ANCC FNP Certification Exam Full-
Length with Expert Rationales
ACTUAL EXAM 2026/2027 | ANCC
FNP Full-Length | Verified Q&A |
Pass Guaranteed - A+ Graded
Domain 1: Assessment (45 Questions)
Q1: A 58-year-old male presents for an annual physical. He has a 30-pack-year smoking history (quit 5
years ago). He is asymptomatic. USPSTF guidelines for lung cancer screening recommend which of the
following?
A. Annual chest X-ray starting at age 55
B. Low-dose CT chest annually now and continue until age 80
C. Low-dose CT chest one time only
D. No screening because he quit >15 years ago
Correct Answer: B [CORRECT]
Rationale: USPSTF Grade B recommendation (2021) for lung cancer screening with low-dose computed
tomography (LDCT) annually for adults aged 50-80 years with a ≥20-pack-year smoking history who
currently smoke or quit within the past 15 years. This patient meets all criteria: age 58 (within 50-80),
30-pack-year history (≥20), and quit 5 years ago (within 15-year window). Screening should continue
annually until age 81 or until the patient is no longer a candidate for curative treatment. Chest X-ray (A)
is not recommended for screening due to lack of mortality benefit and high false-positive rates. One-
time screening (C) is insufficient as lung cancer risk persists. Option (D) is incorrect because the 15-year
clock starts from quit date, and 5 years is well within the window.
Q2: A 4-year-old child is brought in for a well-child visit. The mother reports the child speaks in 4-5 word
sentences, rides a tricycle, and can copy a circle. The child can name some colors but not all, and has
started using scissors with supervision. According to CDC developmental milestones, which skill should
the FNP assess as the next expected milestone?
A. Tying shoelaces
,B. Hopping on one foot
C. Drawing a person with 6 body parts
D. Printing some letters
Correct Answer: B [CORRECT]
Rationale: The described skills (4-5 word sentences, tricycle riding, copying a circle, using scissors) are
consistent with a 4-year-old developmental level. The next expected gross motor milestone is hopping
on one foot, which is typically achieved by age 5. Tying shoelaces (A) and drawing a person with 6 body
parts (C) are 6-year milestones; printing some letters (D) is a 5-year fine motor milestone but hopping on
one foot is the gross motor milestone that emerges at 5 years and is a critical assessment point for
neuromuscular development.
Q3: A 67-year-old female presents for Medicare Annual Wellness Visit. She has no acute complaints.
Which screening combination is MOST appropriate based on current USPSTF recommendations for her
age?
A. Mammography every 2 years, bone density scan (DEXA) now, annual fecal occult blood testing
B. Mammography annually, DEXA at age 65 if not previously done, colonoscopy every 10 years
C. Mammography biennially, DEXA only if risk factors present, colonoscopy at age 75 then stop
D. Mammography every 3 years, DEXA at age 70, flexible sigmoidoscopy every 5 years
Correct Answer: B [CORRECT]
Rationale: USPSTF recommends biennial mammography for women aged 50-74 (Grade B), though
annual screening remains common clinical practice and is supported by ACS guidelines. DEXA screening
is recommended for all women ≥65 years (Grade B) if not previously screened. Colorectal cancer
screening with colonoscopy every 10 years is recommended from age 45-75 (Grade A). Annual fecal
occult blood testing (A) is an option but less preferred than structural screening; DEXA at 65 is indicated
regardless of risk factors (C is incorrect); and every 3-year mammography (D) is below standard
screening frequency.
Q4: [SELECT-ALL-THAT-APPLY] Which of the following are components of the Medicare Annual Wellness
Visit (AWV) that the FNP must document?
A. Health risk assessment (HRA)
B. Review of functional ability and level of safety
C. Physical examination including breast and pelvic exam
D. Establishment of a written screening schedule
E. Detection of cognitive impairment
F. End-of-life advance care planning (mandatory)
Correct Answers: A, B, D, E [CORRECT]
Rationale: The Medicare AWV requires documentation of: (1) Health Risk Assessment (HRA) including
,self-reported health status, psychosocial risks, and behavioral risks; (2) Review of functional ability and
level of safety (falls risk, home safety); (3) Establishment of a written screening schedule for preventive
services; and (4) Detection of any cognitive impairment (via direct observation or validated tool). Breast
and pelvic exam (C) are not required components of the AWV and are billed separately if performed.
Advance care planning (F) is optional and reimbursable when performed but is not mandatory for AWV
completion.
Q5: A 16-year-old female presents for a sports physical. She reports regular menses, no dizziness with
exercise, and no family history of sudden cardiac death. Physical exam reveals a grade 2/6 systolic
murmur at the left lower sternal border that decreases with Valsalva maneuver. Which is the most
appropriate next step?
