SARAH MICHELLE AANP BOARD EXAM 2026/2027
| NP Certification Study Guide | Comprehensive
Prep with Rationale | Pass Guaranteed - A+ Graded
SECTION 1: HEALTH PROMOTION, PREVENTION & SCREENING (25
Questions)
Q1: A 52-year-old African American male presents for an annual wellness visit. He has
no chronic medical conditions, takes no medications, and has a 20 pack-year smoking
history. He quit smoking 2 years ago. His BP is 128/82 mmHg, BMI 29 kg/m², and
fasting lipid panel shows LDL 142 mg/dL, HDL 38 mg/dL, TG 180 mg/dL. According to
2026 ACC/AHA cholesterol guidelines, what is the most appropriate next step in
management?
A. Initiate high-intensity statin therapy immediately [CORRECT]
B. Repeat fasting lipid panel in 3 months before starting therapy
C. Initiate moderate-intensity statin therapy
D. Recommend dietary modification alone and recheck in 6 months
Correct Answer: A
Rationale: This patient has a 20 pack-year smoking history (major ASCVD risk factor)
and LDL ≥130 mg/dL, placing him at high risk for ASCVD. Per 2026 ACC/AHA
guidelines, adults aged 40-75 with LDL 130-189 mg/dL and one major risk factor
(smoking, hypertension, diabetes, family history premature ASCVD) should receive
high-intensity statin therapy. Distractor B is incorrect because treatment should not be
delayed in high-risk individuals. Distractor C underestimates the required intensity.
Distractor D is insufficient for this risk profile.
,Q2: A 45-year-old female presents for her annual well-woman exam. She is up to date on
cervical cancer screening. Her mother was diagnosed with breast cancer at age 52. She
has no personal history of breast cancer. According to 2026 USPSTF breast cancer
screening guidelines, what should the NP recommend?
A. Begin annual mammography now and continue through age 74 [CORRECT]
B. Begin biennial mammography at age 50
C. Begin annual MRI screening now due to family history
D. Begin clinical breast exam every 6 months starting now
Correct Answer: A
Rationale: The 2026 USPSTF recommends biennial screening mammography for
women aged 40-74, with shared decision-making for annual screening in higher-risk
women. A first-degree relative with breast cancer diagnosed <60 years increases risk,
warranting earlier initiation at age 40. Distractor B delays screening unnecessarily.
Distractor C (MRI) is reserved for high-risk genetic mutations or lifetime risk >20%.
Distractor D (CBE) has insufficient evidence per USPSTF.
Q3: A 58-year-old male with a 35 pack-year smoking history presents for a routine visit.
He currently smokes 1 pack per day. He is asymptomatic with normal spirometry.
According to 2026 USPSTF lung cancer screening guidelines, what is the appropriate
recommendation?
A. Annual low-dose CT (LDCT) screening now [CORRECT]
B. LDCT screening beginning at age 60
C. Chest X-ray annually starting now
D. No screening needed since spirometry is normal
Correct Answer: A
Rationale: The 2026 USPSTF recommends annual LDCT for adults aged 50-80 with ≥20
pack-year smoking history who currently smoke or quit within the past 15 years. This
patient meets all criteria. Distractor B delays screening inappropriately. Distractor C
,(chest X-ray) lacks mortality benefit for lung cancer screening. Distractor D is incorrect
because spirometry does not exclude lung cancer risk.
Q4: A 65-year-old female with type 2 diabetes mellitus presents for diabetes follow-up.
Her last eye exam was 18 months ago. She has no visual complaints. According to ADA
2026 standards, what is the recommended eye screening interval?
A. Comprehensive dilated eye exam every 1-2 years if no retinopathy [CORRECT]
B. Annual eye exam only if HbA1c >8%
C. Eye exam every 3 years if asymptomatic
D. Refer to ophthalmology only when visual symptoms develop
Correct Answer: A
Rationale: ADA 2026 recommends comprehensive dilated eye exams by an
ophthalmologist or optometrist at diagnosis of type 2 diabetes, with repeat exams every
1-2 years if no retinopathy is present, and more frequently if retinopathy is identified.
Distractor B incorrectly ties screening to glycemic control. Distractor C extends intervals
too long. Distractor D delays screening until vision-threatening disease may be present.
Q5: A 50-year-old female presents for colorectal cancer screening discussion. She has
no family history of colorectal cancer, no inflammatory bowel disease, and is average
risk. According to 2026 USPSTF guidelines, which screening strategy is NOT
recommended?
