ANCC FNP BOARD EXAM LATEST REAL EXAM 100+ QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES|ALREDY GRADED A+
Question 1
A 55-year-old male presents with new onset erectile dysfunction, fatigue, and unintentional
weight loss. His blood pressure is 150/90 mmHg, and heart rate is 88 bpm. Lab results show a
fasting glucose of 180 mg/dL and a HbA1c of 8.1%. The most appropriate initial pharmacological
management for his hyperglycemia is:
A) Insulin glargine 10 units subcutaneously once daily
B) Glipizide 5 mg orally once daily
C) Metformin 500 mg orally twice daily
D) Sitagliptin 100 mg orally once daily
E) Pioglitazone 15 mg orally once daily
Correct Answer: C) Metformin 500 mg orally twice daily
Rationale: For a newly diagnosed Type 2 Diabetes Mellitus patient, especially one who is
overweight/obese (implied by age, comorbidities, and common presentation), metformin is the
first-line pharmacological agent. It decreases hepatic glucose production and improves insulin
sensitivity without causing hypoglycemia or weight gain. The initial dose is typically titrated.
Question 2
A 28-year-old female presents with recurrent episodes of intense, unilateral, throbbing
headache accompanied by nausea, photophobia, and phonophobia. She reports an "aura" of
flashing lights before the headache onset. The most appropriate acute abortive treatment for
her migraines is:
A) Ibuprofen 800 mg orally as needed
B) Sumatriptan 50 mg orally at onset
C) Acetaminophen 1000 mg orally as needed
D) Propranolol 20 mg orally twice daily
E) Amitriptyline 10 mg orally at bedtime
Correct Answer: B) Sumatriptan 50 mg orally at onset
Rationale: For moderate to severe migraines with aura, triptans (like sumatriptan) are the first-
line abortive therapy. They are serotonin 5-HT1B/1D receptor agonists that cause
vasoconstriction of intracranial blood vessels and inhibit neuropeptide release. Ibuprofen and
acetaminophen are typically for mild to moderate headaches. Propranolol and amitriptyline are
prophylactic treatments.
Question 3
A 68-year-old male with a history of hypertension, hyperlipidemia, and Type 2 Diabetes Mellitus
presents with intermittent claudication in his calves after walking two blocks. His ankle-brachial
index (ABI) is 0.7 on the right and 0.8 on the left. Which medication is most appropriate to
improve his claudication symptoms?
,A) Aspirin 81 mg daily
B) Clopidogrel 75 mg daily
C) Cilostazol 100 mg orally twice daily
D) Pentoxifylline 400 mg orally three times daily
E) Metoprolol 25 mg orally once daily
Correct Answer: C) Cilostazol 100 mg orally twice daily
Rationale: Cilostazol is a phosphodiesterase inhibitor specifically indicated for the symptomatic
treatment of intermittent claudication in patients with peripheral artery disease (PAD). It
improves walking distance and quality of life by inhibiting platelet aggregation and causing
vasodilation. Aspirin and clopidogrel are antiplatelet agents used to reduce cardiovascular event
risk, but not directly for symptom improvement of claudication.
Question 4
A 4-year-old child presents with a sudden onset of a barking, seal-like cough, inspiratory stridor,
and hoarseness, worse at night. The child is afebrile and appears mildly distressed. The most
likely diagnosis is:
A) Epiglottitis
B) Bacterial tracheitis
C) Laryngotracheobronchitis (Croup)
D) Foreign body aspiration
E) Bronchiolitis
Correct Answer: C) Laryngotracheobronchitis (Croup)
Rationale: Croup is a common viral infection in young children characterized by inflammation of
the larynx, trachea, and bronchi, leading to the classic barking cough, inspiratory stridor, and
hoarseness. It typically worsens at night and is often preceded by a viral URI. Epiglottitis is more
severe with drooling and dysphagia, and no cough.