A. Immediate referral to cardiology for echocardiogram
B. Reassurance that this is a benign functional murmur; clear for sports
C. Order ECG and echocardiogram before clearing for sports
D. Restrict from sports until murmur resolves
Correct Answer: B [CORRECT]
Rationale: A grade 2/6 systolic murmur at the left lower sternal border that decreases with Valsalva is
characteristic of a benign functional (innocent) murmur, specifically a Still's murmur or venous hum
variant. Innocent murmurs are soft (<3/6), systolic, vary with position, and decrease with Valsalva
(which decreases venous return). Pathologic murmurs (hypertrophic cardiomyopathy, aortic stenosis)
increase with Valsalva due to decreased preload worsening obstruction. The absence of red flags
(syncope, family history of sudden death, exertional chest pain, diastolic murmur, harsh quality)
supports reassurance and sports clearance without further workup.
Q6: [HOT SPOT - DESCRIBED] A 45-year-old male presents with chest pain. On cardiac auscultation, the
FNP hears a harsh holosystolic murmur best heard at the apex that radiates to the axilla. The murmur
increases with handgrip and decreases with Valsalva. On the cardiac exam diagram, which valve area
corresponds to this finding?
A. Aortic area (right 2nd intercostal space)
B. Pulmonic area (left 2nd intercostal space)
C. Tricuspid area (left 4th/5th intercostal space)
D. Mitral area (left 5th intercostal space, midclavicular line)
Correct Answer: D [CORRECT]
Rationale: The described murmur—harsh holosystolic, apex, radiating to axilla, increasing with handgrip
(increased afterload), decreasing with Valsalva (decreased preload)—is pathognomonic for mitral
regurgitation. The mitral valve is auscultated at the left 5th intercostal space at the midclavicular line
(cardiac apex). Handgrip increases systemic vascular resistance, worsening regurgitant flow into the left
atrium and amplifying the murmur. Valsalva decreases venous return and left ventricular volume,
, reducing regurgitant volume and murmur intensity. This distinguishes it from hypertrophic
cardiomyopathy (murmur increases with Valsalva) and aortic stenosis (best heard at right upper sternal
border).
Q7: [CHART/EXHIBIT] A 55-year-old female presents for follow-up. Her chart shows: BP 142/88 (today),
138/84 (3 months ago), 144/90 (6 months ago). BMI 31. Labs: Na 140, K 4.2, Cr 0.9, eGFR >60, fasting
glucose 102, A1c 5.6%. She exercises 2x/week and follows a DASH diet inconsistently. Current
medications: none. What is the appropriate classification and next step?
A. Normal blood pressure; continue current lifestyle
B. Stage 1 hypertension; initiate lifestyle modification only
C. Stage 2 hypertension; initiate pharmacotherapy with thiazide diuretic
D. Stage 1 hypertension; initiate pharmacotherapy with thiazide-type diuretic or ACE inhibitor
Correct Answer: D [CORRECT]
Rationale: According to ACC/AHA 2017 guidelines, this patient has Stage 1 hypertension (systolic 130-
139 or diastolic 80-89) confirmed by elevated readings on at least two occasions. With a 10-year ASCVD
risk that should be calculated but given age >50, female, and additional risk factors (overweight,
prediabetic fasting glucose), her risk likely exceeds 10%, warranting pharmacotherapy. First-line options
include thiazide-type diuretics, ACE inhibitors, ARBs, or calcium channel blockers. Lifestyle modification
alone (B) is insufficient given persistent elevation over 6 months and cardiovascular risk profile. Stage 2
(C) requires BP ≥140/90; and normal BP (A) is incorrect given the documented readings.
Q8: A 28-year-old female presents for preconception counseling. She has well-controlled epilepsy on
lamotrigine 200 mg BID and takes a prenatal vitamin. Which recommendation is MOST important before
conception?
A. Discontinue lamotrigine immediately due to teratogenicity
B. Switch to valproic acid for better pregnancy safety
C. Continue lamotrigine, ensure folic acid 4 mg daily, and obtain baseline lamotrigine levels
D. Add carbamazepine for seizure control during pregnancy
Correct Answer: C [CORRECT]
Rationale: Lamotrigine is one of the safest antiepileptic drugs in pregnancy (FDA category C, relatively
low teratogenic risk compared to valproic acid or carbamazepine) and should be continued for seizure
control as uncontrolled seizures pose greater fetal risk than medication. However, pregnancy increases
lamotrigine clearance by 50-100%, so baseline preconception levels are essential for monitoring and
dose adjustment. High-dose folic acid (4 mg, 10x the standard 0.4 mg) is recommended for all women
on antiepileptic drugs to reduce neural tube defect risk. Valproic acid (B) is highly teratogenic (neural
tube defects, neurodevelopmental delay) and contraindicated in pregnancy; carbamazepine (D) has
teratogenic risk and is not first-line for adding in pregnancy.
