1|Page
NP CERTIFICATION EXAM PREP 2025 | AANP & ANCC
FNP/AGNP TEST BANK | 140+ PRACTICE QUESTIONS WITH
RATIONALES,100% CORRECT ALREADY GRADED A+
1.
A 34-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. Labs show TSH 9.2 (high), free T4 0.6 (low). What is the
most likely diagnosis?
a. Hyperthyroidism
b. Primary hypothyroidism
c. Subclinical hypothyroidism
d. Central hypothyroidism
Answer: b. Primary hypothyroidism
Rationale: Elevated TSH with low free T4 confirms primary
hypothyroidism, most often Hashimoto’s thyroiditis.
2.
A 52-year-old man with a history of hypertension presents for routine exam.
BP is 152/94 mmHg on repeat checks. What is the best next step?
a. Start lifestyle modification only
b. Initiate antihypertensive therapy
c. Recheck in 6 months
d. Begin low-dose aspirin
Answer: b. Initiate antihypertensive therapy
Rationale: Stage 2 hypertension (≥140/90) requires both lifestyle
modification and pharmacologic therapy.
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3.
A 40-year-old woman presents with new onset palpitations, anxiety, and
heat intolerance. Exam shows a diffusely enlarged, non-tender thyroid. What
is the most likely diagnosis?
a. Subacute thyroiditis
b. Graves’ disease
c. Multinodular goiter
d. Toxic adenoma
Answer: b. Graves’ disease
Rationale: Diffuse goiter with hyperthyroid symptoms in a young woman
suggests Graves’, often with ophthalmopathy.
4.
A 65-year-old man with type 2 diabetes has a urine albumin-to-creatinine
ratio of 150 mg/g. Which medication is most beneficial?
a. Calcium channel blocker
b. ACE inhibitor
c. Beta-blocker
d. Thiazide diuretic
Answer: b. ACE inhibitor
Rationale: ACE inhibitors (or ARBs) reduce proteinuria and protect kidney
function in diabetics.
5.
Which murmur is described as a holosystolic blowing murmur best heard at
the apex radiating to the axilla?
a. Aortic stenosis
b. Mitral regurgitation
c. Mitral stenosis
d. Aortic regurgitation
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Answer: b. Mitral regurgitation
Rationale: Classic description of mitral regurgitation murmur.
6.
A 22-year-old woman presents with dysuria, frequency, and urgency. UA
shows positive leukocyte esterase and nitrites. Best first-line treatment?
a. Ciprofloxacin for 14 days
b. TMP-SMX for 3 days
c. Amoxicillin for 7 days
d. IV ceftriaxone
Answer: b. TMP-SMX for 3 days
Rationale: First-line therapy for uncomplicated cystitis in young women.
7.
A 58-year-old smoker presents with a new cough, hemoptysis, and weight
loss. Which diagnostic test is most appropriate initially?
a. PET scan
b. Chest X-ray
c. MRI chest
d. Pulmonary function test
Answer: b. Chest X-ray
Rationale: Initial evaluation for possible lung cancer begins with a chest X-
ray.
8.
A 19-year-old sexually active woman presents with lower abdominal pain
and cervical motion tenderness. What is the most likely diagnosis?
a. Ovarian torsion
b. PID
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c. Appendicitis
d. Ectopic pregnancy
Answer: b. PID
Rationale: Pelvic inflammatory disease presents with pelvic pain and
“chandelier sign” (cervical motion tenderness).
9.
Which test is used to screen for diabetic nephropathy in type 2 diabetes?
a. Serum creatinine
b. Urine dipstick
c. Urine albumin-to-creatinine ratio
d. 24-hour urine sodium
Answer: c. Urine albumin-to-creatinine ratio
Rationale: Annual microalbuminuria screening is recommended in
diabetics.
10.
A 64-year-old woman has progressive dyspnea, orthopnea, and bilateral leg
edema. BNP is elevated. What is the most likely diagnosis?
a. COPD
b. Heart failure
c. Pulmonary embolism
d. Pneumonia
Answer: b. Heart failure
Rationale: Elevated BNP with classic heart failure symptoms confirms the
diagnosis.
11.
