AANP FNP ACTUAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS
RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–50
1. A 28-year-old female presents with a three-day history of dysuria, urinary frequency, and suprapubic
discomfort. She reports no vaginal discharge or fever. A urine dipstick reveals positive leukocyte esterase and
nitrites. Which of the following is the most appropriate initial management strategy?
A. Prescribe trimethoprim-sulfamethoxazole for three days
B. Obtain a urine culture and sensitivity before initiating antibiotics
C. Prescribe nitrofurantoin monohydrate macrocrystals for five days
D. Recommend increased oral fluid intake and urinary analgesics
Correct Answer: C. Prescribe nitrofurantoin monohydrate macrocrystals for five days
Rationale: This patient presents with classic signs of an uncomplicated acute cystitis. The presence of nitrites on
dipstick is highly specific for a bacterial infection, making empiric treatment appropriate. Nitrofurantoin is a first-line
agent for uncomplicated cystitis due to its high efficacy and low resistance rates, and a five-day course is the
recommended duration. Trimethoprim-sulfamethoxazole (A) is no longer a first-line empiric choice in many regions
due to high rates of E. coli resistance. While a urine culture (B) is useful for complicated cases or treatment failures, it is
,not necessary before initiating empiric therapy in this straightforward presentation. Increased fluids and analgesics (D)
are adjunctive measures but do not address the underlying infection and are not sufficient as monotherapy.
2. A 65-year-old male with a history of hypertension and type 2 diabetes mellitus presents for a routine follow-
up. His blood pressure today is 138/86 mmHg. His home medication log shows he is taking lisinopril 20 mg daily
and metformin 1000 mg twice daily. His most recent laboratory results from two weeks ago show a serum
creatinine of 1.3 mg/dL and a urine albumin-to-creatinine ratio of 45 mg/g. What is the most appropriate
adjustment to his antihypertensive regimen to achieve goal blood pressure?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 12.5 mg daily
D. Maintain current regimen and recheck in three months
Correct Answer: B. Add amlodipine 5 mg daily
Rationale: For a patient with diabetes and albuminuria, the recommended blood pressure goal is less than 130/80
mmHg. While the patient is already on an ACE inhibitor (lisinopril), the blood pressure remains above goal. Given the
serum creatinine of 1.3 mg/dL (an eGFR likely below 45-50 mL/min), the efficacy of a thiazide diuretic is reduced,
making hydrochlorothiazide (C) a less optimal choice. Increasing the lisinopril to 40 mg (A) is a possibility, but in
,patients with renal impairment, hyperkalemia is a significant risk, and a calcium channel blocker like amlodipine is
often the preferred next agent for additional blood pressure lowering. Maintaining the current regimen (D) does not
address the fact that the patient is not at target, which increases their long-term cardiovascular and renal risk.
3. A 45-year-old female presents with complaints of fatigue, weight gain, cold intolerance, and constipation over
the past several months. Physical examination reveals a bradycardic heart rate of 52 bpm, dry skin, and a non-
tender, diffuse goiter. Laboratory results show an elevated TSH of 12.5 mIU/L and a free T4 of 0.6 ng/dL. Which of
the following is the most appropriate next step in management?
A. Initiate levothyroxine at 25 mcg daily
B. Order a thyroid ultrasound to evaluate the goiter
C. Measure anti-thyroid peroxidase antibodies
D. Initiate levothyroxine at 75 mcg daily
Correct Answer: A. Initiate levothyroxine at 25 mcg daily
Rationale: The clinical presentation and labs confirm overt primary hypothyroidism. In otherwise healthy patients
under 60 years old, the standard starting dose of levothyroxine is 1.6 mcg/kg/day. However, for older adults or those
with cardiovascular risk factors (though not specified here, age 45 is a factor), a more conservative starting dose, such
as 25 mcg daily, is recommended to reduce the risk of precipitating angina or arrhythmias. Starting at 75 mcg daily (D)
, would be too high for an initial dose. A thyroid ultrasound (B) is not indicated solely for a diffuse, non-tender goiter in
the context of hypothyroidism. Measuring anti-TPO antibodies (C) would confirm Hashimoto's as the etiology, which is
highly probable, but does not change the immediate need to treat the hypothyroidism.
4. A 16-year-old male is brought to the clinic by his mother for a sports physical. He reports no significant
medical history. His blood pressure is 148/92 mmHg on two separate readings taken five minutes apart. He is
asymptomatic. Which of the following is the most appropriate initial evaluation for this finding?
A. Diagnose primary hypertension and initiate lifestyle modifications
B. Order a comprehensive metabolic panel and urinalysis
C. Reassure the mother that this is likely "white coat hypertension"
D. Order an echocardiogram and renal artery duplex ultrasound
Correct Answer: B. Order a comprehensive metabolic panel and urinalysis
Rationale: This adolescent has confirmed elevated blood pressures and meets the criteria for hypertension. The most
appropriate initial step, after confirming the blood pressure elevation, is to perform a screening evaluation for
secondary causes and end-organ damage, which is recommended for all children and adolescents with confirmed
hypertension. A comprehensive metabolic panel and urinalysis (B) are part of this initial evaluation. Lifestyle
modifications (A) are important but should not be the only intervention before ruling out secondary causes. "White coat
RATIONALES | DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–50
1. A 28-year-old female presents with a three-day history of dysuria, urinary frequency, and suprapubic
discomfort. She reports no vaginal discharge or fever. A urine dipstick reveals positive leukocyte esterase and
nitrites. Which of the following is the most appropriate initial management strategy?
