Page 1 of 135
FNP Exam Review Study Guide |
Comprehensive Nurse Practitioner
Preparation For AANP Boards
EXAM COVERAGE SUMMARY
This comprehensive review covers essential topics for the FNP certification exam including:
Cardiovascular System: Heart murmurs (diastolic, systolic, holosystolic), murmurs grading (I-
VI), peripheral arterial disease, chronic venous insufficiency, hypertension management, carotid
bruits, JVD causes, endocarditis signs (Osler's nodes, Janeway lesions), coarctation of aorta,
S3/S4 gallops, and ECG interpretation.
Pulmonary System: COPD treatment (GOLD guidelines), emphysema findings, pneumonia,
tuberculosis diagnosis and treatment, croup/epiglottitis, OSA, and sinusitis management.
Endocrine/Metabolic: Diabetes management (A1C >9 requires basal insulin), thyroid disorders
(TSH, TPO, hyper/hypothyroidism), Graves disease, PTU in pregnancy, metabolic syndrome
criteria, Cushing's syndrome, Addison's disease, osteoporosis treatment (bisphosphonates,
calcium, vitamin D), and parathyroid disorders.
Neurological: Dementia types (Alzheimer's, vascular), cognitive assessment (Mini-Mental
Exam), stroke evaluation, headache management (migraine abortive/prophylactic), Parkinson's
disease, and cranial nerve assessment (CN 3,4,6,5,7,8,9).
Reproductive/OB-GYN: Fundal height measurements (12,16,20 weeks), ectopic pregnancy risk
factors, preeclampsia management, chlamydia/gonorrhea treatment in pregnancy, breast cancer
screening, cervical cancer (pap smear, colposcopy, LEEP), endometriosis, and infertility
evaluation.
, Page 2 of 135
Pediatrics: Developmental milestones, strabismus, pyloric stenosis (olive-like mass, non-bilious
vomiting), intussusception (currant jelly stool), Wilms tumor (non-painful abdominal mass),
retinoblastoma (white reflex), Kawasaki disease, roseola, fifth disease, and congenital
conditions.
Dermatology: Atopic dermatitis treatment (topical steroids, antihistamines), psoriasis (Koebner
phenomenon, Auspitz sign), tinea corporis, cellulitis vs erysipelas, impetigo, actinic keratosis,
basal cell carcinoma, acne vulgaris vs rosacea, and lichen planus.
Infectious Disease: HIV management (CD4 count, AIDS criteria), MRSA treatment (Bactrim,
doxycycline), TB screening (PPD interpretation), Lyme disease (erythema migrans, ELISA,
Western blot), Rocky Mountain spotted fever (petechial rash), trichomoniasis (wet prep), and
shingles (ophthalmic referral).
Musculoskeletal: Osteoarthritis vs rheumatoid arthritis (morning stiffness, joint involvement),
fibromyalgia (tender points), gout, rotator cuff injury, Osgood-Schlatter disease, Legg-Calve-
Perthes disease, and osteoporosis risk factors (ACCESS).
Psychiatric/Mental Health: Depression screening, anxiety treatment (SSRI, SNRI, buspirone),
bipolar disorder (lithium monitoring), ADHD, seasonal affective disorder, serotonin syndrome
symptoms, and substance abuse assessment (CAGE questionnaire).
ENT/Ophthalmology: Conjunctivitis (allergic vs bacterial), otitis media (AOM, OME),
presbycusis, Ménière's disease, corneal abrasion, acute angle-closure glaucoma (halos, pain,
dilated pupil), papilledema, diabetic/hypertensive retinopathy, and hearing tests (Weber, Rinne,
Romberg).
Gastrointestinal: GERD treatment (H2 blockers first line, PPIs), Barrett's esophagus, IBS,
SIBO, cirrhosis, hepatitis, pancreatitis diagnosis (lipase > amylase), and diverticulitis.
FNP Certification Exam Review
, Page 3 of 135
Question 1: A 65-year-old patient with history of hypertension and stroke presents with
progressive memory loss, confusion, and difficulty with executive function. Physical exam
reveals normal neurological examination findings. Which type of dementia is most consistent
with this clinical presentation?
A) Alzheimer's disease
B) Vascular dementia
C) Frontotemporal dementia
D) Lewy body dementia
Answer: B) Vascular dementia
Rationale: Vascular dementia is characterized by stepwise cognitive decline in patients with
vascular risk factors such as hypertension and stroke. Memory loss combined with executive
dysfunction and history of cerebrovascular disease strongly suggests vascular dementia rather
than Alzheimer's, which typically presents with gradual progressive memory impairment without
clear vascular etiology.
