AANP FNP CERTIFICATION ACTUAL EXAM (2026/2027)
AANP FNP TEST BANK QUESTIONS AND CORRECT ANSWERS RATED A+
Exam: American Association of Nurse Practitioners (AANP) Family Nurse Practitioner
Certification Examination
Core Domains: Health Promotion & Disease Prevention, Assessment & Diagnosis, Pharmacologic
& Non-Pharmacologic Management, Professional Role & Ethical Practice, Health Care Systems &
Policy, Research & Evidence-Based Practice, and Special Populations Across the Lifespan
National FNP Certification Focus | Comprehensive Certification Exam Format
Exam Structure
The AANP FNP Certification Exam for the 2026/2027 certification cycle is a 150-question, multiple-
choice question (MCQ) examination.
Answer Format: All correct answers and clinical management strategies are presented in bold and
green, followed by detailed rationales that integrate AANP competencies, apply evidence-based
clinical guidelines, justify pharmacologic and non-pharmacologic interventions, and reflect the FNP
scope of practice.
1.
A 45-year-old male with no significant past medical history presents for an annual physical. He
smokes one pack per day and has a BMI of 32. His blood pressure is 142/88 mmHg on two readings.
What is the most appropriate next step?
A. Prescribe hydrochlorothiazide
B. Diagnose stage 2 hypertension and initiate lifestyle modifications with follow-up in 1
month
C. Order ambulatory blood pressure monitoring
D. Recheck BP in 6 months
Rationale: Per ACC/AHA 2023 guidelines, BP ≥140/90 mmHg defines stage 2 hypertension. In a
patient with multiple risk factors (smoking, obesity), lifestyle modifications (DASH diet,
weight loss, smoking cessation) should begin immediately, with pharmacotherapy
considered within 1 month if BP remains elevated. Ambulatory monitoring is not needed
when office readings are consistently high.
2.
A 62-year-old female presents with fatigue, weight gain, and cold intolerance. TSH is 12.5 mIU/L
(normal 0.4–4.0), and free T4 is low. What is the most likely diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Pituitary adenoma
D. Thyroiditis
Rationale: Elevated TSH with low free T4 confirms primary hypothyroidism, most commonly
due to Hashimoto’s thyroiditis. Subclinical hypothyroidism has elevated TSH but normal T4.
Pituitary causes would show low or normal TSH with low T4.
3.
,A 30-year-old pregnant woman at 12 weeks gestation asks about vaccinations. Which vaccine is
contraindicated during pregnancy?
A. Influenza (inactivated)
B. Tdap
C. MMR (measles, mumps, rubella)
D. Hepatitis B
Rationale: MMR is a live attenuated vaccine and is contraindicated during pregnancy due to
theoretical fetal risk. Influenza (inactivated), Tdap (recommended between 27–36 weeks), and
hepatitis B are safe and recommended as indicated.
4.
A 55-year-old male with type 2 diabetes has an HbA1c of 8.6%. He is currently on metformin 1000 mg
BID. He has a history of myocardial infarction 2 years ago. What is the most appropriate add-on
therapy?
A. Glipizide
B. Sitagliptin
C. Empagliflozin
D. Pioglitazone
Rationale: For patients with T2DM and established ASCVD, ADA/EASD guidelines recommend
adding an agent with proven cardiovascular benefit. SGLT2 inhibitors like empagliflozin
reduce MACE, heart failure hospitalizations, and CKD progression. Sulfonylureas
(glipizide) increase hypoglycemia risk; pioglitazone may worsen heart failure.
5.
A 7-year-old child presents with fever, sore throat, and tender anterior cervical lymphadenopathy.
Rapid strep test is positive. What is the first-line treatment?
A. Azithromycin
B. Cephalexin
C. Penicillin V
D. Amoxicillin-clavulanate
Rationale: Group A strep pharyngitis is treated with penicillin V (or amoxicillin) as first-line
due to narrow spectrum, efficacy, and low cost. Macrolides are reserved for true penicillin
allergy. Cephalosporins are alternatives but broader spectrum.
6.
A 68-year-old male presents with new-onset atrial fibrillation. CHA₂DS₂-VASc score is 4. What is the
most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Clopidogrel
C. Apixaban
D. No anticoagulation needed
Rationale: CHA₂DS₂-VASc ≥2 in men indicates high stroke risk. DOACs (e.g., apixaban) are
preferred over warfarin for non-valvular AF. Aspirin is ineffective for stroke prevention in
AF and increases bleeding risk without benefit.
