AANP FNP Clinical Review 2026
75 Original Primary Care Practice Questions
Answers and Detailed Rationales
Coverage: adult and geriatric care, pediatrics, women's health, assessment and diagnosis, pharmacology, urgent
presentations, prevention, and health promotion.
Directions: Select the single best answer. Complete the question section before reviewing the answer key and
rationales.
Integrity statement: This independently created educational resource contains original practice questions. It is not
affiliated with or endorsed by AANP, AANPCB, any publisher, or any school. It does not reproduce recalled,
leaked, or secure examination content.
AANP FNP Clinical Review 2026 - Original Practice Resource Page 1
, Practice Questions
1. A 52-year-old with newly diagnosed hypertension has an average blood pressure of 148/92 mm Hg and no
comorbidities. Which initial plan is most appropriate?
A. Begin lifestyle changes plus antihypertensive medication
B. Recheck without intervention in one year
C. Start two loop diuretics
D. Order emergency head CT
2. Which finding in a patient with headache requires urgent evaluation for a secondary cause?
A. Mild bilateral pressure after stress
B. Headache relieved by sleep
C. Stable monthly headache for ten years
D. New headache with focal neurologic deficit
3. A patient with type 2 diabetes has albuminuria and hypertension. Which medication class offers renal protection?
A. Short-acting nitrate
B. First-generation antihistamine
C. ACE inhibitor or angiotensin receptor blocker
D. Alpha-1 blocker only
4. Which symptom pattern most strongly supports stable angina?
A. Sharp pain lasting seconds with movement
B. Predictable chest pressure with exertion that resolves with rest
C. Continuous pain reproducible by palpation
D. Pleuritic pain with fever
5. A patient reports sudden tearing chest pain radiating to the back. What is the priority action?
A. Arrange emergency evaluation for aortic dissection
B. Schedule routine stress testing
C. Recommend an antacid trial
D. Reassess in one month
6. Which examination finding is most consistent with heart failure?
A. Isolated cerumen impaction
B. Hyperactive bowel sounds
C. Tender lateral epicondyle
D. Elevated jugular venous pressure and bilateral crackles
7. A patient with atrial fibrillation is hemodynamically unstable. What is the immediate management priority?
A. Routine follow-up in six months
B. Begin an exercise program
C. Urgent synchronized cardioversion
D. Administer an oral antibiotic
AANP FNP Clinical Review 2026 - Original Practice Resource Page 2
, 8. Which presentation is most typical of acute bacterial sinusitis rather than a viral upper respiratory infection?
A. Clear rhinorrhea for two days
B. Symptoms lasting over 10 days without improvement
C. Sneezing after pollen exposure
D. Mild sore throat for one day
9. A patient with asthma uses a rescue inhaler four days each week. What does this suggest?
A. Asthma is not well controlled and controller therapy should be reviewed
B. Asthma is fully controlled
C. The rescue inhaler should be stopped abruptly
D. No follow-up is necessary
10. Which spirometry pattern supports obstructive lung disease?
A. Increased FEV1/FVC with low total lung capacity
B. Normal FEV1 with isolated anemia
C. Increased diffusion capacity in every case
D. Reduced FEV1/FVC ratio
11. A smoker aged 58 has a 30 pack-year history and currently smokes. Which screening is appropriate?
A. Annual chest radiograph only
B. Routine sputum culture
C. Annual low-dose CT for lung cancer
D. No screening until symptoms develop
12. Which finding in a patient with pneumonia most strongly indicates need for urgent escalation?
A. Mild cough with normal oxygenation
B. New confusion with oxygen saturation of 86%
C. Temperature of 37.2 C
D. Nasal congestion alone
13. A patient with suspected pulmonary embolism has hypotension and severe dyspnea. What is the priority?
A. Emergency transfer for immediate evaluation and treatment
B. Outpatient follow-up next week
C. Trial of an antihistamine
D. Routine pulmonary function testing
14. Which symptom combination is most consistent with primary hypothyroidism?
A. Weight loss, tremor, and heat intolerance
B. Polyuria and polydipsia only
C. Fever and productive cough
D. Fatigue, constipation, weight gain, and cold intolerance
AANP FNP Clinical Review 2026 - Original Practice Resource Page 3
75 Original Primary Care Practice Questions
Answers and Detailed Rationales
Coverage: adult and geriatric care, pediatrics, women's health, assessment and diagnosis, pharmacology, urgent
presentations, prevention, and health promotion.
