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ANCC FNP study materials
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ANCC FNP practice questions

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Question 1Assessment

A patient's blood pressure is measured while supine and again after standing for 3 minutes. Which finding meets the criteria for orthostatic hypotension?

  1. Fall in systolic pressure of 8 mm Hg with a fall in diastolic pressure of 4 mm Hg
  2. Fall in diastolic pressure of 6 mm Hg
  3. Rise in systolic pressure of 12 mm Hg after standing
  4. Fall in systolic pressure of 22 mm Hg Correct answer.

Explanation

Orthostatic hypotension is defined as a sustained fall in systolic pressure of at least 20 mm Hg or diastolic pressure of at least 10 mm Hg within 3 minutes of standing. A 22 mm Hg systolic fall therefore meets the criterion.

Question 2Assessment

Which part of the stethoscope is best suited to hear a low-pitched diastolic murmur?

  1. The diaphragm, applied with firm pressure over the apex
  2. The diaphragm, because it filters high-pitched sounds
  3. The bell, pressed firmly enough to stretch the skin
  4. The bell, applied with light pressure Correct answer.

Explanation

The bell transmits low-frequency sounds when applied with light pressure, making it best for low-pitched murmurs such as mitral stenosis and for S3 and S4. The diaphragm is used for high-pitched sounds.

Question 3Assessment

Which sequence of examination techniques is correct for the abdomen?

  1. Inspection, auscultation, percussion, palpation Correct answer.
  2. Auscultation, percussion, palpation, inspection
  3. Palpation, inspection, auscultation, percussion
  4. Inspection, palpation, percussion, auscultation

Explanation

Auscultation is performed before percussion and palpation because those maneuvers can alter bowel sounds. The correct order is inspection, auscultation, percussion, then palpation.

Question 4Assessment

A 72-year-old reports difficulty hearing grandchildren but not low-pitched voices. Audiometry shows bilateral high-frequency sensorineural loss. Which term describes this finding?

  1. Mixed hearing loss from chronic otitis media
  2. Central auditory processing disorder
  3. Presbycusis Correct answer.
  4. Conductive hearing loss from cerumen impaction

Explanation

Presbycusis is age-related bilateral sensorineural hearing loss that affects high frequencies first, which impairs hearing of higher-pitched voices. Conductive loss involves the outer or middle ear and typically affects all frequencies.

Question 5Assessment

Which statement best describes the purpose of the review of systems?

  1. It lists the patient's immunizations and past surgeries
  2. It records the family's causes of death and ages
  3. It collects subjective symptoms by body system Correct answer.
  4. It documents objective findings from the physical examination

Explanation

The review of systems is a subjective inventory of symptoms organized by body system. Past medical history, immunizations, and family history are documented separately.

Question 6Assessment

Which pain scale is most appropriate for a healthy 6-year-old child?

  1. Wong-Baker FACES scale Correct answer.
  2. Verbal descriptor scale designed for adults
  3. Visual analog scale
  4. Numeric rating scale from 0 to 10

Explanation

The Wong-Baker FACES scale uses simple drawings and is validated for children about 3 to 7 years old. A numeric 0-to-10 scale requires abstract number understanding that many 6-year-olds have not yet developed.

Question 7Assessment

In the ABCDE criteria for melanoma, which feature does the 'E' represent?

  1. Erosion of the lesion's surface
  2. Elevation above the skin surface
  3. Evolution in size or color Correct answer.
  4. Erythema surrounding the lesion

Explanation

The ABCDE criteria are asymmetry, border irregularity, color variation, diameter greater than 6 mm, and evolution. Evolution refers to a lesion changing in size, shape, or color over time.

Question 8Assessment

A positive Babinski sign in an adult indicates which type of lesion?

  1. Peripheral neuropathy
  2. Cerebellar lesion
  3. Lower motor neuron lesion of the spinal cord
  4. Upper motor neuron lesion Correct answer.