Question 2: A 4-month-old infant is brought to the clinic by concerned parents who notice that
the baby's eyes appear to be misaligned. The infant is otherwise healthy, meeting all
developmental milestones, and there is no family history of eye disorders. What is the most
appropriate response to the parents?
A) Refer immediately to pediatric ophthalmology
B) Order a brain MRI to rule out neurological causes
C) Reassure the parents that this is normal at this age
D) Prescribe patching therapy to strengthen the weaker eye
Answer: C) Reassure the parents that this is normal at this age
Rationale: Strabismus is common in infants up to 6 months of age due to immaturity of the
oculomotor system. If the eyes are intermittently misaligned and the infant is otherwise healthy
with no other concerning findings, it is considered normal and typically resolves spontaneously.
Persistent strabismus after 6 months requires further evaluation.
, Page 4 of 135
Question 3: A 28-year-old female presents with severe right lower quadrant abdominal pain,
nausea, and vomiting. On physical examination, palpation of the left lower quadrant elicits pain
in the right lower quadrant. What does this clinical sign indicate?
A) Cholecystitis
B) Appendicitis
C) Diverticulitis
D) Ectopic pregnancy
Answer: B) Appendicitis
Rationale: Rovsing's sign is pain in the right lower quadrant when the left lower quadrant is
palpated, indicating peritoneal irritation and is classic for appendicitis. This occurs because
palpation of the left lower quadrant increases pressure throughout the abdomen, causing pain in
the area of the inflamed appendix on the right side.
Question 4: A 45-year-old patient with a history of GERD presents with chronic heartburn
symptoms despite lifestyle modifications. Which medication class is considered the first-line
treatment for this patient's condition?
A) Proton pump inhibitors
B) Antacids
C) H2 receptor antagonists
D) Prokinetic agents
Answer: C) H2 receptor antagonists
Rationale: H2 receptor antagonists (H2 blockers) such as ranitidine or famotidine are first-line
therapy for GERD due to their effectiveness in reducing acid production with fewer side effects
than PPIs. They are typically administered at bedtime (hs) to suppress nocturnal acid
production, which is particularly important for symptom control.
FNP Exam Review Study Guide |
Comprehensive Nurse Practitioner
Preparation For AANP Boards
EXAM COVERAGE SUMMARY
This comprehensive review covers essential topics for the FNP certification exam including:
Cardiovascular System: Heart murmurs (diastolic, systolic, holosystolic), murmurs grading (I-
VI), peripheral arterial disease, chronic venous insufficiency, hypertension management, carotid
bruits, JVD causes, endocarditis signs (Osler's nodes, Janeway lesions), coarctation of aorta,
S3/S4 gallops, and ECG interpretation.
Pulmonary System: COPD treatment (GOLD guidelines), emphysema findings, pneumonia,
tuberculosis diagnosis and treatment, croup/epiglottitis, OSA, and sinusitis management.
Endocrine/Metabolic: Diabetes management (A1C >9 requires basal insulin), thyroid disorders
(TSH, TPO, hyper/hypothyroidism), Graves disease, PTU in pregnancy, metabolic syndrome
criteria, Cushing's syndrome, Addison's disease, osteoporosis treatment (bisphosphonates,
calcium, vitamin D), and parathyroid disorders.
Neurological: Dementia types (Alzheimer's, vascular), cognitive assessment (Mini-Mental
Exam), stroke evaluation, headache management (migraine abortive/prophylactic), Parkinson's
disease, and cranial nerve assessment (CN 3,4,6,5,7,8,9).
Reproductive/OB-GYN: Fundal height measurements (12,16,20 weeks), ectopic pregnancy risk
factors, preeclampsia management, chlamydia/gonorrhea treatment in pregnancy, breast cancer
screening, cervical cancer (pap smear, colposcopy, LEEP), endometriosis, and infertility
evaluation.
, Page 2 of 135
Pediatrics: Developmental milestones, strabismus, pyloric stenosis (olive-like mass, non-bilious
vomiting), intussusception (currant jelly stool), Wilms tumor (non-painful abdominal mass),
retinoblastoma (white reflex), Kawasaki disease, roseola, fifth disease, and congenital
conditions.
Dermatology: Atopic dermatitis treatment (topical steroids, antihistamines), psoriasis (Koebner
phenomenon, Auspitz sign), tinea corporis, cellulitis vs erysipelas, impetigo, actinic keratosis,
basal cell carcinoma, acne vulgaris vs rosacea, and lichen planus.