A. Annual guaiac-based fecal occult blood testing (gFOBT) [CORRECT]
B. Colonoscopy every 10 years
C. FIT-DNA testing every 1-3 years
D. CT colonography every 5 years
Correct Answer: A
Rationale: The 2026 USPSTF recommends colorectal cancer screening for adults aged
45-75 using FIT annually, FIT-DNA every 1-3 years, colonoscopy every 10 years, CT
colonography every 5 years, or flexible sigmoidoscopy every 5 years. Guaiac-based
, FOBT (gFOBT) is no longer recommended due to inferior sensitivity compared to FIT;
FIT is the preferred stool-based test. Distractors B, C, and D are all acceptable screening
modalities.
Q6: A 42-year-old female presents requesting human papillomavirus (HPV) vaccination.
She has never received the vaccine. She is in a monogamous relationship and has no
history of abnormal Pap smears. According to CDC 2026 immunization guidelines, what
is the appropriate recommendation?
A. Offer HPV vaccination as a shared clinical decision [CORRECT]
B. Recommend routine HPV vaccination as standard of care
C. Decline vaccination as she is over age 26
D. Vaccinate only if she plans to become sexually active with new partners
Correct Answer: A
Rationale: CDC 2026 ACIP recommends routine HPV vaccination through age 26 for
those not adequately vaccinated. For adults aged 27-45, vaccination is recommended
based on shared clinical decision-making due to lower benefit and cost-effectiveness.
This patient is 42, so shared decision-making applies. Distractor B applies to ages
11-26. Distractor C is incorrect because vaccination is not contraindicated, just not
routinely recommended. Distractor D is irrelevant to the decision framework.
Q7: A 38-year-old male presents for a pre-employment physical. He has no chronic
conditions. His blood pressure is 134/84 mmHg on two separate occasions. BMI is 27
kg/m². He exercises occasionally. According to JNC 9/ACC/AHA 2026 guidelines, what
is the classification and next best step?
A. Stage 1 hypertension; recommend lifestyle modification and reassess in 3-6 months
[CORRECT]
B. Stage 2 hypertension; initiate antihypertensive therapy
C. Elevated blood pressure; lifestyle modification only
D. Normal blood pressure; routine follow-up in 1 year
| NP Certification Study Guide | Comprehensive
Prep with Rationale | Pass Guaranteed - A+ Graded
SECTION 1: HEALTH PROMOTION, PREVENTION & SCREENING (25
Questions)
Q1: A 52-year-old African American male presents for an annual wellness visit. He has
no chronic medical conditions, takes no medications, and has a 20 pack-year smoking
history. He quit smoking 2 years ago. His BP is 128/82 mmHg, BMI 29 kg/m², and
fasting lipid panel shows LDL 142 mg/dL, HDL 38 mg/dL, TG 180 mg/dL. According to
2026 ACC/AHA cholesterol guidelines, what is the most appropriate next step in
management?
A. Initiate high-intensity statin therapy immediately [CORRECT]
B. Repeat fasting lipid panel in 3 months before starting therapy
C. Initiate moderate-intensity statin therapy
D. Recommend dietary modification alone and recheck in 6 months
Correct Answer: A
Rationale: This patient has a 20 pack-year smoking history (major ASCVD risk factor)
and LDL ≥130 mg/dL, placing him at high risk for ASCVD. Per 2026 ACC/AHA
guidelines, adults aged 40-75 with LDL 130-189 mg/dL and one major risk factor
(smoking, hypertension, diabetes, family history premature ASCVD) should receive
high-intensity statin therapy. Distractor B is incorrect because treatment should not be
delayed in high-risk individuals. Distractor C underestimates the required intensity.
Distractor D is insufficient for this risk profile.
,Q2: A 45-year-old female presents for her annual well-woman exam. She is up to date on
cervical cancer screening. Her mother was diagnosed with breast cancer at age 52. She
has no personal history of breast cancer. According to 2026 USPSTF breast cancer
screening guidelines, what should the NP recommend?
A. Begin annual mammography now and continue through age 74 [CORRECT]
B. Begin biennial mammography at age 50
C. Begin annual MRI screening now due to family history
D. Begin clinical breast exam every 6 months starting now
Correct Answer: A
Rationale: The 2026 USPSTF recommends biennial screening mammography for
women aged 40-74, with shared decision-making for annual screening in higher-risk
women. A first-degree relative with breast cancer diagnosed <60 years increases risk,
warranting earlier initiation at age 40. Distractor B delays screening unnecessarily.