Explanation

In adults, a positive Babinski sign reflects an upper motor neuron lesion in the corticospinal tract. It is a normal finding in infants until about 1 to 2 years of age as myelination completes.

Question 9Assessment

A patient with right lower lobe pneumonia is examined. Which finding is most consistent?

  1. Tympanic percussion note over the right base
  2. Decreased tactile fremitus over the right lower lobe
  3. Increased tactile fremitus over the right base Correct answer.
  4. Hyperresonance over the right base

Explanation

Consolidation from pneumonia increases transmission of sound and vibration, producing increased tactile fremitus and dullness to percussion over the affected area. Hyperresonance and decreased fremitus suggest air trapping or pneumothorax.

Question 10Assessment

Which description fits the murmur of aortic stenosis?

  1. Early diastolic decrescendo murmur heard along the left lower sternal border
  2. Holosystolic murmur heard at the apex and radiating to the axilla
  3. Crescendo-decrescendo systolic murmur at the right sternal border Correct answer.
  4. Continuous machinery murmur heard throughout systole and diastole beneath the left clavicle

Explanation

Aortic stenosis produces a crescendo-decrescendo systolic murmur at the right upper sternal border that radiates to the carotids. Mitral regurgitation is holosystolic at the apex, and aortic regurgitation is an early diastolic murmur.

Question 11Assessment

A positive Murphy sign during abdominal examination suggests which condition?

  1. Perforated peptic ulcer
  2. Small bowel obstruction
  3. Acute appendicitis
  4. Acute cholecystitis Correct answer.

Explanation

Murphy sign is inspiratory arrest or sharp pain when the examiner presses under the right costal margin during inspiration, reflecting an inflamed gallbladder. Appendicitis pain localizes to the right lower quadrant.

Question 12Assessment

Which cranial nerves mediate the corneal reflex?

  1. CN II and CN III
  2. CN V and CN VII Correct answer.
  3. CN V and CN XII
  4. CN VII and CN VIII

Explanation

The corneal reflex uses the ophthalmic branch of CN V as the afferent limb and CN VII as the efferent limb. CN III controls pupil constriction but not the blink response.

Question 13Assessment

According to the USPSTF, at what age should average-risk adults begin colorectal cancer screening?

  1. 40 years
  2. 45 years Correct answer.
  3. 50 years
  4. 55 years

Explanation

The USPSTF recommends colorectal cancer screening for average-risk adults beginning at age 45 and continuing through age 75. Earlier guidance started at 50, but the recommendation was updated in 2021.

Question 14Assessment

Cervical cancer screening with cytology should begin at what age for average-risk women?

  1. 21 years Correct answer.
  2. 25 years
  3. 18 years or at first intercourse
  4. 30 years

Explanation

Cytology-based cervical cancer screening begins at age 21, regardless of the age of first intercourse. Screening before 21 is not recommended because cervical cancer is rare and HPV infections often clear.

Question 15Assessment

On the GAD-7, a score of 15 corresponds to which level of anxiety?

  1. Minimal
  2. Mild
  3. No anxiety detected
  4. Severe Correct answer.

Explanation

GAD-7 scores of 5 to 9 indicate mild anxiety, 10 to 14 moderate, and 15 or greater severe anxiety. A score of 15 therefore falls in the severe range.

Question 16Assessment

Which tool is a validated brief screen for unhealthy alcohol use in primary care?

  1. Mini-Cog
  2. PHQ-2
  3. CAGE-AID for drug use only
  4. AUDIT-C Correct answer.

Explanation

The AUDIT-C is a three-item screen for unhealthy alcohol use that is validated for primary care. The PHQ-2 screens for depression, and the Mini-Cog screens for cognitive impairment.

Question 17Assessment

At what age does a social smile typically first appear in an infant?