Question 5
A 32-year-old female presents with burning on urination, urinary frequency, and urgency for 2
days. She denies fever, flank pain, or vaginal discharge. A urine dipstick shows positive nitrites
and leukocyte esterase. The most appropriate initial empiric antibiotic treatment is:
A) Ciprofloxacin 250 mg orally twice daily for 3 days
B) Amoxicillin 500 mg orally twice daily for 7 days
C) Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet orally twice daily for 3 days
D) Doxycycline 100 mg orally twice daily for 7 days
E) Nitrofurantoin 100 mg orally twice daily for 5 days
Correct Answer: C) Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet orally twice daily for 3
days
Rationale: For uncomplicated cystitis in an otherwise healthy non-pregnant woman, first-line
,empiric treatment options include trimethoprim-sulfamethoxazole (if local resistance rates are
low), nitrofurantoin, or fosfomycin. Ciprofloxacin is generally reserved for more complicated
UTIs or resistance patterns. Nitrofurantoin for 5 days is also a first-line option, but Bactrim DS
for 3 days is another very common and effective first-line choice for uncomplicated UTIs.
Question 6
A 78-year-old female with a history of hypertension and osteoarthritis is taking ibuprofen 600
mg three times daily for knee pain. She now presents with lower extremity edema, shortness of
breath, and a weight gain of 5 pounds in 3 days. Her blood pressure is 160/98 mmHg. The nurse
practitioner suspects medication-induced fluid retention and worsening heart failure. What is
the most likely contributing medication?
A) Hydrochlorothiazide
B) Metoprolol
C) Lisinopril
D) Ibuprofen
E) Acetaminophen
Correct Answer: D) Ibuprofen
Rationale: NSAIDs like ibuprofen can cause sodium and water retention and can also increase
systemic vascular resistance by inhibiting prostaglandin synthesis. In elderly patients with
underlying cardiovascular disease, this can lead to fluid overload, elevated blood pressure, and
exacerbation of heart failure symptoms.
Question 7
A 45-year-old male with a 20-year history of smoking presents with a chronic productive cough,
worse in the mornings, for the past 3 months in each of the last 2 years. He denies fever or
hemoptysis. His forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio is
0.65 (normal >0.70). The most likely diagnosis is:
A) Asthma
B) Bronchiectasis
C) Chronic bronchitis
D) Emphysema
E) Tuberculosis
Correct Answer: C) Chronic bronchitis
Rationale: The clinical definition of chronic bronchitis is a chronic productive cough for at least 3
months in each of 2 consecutive years, in a patient for whom other causes of chronic cough
have been excluded. The FEV1/FVC ratio <0.70 confirms obstructive lung disease, consistent
with COPD, of which chronic bronchitis is a component.
, Question 8
A 6-month-old infant presents for a well-child visit. The mother expresses concern about the
infant's development, stating the infant is not yet rolling over from back to front. The nurse
practitioner assesses the infant. At what age should an infant typically roll from back to front?
A) 2 months
B) 4 months
C) 6 months
D) 8 months
E) 10 months
Correct Answer: C) 6 months
Rationale: Most infants typically achieve the developmental milestone of rolling from back to
front by 6 months of age. Rolling from front to back often occurs earlier (around 4-5 months).
While individual variations exist, this is a reasonable age to assess for this milestone.
Question 9
A 38-year-old female is diagnosed with Helicobacter pylori infection. Which of the following is
the most appropriate initial "triple therapy" regimen?
A) Amoxicillin, metronidazole, and omeprazole
B) Clarithromycin, amoxicillin, and omeprazole
C) Ciprofloxacin, metronidazole, and ranitidine
D) Doxycycline, metronidazole, and bismuth subsalicylate
E) Levofloxacin, amoxicillin, and pantoprazole
Correct Answer: B) Clarithromycin, amoxicillin, and omeprazole
Rationale: Standard triple therapy for H. pylori infection typically consists of a proton pump
inhibitor (PPI, e.g., omeprazole) and two antibiotics, usually clarithromycin and amoxicillin (or
metronidazole if penicillin allergy exists). This regimen is usually given for 10-14 days.
