ANCC FNP EXAM AND PRACTICE EXAM NEWEST ACTUAL EXAM COMPLETE 350+
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+||BRAND NEW VERSION!!
Question 1
A 24-year-old female presents to the clinic complaining of a sore throat. She has a history of
allergic rhinitis. On exam, she has no fever, no tonsillar exudate, and no tender anterior cervical
adenopathy. She does have a cough. Using the Centor criteria (Strep Score), which course of
action is most appropriate?
A) Perform a rapid antigen detection test immediately.
B) Prescribe empiric penicillin V potassium.
C) Order a throat culture and isolate until results are back.
D) Provide symptomatic treatment only (fluids, rest, lozenges).
E) Prescribe a macrolide antibiotic due to potential allergy.
Correct Answer: D) Provide symptomatic treatment only (fluids, rest, lozenges)
Rationale: According to the Centor criteria (Strep Score), one point is assigned for each of
the following: fever, absence of cough, tender anterior cervical adenopathy, and tonsillar
swelling or exudate. This patient has a cough (0 points), no fever (0 points), no exudate (0
points), and no adenopathy (0 points). A score of 0 to 1 indicates a very low probability of
Group A Streptococcus infection. Therefore, the recommended guideline is to provide
symptomatic treatment for likely viral pharyngitis and avoid diagnostic testing or
antibiotic therapy.
Question 2
During a fundoscopic examination of a 68-year-old male with a history of uncontrolled
hypertension, you observe "nicking" where the venules and arterioles cross. You also note copper
and silver wiring of the arterioles. Which condition is primarily associated with these findings?
A) Diabetic Retinopathy
B) Hypertensive Retinopathy
C) Glaucoma
D) Macular Degeneration
E) Retinal Detachment
Correct Answer: B) Hypertensive Retinopathy
Rationale: AV nicking (arteriovenous nicking) is a hallmark sign of chronic hypertension,
caused when a thickened arteriosclerotic arteriole crosses over a vein and compresses it.
Copper and silver wiring descriptions refer to the appearance of the arterioles due to wall
thickening from hypertension. While diabetic retinopathy presents with cotton wool spots
and microaneurysms (and cotton wool spots can occur in HTN too), AV nicking and
copper/silver wiring are distinct to hypertensive changes.
Question 3
A 72-year-old male presents for a routine physical. Upon auscultation of the heart, you hear a
, 2
blowing, holosystolic murmur best heard at the apex which radiates to the left axilla. Which
valvular disorder is most likely present?
A) Aortic Stenosis
B) Mitral Stenosis
C) Mitral Regurgitation
D) Aortic Regurgitation
E) Pulmonic Stenosis
Correct Answer: C) Mitral Regurgitation
Rationale: Using the mnemonic "MR Peyton Manning As MVP," we identify systolic
murmurs. MR (Mitral Regurgitation) is a systolic murmur that is often described as
holosystolic or pansystolic. The classic radiation pattern for Mitral Regurgitation is to the
left axilla. In contrast, Aortic Stenosis radiates to the neck/carotids, and Mitral Stenosis is a
diastolic murmur (ARMS mnemonic).
Question 4
You are reviewing the Hepatitis B serology results for a new patient. The results are as follows:
• HBsAg (Surface Antigen): Negative
• Anti-HBc (Core Antibody): Positive
• Anti-HBs (Surface Antibody): Positive
What is the correct interpretation of the patient's status?
A) Acute Hepatitis B infection
B) Chronic Hepatitis B infection
C) Immunity due to vaccination
D) Immunity due to natural infection
E) Susceptible to Hepatitis B
Correct Answer: D) Immunity due to natural infection
Rationale: The presence of Anti-HBs (Surface Antibody) indicates immunity. To distinguish
between vaccine immunity and natural immunity, look at the Anti-HBc (Core Antibody). A
vaccine only stimulates the Surface Antibody. A natural infection exposes the body to the
core of the virus, resulting in a positive Core Antibody. Since both antibodies are positive
and the Antigen (active virus) is negative, the patient has recovered from a past infection
and is naturally immune.