  1. 2 months Correct answer.
  2. 4 months
  3. 9 months
  4. 6 months

Explanation

A social smile typically appears at about 6 to 8 weeks, or 2 months of age. A laugh usually emerges around 4 months, and stranger anxiety around 6 to 9 months.

Question 18Assessment

Which two components make up the Mini-Cog?

  1. Animal naming plus the trail making test
  2. The MMSE plus a clock drawing task
  3. Three-item recall and clock drawing Correct answer.
  4. The MoCA plus a functional assessment scale

Explanation

The Mini-Cog combines a three-item recall task with a clock-drawing test and takes about 3 minutes to administer. It is used to screen for cognitive impairment in older adults.

Question 19Assessment

A 34-year-old woman has hemoglobin 9.8 g/dL, MCV 74 fL, and ferritin 6 ng/mL. Which is the most likely diagnosis?

  1. Vitamin B12 deficiency
  2. Iron deficiency anemia Correct answer.
  3. Anemia of chronic disease
  4. Thalassemia trait

Explanation

Microcytosis with a low ferritin level strongly supports iron deficiency anemia. Thalassemia trait usually has a normal ferritin, and anemia of chronic disease typically has a normal or high ferritin.

Question 20Assessment

An ECG shows ST elevation in leads II, III, and aVF. Which region is infarcting?

  1. Lateral wall
  2. Posterior wall
  3. Anterior wall
  4. Inferior wall Correct answer.

Explanation

Leads II, III, and aVF look at the inferior wall of the left ventricle, so ST elevation there indicates an inferior myocardial infarction. Anterior changes appear in V1 through V4, and lateral changes in I, aVL, V5, and V6.

Question 21Assessment

A patient with a large pericardial effusion has a systolic blood pressure that falls 14 mm Hg during inspiration. Which finding does this represent?

  1. Pulsus alternans
  2. Pulsus parvus et tardus
  3. Pulsus bisferiens
  4. Pulsus paradoxus Correct answer.

Explanation

An inspiratory fall in systolic pressure greater than 10 mm Hg is pulsus paradoxus, classically seen with cardiac tamponade. Pulsus alternans is an alternating strong and weak pulse, and pulsus parvus et tardus is a weak, delayed pulse of aortic stenosis.

Question 22Assessment

A patient with chronic right heart failure is examined. Firm pressure over the right upper quadrant for 30 seconds produces a sustained rise in jugular venous pressure. Which finding is this?

  1. Positive hepatojugular reflux Correct answer.
  2. Traube semilunar space dullness
  3. Kussmaul sign
  4. Abdominal paradoxical pulse

Explanation

Hepatojugular reflux is a sustained rise in jugular venous pressure during firm right upper quadrant pressure, reflecting right heart failure or a noncompliant right ventricle. Kussmaul sign is a paradoxical rise in JVP with inspiration.

Question 23Assessment

A patient has ptosis, a dilated pupil, and the eye deviates down and out. Which cranial nerve is affected?

  1. CN VII
  2. CN III Correct answer.
  3. CN VI
  4. CN IV

Explanation

CN III supplies the levator palpebrae and most extraocular muscles, so a lesion causes ptosis and a down-and-out eye. Parasympathetic fibers travel on the outside of CN III, so compression often produces a dilated pupil.

Question 24Assessment

A screening test has sensitivity 90% and specificity 80%. In a population with low prevalence, which measure is most affected and will be low?

  1. Specificity
  2. Sensitivity
  3. Positive predictive value Correct answer.
  4. Negative likelihood ratio

Explanation

Positive predictive value depends on prevalence, so in a low-prevalence population most positive results are false positives and PPV falls. Sensitivity and specificity are properties of the test and do not change with prevalence.

Question 25Assessment

Which technique best confirms a patient understands new medication instructions?

  1. Giving the patient a printed handout at a 12th-grade reading level
  2. Asking the patient whether they have any questions
  3. Asking the patient to explain the instructions in their own words Correct answer.
  4. Repeating the instructions slowly and loudly

Explanation

Teach-back, in which the patient restates instructions in their own words, is the best way to confirm comprehension. Asking whether the patient has questions or repeating instructions does not verify understanding.

