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AANP FNP Certification Practice Exam: 100 Questions with Answers
Section 1: Assessment & Health Promotion (Questions 1–25)
Q1. A 58-year-old male with a 30-pack-year smoking history who quit 2 years ago presents
for a routine physical. According to 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 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) .
Q2. A 6-month-old infant is exclusively breastfed. 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 AAP recommends vitamin D supplementation (400 IU/day) for all breastfed
infants starting shortly after birth, as breast milk contains insufficient vitamin D .
Q3. A 72-year-old woman is brought in by her daughter concerned about memory decline.
She scores 22/30 on the MMSE. What is the most appropriate next step?
A. Diagnose Alzheimer's disease and start donepezil
B. Perform a functional assessment including 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 .
Q4. A 65-year-old woman with no history of cardiovascular disease has a 10-year ASCVD risk
score of 12%. According to ACC/AHA guidelines, what is the most appropriate management?
A. No statin therapy indicated
B. Moderate-intensity statin therapy
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C. High-intensity statin therapy
D. Aspirin therapy alone
Answer: B
Rationale: For patients aged 40–75 with a 10-year ASCVD risk of 7.5% to <20%, moderate-
intensity statin therapy is recommended. Risk scores ≥20% warrant high-intensity statins .
Q5. A 16-year-old presents for a well-adolescent visit. The PHQ-9 score is 14, and the parent
is not in the room. Which element of the assessment is highest priority?
A. Referral to psychiatry without further questions
B. Immediate initiation of SSRI
C. Assessment of suicidal ideation and safety plan
D. Reassurance that symptoms are normal for age
Answer: C
Rationale: A PHQ-9 score of 14 indicates moderate depression. The highest priority is
assessing suicidal ideation and developing a safety plan before treatment planning .
Q6. A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On exam,
she has delayed relaxation of deep tendon reflexes. Which laboratory test should be ordered
initially?
A. TSH and free T4
B. Complete blood count
C. Basic metabolic panel
D. Cortisol level
Answer: A
Rationale: The symptoms and physical finding are classic for hypothyroidism. Initial
evaluation should include TSH and free T4 .
Q7. A 72-year-old man with known HFrEF presents with progressive dyspnea and 4 kg weight
gain over 10 days. Which physical examination finding best confirms volume overload
requiring diuretic adjustment?
A. Isolated mild ankle swelling
B. Clear lung fields and normal JVP
C. Tachycardia alone
D. Bilateral pitting edema to the mid-calf and elevated JVP
Answer: D
Rationale: Bilateral pitting edema to the mid-calf and elevated JVP indicate significant
volume overload requiring diuretic adjustment .
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Q8. A 24-month-old is seen for a well-child visit. Parents express concern the child uses only
single words and does not combine two words. Which standardized screening tool is most
appropriate?
A. Denver II Developmental Screening Test
B. M-CHAT
C. PHQ-9
D. CRAFFT
Answer: A
Rationale: The Denver II assesses developmental milestones including language. At 24
months, children should be combining two-word phrases .
Q9. A 45-year-old woman has an incidental 1.8 cm thyroid nodule discovered on CT. TSH is
normal. Which next diagnostic action is most appropriate?
A. Empiric levothyroxine
B. Thyroid ultrasound with fine-needle aspiration if indicated by sonographic features
C. Immediate total thyroidectomy referral
D. Repeat CT in 6 months only
Answer: B
Rationale: For incidental thyroid nodules, thyroid ultrasound characterizes the nodule, and
FNA is performed if sonographic features are suspicious .
Q10. A 34-year-old woman reports fatigue, weight gain, and cold intolerance. Labs show TSH
8.2 mIU/L, free T4 0.6 ng/dL, and positive TPO antibodies. What is the most appropriate
initial management?
A. Start levothyroxine 75 mcg daily and recheck TSH in 6 weeks
B. Start levothyroxine 25 mcg daily and titrate gradually
C. Start liothyronine (T3)
D. No treatment needed
Answer: B
Rationale: Start levothyroxine at a low dose (25–50 mcg) and titrate based on TSH response.
Starting high can precipitate cardiac issues .
Q11. A 68-year-old male with a 45-pack-year smoking history presents with chronic cough
and weight loss. Chest X-ray reveals a suspicious mass. What is the most appropriate next
step?