Length with Expert Rationales
ACTUAL EXAM 2026/2027 | ANCC
FNP Full-Length | Verified Q&A |
Pass Guaranteed - A+ Graded
Domain 1: Assessment (45 Questions)
Q1: A 58-year-old male presents for an annual physical. He has a 30-pack-year smoking history (quit 5
years ago). He is asymptomatic. USPSTF guidelines for lung cancer screening recommend which of the
following?
A. Annual chest X-ray starting at age 55
B. Low-dose CT chest annually now and continue until age 80
C. Low-dose CT chest one time only
D. No screening because he quit >15 years ago
Correct Answer: B [CORRECT]
Rationale: USPSTF Grade B recommendation (2021) for lung cancer screening with low-dose computed
tomography (LDCT) annually for adults aged 50-80 years with a ≥20-pack-year smoking history who
currently smoke or quit within the past 15 years. This patient meets all criteria: age 58 (within 50-80),
30-pack-year history (≥20), and quit 5 years ago (within 15-year window). Screening should continue
annually until age 81 or until the patient is no longer a candidate for curative treatment. Chest X-ray (A)
is not recommended for screening due to lack of mortality benefit and high false-positive rates. One-
time screening (C) is insufficient as lung cancer risk persists. Option (D) is incorrect because the 15-year
clock starts from quit date, and 5 years is well within the window.
Q2: A 4-year-old child is brought in for a well-child visit. The mother reports the child speaks in 4-5 word
sentences, rides a tricycle, and can copy a circle. The child can name some colors but not all, and has
started using scissors with supervision. According to CDC developmental milestones, which skill should
the FNP assess as the next expected milestone?
A. Tying shoelaces
,B. Hopping on one foot
C. Drawing a person with 6 body parts
D. Printing some letters
Correct Answer: B [CORRECT]
Rationale: The described skills (4-5 word sentences, tricycle riding, copying a circle, using scissors) are
consistent with a 4-year-old developmental level. The next expected gross motor milestone is hopping
on one foot, which is typically achieved by age 5. Tying shoelaces (A) and drawing a person with 6 body
parts (C) are 6-year milestones; printing some letters (D) is a 5-year fine motor milestone but hopping on
one foot is the gross motor milestone that emerges at 5 years and is a critical assessment point for
neuromuscular development.
Q3: A 67-year-old female presents for Medicare Annual Wellness Visit. She has no acute complaints.
Which screening combination is MOST appropriate based on current USPSTF recommendations for her
age?
A. Mammography every 2 years, bone density scan (DEXA) now, annual fecal occult blood testing
B. Mammography annually, DEXA at age 65 if not previously done, colonoscopy every 10 years
C. Mammography biennially, DEXA only if risk factors present, colonoscopy at age 75 then stop
D. Mammography every 3 years, DEXA at age 70, flexible sigmoidoscopy every 5 years
Correct Answer: B [CORRECT]
Rationale: USPSTF recommends biennial mammography for women aged 50-74 (Grade B), though
annual screening remains common clinical practice and is supported by ACS guidelines. DEXA screening
is recommended for all women ≥65 years (Grade B) if not previously screened. Colorectal cancer
screening with colonoscopy every 10 years is recommended from age 45-75 (Grade A). Annual fecal
occult blood testing (A) is an option but less preferred than structural screening; DEXA at 65 is indicated
regardless of risk factors (C is incorrect); and every 3-year mammography (D) is below standard
screening frequency.
Q4: [SELECT-ALL-THAT-APPLY] Which of the following are components of the Medicare Annual Wellness
Visit (AWV) that the FNP must document?
A. Health risk assessment (HRA)
B. Review of functional ability and level of safety
C. Physical examination including breast and pelvic exam
D. Establishment of a written screening schedule
E. Detection of cognitive impairment
F. End-of-life advance care planning (mandatory)
Correct Answers: A, B, D, E [CORRECT]
Rationale: The Medicare AWV requires documentation of: (1) Health Risk Assessment (HRA) including
,self-reported health status, psychosocial risks, and behavioral risks; (2) Review of functional ability and
level of safety (falls risk, home safety); (3) Establishment of a written screening schedule for preventive
services; and (4) Detection of any cognitive impairment (via direct observation or validated tool). Breast
and pelvic exam (C) are not required components of the AWV and are billed separately if performed.
Advance care planning (F) is optional and reimbursable when performed but is not mandatory for AWV
completion.
Q5: A 16-year-old female presents for a sports physical. She reports regular menses, no dizziness with
exercise, and no family history of sudden cardiac death. Physical exam reveals a grade 2/6 systolic
murmur at the left lower sternal border that decreases with Valsalva maneuver. Which is the most
appropriate next step?
