-old male presents with progressive dyspnea on exertion and orthopnea.
On physical examination, an S3 gallop is auscultated. Which finding on chest X-ray is
most consistent with this presentation?
A. Hyperinflation with flattened diaphragms
B. Kerley B lines and cephalization of vessels
C. Unilateral pleural effusion
D. Solitary pulmonary nodule
B. Kerley B lines and cephalization of vessels. [CORRECT]
Correct Answer: B
Rationale: The presentation of dyspnea on exertion, orthopnea, and S3 gallop is classic
for left-sided heart failure (systolic dysfunction). Kerley B lines (short horizontal lines
seen in the lung periphery on CXR) represent interstitial edema, and cephalization of
vessels (upper lobe vessel prominence) indicates increased pulmonary venous
pressure—both hallmark radiographic findings of pulmonary congestion from left heart
failure. Why A is incorrect: Hyperinflation with flattened diaphragms is characteristic of
COPD/emphysema, not heart failure. Why C is incorrect: While pleural effusions can
occur in heart failure, they are typically bilateral; unilateral effusion suggests other
etiologies (malignancy, pneumonia, pulmonary embolism). Why D is incorrect: A solitary
pulmonary nodule is unrelated to acute heart failure presentation and would suggest
neoplasm or granulomatous disease.
,Q2: A 28-year-old female at 32 weeks gestation presents with a severe headache, visual
disturbances, and right upper quadrant pain. Her blood pressure is 162/104 mmHg.
Which laboratory finding is most specific for the diagnosis of severe preeclampsia?
A. Platelet count 180,000/µL
B. Serum creatinine 0.9 mg/dL
C. LDH 450 U/L (elevated)
D. Hemoglobin 11.2 g/dL
C. LDH 450 U/L (elevated). [CORRECT]
Correct Answer: C
Rationale: This patient has classic triad of severe preeclampsia: hypertension
(>160/110 or >140/90 with symptoms), headache, visual changes, and RUQ pain
(hepatic involvement). Elevated LDH indicates hemolysis, which along with elevated
liver enzymes and low platelets (HELLP syndrome) represents severe end-organ
involvement. Diagnostic criteria for severe features: Thrombocytopenia (<100,000),
impaired liver function (elevated transaminases >2x normal or severe persistent
RUQ/epigastric pain), renal insufficiency (creatinine >1.1 mg/dL or doubling), pulmonary
edema, new-onset cerebral/visual disturbances, or HELLP syndrome. Why A is incorrect:
Platelet count of 180,000 is within normal range (normal >150,000); thrombocytopenia
would be <100,000. Why B is incorrect: Creatinine 0.9 mg/dL is normal in pregnancy;
renal insufficiency criterion is >1.1 mg/dL. Why D is incorrect: Mild anemia is common
in pregnancy due to hemodilution and is not specific to preeclampsia.
Q3: During a routine well-child visit, a 4-month-old infant demonstrates the following:
follows objects 180 degrees, laughs out loud, bears weight on legs when held, and
brings hands to midline. Which developmental milestone is delayed?
A. Following objects 180 degrees
B. Laughing out loud
C. Bearing weight on legs
D. None—this is appropriate for age
,D. None—this is appropriate for age. [CORRECT]
Correct Answer: D
Rationale: At 4 months, expected milestones include: social smile (by 2 months),
laughing out loud, tracking objects 180 degrees, bringing hands to midline, and bearing
weight on legs with support. All described behaviors are age-appropriate. Key 4-month
milestones: Gross motor: head steady, rolls front to back, bears weight on legs; Fine
motor: holds rattle, brings hands together; Language: cooing, laughing; Social:
recognizes familiar faces, enjoys play. Why other options are incorrect: Each milestone
listed is achieved by 4 months. Following objects 180° is expected by 3-4 months;
laughing emerges around 4 months; bearing weight on legs when held is a 4-month
milestone (not to be confused with standing independently).
Q4: A 45-year-old male with a 30 pack-year smoking history presents for a physical
examination. Which finding on chest percussion would be most consistent with COPD?