Directions: Select the single best answer. Complete the question section before reviewing the answer key and
rationales.
Integrity statement: This independently created educational resource contains original practice questions. It is not
affiliated with or endorsed by AANP, AANPCB, any publisher, or any school. It does not reproduce recalled,
leaked, or secure examination content.
AANP FNP Clinical Review 2026 - Original Practice Resource Page 1
, Practice Questions
1. A 52-year-old with newly diagnosed hypertension has an average blood pressure of 148/92 mm Hg and no
comorbidities. Which initial plan is most appropriate?
A. Begin lifestyle changes plus antihypertensive medication
B. Recheck without intervention in one year
C. Start two loop diuretics
D. Order emergency head CT
2. Which finding in a patient with headache requires urgent evaluation for a secondary cause?
A. Mild bilateral pressure after stress
B. Headache relieved by sleep
C. Stable monthly headache for ten years
D. New headache with focal neurologic deficit
3. A patient with type 2 diabetes has albuminuria and hypertension. Which medication class offers renal protection?
A. Short-acting nitrate
B. First-generation antihistamine
C. ACE inhibitor or angiotensin receptor blocker
D. Alpha-1 blocker only
4. Which symptom pattern most strongly supports stable angina?
A. Sharp pain lasting seconds with movement
B. Predictable chest pressure with exertion that resolves with rest
C. Continuous pain reproducible by palpation
D. Pleuritic pain with fever
5. A patient reports sudden tearing chest pain radiating to the back. What is the priority action?
A. Arrange emergency evaluation for aortic dissection
B. Schedule routine stress testing
C. Recommend an antacid trial
D. Reassess in one month
6. Which examination finding is most consistent with heart failure?
A. Isolated cerumen impaction
B. Hyperactive bowel sounds
C. Tender lateral epicondyle
D. Elevated jugular venous pressure and bilateral crackles
7. A patient with atrial fibrillation is hemodynamically unstable. What is the immediate management priority?
A. Routine follow-up in six months
B. Begin an exercise program
C. Urgent synchronized cardioversion
D. Administer an oral antibiotic
AANP FNP Clinical Review 2026 - Original Practice Resource Page 2
, 8. Which presentation is most typical of acute bacterial sinusitis rather than a viral upper respiratory infection?
A. Clear rhinorrhea for two days
B. Symptoms lasting over 10 days without improvement
C. Sneezing after pollen exposure
D. Mild sore throat for one day
9. A patient with asthma uses a rescue inhaler four days each week. What does this suggest?
A. Asthma is not well controlled and controller therapy should be reviewed
B. Asthma is fully controlled
C. The rescue inhaler should be stopped abruptly
D. No follow-up is necessary
10. Which spirometry pattern supports obstructive lung disease?
A. Increased FEV1/FVC with low total lung capacity
B. Normal FEV1 with isolated anemia
C. Increased diffusion capacity in every case
D. Reduced FEV1/FVC ratio
11. A smoker aged 58 has a 30 pack-year history and currently smokes. Which screening is appropriate?
A. Annual chest radiograph only
B. Routine sputum culture
C. Annual low-dose CT for lung cancer
D. No screening until symptoms develop
12. Which finding in a patient with pneumonia most strongly indicates need for urgent escalation?
A. Mild cough with normal oxygenation
B. New confusion with oxygen saturation of 86%
C. Temperature of 37.2 C
D. Nasal congestion alone
13. A patient with suspected pulmonary embolism has hypotension and severe dyspnea. What is the priority?
A. Emergency transfer for immediate evaluation and treatment
B. Outpatient follow-up next week
C. Trial of an antihistamine
D. Routine pulmonary function testing
14. Which symptom combination is most consistent with primary hypothyroidism?
A. Weight loss, tremor, and heat intolerance
B. Polyuria and polydipsia only
C. Fever and productive cough
D. Fatigue, constipation, weight gain, and cold intolerance
AANP FNP Clinical Review 2026 - Original Practice Resource Page 3