Question 5
A 4-week-old male infant presents with non-bilious projectile vomiting immediately after
feeding. On physical palpation, an olive-shaped mass is noted in the right upper quadrant (RUQ).
What is the most likely diagnosis?
A) Gastroesophageal Reflux Disease (GERD)
, 3
B) Intussusception
C) Pyloric Stenosis
D) Hirschsprung's Disease
E) Volvulus
Correct Answer: C) Pyloric Stenosis
Rationale: Pyloric stenosis typically presents in infants (2–8 weeks old) with forceful,
projectile, non-bilious vomiting. The hallmark physical exam finding is a palpable "olive-
like" mass in the RUQ, which is the hypertrophied pylorus. Intussusception typically
presents with a "sausage-shaped" mass and currant jelly stools, usually in slightly older
infants (6-36 months).
Question 6
A 30-year-old female at 32 weeks gestation presents to the ER with sudden, painless, bright red
vaginal bleeding. Her uterus is soft and non-tender. Which of the following is the most likely
diagnosis?
A) Placenta Abruption
B) Placenta Previa
C) Uterine Rupture
D) Bloody Show
E) Vasa Previa
Correct Answer: B) Placenta Previa
Rationale: Placenta Previa involves the placenta covering the cervix and is classically
characterized by sudden, painless, bright red bleeding in the third trimester. Placenta
Abruption typically presents with painful vaginal bleeding (often dark red), back pain, and
a rigid, board-like uterus.
Question 7
A 65-year-old African American female with a history of hypertension and osteoporosis requires
a new antihypertensive medication. Which class of medication would be most beneficial for
treating her hypertension while also aiding her bone density?
A) ACE Inhibitors (e.g., Lisinopril)
B) Calcium Channel Blockers (e.g., Amlodipine)
C) Thiazide Diuretics (e.g., Hydrochlorothiazide)
D) Beta Blockers (e.g., Metoprolol)
E) Angiotensin Receptor Blockers (e.g., Losartan)
Correct Answer: C) Thiazide Diuretics (e.g., Hydrochlorothiazide)
Rationale: Thiazide diuretics work by increasing the excretion of sodium and water while
decreasing the excretion of calcium. This calcium retention can help maintain bone mineral
, 4
density, making it an ideal choice for elderly patients with comorbid hypertension and
osteoporosis.
Question 8
During an otoscopic examination of a patient with a history of chronic otitis media, you visualize
a pearly white, cauliflower-like mass behind the tympanic membrane. The patient reports
painless otorrhea and some hearing loss. What is the priority intervention?
A) Prescribe oral amoxicillin.
B) Prescribe otic antibiotic drops.
C) Perform irrigation to remove the mass.
D) Refer to an Otolaryngologist (ENT).
E) Recommend antihistamines for allergic rhinitis.
Correct Answer: D) Refer to an Otolaryngologist (ENT).
Rationale: The description of a pearly white, cauliflower-like mass is highly suggestive of a
Cholesteatoma. This is an abnormal skin growth in the middle ear that can erode bone and
damage the ossicles, leading to permanent hearing loss, facial paralysis, or intracranial
complications. Immediate referral to an ENT for surgical evaluation is required.
Question 9
You are assessing a patient with suspected heart failure. Physical exam reveals jugular venous
distention (JVD), peripheral edema in the lower extremities, and hepatomegaly. The lungs are
clear to auscultation. These findings are most consistent with:
A) Left-sided Heart Failure
B) Right-sided Heart Failure
C) Pulmonary Embolism
D) Aortic Stenosis
E) Mitral Regurgitation
Correct Answer: B) Right-sided Heart Failure
Rationale: Right-sided heart failure results in the backup of blood into the systemic
circulation. This manifests as Jugular Venous Distention (JVD), peripheral edema, and
organomegaly (e.g., liver/spleen). Left-sided heart failure typically causes backup into the
lungs, presenting with crackles, dyspnea, and pulmonary edema.
Question 10
A 13-year-old male is seen for a sports physical. On examination, the testes volume is between
12 and 20 ml, the scrotum has enlarged and darkened, and the penis has increased in length
(approx 10 cm). Pubic hair is adult-like in quality but spares the medial thighs. Which Tanner
Stage does this represent?
