AANP FNP CertiFiCAtioN exAm PrACtiCe
QuestioNs (2024-2026 BluePriNt) 100
QuestioNs AND ANsWers WitH DetAileD
DesCriPtioN lAtest uPDAte 2026 AlreWADY
GrADeD A+
The AANP FNP certification exam consists of 150 questions, with 135 scored items and 15 pretest questions that
do not count toward your score. You have 3 hours to complete the exam. The exam is divided into four content
domains and distributed across patient age groups based on the 2024 updated blueprint:
Domain Number of Items Percentage
Assess 43 32%
Diagnose 36 26.5%
Plan 36 26.5%
Evaluate 20 15%
Patient Age Number of Items Percentage
Newborn 3 2%
Infant 4 3%
Toddler 5 4%
1
, Patient Age Number of Items Percentage
Child 6 4%
Adolescent* 12 9%
Young Adult* 30 22%
Middle Adult* 35 26%
Older Adult 40 30%
*Includes Prenatal
DOMAIN 1: ASSESS (Questions 1-32)
Question 1
A 58-year-old male presents for a routine physical. He has a 30-pack-year smoking history and
quit smoking 2 years ago. According to the USPSTF guidelines, which screening is most
appropriate?
A) Annual low-dose CT for lung cancer
B) Abdominal aortic aneurysm screening with ultrasound
C) Colonoscopy every 10 years
D) PSA screening for prostate cancer
Answer: A
Rationale: The USPSTF recommends annual low-dose CT (LDCT) screening for lung cancer in
adults aged 50-80 years with a 20-pack-year smoking history who currently smoke or have quit
within the past 15 years. This patient meets the criteria (30 pack-years, quit within 2 years).
Abdominal aortic aneurysm screening (Choice B) is recommended for men aged 65-75 with a
smoking history. Colonoscopy (Choice C) is recommended starting at age 45 for average-risk
individuals. PSA screening (Choice D) is an individualized decision for men aged 55-69.
2
, Question 2
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On physical
exam, she has a delayed relaxation phase of her deep tendon reflexes. Which laboratory test
is most appropriate to order initially?
A) TSH and free T4
B) Complete blood count
C) Basic metabolic panel
D) Cortisol level
Answer: A
Rationale: The patient's symptoms (fatigue, weight gain, cold intolerance) and physical finding
(delayed reflex relaxation) are classic for hypothyroidism. The initial laboratory evaluation
should include TSH and free T4. A CBC (Choice B) may be indicated but is not the most specific
initial test. A basic metabolic panel (Choice C) would not diagnose hypothyroidism. A cortisol
level (Choice D) would evaluate for adrenal insufficiency, which presents with different
symptoms.
Question 3
A 72-year-old woman is brought in by her daughter who is concerned about memory decline.
The patient scores 22/30 on the Mini-Mental State Examination (MMSE). What is the most
appropriate next step?
A) Diagnose Alzheimer's disease and start donepezil
B) Perform a functional assessment including the patient's ability to manage finances and
medications
C) Order a CT scan of the head immediately
D) Refer to neurology for definitive diagnosis
Answer: B
Rationale: An MMSE score below 24 suggests cognitive impairment, but a diagnosis of
dementia requires evidence of functional decline in daily activities. The next step is to assess
functional status. Diagnosing Alzheimer's (Choice A) without functional assessment is
premature. Imaging (Choice C) is not the first step without focal neurological findings. Referral
to neurology (Choice D) may be appropriate but after initial functional assessment.
3
, Question 4
A 6-month-old infant is brought for a well-child visit. The mother reports the infant has been
exclusively breastfed since birth. Which supplement should the nurse practitioner
recommend?
A) Iron supplementation
B) Vitamin D 400 IU daily
C) Fluoride supplementation
D) Vitamin B12 supplementation
Answer: B
Rationale: The American Academy of Pediatrics recommends vitamin D supplementation (400
IU/day) for all breastfed infants starting shortly after birth, as breast milk contains insufficient
vitamin D. Iron supplementation (Choice A) is typically recommended starting at 4-6 months but
vitamin D is the more immediate priority at this visit. Fluoride supplementation (Choice C)
depends on water fluoridation levels. Vitamin B12 (Choice D) is only needed if the mother is B12
deficient.
Question 5
A 65-year-old woman with no history of cardiovascular disease has a 10-year ASCVD risk score
of 14%. What is the most appropriate lipid-lowering therapy according to ACC/AHA
guidelines?
A) Lifestyle modifications only
B) Moderate-intensity statin
C) High-intensity statin
D) Ezetimibe
Answer: B
Rationale: The ACC/AHA guidelines recommend moderate-intensity statin therapy for primary
prevention in patients with an estimated 10-year ASCVD risk of 7.5% to <20%. High-intensity
statin (Choice C) is recommended for patients with ASCVD risk ≥20% or those with clinical
ASCVD. Lifestyle modifications alone (Choice A) are insufficient for a 14% risk. Ezetimibe (Choice
D) is an adjunctive therapy, not first-line.
