ANCC FNP EXAM AND PRACTICE EXAM 2024 -
2025 WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED RATIONALES ANSWERS
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A 15-year-old male with no PMH presents with shoulder pain that has occurred for several months. He
has been playing baseball for the last 3 years and began feeling pain in his arm and shoulder when he
started learning and practicing the breaking-ball pitch over the last 6 months. He denies any trauma.
Pain only occurs when the patient is pitching and is relieved by rest. Pain also tends to occur in the
deceleration portion of his pitch and is not related to temperature or time of day. The patient's
temperature is 98°F, HR is 70, RR is 14, and BP is 110/75. Physical exam shows pinpoint tenderness
where the shoulder meets with the arm. What is the most likely diagnosis?
A. Thoracic outlet syndrome
B. Rotator cuff tendinitis
C. Shoulder impingement
D. Proximal humerus stress injury (little leaguer's shoulder)
Correct Answer: D. Proximal humerus stress injury (little leaguer's shoulder)
Proximal humerus stress injury affects the growth plate of the proximal humerus after repetitive
microtrauma. It occurs in young pitchers who throw many breaking balls. Patients present with arm
and shoulder pain when throwing the ball that increases in intensity over time. The pain is worsened
in the late cocking or deceleration phases of throwing and resolves with rest. Patients complain of
point tenderness over the shoulder physis, and pain is reproduced when throwing. This patient has
pinpoint tenderness, probably due to microtrauma on the physis from long periods of pitching a
breaking ball. These problems, along with relief of shoulder pain at rest, make little leaguer's shoulder
most likely.
Incorrect Answers:
A. Thoracic outlet syndrome occurs when there is compression at the superior thoracic outlet due to
excess pressure placed on a neurovascular bundle between the scalene muscles. Because the nerves
of the upper limb and/or vessels pass through the outlet, all of them can be affected. Typically, the
syndrome is caused by congenital abnormalities (e.g. cervical rib or prolonged transverse process) or
by trauma or repetitive strain. Patients present with sharp, burning pain in the upper arm, forearm,
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,and/or fingers. Decreased coloring of the hands, tingling, and coldness are found as well. This patient
does not present with any tingling or burning pain, and thus this condition is unlikely.
B. Rotator cuff tendinitis involves the swelling of the rotator cuff tendons. This typically is caused by
repetitive activities associated with overuse of the arm and shoulder, especially in physical activities
such as volleyball or baseball. Symptoms involve shoulder weakness and difficulty lifting the arm over
the head. In addition, there may be
A 33-year-old woman complains of mild pain and swelling in her wrist. The pain is located along the
radial side of the wrist. She reports reduced sensation along the radial side of her hand with
accompanying numbness and tingling. In addition, she notes a nodule on the dorsal aspect of her wrist.
She does not know exactly when the pain and discomfort started and cannot recall any traumatic or
inciting event. She has taken pain medication with no improvement in her symptoms.
The patient's temperature is 98.3 degrees Fahrenheit, heart rate is 80 beats/minute, respiratory rate is
16 breaths/minute, and blood pressure is 130/90 mmHg. On physical exam, the nodule is firm, tender,
and transilluminates. Which of the following diagnostic tests is indicated for this patient?
A. X-ray
B. MRI
C. Arthroscopic exam
D. No imaging needed
Correct Answer: B. MRI
A ganglion cyst is a cystic swelling typically found on the dorsal side of the wrist. These cysts are
thought to arise from herniation of synovial tissue from a joint capsule or tendon sheath. They
present with chronic wrist pain and may be accompanied by the coolness of the hand,
numbness/tingling, and possible paresthesias. Classically on exam, the mass itself is mobile, tender to
palpation, and transilluminates. Most cases of ganglion cysts are diagnosed by history and physical
exam, so no further imaging is needed. Transillumination will differentiate a cystic lesion from a solid
mass, but an ultrasound is more reliable.
This patient presents with pain and neurovascular symptoms, indicating possible structural damage to
the cyst invading deeper tissues. In these cases, MRI will allow the best visualization of the tissue and
assess neurovascular damage more accurately and rule out other potential causes.
Incorrect Answers:
(A) An X-ray will not provide the needed visualization of the tissue.(C) A diagnostic test is needed for
this patient as the patient presents with pain and neurovascular symptoms. (D) Since the patient
presents with pain and neurovascular symptoms, further imaging is needed.
A 68-year-old male presents with an acute onset of a red, swollen, painful knee. He has diabetes,
hyperlipidemia, and chronic kidney disease. He denies fevers, chills, and trauma. His vitals are as follows:
Temp = 98°F HR = 70BP = 140/80 RR = 14
On exam, he has a joint effusion with erythema and generalized tenderness. There is no streaking. Fluid
from the knee aspiration reveals a cell count of <1000, and his culture 72 hours later shows no growth.
What is the most likely diagnosis?