A) Tanner Stage II
B) Tanner Stage III
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+||BRAND NEW VERSION!!
Question 1
A 24-year-old female presents to the clinic complaining of a sore throat. She has a history of
allergic rhinitis. On exam, she has no fever, no tonsillar exudate, and no tender anterior cervical
adenopathy. She does have a cough. Using the Centor criteria (Strep Score), which course of
action is most appropriate?
A) Perform a rapid antigen detection test immediately.
B) Prescribe empiric penicillin V potassium.
C) Order a throat culture and isolate until results are back.
D) Provide symptomatic treatment only (fluids, rest, lozenges).
E) Prescribe a macrolide antibiotic due to potential allergy.
Correct Answer: D) Provide symptomatic treatment only (fluids, rest, lozenges)
Rationale: According to the Centor criteria (Strep Score), one point is assigned for each of
the following: fever, absence of cough, tender anterior cervical adenopathy, and tonsillar
swelling or exudate. This patient has a cough (0 points), no fever (0 points), no exudate (0
points), and no adenopathy (0 points). A score of 0 to 1 indicates a very low probability of
Group A Streptococcus infection. Therefore, the recommended guideline is to provide
symptomatic treatment for likely viral pharyngitis and avoid diagnostic testing or
antibiotic therapy.
Question 2
During a fundoscopic examination of a 68-year-old male with a history of uncontrolled
hypertension, you observe "nicking" where the venules and arterioles cross. You also note copper
and silver wiring of the arterioles. Which condition is primarily associated with these findings?
A) Diabetic Retinopathy
B) Hypertensive Retinopathy
C) Glaucoma
D) Macular Degeneration
E) Retinal Detachment
Correct Answer: B) Hypertensive Retinopathy
Rationale: AV nicking (arteriovenous nicking) is a hallmark sign of chronic hypertension,
caused when a thickened arteriosclerotic arteriole crosses over a vein and compresses it.
Copper and silver wiring descriptions refer to the appearance of the arterioles due to wall
thickening from hypertension. While diabetic retinopathy presents with cotton wool spots
and microaneurysms (and cotton wool spots can occur in HTN too), AV nicking and
copper/silver wiring are distinct to hypertensive changes.
Question 3
A 72-year-old male presents for a routine physical. Upon auscultation of the heart, you hear a
, 2
blowing, holosystolic murmur best heard at the apex which radiates to the left axilla. Which
valvular disorder is most likely present?
A) Aortic Stenosis
B) Mitral Stenosis
C) Mitral Regurgitation
D) Aortic Regurgitation
E) Pulmonic Stenosis
Correct Answer: C) Mitral Regurgitation
Rationale: Using the mnemonic "MR Peyton Manning As MVP," we identify systolic
murmurs. MR (Mitral Regurgitation) is a systolic murmur that is often described as
holosystolic or pansystolic. The classic radiation pattern for Mitral Regurgitation is to the
left axilla. In contrast, Aortic Stenosis radiates to the neck/carotids, and Mitral Stenosis is a
diastolic murmur (ARMS mnemonic).
Question 4
You are reviewing the Hepatitis B serology results for a new patient. The results are as follows:
• HBsAg (Surface Antigen): Negative
• Anti-HBc (Core Antibody): Positive
• Anti-HBs (Surface Antibody): Positive
What is the correct interpretation of the patient's status?
A) Acute Hepatitis B infection
B) Chronic Hepatitis B infection
C) Immunity due to vaccination
D) Immunity due to natural infection
E) Susceptible to Hepatitis B
Correct Answer: D) Immunity due to natural infection
Rationale: The presence of Anti-HBs (Surface Antibody) indicates immunity. To distinguish
between vaccine immunity and natural immunity, look at the Anti-HBc (Core Antibody). A
vaccine only stimulates the Surface Antibody. A natural infection exposes the body to the
core of the virus, resulting in a positive Core Antibody. Since both antibodies are positive
and the Antigen (active virus) is negative, the patient has recovered from a past infection
and is naturally immune.
Question 5
A 4-week-old male infant presents with non-bilious projectile vomiting immediately after
feeding. On physical palpation, an olive-shaped mass is noted in the right upper quadrant (RUQ).