Question 6
4
QuestioNs (2024-2026 BluePriNt) 100
QuestioNs AND ANsWers WitH DetAileD
DesCriPtioN lAtest uPDAte 2026 AlreWADY
GrADeD A+
The AANP FNP certification exam consists of 150 questions, with 135 scored items and 15 pretest questions that
do not count toward your score. You have 3 hours to complete the exam. The exam is divided into four content
domains and distributed across patient age groups based on the 2024 updated blueprint:
Domain Number of Items Percentage
Assess 43 32%
Diagnose 36 26.5%
Plan 36 26.5%
Evaluate 20 15%
Patient Age Number of Items Percentage
Newborn 3 2%
Infant 4 3%
Toddler 5 4%
1
, Patient Age Number of Items Percentage
Child 6 4%
Adolescent* 12 9%
Young Adult* 30 22%
Middle Adult* 35 26%
Older Adult 40 30%
*Includes Prenatal
DOMAIN 1: ASSESS (Questions 1-32)
Question 1
A 58-year-old male presents for a routine physical. He has a 30-pack-year smoking history and
quit smoking 2 years ago. According to the USPSTF guidelines, which screening is most
appropriate?
A) Annual low-dose CT for lung cancer
B) Abdominal aortic aneurysm screening with ultrasound
C) Colonoscopy every 10 years
D) PSA screening for prostate cancer
Answer: A
Rationale: The USPSTF recommends annual low-dose CT (LDCT) screening for lung cancer in
adults aged 50-80 years with a 20-pack-year smoking history who currently smoke or have quit
within the past 15 years. This patient meets the criteria (30 pack-years, quit within 2 years).
Abdominal aortic aneurysm screening (Choice B) is recommended for men aged 65-75 with a
smoking history. Colonoscopy (Choice C) is recommended starting at age 45 for average-risk
individuals. PSA screening (Choice D) is an individualized decision for men aged 55-69.
2
, Question 2
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On physical
exam, she has a delayed relaxation phase of her deep tendon reflexes. Which laboratory test
is most appropriate to order initially?
A) TSH and free T4
B) Complete blood count
C) Basic metabolic panel
D) Cortisol level
Answer: A
Rationale: The patient's symptoms (fatigue, weight gain, cold intolerance) and physical finding
(delayed reflex relaxation) are classic for hypothyroidism. The initial laboratory evaluation
should include TSH and free T4. A CBC (Choice B) may be indicated but is not the most specific
initial test. A basic metabolic panel (Choice C) would not diagnose hypothyroidism. A cortisol
level (Choice D) would evaluate for adrenal insufficiency, which presents with different
symptoms.
Question 3
A 72-year-old woman is brought in by her daughter who is concerned about memory decline.
The patient scores 22/30 on the Mini-Mental State Examination (MMSE). What is the most
appropriate next step?
A) Diagnose Alzheimer's disease and start donepezil
B) Perform a functional assessment including the patient's ability to manage finances and
medications
C) Order a CT scan of the head immediately
D) Refer to neurology for definitive diagnosis
Answer: B
Rationale: An MMSE score below 24 suggests cognitive impairment, but a diagnosis of
dementia requires evidence of functional decline in daily activities. The next step is to assess
functional status. Diagnosing Alzheimer's (Choice A) without functional assessment is
premature. Imaging (Choice C) is not the first step without focal neurological findings. Referral
to neurology (Choice D) may be appropriate but after initial functional assessment.
3
, Question 4
A 6-month-old infant is brought for a well-child visit. The mother reports the infant has been
exclusively breastfed since birth. Which supplement should the nurse practitioner
recommend?
A) Iron supplementation
B) Vitamin D 400 IU daily
C) Fluoride supplementation
D) Vitamin B12 supplementation
Answer: B
Rationale: The American Academy of Pediatrics recommends vitamin D supplementation (400
IU/day) for all breastfed infants starting shortly after birth, as breast milk contains insufficient
vitamin D. Iron supplementation (Choice A) is typically recommended starting at 4-6 months but
vitamin D is the more immediate priority at this visit. Fluoride supplementation (Choice C)
depends on water fluoridation levels. Vitamin B12 (Choice D) is only needed if the mother is B12
deficient.
Question 5
A 65-year-old woman with no history of cardiovascular disease has a 10-year ASCVD risk score
of 14%. What is the most appropriate lipid-lowering therapy according to ACC/AHA
guidelines?
A) Lifestyle modifications only
B) Moderate-intensity statin
C) High-intensity statin
D) Ezetimibe
Answer: B
Rationale: The ACC/AHA guidelines recommend moderate-intensity statin therapy for primary
prevention in patients with an estimated 10-year ASCVD risk of 7.5% to <20%. High-intensity
statin (Choice C) is recommended for patients with ASCVD risk ≥20% or those with clinical
ASCVD. Lifestyle modifications alone (Choice A) are insufficient for a 14% risk. Ezetimibe (Choice
D) is an adjunctive therapy, not first-line.
Question 6
4