A. Dullness to percussion
B. Hyperresonance
C. Flat percussion note
D. Tympany
B. Hyperresonance. [CORRECT]
Correct Answer: B
Rationale: Hyperresonance (increased resonance, drum-like sound) is the characteristic
percussion finding in COPD/emphysema due to air trapping, loss of elastic recoil, and
hyperinflation of lungs. Percussion sounds: Resonant (normal lung), Hyperresonant
(COPD, pneumothorax—though tension pneumothorax may be hyperresonant), Dull
(consolidation, pleural effusion, atelectasis), Flat (large pleural effusion, lobar
consolidation), Tympanic (gastric air bubble, intestinal obstruction, pneumothorax with
, chest wall defect). Why A is incorrect: Dullness suggests fluid (effusion) or
consolidation (pneumonia). Why C is incorrect: Flatness suggests large effusion or
dense consolidation. Why D is incorrect: Tympany is heard over air-filled viscera
(stomach) or pneumothorax with open chest wound, not typical COPD.
Q5: A 68-year-old female with diabetes mellitus presents with numbness and tingling in
a stocking-glove distribution. Monofilament testing reveals loss of protective sensation
at multiple sites. Which additional examination finding is most consistent with diabetic
peripheral neuropathy?
A. Hyperreflexia at the ankles
B. Decreased vibration sense at the great toe
C. Positive Romberg sign with eyes open
D. Clonus at the ankles
B. Decreased vibration sense at the great toe. [CORRECT]
Correct Answer: B
Rationale: Diabetic peripheral neuropathy (DPN) is a symmetric, distal, sensorimotor
polyneuropathy affecting longest nerves first (stocking-glove distribution). Large fiber
involvement causes loss of vibration sense, proprioception, light touch; small fiber
involvement causes pain and temperature loss. Clinical features: Loss of ankle reflexes
(not hyperreflexia), decreased vibration perception (using 128 Hz tuning fork at great
toe), reduced monofilament sensation. Why A is incorrect: Hyperreflexia indicates upper
motor neuron lesions; DPN causes diminished or absent reflexes
(hyporeflexia/areflexia), especially at ankles. Why C is incorrect: Romberg sign
(increased sway with eyes closed) indicates proprioceptive loss; with eyes open,
cerebellar or vestibular dysfunction is suggested. Why D is incorrect: Clonus indicates
upper motor neuron pathology (corticospinal tract lesions), not peripheral neuropathy.
Questions and 100% Correct Answers Graded A+ | Family
Nurse Practitioner | 2026/2027 New | Pass Guaranteed
Domain 1: Assessment (35 Questions)
Q1: A 62-year-old male presents with progressive dyspnea on exertion and orthopnea.
On physical examination, an S3 gallop is auscultated. Which finding on chest X-ray is
most consistent with this presentation?
A. Hyperinflation with flattened diaphragms
B. Kerley B lines and cephalization of vessels
C. Unilateral pleural effusion
D. Solitary pulmonary nodule
B. Kerley B lines and cephalization of vessels. [CORRECT]
Correct Answer: B
Rationale: The presentation of dyspnea on exertion, orthopnea, and S3 gallop is classic
for left-sided heart failure (systolic dysfunction). Kerley B lines (short horizontal lines
seen in the lung periphery on CXR) represent interstitial edema, and cephalization of
vessels (upper lobe vessel prominence) indicates increased pulmonary venous
pressure—both hallmark radiographic findings of pulmonary congestion from left heart
failure. Why A is incorrect: Hyperinflation with flattened diaphragms is characteristic of
COPD/emphysema, not heart failure. Why C is incorrect: While pleural effusions can
occur in heart failure, they are typically bilateral; unilateral effusion suggests other
etiologies (malignancy, pneumonia, pulmonary embolism). Why D is incorrect: A solitary
pulmonary nodule is unrelated to acute heart failure presentation and would suggest
neoplasm or granulomatous disease.
,Q2: A 28-year-old female at 32 weeks gestation presents with a severe headache, visual
disturbances, and right upper quadrant pain. Her blood pressure is 162/104 mmHg.
Which laboratory finding is most specific for the diagnosis of severe preeclampsia?