Question 26Assessment

What is the normal resting heart rate range for a healthy adult?

  1. 100 to 120 beats/min
  2. 60 to 100 beats/min Correct answer.
  3. 120 to 140 beats/min
  4. 40 to 60 beats/min

Explanation

A normal adult resting heart rate is 60 to 100 beats/min. Rates below 60 beats/min are bradycardic, and rates above 100 beats/min are tachycardic.

Question 27Assessment

A patient has a body mass index of 27 kg/m². Which weight category does this represent?

  1. Underweight
  2. Obesity class I
  3. Overweight Correct answer.
  4. Normal weight

Explanation

A BMI of 25.0 to 29.9 kg/m² is classified as overweight. Normal weight is 18.5 to 24.9 kg/m², and obesity begins at 30 kg/m².

Question 28Assessment

In the PQRST mnemonic for pain assessment, what does the 'R' represent?

  1. Relief
  2. Radiation Correct answer.
  3. Recurrence
  4. Rigidity

Explanation

PQRST stands for Provocation or Palliation, Quality, Region or Radiation, Severity, and Timing. The 'R' refers to region and radiation of the pain.

Question 29Assessment

Which finding defines orthostatic hypotension when vital signs are measured after standing?

  1. Systolic fall ≥20 mm Hg or diastolic fall ≥10 mm Hg Correct answer.
  2. Diastolic rise ≥20 mm Hg with systolic rise
  3. Systolic fall ≥10 mm Hg with no diastolic change
  4. Systolic fall ≥30 mm Hg with preserved diastolic pressure alone

Explanation

Orthostatic hypotension is defined as a systolic blood pressure fall of at least 20 mm Hg or a diastolic fall of at least 10 mm Hg within 3 minutes of standing. This reflects impaired baroreflex compensation.

Question 30Assessment

The point of maximal impulse of the heart is normally palpated at which location?

  1. Third intercostal space at the left sternal border
  2. Fourth intercostal space at the anterior axillary line
  3. Second intercostal space at the right sternal border
  4. Fifth intercostal space at the midclavicular line Correct answer.

Explanation

The point of maximal impulse is normally located at the fifth intercostal space at the midclavicular line. This corresponds to the cardiac apex.

Question 31Assessment

Which newborn reflex is elicited by allowing the head to drop backward, producing arm abduction followed by adduction?

  1. Palmar grasp reflex
  2. Rooting reflex
  3. Moro reflex Correct answer.
  4. Asymmetric tonic neck reflex

Explanation

The Moro reflex is a startle response triggered by sudden head extension, with symmetric arm abduction and then adduction. It typically disappears by 4 to 6 months of age.

Question 32Assessment

Which instrument is the standard brief screening tool for depression in primary care?

  1. Mini-Mental State Examination
  2. PHQ-9 Correct answer.
  3. AUDIT-C
  4. CAGE questionnaire

Explanation

The PHQ-9 is a validated brief tool used to screen for and monitor depression severity. AUDIT-C and CAGE screen for alcohol use, and the MMSE assesses cognition.

Question 33Assessment

A BUN-to-creatinine ratio greater than 20:1 most often indicates which process?

  1. Postrenal obstruction
  2. Prerenal azotemia Correct answer.
  3. Intrinsic renal failure
  4. Normal renal function

Explanation

A BUN-to-creatinine ratio above 20:1 suggests prerenal azotemia, in which increased proximal tubular urea reabsorption raises BUN disproportionately. Intrinsic renal disease usually produces a ratio of 10:1 to 20:1.

Question 34Assessment

Which otoscopic finding is most consistent with acute otitis media?