NP CERTIFICATION EXAM PREP 2025 | AANP & ANCC
FNP/AGNP TEST BANK | 140+ PRACTICE QUESTIONS WITH
RATIONALES,100% CORRECT ALREADY GRADED A+
1.
A 34-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. Labs show TSH 9.2 (high), free T4 0.6 (low). What is the
most likely diagnosis?
a. Hyperthyroidism
b. Primary hypothyroidism
c. Subclinical hypothyroidism
d. Central hypothyroidism
Answer: b. Primary hypothyroidism
Rationale: Elevated TSH with low free T4 confirms primary
hypothyroidism, most often Hashimoto’s thyroiditis.
2.
A 52-year-old man with a history of hypertension presents for routine exam.
BP is 152/94 mmHg on repeat checks. What is the best next step?
a. Start lifestyle modification only
b. Initiate antihypertensive therapy
c. Recheck in 6 months
d. Begin low-dose aspirin
Answer: b. Initiate antihypertensive therapy
Rationale: Stage 2 hypertension (≥140/90) requires both lifestyle
modification and pharmacologic therapy.
,2|Page
3.
A 40-year-old woman presents with new onset palpitations, anxiety, and
heat intolerance. Exam shows a diffusely enlarged, non-tender thyroid. What
is the most likely diagnosis?
a. Subacute thyroiditis
b. Graves’ disease
c. Multinodular goiter
d. Toxic adenoma
Answer: b. Graves’ disease
Rationale: Diffuse goiter with hyperthyroid symptoms in a young woman
suggests Graves’, often with ophthalmopathy.
4.
A 65-year-old man with type 2 diabetes has a urine albumin-to-creatinine
ratio of 150 mg/g. Which medication is most beneficial?
a. Calcium channel blocker
b. ACE inhibitor
c. Beta-blocker
d. Thiazide diuretic
Answer: b. ACE inhibitor
Rationale: ACE inhibitors (or ARBs) reduce proteinuria and protect kidney
function in diabetics.
5.
Which murmur is described as a holosystolic blowing murmur best heard at
the apex radiating to the axilla?
a. Aortic stenosis
b. Mitral regurgitation
c. Mitral stenosis
d. Aortic regurgitation
,3|Page
Answer: b. Mitral regurgitation
Rationale: Classic description of mitral regurgitation murmur.
6.
A 22-year-old woman presents with dysuria, frequency, and urgency. UA
shows positive leukocyte esterase and nitrites. Best first-line treatment?
a. Ciprofloxacin for 14 days
b. TMP-SMX for 3 days
c. Amoxicillin for 7 days
d. IV ceftriaxone
Answer: b. TMP-SMX for 3 days
Rationale: First-line therapy for uncomplicated cystitis in young women.
7.
A 58-year-old smoker presents with a new cough, hemoptysis, and weight
loss. Which diagnostic test is most appropriate initially?
a. PET scan
b. Chest X-ray
c. MRI chest
d. Pulmonary function test
Answer: b. Chest X-ray
Rationale: Initial evaluation for possible lung cancer begins with a chest X-
ray.
8.
A 19-year-old sexually active woman presents with lower abdominal pain
and cervical motion tenderness. What is the most likely diagnosis?
a. Ovarian torsion
b. PID
, 4|Page
c. Appendicitis
d. Ectopic pregnancy
Answer: b. PID
Rationale: Pelvic inflammatory disease presents with pelvic pain and
“chandelier sign” (cervical motion tenderness).
9.
Which test is used to screen for diabetic nephropathy in type 2 diabetes?
a. Serum creatinine
b. Urine dipstick
c. Urine albumin-to-creatinine ratio
d. 24-hour urine sodium
Answer: c. Urine albumin-to-creatinine ratio
Rationale: Annual microalbuminuria screening is recommended in
diabetics.
10.
A 64-year-old woman has progressive dyspnea, orthopnea, and bilateral leg
edema. BNP is elevated. What is the most likely diagnosis?
a. COPD
b. Heart failure
c. Pulmonary embolism
d. Pneumonia
Answer: b. Heart failure
Rationale: Elevated BNP with classic heart failure symptoms confirms the
diagnosis.
11.
