ANCC FNP Exam Questions and Answers
Latest Version Top Rated A+
Question>> 1
A 65-year-old female presents to the office for a wellness check. What is the best next step to take for a patient with the
funduscopic exam in the image below? (add image of papilledema)
A. Normal exam, no further steps needed
B. Refer to ophthalmology as outpatient
C. Patient is likely diabetic, check finger-stick glucose and HBA1c
D. Send for urgent neuro evaluation and imaging
Correct Answer
Correct Answer: D. Send for urgent neuro evaluation and imaging
This is papilledema, which is optic disc edema due to intracranial hypertension. This can be caused by an intracranial
mass, cerebral swelling due to infarction or trauma, increased CSF, hydrocephalus, outflow obstruction due to thrombosis
or other mass/compression, or pseudotumor cerebri, among other things. All cases of papilledema need to be referred
for urgent evaluation by neurology/neurosurgery and head imaging.
In contrast, the image of a normal funduscopic exam is also seen below. Note how you can see the sharp clear edges of
the disc in the normal eye
Incorrect Answers:
A. This is not a normal examination.B. This patient requires urgent imaging and neurology consultation.
C. Fingerstick and laboratory workup is not the priority in this case.
Page 1 of 129
,Vital Concepts:
All cases of papilledema need to be referred for urgent evaluation by neurology/neurosurgery and head imaging.
Page 2 of 129
,Question>> 2
A 3-week-old male presents because of a sudden onset of bilious vomiting of several hours' duration. He is irritable and
refuses to breastfeed, but his stools have been normal. He was delivered at term after a normal pregnancy and has had no
health problems to date. Physical examination shows a fussy child with a distended abdomen. Radiography of the
abdomen shows a corkscrew appearance of the duodenum. Which of the following is the most likely diagnosis?
A. Infantile colic
B. Necrotizing enterocolitis
C. Hypertrophic pyloric stenosis
D. Midgut volvulus
Correct Answer
A. Infantile colicB. Necrotizing enterocolitisC. Hypertrophic pyloric stenosis D. Midgut volvulus
Incorrect
Correct Answer: D. Midgut volvulus
The most common type of intestinal rotation in pediatric patients is an incomplete rotation that predisposes to midgut
volvulus. Volvulus may present in three ways: as a sudden onset of bilious vomiting and abdominal pain in a neonate; as
a history of "feeding problems" with bilious vomiting that appears to be a bowel obstruction; or less commonly, as failure
to thrive with severe feeding intolerance. Volvulus occurs because the narrow mesenteric base, which develops as a result
of malrotation, allows the small bowel to twist around the superior mesenteric artery. This leads to vascular compromise
of large portions of the midgut. classic finding on abdominal plain films is the corkscrew sign. However, plain film can be
entirely normal. The upper gastrointestinal contrast study is considered the gold standard for diagnosing volvulus.
Incorrect Answers:
A. Infantile colic usually begins during the second week of life and typically occurs in the evening. It is characterized by
screaming episodes and a distended or tight abdomen. Its etiology has yet to be determined. There are no abnormalities
on physical examination and ancillary studies, and symptoms usually resolve spontaneously around 12 weeks of age.
B. Necrotizing enterocolitis is typically seen in the distressed neonate in the intensive-care nursery, but it may
occasionally be seen in the healthy neonate within the first two weeks of life. The child will appear ill, with symptoms
including irritability, poor feeding, a distended abdomen, and bloody stools. Abdominal plain films will show
pneumatosis intestinalis caused by gas in the intestinal wall, which is diagnostic of the condition.
C. Hypertrophic pyloric stenosis is a narrowing of the pyloric canal caused by hypertrophy of the musculature. It usually
presents during the third to fifth weeks of life. Projectile vomiting after feeding, weight loss, and dehydration are
Page 3 of 129
, common. The vomitus is always nonbilious, because the obstruction is proximal to the duodenum. If a small olive-size
mass cannot be felt in the right upper or middle quadrant, ultrasonography will confirm the diagnosis.