Distractor C (MRI) is reserved for high-risk genetic mutations or lifetime risk >20%.
Distractor D (CBE) has insufficient evidence per USPSTF.
Q3: A 58-year-old male with a 35 pack-year smoking history presents for a routine visit.
He currently smokes 1 pack per day. He is asymptomatic with normal spirometry.
According to 2026 USPSTF lung cancer screening guidelines, what is the appropriate
recommendation?
A. Annual low-dose CT (LDCT) screening now [CORRECT]
B. LDCT screening beginning at age 60
C. Chest X-ray annually starting now
D. No screening needed since spirometry is normal
Correct Answer: A
Rationale: The 2026 USPSTF recommends annual LDCT for adults aged 50-80 with ≥20
pack-year smoking history who currently smoke or quit within the past 15 years. This
patient meets all criteria. Distractor B delays screening inappropriately. Distractor C
,(chest X-ray) lacks mortality benefit for lung cancer screening. Distractor D is incorrect
because spirometry does not exclude lung cancer risk.
Q4: A 65-year-old female with type 2 diabetes mellitus presents for diabetes follow-up.
Her last eye exam was 18 months ago. She has no visual complaints. According to ADA
2026 standards, what is the recommended eye screening interval?
A. Comprehensive dilated eye exam every 1-2 years if no retinopathy [CORRECT]
B. Annual eye exam only if HbA1c >8%
C. Eye exam every 3 years if asymptomatic
D. Refer to ophthalmology only when visual symptoms develop
Correct Answer: A
Rationale: ADA 2026 recommends comprehensive dilated eye exams by an
ophthalmologist or optometrist at diagnosis of type 2 diabetes, with repeat exams every
1-2 years if no retinopathy is present, and more frequently if retinopathy is identified.
Distractor B incorrectly ties screening to glycemic control. Distractor C extends intervals
too long. Distractor D delays screening until vision-threatening disease may be present.
Q5: A 50-year-old female presents for colorectal cancer screening discussion. She has
no family history of colorectal cancer, no inflammatory bowel disease, and is average
risk. According to 2026 USPSTF guidelines, which screening strategy is NOT
recommended?
A. Annual guaiac-based fecal occult blood testing (gFOBT) [CORRECT]
B. Colonoscopy every 10 years
C. FIT-DNA testing every 1-3 years
D. CT colonography every 5 years
Correct Answer: A
Rationale: The 2026 USPSTF recommends colorectal cancer screening for adults aged
45-75 using FIT annually, FIT-DNA every 1-3 years, colonoscopy every 10 years, CT
colonography every 5 years, or flexible sigmoidoscopy every 5 years. Guaiac-based
, FOBT (gFOBT) is no longer recommended due to inferior sensitivity compared to FIT;
FIT is the preferred stool-based test. Distractors B, C, and D are all acceptable screening
modalities.
Q6: A 42-year-old female presents requesting human papillomavirus (HPV) vaccination.
She has never received the vaccine. She is in a monogamous relationship and has no
history of abnormal Pap smears. According to CDC 2026 immunization guidelines, what
is the appropriate recommendation?
A. Offer HPV vaccination as a shared clinical decision [CORRECT]
B. Recommend routine HPV vaccination as standard of care
C. Decline vaccination as she is over age 26
D. Vaccinate only if she plans to become sexually active with new partners
Correct Answer: A
Rationale: CDC 2026 ACIP recommends routine HPV vaccination through age 26 for
those not adequately vaccinated. For adults aged 27-45, vaccination is recommended
based on shared clinical decision-making due to lower benefit and cost-effectiveness.
This patient is 42, so shared decision-making applies. Distractor B applies to ages
11-26. Distractor C is incorrect because vaccination is not contraindicated, just not
routinely recommended. Distractor D is irrelevant to the decision framework.
Q7: A 38-year-old male presents for a pre-employment physical. He has no chronic
conditions. His blood pressure is 134/84 mmHg on two separate occasions. BMI is 27
kg/m². He exercises occasionally. According to JNC 9/ACC/AHA 2026 guidelines, what
is the classification and next best step?
A. Stage 1 hypertension; recommend lifestyle modification and reassess in 3-6 months
[CORRECT]
B. Stage 2 hypertension; initiate antihypertensive therapy
C. Elevated blood pressure; lifestyle modification only
D. Normal blood pressure; routine follow-up in 1 year