Infectious Disease: HIV management (CD4 count, AIDS criteria), MRSA treatment (Bactrim,
doxycycline), TB screening (PPD interpretation), Lyme disease (erythema migrans, ELISA,
Western blot), Rocky Mountain spotted fever (petechial rash), trichomoniasis (wet prep), and
shingles (ophthalmic referral).
Musculoskeletal: Osteoarthritis vs rheumatoid arthritis (morning stiffness, joint involvement),
fibromyalgia (tender points), gout, rotator cuff injury, Osgood-Schlatter disease, Legg-Calve-
Perthes disease, and osteoporosis risk factors (ACCESS).
Psychiatric/Mental Health: Depression screening, anxiety treatment (SSRI, SNRI, buspirone),
bipolar disorder (lithium monitoring), ADHD, seasonal affective disorder, serotonin syndrome
symptoms, and substance abuse assessment (CAGE questionnaire).
ENT/Ophthalmology: Conjunctivitis (allergic vs bacterial), otitis media (AOM, OME),
presbycusis, Ménière's disease, corneal abrasion, acute angle-closure glaucoma (halos, pain,
dilated pupil), papilledema, diabetic/hypertensive retinopathy, and hearing tests (Weber, Rinne,
Romberg).
Gastrointestinal: GERD treatment (H2 blockers first line, PPIs), Barrett's esophagus, IBS,
SIBO, cirrhosis, hepatitis, pancreatitis diagnosis (lipase > amylase), and diverticulitis.
FNP Certification Exam Review
, Page 3 of 135
Question 1: A 65-year-old patient with history of hypertension and stroke presents with
progressive memory loss, confusion, and difficulty with executive function. Physical exam
reveals normal neurological examination findings. Which type of dementia is most consistent
with this clinical presentation?
A) Alzheimer's disease
B) Vascular dementia
C) Frontotemporal dementia
D) Lewy body dementia
Answer: B) Vascular dementia
Rationale: Vascular dementia is characterized by stepwise cognitive decline in patients with
vascular risk factors such as hypertension and stroke. Memory loss combined with executive
dysfunction and history of cerebrovascular disease strongly suggests vascular dementia rather
than Alzheimer's, which typically presents with gradual progressive memory impairment without
clear vascular etiology.
Question 2: A 4-month-old infant is brought to the clinic by concerned parents who notice that
the baby's eyes appear to be misaligned. The infant is otherwise healthy, meeting all
developmental milestones, and there is no family history of eye disorders. What is the most
appropriate response to the parents?
A) Refer immediately to pediatric ophthalmology
B) Order a brain MRI to rule out neurological causes
C) Reassure the parents that this is normal at this age
D) Prescribe patching therapy to strengthen the weaker eye
Answer: C) Reassure the parents that this is normal at this age
Rationale: Strabismus is common in infants up to 6 months of age due to immaturity of the
oculomotor system. If the eyes are intermittently misaligned and the infant is otherwise healthy
with no other concerning findings, it is considered normal and typically resolves spontaneously.
Persistent strabismus after 6 months requires further evaluation.
, Page 4 of 135
Question 3: A 28-year-old female presents with severe right lower quadrant abdominal pain,
nausea, and vomiting. On physical examination, palpation of the left lower quadrant elicits pain
in the right lower quadrant. What does this clinical sign indicate?
A) Cholecystitis
B) Appendicitis
C) Diverticulitis
D) Ectopic pregnancy
Answer: B) Appendicitis
Rationale: Rovsing's sign is pain in the right lower quadrant when the left lower quadrant is
palpated, indicating peritoneal irritation and is classic for appendicitis. This occurs because
palpation of the left lower quadrant increases pressure throughout the abdomen, causing pain in
the area of the inflamed appendix on the right side.
Question 4: A 45-year-old patient with a history of GERD presents with chronic heartburn
symptoms despite lifestyle modifications. Which medication class is considered the first-line
treatment for this patient's condition?
A) Proton pump inhibitors
B) Antacids
C) H2 receptor antagonists
D) Prokinetic agents
Answer: C) H2 receptor antagonists
Rationale: H2 receptor antagonists (H2 blockers) such as ranitidine or famotidine are first-line
therapy for GERD due to their effectiveness in reducing acid production with fewer side effects
than PPIs. They are typically administered at bedtime (hs) to suppress nocturnal acid
production, which is particularly important for symptom control.