  1. A tympanic membrane perforation with clear drainage
  2. A bulging, erythematous tympanic membrane Correct answer.
  3. A retracted tympanic membrane with an air-fluid level
  4. A pearly gray tympanic membrane with a visible light reflex

Explanation

Acute otitis media classically shows a bulging, erythematous, opaque tympanic membrane with reduced mobility. A pearly gray membrane is normal, and a retracted membrane with fluid suggests otitis media with effusion.

Question 35Assessment

A patient reports recurrent episodes of vertigo lasting hours, with unilateral hearing loss and tinnitus. Which diagnosis is most likely?

  1. Vestibular neuritis
  2. Benign paroxysmal positional vertigo
  3. Acoustic neuroma
  4. Meniere disease Correct answer.

Explanation

Meniere disease classically presents with episodic vertigo lasting minutes to hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Benign paroxysmal positional vertigo causes brief positional vertigo without hearing loss.

Question 36Assessment

When the neck is flexed during physical examination, a patient flexes the hips and knees. Which sign is this?

  1. Romberg sign
  2. Brudzinski sign Correct answer.
  3. Lasegue sign
  4. Kernig sign

Explanation

The Brudzinski neck sign is hip and knee flexion elicited by passive neck flexion, suggesting meningeal irritation. Kernig sign is resistance or pain with knee extension after hip flexion.

Question 37Assessment

Which heart sound is a low-pitched extra sound heard at the apex in early diastole and is associated with heart failure?

  1. S1
  2. S3 Correct answer.
  3. S2
  4. S4

Explanation

An S3 is a low-pitched early diastolic sound best heard at the apex and is associated with volume overload and heart failure. S4 occurs in late diastole and is associated with stiff ventricles.

Question 38Assessment

A 68-year-old patient reports new-onset unilateral headache, jaw claudication, and scalp tenderness. Which diagnosis should be suspected?

  1. Cluster headache
  2. Tension-type headache
  3. Giant cell arteritis Correct answer.
  4. Migraine without aura

Explanation

New headache in an older adult with jaw claudication and scalp tenderness suggests giant cell arteritis, which carries a risk of vision loss. An elevated ESR and CRP often support the diagnosis.

Question 39Assessment

Which physical examination technique is most useful for detecting ascites when abdominal distention is present?

  1. Auscultation for bowel sounds
  2. Percussion for tympany
  3. Palpation of the liver edge
  4. Testing for shifting dullness Correct answer.

Explanation

Shifting dullness detects free peritoneal fluid by demonstrating a change in the percussion note as the patient turns. Tympany suggests gas, and bowel sounds and liver palpation do not confirm ascites.

Question 40Assessment

Which finding is most characteristic of plaque psoriasis?

  1. Well-demarcated silvery plaques on extensor surfaces Correct answer.
  2. Target lesions on the palms and soles
  3. Honey-colored crusts around the nose and mouth
  4. Linear burrows in the finger webs

Explanation

Plaque psoriasis produces well-demarcated erythematous plaques with silvery scale, typically on extensor surfaces such as the elbows and knees. Honey-colored crusts suggest impetigo, target lesions suggest erythema multiforme, and burrows suggest scabies.

Question 41Assessment

Which cranial nerve provides the motor (efferent) limb of the gag reflex?

  1. Vagus nerve (CN X) Correct answer.
  2. Facial nerve (CN VII)
  3. Glossopharyngeal nerve (CN IX)
  4. Hypoglossal nerve (CN XII)

Explanation

The gag reflex has an afferent limb carried by CN IX and an efferent limb carried by CN X. The vagus nerve triggers pharyngeal constriction.

Question 42Assessment

Which deep tendon reflex finding is most characteristic of hypothyroidism?

  1. Delayed relaxation phase Correct answer.
  2. Hyperreflexia
  3. Clonus
  4. Absent reflexes

Explanation

Hypothyroidism produces a delayed relaxation phase of the deep tendon reflexes, sometimes called Woltman sign. Hyperreflexia is more typical of hyperthyroidism.