Question 10
A 72-year-old male with Type 2 Diabetes Mellitus has a new onset of painful burning and
tingling sensations in his feet, worse at night. Physical exam reveals diminished sensation to
light touch and vibratory sense in a stocking-glove distribution. The most appropriate initial
pharmacological treatment for his neuropathic pain is:
A) Acetaminophen 500 mg orally as needed
B) Gabapentin 300 mg orally at bedtime
C) Morphine ER 15 mg orally daily
D) Prednisone 20 mg orally daily
E) Ibuprofen 400 mg orally as needed
Correct Answer: B) Gabapentin 300 mg orally at bedtime
Rationale: Gabapentin and pregabalin (alpha-2-delta ligands), as well as tricyclic antidepressants
ANSWERS WITH RATIONALES|ALREDY GRADED A+
Question 1
A 55-year-old male presents with new onset erectile dysfunction, fatigue, and unintentional
weight loss. His blood pressure is 150/90 mmHg, and heart rate is 88 bpm. Lab results show a
fasting glucose of 180 mg/dL and a HbA1c of 8.1%. The most appropriate initial pharmacological
management for his hyperglycemia is:
A) Insulin glargine 10 units subcutaneously once daily
B) Glipizide 5 mg orally once daily
C) Metformin 500 mg orally twice daily
D) Sitagliptin 100 mg orally once daily
E) Pioglitazone 15 mg orally once daily
Correct Answer: C) Metformin 500 mg orally twice daily
Rationale: For a newly diagnosed Type 2 Diabetes Mellitus patient, especially one who is
overweight/obese (implied by age, comorbidities, and common presentation), metformin is the
first-line pharmacological agent. It decreases hepatic glucose production and improves insulin
sensitivity without causing hypoglycemia or weight gain. The initial dose is typically titrated.
Question 2
A 28-year-old female presents with recurrent episodes of intense, unilateral, throbbing
headache accompanied by nausea, photophobia, and phonophobia. She reports an "aura" of
flashing lights before the headache onset. The most appropriate acute abortive treatment for
her migraines is:
A) Ibuprofen 800 mg orally as needed
B) Sumatriptan 50 mg orally at onset
C) Acetaminophen 1000 mg orally as needed
D) Propranolol 20 mg orally twice daily
E) Amitriptyline 10 mg orally at bedtime
Correct Answer: B) Sumatriptan 50 mg orally at onset
Rationale: For moderate to severe migraines with aura, triptans (like sumatriptan) are the first-
line abortive therapy. They are serotonin 5-HT1B/1D receptor agonists that cause
vasoconstriction of intracranial blood vessels and inhibit neuropeptide release. Ibuprofen and
acetaminophen are typically for mild to moderate headaches. Propranolol and amitriptyline are
prophylactic treatments.
Question 3
A 68-year-old male with a history of hypertension, hyperlipidemia, and Type 2 Diabetes Mellitus
presents with intermittent claudication in his calves after walking two blocks. His ankle-brachial
index (ABI) is 0.7 on the right and 0.8 on the left. Which medication is most appropriate to
improve his claudication symptoms?
,A) Aspirin 81 mg daily
B) Clopidogrel 75 mg daily
C) Cilostazol 100 mg orally twice daily
D) Pentoxifylline 400 mg orally three times daily
E) Metoprolol 25 mg orally once daily
Correct Answer: C) Cilostazol 100 mg orally twice daily
Rationale: Cilostazol is a phosphodiesterase inhibitor specifically indicated for the symptomatic
treatment of intermittent claudication in patients with peripheral artery disease (PAD). It
improves walking distance and quality of life by inhibiting platelet aggregation and causing
vasodilation. Aspirin and clopidogrel are antiplatelet agents used to reduce cardiovascular event
risk, but not directly for symptom improvement of claudication.
Question 4
A 4-year-old child presents with a sudden onset of a barking, seal-like cough, inspiratory stridor,
and hoarseness, worse at night. The child is afebrile and appears mildly distressed. The most
likely diagnosis is:
A) Epiglottitis
B) Bacterial tracheitis
C) Laryngotracheobronchitis (Croup)
D) Foreign body aspiration
E) Bronchiolitis
Correct Answer: C) Laryngotracheobronchitis (Croup)
Rationale: Croup is a common viral infection in young children characterized by inflammation of
the larynx, trachea, and bronchi, leading to the classic barking cough, inspiratory stridor, and
hoarseness. It typically worsens at night and is often preceded by a viral URI. Epiglottitis is more
severe with drooling and dysphagia, and no cough.