A. Prescribe trimethoprim-sulfamethoxazole for three days
B. Obtain a urine culture and sensitivity before initiating antibiotics
C. Prescribe nitrofurantoin monohydrate macrocrystals for five days
D. Recommend increased oral fluid intake and urinary analgesics
Correct Answer: C. Prescribe nitrofurantoin monohydrate macrocrystals for five days
Rationale: This patient presents with classic signs of an uncomplicated acute cystitis. The presence of nitrites on
dipstick is highly specific for a bacterial infection, making empiric treatment appropriate. Nitrofurantoin is a first-line
agent for uncomplicated cystitis due to its high efficacy and low resistance rates, and a five-day course is the
recommended duration. Trimethoprim-sulfamethoxazole (A) is no longer a first-line empiric choice in many regions
due to high rates of E. coli resistance. While a urine culture (B) is useful for complicated cases or treatment failures, it is
,not necessary before initiating empiric therapy in this straightforward presentation. Increased fluids and analgesics (D)
are adjunctive measures but do not address the underlying infection and are not sufficient as monotherapy.
2. A 65-year-old male with a history of hypertension and type 2 diabetes mellitus presents for a routine follow-
up. His blood pressure today is 138/86 mmHg. His home medication log shows he is taking lisinopril 20 mg daily
and metformin 1000 mg twice daily. His most recent laboratory results from two weeks ago show a serum
creatinine of 1.3 mg/dL and a urine albumin-to-creatinine ratio of 45 mg/g. What is the most appropriate
adjustment to his antihypertensive regimen to achieve goal blood pressure?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily
C. Add hydrochlorothiazide 12.5 mg daily
D. Maintain current regimen and recheck in three months
Correct Answer: B. Add amlodipine 5 mg daily
Rationale: For a patient with diabetes and albuminuria, the recommended blood pressure goal is less than 130/80
mmHg. While the patient is already on an ACE inhibitor (lisinopril), the blood pressure remains above goal. Given the
serum creatinine of 1.3 mg/dL (an eGFR likely below 45-50 mL/min), the efficacy of a thiazide diuretic is reduced,
making hydrochlorothiazide (C) a less optimal choice. Increasing the lisinopril to 40 mg (A) is a possibility, but in
,patients with renal impairment, hyperkalemia is a significant risk, and a calcium channel blocker like amlodipine is
often the preferred next agent for additional blood pressure lowering. Maintaining the current regimen (D) does not
address the fact that the patient is not at target, which increases their long-term cardiovascular and renal risk.
3. A 45-year-old female presents with complaints of fatigue, weight gain, cold intolerance, and constipation over
the past several months. Physical examination reveals a bradycardic heart rate of 52 bpm, dry skin, and a non-
tender, diffuse goiter. Laboratory results show an elevated TSH of 12.5 mIU/L and a free T4 of 0.6 ng/dL. Which of
the following is the most appropriate next step in management?
A. Initiate levothyroxine at 25 mcg daily
B. Order a thyroid ultrasound to evaluate the goiter
C. Measure anti-thyroid peroxidase antibodies
D. Initiate levothyroxine at 75 mcg daily
Correct Answer: A. Initiate levothyroxine at 25 mcg daily
Rationale: The clinical presentation and labs confirm overt primary hypothyroidism. In otherwise healthy patients
under 60 years old, the standard starting dose of levothyroxine is 1.6 mcg/kg/day. However, for older adults or those
with cardiovascular risk factors (though not specified here, age 45 is a factor), a more conservative starting dose, such
as 25 mcg daily, is recommended to reduce the risk of precipitating angina or arrhythmias. Starting at 75 mcg daily (D)
, would be too high for an initial dose. A thyroid ultrasound (B) is not indicated solely for a diffuse, non-tender goiter in
the context of hypothyroidism. Measuring anti-TPO antibodies (C) would confirm Hashimoto's as the etiology, which is
highly probable, but does not change the immediate need to treat the hypothyroidism.
4. A 16-year-old male is brought to the clinic by his mother for a sports physical. He reports no significant
medical history. His blood pressure is 148/92 mmHg on two separate readings taken five minutes apart. He is
asymptomatic. Which of the following is the most appropriate initial evaluation for this finding?
A. Diagnose primary hypertension and initiate lifestyle modifications
B. Order a comprehensive metabolic panel and urinalysis
C. Reassure the mother that this is likely "white coat hypertension"
D. Order an echocardiogram and renal artery duplex ultrasound
Correct Answer: B. Order a comprehensive metabolic panel and urinalysis
Rationale: This adolescent has confirmed elevated blood pressures and meets the criteria for hypertension. The most
appropriate initial step, after confirming the blood pressure elevation, is to perform a screening evaluation for
secondary causes and end-organ damage, which is recommended for all children and adolescents with confirmed
hypertension. A comprehensive metabolic panel and urinalysis (B) are part of this initial evaluation. Lifestyle
modifications (A) are important but should not be the only intervention before ruling out secondary causes. "White coat