A. CT-guided biopsy
B. Repeat X-ray in 3 months
C. Empiric antibiotics
D. CBC only
AANP FNP Certification Practice Exam: 100 Questions with Answers
Section 1: Assessment & Health Promotion (Questions 1–25)
Q1. A 58-year-old male with a 30-pack-year smoking history who quit 2 years ago presents
for a routine physical. According to 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 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) .
Q2. A 6-month-old infant is exclusively breastfed. 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 AAP recommends vitamin D supplementation (400 IU/day) for all breastfed
infants starting shortly after birth, as breast milk contains insufficient vitamin D .
Q3. A 72-year-old woman is brought in by her daughter concerned about memory decline.
She scores 22/30 on the MMSE. What is the most appropriate next step?
A. Diagnose Alzheimer's disease and start donepezil
B. Perform a functional assessment including 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 .
Q4. A 65-year-old woman with no history of cardiovascular disease has a 10-year ASCVD risk
score of 12%. According to ACC/AHA guidelines, what is the most appropriate management?
A. No statin therapy indicated
B. Moderate-intensity statin therapy
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C. High-intensity statin therapy
D. Aspirin therapy alone
Answer: B
Rationale: For patients aged 40–75 with a 10-year ASCVD risk of 7.5% to <20%, moderate-
intensity statin therapy is recommended. Risk scores ≥20% warrant high-intensity statins .
Q5. A 16-year-old presents for a well-adolescent visit. The PHQ-9 score is 14, and the parent
is not in the room. Which element of the assessment is highest priority?
A. Referral to psychiatry without further questions
B. Immediate initiation of SSRI
C. Assessment of suicidal ideation and safety plan
D. Reassurance that symptoms are normal for age
Answer: C
Rationale: A PHQ-9 score of 14 indicates moderate depression. The highest priority is
assessing suicidal ideation and developing a safety plan before treatment planning .
Q6. A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On exam,
she has delayed relaxation of deep tendon reflexes. Which laboratory test should be ordered
initially?
A. TSH and free T4
B. Complete blood count
C. Basic metabolic panel
D. Cortisol level
Answer: A
Rationale: The symptoms and physical finding are classic for hypothyroidism. Initial
evaluation should include TSH and free T4 .
Q7. A 72-year-old man with known HFrEF presents with progressive dyspnea and 4 kg weight
gain over 10 days. Which physical examination finding best confirms volume overload
requiring diuretic adjustment?
A. Isolated mild ankle swelling
B. Clear lung fields and normal JVP
C. Tachycardia alone
D. Bilateral pitting edema to the mid-calf and elevated JVP
Answer: D
Rationale: Bilateral pitting edema to the mid-calf and elevated JVP indicate significant
volume overload requiring diuretic adjustment .
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Q8. A 24-month-old is seen for a well-child visit. Parents express concern the child uses only
single words and does not combine two words. Which standardized screening tool is most
appropriate?
A. Denver II Developmental Screening Test
B. M-CHAT
C. PHQ-9
D. CRAFFT
Answer: A
Rationale: The Denver II assesses developmental milestones including language. At 24
months, children should be combining two-word phrases .
Q9. A 45-year-old woman has an incidental 1.8 cm thyroid nodule discovered on CT. TSH is
normal. Which next diagnostic action is most appropriate?
A. Empiric levothyroxine
B. Thyroid ultrasound with fine-needle aspiration if indicated by sonographic features
C. Immediate total thyroidectomy referral
D. Repeat CT in 6 months only
Answer: B
Rationale: For incidental thyroid nodules, thyroid ultrasound characterizes the nodule, and
FNA is performed if sonographic features are suspicious .
Q10. A 34-year-old woman reports fatigue, weight gain, and cold intolerance. Labs show TSH
8.2 mIU/L, free T4 0.6 ng/dL, and positive TPO antibodies. What is the most appropriate
initial management?
A. Start levothyroxine 75 mcg daily and recheck TSH in 6 weeks
B. Start levothyroxine 25 mcg daily and titrate gradually
C. Start liothyronine (T3)
D. No treatment needed
Answer: B
Rationale: Start levothyroxine at a low dose (25–50 mcg) and titrate based on TSH response.
Starting high can precipitate cardiac issues .
Q11. A 68-year-old male with a 45-pack-year smoking history presents with chronic cough
and weight loss. Chest X-ray reveals a suspicious mass. What is the most appropriate next
step?
A. CT-guided biopsy
B. Repeat X-ray in 3 months
C. Empiric antibiotics
D. CBC only