A. Prepatellar bursitis
B. Gout
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,C. Septic arthritis
D. Meniscal tear
Correct Answer: B. Gout
The most likely diagnosis is gout. The sudden onset and co-morbidities are highly suspicious for gout.
The white blood cell count is not high enough to suggest a bacterial joint infection, but it does suggest
an inflammatory process.Of the answers given, gout is most likely. The joint aspirate in a patient with
acute gout also contains negatively birefringent needle-shaped crystals of monosodium urate.
Incorrect Answers:
A. Prepatellar bursitis can be difficult to distinguish from other diagnoses, as it causes redness and
swelling in the knee area. As the bursa is extra-articular, it does not cause a knee effusion.
C. Gout and septic arthritis can present very similarly clinically. The best management is to aspirate
the knee to obtain a cell count. While joint-fluid aspiration only grows a specific organism <50% of the
time, his cell count makes septic joint unlikely. Bacterial joint infections usually produce purulent
effusion with leukocyte counts (most of which are neutrophils) of 50,000 to 150,000 cells/mm3.
D. Meniscal tears can be insidious in this age population and can cause joint effusions. However, they
are unlikely to cause erythema.
An 11-year-old male was playing baseball as a pitcher when he took a line drive to the chest. He
immediately collapsed on the field and was unresponsive. What is his most likely diagnosis?
A. Mediastinal carcinoma
B. Commotio cordis
C. Rib fracture
D. Pulmonary contusion
Correct Answer: B. Commotio cordis
Commotio cordis is a cause of sudden cardiac death in sports. Common sports are baseball, lacrosse,
and hockey. Softer balls in have been attempted in baseball, and rule changes are also thought to
decrease risk, but evidence has not yet shown this to be true.
Incorrect Answers:
A. Mediastinal carcinoma may impinge on vital structures but does not often lead to a sudden
collapse.
C. Rib fractures usually result from a major trauma like a motor vehicle accident, even if a rib had a
pathologic weak point from a metastasis.
D. Pulmonary contusion is possible but less likely to lead to immediate collapse.
A 17-year-old girl who fell on her right arm 8 hours ago on a remote hiking trail is evaluated in the
emergency department. Her elbow is swollen and painful, and she is hesitant to move it. She has a loss
of capillary refill in her right fingers, without sensation. An X-ray shows a fracture-dislocation of the
humerus at the elbow. What is a contraindication to open reduction and internal fixation (ORIF)?
A. Prolonged ischemic time
B. Severe contamination
C. Advanced age
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, D. Potential for further damage
E. Long length of immobilization
Correct Answer: A. Prolonged ischemic time
Prolonged ischemia (>6 hours) makes surgical treatment short of amputation futile. Other
contraindications to ORIF include active infection or osteomyelitis, poor soft-tissue quality overlying
the injury, medical conditions that contraindicate surgery or anesthesia (recent myocardial infarction),
and cases in which amputation is a better solution than attempted reduction and fracture fixation.
Incorrect Answers:
B. Areas of severe contamination must be decontaminated prior to final stabilization.
C. Advanced age is not a contraindication.
D. Reducing the potential for further damage is an indication for surgery.
E. With advanced surgical techniques, the period of immobilization is reduced and no longer poses the
same problem.
A 14-year-old female soccer player presents for right knee pain and swelling. She states during a game
over the weekend, she injured her knee. She does not recall the mechanism of injury, but her knee gave
way and she heard a "pop." She noticed some swelling within an hour and has had pain since. She has
no history of a knee injury. She denies any locking but feels instability in her knee. On examination, you
notice mild to moderate anterior swelling. She has some physiologic knee valgus deformity. She is
tender over the medial patellar edge on palpation. Her range of motion is limited due to the pain and
swelling. She has negative varus and valgus stress tests and a negative Lachman's test with good end-
point. The patient also has a negative anterior and posterior drawer test and a negative McMurray test.
She has some patellar apprehension. Her right knee X-rays show some soft-tissue swelling but no
fracture or othe
Correct Answer: D. Patellar sub-luxation
Patellar subluxation is the most likely diagnosis in a teenage girl who presents with giving-way
episodes of the knee. This injury occurs more often in girls and young women because of an increased
quadriceps angle (Q angle), usually greater than 15 degrees. Patellar apprehension is elicited by
subluxing the patella laterally, and a mild effusion is usually present. Moderate to severe knee
swelling may indicate hemarthrosis, which suggests patellar dislocation with osteochondral fracture
and bleeding.
What is a frequent cause of exercise-induced patellar pain and swelling at the tibial tubercle in pre-
adolescent girls and early adolescent boys?
A. Osgood-Schlatter disease
B. Charcot-Marie-Tooth disease
C. Baker's cyst
D. Osteochondritis dissecans
Correct Answer: A. Osgood-Schlatter disease
Osgood-Schlatter disease refers to a microfracture at the ossification center near the tibial tubercle,
where the patellar tendon inserts.
Incorrect Answers:
B. Charcot-Marie-Tooth disease is characterized by a cavus foot and familial neuropathy.
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