A. Platelet count 180,000/µL
B. Serum creatinine 0.9 mg/dL
C. LDH 450 U/L (elevated)
D. Hemoglobin 11.2 g/dL
C. LDH 450 U/L (elevated). [CORRECT]
Correct Answer: C
Rationale: This patient has classic triad of severe preeclampsia: hypertension
(>160/110 or >140/90 with symptoms), headache, visual changes, and RUQ pain
(hepatic involvement). Elevated LDH indicates hemolysis, which along with elevated
liver enzymes and low platelets (HELLP syndrome) represents severe end-organ
involvement. Diagnostic criteria for severe features: Thrombocytopenia (<100,000),
impaired liver function (elevated transaminases >2x normal or severe persistent
RUQ/epigastric pain), renal insufficiency (creatinine >1.1 mg/dL or doubling), pulmonary
edema, new-onset cerebral/visual disturbances, or HELLP syndrome. Why A is incorrect:
Platelet count of 180,000 is within normal range (normal >150,000); thrombocytopenia
would be <100,000. Why B is incorrect: Creatinine 0.9 mg/dL is normal in pregnancy;
renal insufficiency criterion is >1.1 mg/dL. Why D is incorrect: Mild anemia is common
in pregnancy due to hemodilution and is not specific to preeclampsia.
Q3: During a routine well-child visit, a 4-month-old infant demonstrates the following:
follows objects 180 degrees, laughs out loud, bears weight on legs when held, and
brings hands to midline. Which developmental milestone is delayed?
A. Following objects 180 degrees
B. Laughing out loud
C. Bearing weight on legs
D. None—this is appropriate for age
,D. None—this is appropriate for age. [CORRECT]
Correct Answer: D
Rationale: At 4 months, expected milestones include: social smile (by 2 months),
laughing out loud, tracking objects 180 degrees, bringing hands to midline, and bearing
weight on legs with support. All described behaviors are age-appropriate. Key 4-month
milestones: Gross motor: head steady, rolls front to back, bears weight on legs; Fine
motor: holds rattle, brings hands together; Language: cooing, laughing; Social:
recognizes familiar faces, enjoys play. Why other options are incorrect: Each milestone
listed is achieved by 4 months. Following objects 180° is expected by 3-4 months;
laughing emerges around 4 months; bearing weight on legs when held is a 4-month
milestone (not to be confused with standing independently).
Q4: A 45-year-old male with a 30 pack-year smoking history presents for a physical
examination. Which finding on chest percussion would be most consistent with COPD?
A. Dullness to percussion
B. Hyperresonance
C. Flat percussion note
D. Tympany
B. Hyperresonance. [CORRECT]
Correct Answer: B
Rationale: Hyperresonance (increased resonance, drum-like sound) is the characteristic
percussion finding in COPD/emphysema due to air trapping, loss of elastic recoil, and
hyperinflation of lungs. Percussion sounds: Resonant (normal lung), Hyperresonant
(COPD, pneumothorax—though tension pneumothorax may be hyperresonant), Dull
(consolidation, pleural effusion, atelectasis), Flat (large pleural effusion, lobar
consolidation), Tympanic (gastric air bubble, intestinal obstruction, pneumothorax with
, chest wall defect). Why A is incorrect: Dullness suggests fluid (effusion) or
consolidation (pneumonia). Why C is incorrect: Flatness suggests large effusion or
dense consolidation. Why D is incorrect: Tympany is heard over air-filled viscera
(stomach) or pneumothorax with open chest wound, not typical COPD.
Q5: A 68-year-old female with diabetes mellitus presents with numbness and tingling in
a stocking-glove distribution. Monofilament testing reveals loss of protective sensation
at multiple sites. Which additional examination finding is most consistent with diabetic
peripheral neuropathy?
A. Hyperreflexia at the ankles
B. Decreased vibration sense at the great toe
C. Positive Romberg sign with eyes open
D. Clonus at the ankles
B. Decreased vibration sense at the great toe. [CORRECT]
Correct Answer: B
Rationale: Diabetic peripheral neuropathy (DPN) is a symmetric, distal, sensorimotor
polyneuropathy affecting longest nerves first (stocking-glove distribution). Large fiber
involvement causes loss of vibration sense, proprioception, light touch; small fiber
involvement causes pain and temperature loss. Clinical features: Loss of ankle reflexes
(not hyperreflexia), decreased vibration perception (using 128 Hz tuning fork at great
toe), reduced monofilament sensation. Why A is incorrect: Hyperreflexia indicates upper
motor neuron lesions; DPN causes diminished or absent reflexes
(hyporeflexia/areflexia), especially at ankles. Why C is incorrect: Romberg sign
(increased sway with eyes closed) indicates proprioceptive loss; with eyes open,
cerebellar or vestibular dysfunction is suggested. Why D is incorrect: Clonus indicates
upper motor neuron pathology (corticospinal tract lesions), not peripheral neuropathy.