Question 5
A 32-year-old female presents with burning on urination, urinary frequency, and urgency for 2
days. She denies fever, flank pain, or vaginal discharge. A urine dipstick shows positive nitrites
and leukocyte esterase. The most appropriate initial empiric antibiotic treatment is:
A) Ciprofloxacin 250 mg orally twice daily for 3 days
B) Amoxicillin 500 mg orally twice daily for 7 days
C) Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet orally twice daily for 3 days
D) Doxycycline 100 mg orally twice daily for 7 days
E) Nitrofurantoin 100 mg orally twice daily for 5 days
Correct Answer: C) Trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet orally twice daily for 3
days
Rationale: For uncomplicated cystitis in an otherwise healthy non-pregnant woman, first-line
,empiric treatment options include trimethoprim-sulfamethoxazole (if local resistance rates are
low), nitrofurantoin, or fosfomycin. Ciprofloxacin is generally reserved for more complicated
UTIs or resistance patterns. Nitrofurantoin for 5 days is also a first-line option, but Bactrim DS
for 3 days is another very common and effective first-line choice for uncomplicated UTIs.
Question 6
A 78-year-old female with a history of hypertension and osteoarthritis is taking ibuprofen 600
mg three times daily for knee pain. She now presents with lower extremity edema, shortness of
breath, and a weight gain of 5 pounds in 3 days. Her blood pressure is 160/98 mmHg. The nurse
practitioner suspects medication-induced fluid retention and worsening heart failure. What is
the most likely contributing medication?
A) Hydrochlorothiazide
B) Metoprolol
C) Lisinopril
D) Ibuprofen
E) Acetaminophen
Correct Answer: D) Ibuprofen
Rationale: NSAIDs like ibuprofen can cause sodium and water retention and can also increase
systemic vascular resistance by inhibiting prostaglandin synthesis. In elderly patients with
underlying cardiovascular disease, this can lead to fluid overload, elevated blood pressure, and
exacerbation of heart failure symptoms.
Question 7
A 45-year-old male with a 20-year history of smoking presents with a chronic productive cough,
worse in the mornings, for the past 3 months in each of the last 2 years. He denies fever or
hemoptysis. His forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio is
0.65 (normal >0.70). The most likely diagnosis is:
A) Asthma
B) Bronchiectasis
C) Chronic bronchitis
D) Emphysema
E) Tuberculosis
Correct Answer: C) Chronic bronchitis
Rationale: The clinical definition of chronic bronchitis is a chronic productive cough for at least 3
months in each of 2 consecutive years, in a patient for whom other causes of chronic cough
have been excluded. The FEV1/FVC ratio <0.70 confirms obstructive lung disease, consistent
with COPD, of which chronic bronchitis is a component.
, Question 8
A 6-month-old infant presents for a well-child visit. The mother expresses concern about the
infant's development, stating the infant is not yet rolling over from back to front. The nurse
practitioner assesses the infant. At what age should an infant typically roll from back to front?
A) 2 months
B) 4 months
C) 6 months
D) 8 months
E) 10 months
Correct Answer: C) 6 months
Rationale: Most infants typically achieve the developmental milestone of rolling from back to
front by 6 months of age. Rolling from front to back often occurs earlier (around 4-5 months).
While individual variations exist, this is a reasonable age to assess for this milestone.
Question 9
A 38-year-old female is diagnosed with Helicobacter pylori infection. Which of the following is
the most appropriate initial "triple therapy" regimen?
A) Amoxicillin, metronidazole, and omeprazole
B) Clarithromycin, amoxicillin, and omeprazole
C) Ciprofloxacin, metronidazole, and ranitidine
D) Doxycycline, metronidazole, and bismuth subsalicylate
E) Levofloxacin, amoxicillin, and pantoprazole
Correct Answer: B) Clarithromycin, amoxicillin, and omeprazole
Rationale: Standard triple therapy for H. pylori infection typically consists of a proton pump
inhibitor (PPI, e.g., omeprazole) and two antibiotics, usually clarithromycin and amoxicillin (or
metronidazole if penicillin allergy exists). This regimen is usually given for 10-14 days.
Question 10
A 72-year-old male with Type 2 Diabetes Mellitus has a new onset of painful burning and
tingling sensations in his feet, worse at night. Physical exam reveals diminished sensation to
light touch and vibratory sense in a stocking-glove distribution. The most appropriate initial
pharmacological treatment for his neuropathic pain is:
A) Acetaminophen 500 mg orally as needed
B) Gabapentin 300 mg orally at bedtime
C) Morphine ER 15 mg orally daily
D) Prednisone 20 mg orally daily
E) Ibuprofen 400 mg orally as needed
Correct Answer: B) Gabapentin 300 mg orally at bedtime
Rationale: Gabapentin and pregabalin (alpha-2-delta ligands), as well as tricyclic antidepressants