A. Immediate referral to cardiology for echocardiogram
B. Reassurance that this is a benign functional murmur; clear for sports
C. Order ECG and echocardiogram before clearing for sports
D. Restrict from sports until murmur resolves
Correct Answer: B [CORRECT]
Rationale: A grade 2/6 systolic murmur at the left lower sternal border that decreases with Valsalva is
characteristic of a benign functional (innocent) murmur, specifically a Still's murmur or venous hum
variant. Innocent murmurs are soft (<3/6), systolic, vary with position, and decrease with Valsalva
(which decreases venous return). Pathologic murmurs (hypertrophic cardiomyopathy, aortic stenosis)
increase with Valsalva due to decreased preload worsening obstruction. The absence of red flags
(syncope, family history of sudden death, exertional chest pain, diastolic murmur, harsh quality)
supports reassurance and sports clearance without further workup.
Q6: [HOT SPOT - DESCRIBED] A 45-year-old male presents with chest pain. On cardiac auscultation, the
FNP hears a harsh holosystolic murmur best heard at the apex that radiates to the axilla. The murmur
increases with handgrip and decreases with Valsalva. On the cardiac exam diagram, which valve area
corresponds to this finding?
A. Aortic area (right 2nd intercostal space)
B. Pulmonic area (left 2nd intercostal space)
C. Tricuspid area (left 4th/5th intercostal space)
D. Mitral area (left 5th intercostal space, midclavicular line)
Correct Answer: D [CORRECT]
Rationale: The described murmur—harsh holosystolic, apex, radiating to axilla, increasing with handgrip
(increased afterload), decreasing with Valsalva (decreased preload)—is pathognomonic for mitral
regurgitation. The mitral valve is auscultated at the left 5th intercostal space at the midclavicular line
(cardiac apex). Handgrip increases systemic vascular resistance, worsening regurgitant flow into the left
atrium and amplifying the murmur. Valsalva decreases venous return and left ventricular volume,
, reducing regurgitant volume and murmur intensity. This distinguishes it from hypertrophic
cardiomyopathy (murmur increases with Valsalva) and aortic stenosis (best heard at right upper sternal
border).
Q7: [CHART/EXHIBIT] A 55-year-old female presents for follow-up. Her chart shows: BP 142/88 (today),
138/84 (3 months ago), 144/90 (6 months ago). BMI 31. Labs: Na 140, K 4.2, Cr 0.9, eGFR >60, fasting
glucose 102, A1c 5.6%. She exercises 2x/week and follows a DASH diet inconsistently. Current
medications: none. What is the appropriate classification and next step?
A. Normal blood pressure; continue current lifestyle
B. Stage 1 hypertension; initiate lifestyle modification only
C. Stage 2 hypertension; initiate pharmacotherapy with thiazide diuretic
D. Stage 1 hypertension; initiate pharmacotherapy with thiazide-type diuretic or ACE inhibitor
Correct Answer: D [CORRECT]
Rationale: According to ACC/AHA 2017 guidelines, this patient has Stage 1 hypertension (systolic 130-
139 or diastolic 80-89) confirmed by elevated readings on at least two occasions. With a 10-year ASCVD
risk that should be calculated but given age >50, female, and additional risk factors (overweight,
prediabetic fasting glucose), her risk likely exceeds 10%, warranting pharmacotherapy. First-line options
include thiazide-type diuretics, ACE inhibitors, ARBs, or calcium channel blockers. Lifestyle modification
alone (B) is insufficient given persistent elevation over 6 months and cardiovascular risk profile. Stage 2
(C) requires BP ≥140/90; and normal BP (A) is incorrect given the documented readings.
Q8: A 28-year-old female presents for preconception counseling. She has well-controlled epilepsy on
lamotrigine 200 mg BID and takes a prenatal vitamin. Which recommendation is MOST important before
conception?
A. Discontinue lamotrigine immediately due to teratogenicity
B. Switch to valproic acid for better pregnancy safety
C. Continue lamotrigine, ensure folic acid 4 mg daily, and obtain baseline lamotrigine levels
D. Add carbamazepine for seizure control during pregnancy
Correct Answer: C [CORRECT]
Rationale: Lamotrigine is one of the safest antiepileptic drugs in pregnancy (FDA category C, relatively
low teratogenic risk compared to valproic acid or carbamazepine) and should be continued for seizure
control as uncontrolled seizures pose greater fetal risk than medication. However, pregnancy increases
lamotrigine clearance by 50-100%, so baseline preconception levels are essential for monitoring and
dose adjustment. High-dose folic acid (4 mg, 10x the standard 0.4 mg) is recommended for all women
on antiepileptic drugs to reduce neural tube defect risk. Valproic acid (B) is highly teratogenic (neural
tube defects, neurodevelopmental delay) and contraindicated in pregnancy; carbamazepine (D) has
teratogenic risk and is not first-line for adding in pregnancy.