What is the most likely diagnosis?
A) Gastroesophageal Reflux Disease (GERD)
, 3
B) Intussusception
C) Pyloric Stenosis
D) Hirschsprung's Disease
E) Volvulus
Correct Answer: C) Pyloric Stenosis
Rationale: Pyloric stenosis typically presents in infants (2–8 weeks old) with forceful,
projectile, non-bilious vomiting. The hallmark physical exam finding is a palpable "olive-
like" mass in the RUQ, which is the hypertrophied pylorus. Intussusception typically
presents with a "sausage-shaped" mass and currant jelly stools, usually in slightly older
infants (6-36 months).
Question 6
A 30-year-old female at 32 weeks gestation presents to the ER with sudden, painless, bright red
vaginal bleeding. Her uterus is soft and non-tender. Which of the following is the most likely
diagnosis?
A) Placenta Abruption
B) Placenta Previa
C) Uterine Rupture
D) Bloody Show
E) Vasa Previa
Correct Answer: B) Placenta Previa
Rationale: Placenta Previa involves the placenta covering the cervix and is classically
characterized by sudden, painless, bright red bleeding in the third trimester. Placenta
Abruption typically presents with painful vaginal bleeding (often dark red), back pain, and
a rigid, board-like uterus.
Question 7
A 65-year-old African American female with a history of hypertension and osteoporosis requires
a new antihypertensive medication. Which class of medication would be most beneficial for
treating her hypertension while also aiding her bone density?
A) ACE Inhibitors (e.g., Lisinopril)
B) Calcium Channel Blockers (e.g., Amlodipine)
C) Thiazide Diuretics (e.g., Hydrochlorothiazide)
D) Beta Blockers (e.g., Metoprolol)
E) Angiotensin Receptor Blockers (e.g., Losartan)
Correct Answer: C) Thiazide Diuretics (e.g., Hydrochlorothiazide)
Rationale: Thiazide diuretics work by increasing the excretion of sodium and water while
decreasing the excretion of calcium. This calcium retention can help maintain bone mineral
, 4
density, making it an ideal choice for elderly patients with comorbid hypertension and
osteoporosis.
Question 8
During an otoscopic examination of a patient with a history of chronic otitis media, you visualize
a pearly white, cauliflower-like mass behind the tympanic membrane. The patient reports
painless otorrhea and some hearing loss. What is the priority intervention?
A) Prescribe oral amoxicillin.
B) Prescribe otic antibiotic drops.
C) Perform irrigation to remove the mass.
D) Refer to an Otolaryngologist (ENT).
E) Recommend antihistamines for allergic rhinitis.
Correct Answer: D) Refer to an Otolaryngologist (ENT).
Rationale: The description of a pearly white, cauliflower-like mass is highly suggestive of a
Cholesteatoma. This is an abnormal skin growth in the middle ear that can erode bone and
damage the ossicles, leading to permanent hearing loss, facial paralysis, or intracranial
complications. Immediate referral to an ENT for surgical evaluation is required.
Question 9
You are assessing a patient with suspected heart failure. Physical exam reveals jugular venous
distention (JVD), peripheral edema in the lower extremities, and hepatomegaly. The lungs are
clear to auscultation. These findings are most consistent with:
A) Left-sided Heart Failure
B) Right-sided Heart Failure
C) Pulmonary Embolism
D) Aortic Stenosis
E) Mitral Regurgitation
Correct Answer: B) Right-sided Heart Failure
Rationale: Right-sided heart failure results in the backup of blood into the systemic
circulation. This manifests as Jugular Venous Distention (JVD), peripheral edema, and
organomegaly (e.g., liver/spleen). Left-sided heart failure typically causes backup into the
lungs, presenting with crackles, dyspnea, and pulmonary edema.
Question 10
A 13-year-old male is seen for a sports physical. On examination, the testes volume is between
12 and 20 ml, the scrotum has enlarged and darkened, and the penis has increased in length
(approx 10 cm). Pubic hair is adult-like in quality but spares the medial thighs. Which Tanner
Stage does this represent?
A) Tanner Stage II
B) Tanner Stage III