Question 43Assessment

A positive straight leg raise test suggests which condition?

  1. Femoral neuropathy
  2. Sacroiliac joint dysfunction
  3. Lumbar radiculopathy Correct answer.
  4. Hip osteoarthritis

Explanation

The straight leg raise test stretches the sciatic nerve and lower lumbar roots, so a positive test suggests lumbar radiculopathy. Pain reproduced between 30 and 70 degrees of elevation is typical.

Question 44Assessment

Which question is recommended as an initial screen for intimate partner violence in primary care?

  1. 'Are you currently employed?'
  2. 'Have you ever been arrested?'
  3. 'Do you feel safe at home?' Correct answer.
  4. 'Do you drink alcohol daily?'

Explanation

A brief safety question such as 'Do you feel safe at home?' is a validated initial screen for intimate partner violence. It is nonjudgmental and can be asked routinely during history taking.

Question 45Assessment

A patient exhibits facial twitching when the facial nerve is tapped just anterior to the ear. This Chvostek sign suggests which electrolyte abnormality?

  1. Hypocalcemia Correct answer.
  2. Hypokalemia
  3. Hyponatremia
  4. Hypermagnesemia

Explanation

Chvostek sign reflects neuromuscular irritability caused by hypocalcemia. Tapping the facial nerve triggers ipsilateral facial muscle twitching.

Question 46Assessment

Which auscultatory finding is most characteristic of mitral stenosis?

  1. Early diastolic decrescendo murmur at the left upper sternal border
  2. Harsh systolic crescendo-decrescendo murmur at the right upper sternal border
  3. Opening snap followed by diastolic rumble at the apex Correct answer.
  4. Blowing holosystolic murmur at the apex radiating to the axilla

Explanation

Mitral stenosis produces an opening snap followed by a low-pitched rumbling diastolic murmur at the apex. The murmur is caused by turbulent flow across a narrowed mitral valve.

Question 47Assessment

A patient has unilateral facial weakness that spares the forehead. Which lesion location best explains this finding?

  1. A lesion of the facial nerve in the facial canal
  2. A lesion of the contralateral corticobulbar tract Correct answer.
  3. A lesion at the neuromuscular junction
  4. A lesion of the trigeminal nerve

Explanation

An upper motor neuron lesion of the contralateral corticobulbar tract spares the forehead because the upper face receives bilateral cortical innervation. A peripheral facial nerve lesion affects the entire side of the face, including the forehead.

Question 48Assessment

Which fundoscopic finding is most consistent with chronic hypertensive retinopathy?

  1. Drusen deposits at the macula
  2. A cherry-red spot at the macula
  3. Optic disc cupping
  4. Arteriovenous nicking Correct answer.

Explanation

Chronic hypertensive retinopathy produces arteriovenous nicking, arteriolar narrowing, flame-shaped hemorrhages, and cotton-wool spots. Drusen suggest age-related macular degeneration, a cherry-red spot suggests central retinal artery occlusion, and disc cupping suggests glaucoma.

Question 49Assessment

Which feature best distinguishes delirium from dementia?

  1. Acute onset with fluctuating course Correct answer.
  2. Gradual onset over months
  3. Preserved attention
  4. Stable course over the day

Explanation

Delirium has an acute onset with a fluctuating course and impaired attention. Dementia typically has an insidious, gradual decline with attention preserved until later stages.

Question 50Assessment

During evaluation of a 3-week-old with a spiral humeral fracture, which caregiver history feature most strongly suggests physical abuse?

  1. A consistent explanation over repeated interviews
  2. A documented bleeding disorder
  3. A changing explanation with each retelling Correct answer.
  4. Recent relocation of the family

Explanation

An explanation that changes with each retelling is a red flag for abuse, especially when the injury mechanism is inconsistent with the infant's developmental stage. A spiral fracture in a nonmobile infant also raises concern.