ANCC Family Nurse Practitioner (FNP) Certification Exam
1.
A 62-year-old male with a history of hypertension and diabetes presents with sudden onset of
unilateral weakness and aphasia lasting 20 minutes, now resolved. What is the most appropriate
next step?
A. Start aspirin and discharge
B. Order MRI of the brain and carotid imaging
C. Begin thrombolytic therapy
D. Reassure patient and schedule follow-up
Correct Answer: B
Rationale:
This presentation is consistent with a transient ischemic attack (TIA). Urgent evaluation with
MRI and carotid imaging is necessary to identify stroke risk and prevent recurrence. Immediate
discharge without workup is inappropriate.
2.
A patient with chronic kidney disease (eGFR 28 mL/min) is prescribed metformin. What is the
most appropriate action?
A. Continue metformin without changes
B. Reduce dose by half
C. Discontinue metformin
D. Add insulin only if glucose rises
Correct Answer: C
Rationale:
Metformin is contraindicated in patients with eGFR <30 mL/min due to risk of lactic acidosis.
It should be discontinued immediately.
3.
A 28-year-old woman presents with heat intolerance, weight loss, and palpitations. Labs show
suppressed TSH and elevated free T4. Which diagnostic test confirms Graves’ disease?
,A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Anti-thyroid peroxidase antibodies
D. Serum thyroglobulin
Correct Answer: B
Rationale:
A radioactive iodine uptake scan shows diffuse increased uptake in Graves’ disease,
confirming hyperthyroidism etiology.
4.
A patient presents with chest pain that improves when leaning forward and worsens when lying
flat. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Pericarditis
D. Aortic dissection
Correct Answer: C
Rationale:
Classic presentation of pericarditis includes positional chest pain relieved by leaning forward
and worsened supine.
5.
Which medication is first-line for reducing mortality in patients with heart failure with reduced
ejection fraction (HFrEF)?
A. Digoxin
B. Loop diuretics
C. ACE inhibitors
D. Calcium channel blockers
Correct Answer: C
Rationale:
ACE inhibitors reduce mortality and morbidity in HFrEF and are foundational therapy.
,6.
A diabetic patient presents with albuminuria. Which medication provides renal protection?
A. Amlodipine
B. Metoprolol
C. Lisinopril
D. Hydrochlorothiazide
Correct Answer: C
Rationale:
ACE inhibitors like lisinopril reduce intraglomerular pressure and slow progression of diabetic
nephropathy.
7.
A 45-year-old presents with severe epigastric pain radiating to the back and elevated lipase.
What is the most common cause?
A. Alcohol use
B. Gallstones
C. Hypertriglyceridemia
D. Infection
Correct Answer: B
Rationale:
Gallstones are the most common cause of acute pancreatitis overall (alcohol is second).
8.
A patient with COPD has increasing dyspnea and sputum purulence. What is the best initial
management?
A. Oral corticosteroids and antibiotics
B. Increase oxygen only
C. Start inhaled steroids
D. Immediate intubation
, Correct Answer: A
Rationale:
COPD exacerbations with increased sputum and dyspnea require steroids + antibiotics.
9.
Which finding is most specific for iron deficiency anemia?
A. Low hemoglobin
B. Low ferritin
C. Elevated TIBC
D. Microcytosis
Correct Answer: B
Rationale:
Low ferritin is the most specific indicator of iron deficiency.
10.
A patient presents with unilateral leg swelling and pain. What is the best initial diagnostic test?
A. D-dimer
B. Venous duplex ultrasound
C. CT scan
D. MRI
Correct Answer: B
Rationale:
Venous ultrasound is the first-line test for suspected DVT.
11.
A 30-year-old presents with dysuria and vaginal discharge. What test differentiates UTI from
vaginitis?
A. Urinalysis
B. Wet mount microscopy
1.
A 62-year-old male with a history of hypertension and diabetes presents with sudden onset of
unilateral weakness and aphasia lasting 20 minutes, now resolved. What is the most appropriate
next step?
A. Start aspirin and discharge
B. Order MRI of the brain and carotid imaging
C. Begin thrombolytic therapy
D. Reassure patient and schedule follow-up
Correct Answer: B
Rationale:
This presentation is consistent with a transient ischemic attack (TIA). Urgent evaluation with
MRI and carotid imaging is necessary to identify stroke risk and prevent recurrence. Immediate
discharge without workup is inappropriate.
2.
A patient with chronic kidney disease (eGFR 28 mL/min) is prescribed metformin. What is the
most appropriate action?
A. Continue metformin without changes
B. Reduce dose by half
C. Discontinue metformin
D. Add insulin only if glucose rises
Correct Answer: C
Rationale:
Metformin is contraindicated in patients with eGFR <30 mL/min due to risk of lactic acidosis.
It should be discontinued immediately.
3.
A 28-year-old woman presents with heat intolerance, weight loss, and palpitations. Labs show
suppressed TSH and elevated free T4. Which diagnostic test confirms Graves’ disease?
,A. Thyroid ultrasound
B. Radioactive iodine uptake scan
C. Anti-thyroid peroxidase antibodies
D. Serum thyroglobulin
Correct Answer: B
Rationale:
A radioactive iodine uptake scan shows diffuse increased uptake in Graves’ disease,
confirming hyperthyroidism etiology.
4.
A patient presents with chest pain that improves when leaning forward and worsens when lying
flat. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Pericarditis
D. Aortic dissection
Correct Answer: C
Rationale:
Classic presentation of pericarditis includes positional chest pain relieved by leaning forward
and worsened supine.
5.
Which medication is first-line for reducing mortality in patients with heart failure with reduced
ejection fraction (HFrEF)?
A. Digoxin
B. Loop diuretics
C. ACE inhibitors
D. Calcium channel blockers
Correct Answer: C
Rationale:
ACE inhibitors reduce mortality and morbidity in HFrEF and are foundational therapy.
,6.
A diabetic patient presents with albuminuria. Which medication provides renal protection?
A. Amlodipine
B. Metoprolol
C. Lisinopril
D. Hydrochlorothiazide
Correct Answer: C
Rationale:
ACE inhibitors like lisinopril reduce intraglomerular pressure and slow progression of diabetic
nephropathy.
7.
A 45-year-old presents with severe epigastric pain radiating to the back and elevated lipase.
What is the most common cause?
A. Alcohol use
B. Gallstones
C. Hypertriglyceridemia
D. Infection
Correct Answer: B
Rationale:
Gallstones are the most common cause of acute pancreatitis overall (alcohol is second).
8.
A patient with COPD has increasing dyspnea and sputum purulence. What is the best initial
management?
A. Oral corticosteroids and antibiotics
B. Increase oxygen only
C. Start inhaled steroids
D. Immediate intubation
, Correct Answer: A
Rationale:
COPD exacerbations with increased sputum and dyspnea require steroids + antibiotics.
9.
Which finding is most specific for iron deficiency anemia?
A. Low hemoglobin
B. Low ferritin
C. Elevated TIBC
D. Microcytosis
Correct Answer: B
Rationale:
Low ferritin is the most specific indicator of iron deficiency.
10.
A patient presents with unilateral leg swelling and pain. What is the best initial diagnostic test?
A. D-dimer
B. Venous duplex ultrasound
C. CT scan
D. MRI
Correct Answer: B
Rationale:
Venous ultrasound is the first-line test for suspected DVT.
11.
A 30-year-old presents with dysuria and vaginal discharge. What test differentiates UTI from
vaginitis?
A. Urinalysis
B. Wet mount microscopy