Page 4 of 129
Latest Version Top Rated A+
Question>> 1
A 65-year-old female presents to the office for a wellness check. What is the best next step to take for a patient with the
funduscopic exam in the image below? (add image of papilledema)
A. Normal exam, no further steps needed
B. Refer to ophthalmology as outpatient
C. Patient is likely diabetic, check finger-stick glucose and HBA1c
D. Send for urgent neuro evaluation and imaging
Correct Answer
Correct Answer: D. Send for urgent neuro evaluation and imaging
This is papilledema, which is optic disc edema due to intracranial hypertension. This can be caused by an intracranial
mass, cerebral swelling due to infarction or trauma, increased CSF, hydrocephalus, outflow obstruction due to thrombosis
or other mass/compression, or pseudotumor cerebri, among other things. All cases of papilledema need to be referred
for urgent evaluation by neurology/neurosurgery and head imaging.
In contrast, the image of a normal funduscopic exam is also seen below. Note how you can see the sharp clear edges of
the disc in the normal eye
Incorrect Answers:
A. This is not a normal examination.B. This patient requires urgent imaging and neurology consultation.
C. Fingerstick and laboratory workup is not the priority in this case.
Page 1 of 129
,Vital Concepts:
All cases of papilledema need to be referred for urgent evaluation by neurology/neurosurgery and head imaging.
Page 2 of 129
,Question>> 2
A 3-week-old male presents because of a sudden onset of bilious vomiting of several hours' duration. He is irritable and
refuses to breastfeed, but his stools have been normal. He was delivered at term after a normal pregnancy and has had no
health problems to date. Physical examination shows a fussy child with a distended abdomen. Radiography of the
abdomen shows a corkscrew appearance of the duodenum. Which of the following is the most likely diagnosis?
A. Infantile colic
B. Necrotizing enterocolitis
C. Hypertrophic pyloric stenosis
D. Midgut volvulus
Correct Answer
A. Infantile colicB. Necrotizing enterocolitisC. Hypertrophic pyloric stenosis D. Midgut volvulus
Incorrect
Correct Answer: D. Midgut volvulus
The most common type of intestinal rotation in pediatric patients is an incomplete rotation that predisposes to midgut
volvulus. Volvulus may present in three ways: as a sudden onset of bilious vomiting and abdominal pain in a neonate; as
a history of "feeding problems" with bilious vomiting that appears to be a bowel obstruction; or less commonly, as failure
to thrive with severe feeding intolerance. Volvulus occurs because the narrow mesenteric base, which develops as a result
of malrotation, allows the small bowel to twist around the superior mesenteric artery. This leads to vascular compromise
of large portions of the midgut. classic finding on abdominal plain films is the corkscrew sign. However, plain film can be
entirely normal. The upper gastrointestinal contrast study is considered the gold standard for diagnosing volvulus.
Incorrect Answers:
A. Infantile colic usually begins during the second week of life and typically occurs in the evening. It is characterized by
screaming episodes and a distended or tight abdomen. Its etiology has yet to be determined. There are no abnormalities
on physical examination and ancillary studies, and symptoms usually resolve spontaneously around 12 weeks of age.
B. Necrotizing enterocolitis is typically seen in the distressed neonate in the intensive-care nursery, but it may
occasionally be seen in the healthy neonate within the first two weeks of life. The child will appear ill, with symptoms
including irritability, poor feeding, a distended abdomen, and bloody stools. Abdominal plain films will show
pneumatosis intestinalis caused by gas in the intestinal wall, which is diagnostic of the condition.
C. Hypertrophic pyloric stenosis is a narrowing of the pyloric canal caused by hypertrophy of the musculature. It usually
presents during the third to fifth weeks of life. Projectile vomiting after feeding, weight loss, and dehydration are
Page 3 of 129
, common. The vomitus is always nonbilious, because the obstruction is proximal to the duodenum. If a small olive-size
mass cannot be felt in the right upper or middle quadrant, ultrasonography will confirm the diagnosis.
Page 4 of 129