7.
A 24-year-old female presents with dysuria, frequency, and suprapubic tenderness. Urinalysis shows
>50 WBCs/hpf and positive nitrites. She has no drug allergies. What is the best empiric antibiotic
choice?
,A. Ciprofloxacin
B. Amoxicillin-clavulanate
C. Nitrofurantoin
D. Doxycycline
Rationale: For uncomplicated cystitis in a non-pregnant woman, nitrofurantoin is first-line
due to low resistance rates and minimal systemic absorption. Fluoroquinolones
(ciprofloxacin) are reserved for complicated UTIs due to risks of C. diff and tendon rupture.
8.
A 50-year-old male with chronic hepatitis C (genotype 1) and no cirrhosis is seeking treatment. What
is the recommended regimen?
A. Pegylated interferon + ribavirin
B. Glecaprevir/pibrentasvir for 8 weeks
C. Sofosbuvir/velpatasvir for 24 weeks
D. Ribavirin monotherapy
Rationale: Current AASLD guidelines recommend glecaprevir/pibrentasvir (Mavyret) for 8
weeks in treatment-naïve patients without cirrhosis. Interferon-based regimens are
obsolete due to toxicity and lower efficacy.
9.
A 40-year-old female presents with bilateral wrist pain, morning stiffness lasting 2 hours, and fatigue.
Rheumatoid factor is positive. What is the most appropriate initial disease-modifying therapy?
A. Prednisone
B. Ibuprofen
C. Methotrexate
D. Hydroxychloroquine
Rationale: Methotrexate is the anchor DMARD for rheumatoid arthritis, shown to slow
radiographic progression and improve function. NSAIDs and steroids provide symptomatic relief
but do not alter disease course.
10.
A 65-year-old male with a 40-pack-year smoking history presents for lung cancer screening. What is
the current USPSTF recommendation?
A. Annual chest X-ray
B. Annual low-dose CT scan if aged 50–80, quit within past 15 years, and ≥20 pack-year
history
C. Sputum cytology yearly
D. No screening recommended
Rationale: USPSTF (2023) recommends annual LDCT for adults aged 50–80 with ≥20 pack-
year history who currently smoke or quit within the past 15 years. Chest X-ray is not
effective for mortality reduction.
11.
A 32-year-old female presents with amenorrhea for 3 months. Pregnancy test is negative. TSH and
prolactin are normal. What is the next best diagnostic step?
A. Pelvic ultrasound
B. Progesterone challenge test
C. FSH and LH levels
D. Endometrial biopsy
, Rationale: In secondary amenorrhea with normal TSH/prolactin, the progesterone challenge
(medroxyprogesterone 10 mg × 10 days) assesses estrogen status. Withdrawal bleed
indicates adequate estrogen; no bleed suggests hypoestrogenism or outflow tract obstruction.
12.
A 58-year-old male presents with acute onset of right-sided weakness and slurred speech. Symptoms
began 60 minutes ago. CT head shows no hemorrhage. What is the most time-sensitive intervention?
A. Start aspirin
B. Administer IV alteplase within 4.5 hours of symptom onset
C. Order MRI brain
D. Begin statin therapy
Rationale: For ischemic stroke within 4.5 hours, IV alteplase improves functional outcomes if
no contraindications exist. Door-to-needle time should be ≤60 minutes. Aspirin is given after
alteplase or if thrombolysis is contraindicated.
13.
A 28-year-old pregnant woman at 28 weeks gestation has a 1-hour glucose challenge test result of 190
mg/dL. What is the next step?
A. Diagnose gestational diabetes
B. Order 3-hour oral glucose tolerance test (OGTT)
C. Start insulin therapy
D. Repeat fasting glucose
Rationale: A 1-hour glucose ≥190 mg/dL is abnormal, but diagnosis requires a 3-hour OGTT with
two or more abnormal values (fasting ≥95, 1-hr ≥180, 2-hr ≥155, 3-hr ≥140 mg/dL).
14.
A 70-year-old male presents with progressive memory loss, getting lost in familiar places, and
difficulty managing medications. MMSE score is 20/30. What is the most likely diagnosis?
A. Delirium
B. Alzheimer’s disease
C. Depression
D. Vitamin B12 deficiency
Rationale: Insidious onset of memory impairment with disorientation and functional decline is
classic for Alzheimer’s disease. Delirium is acute and fluctuating; depression may mimic
dementia (“pseudodementia”) but typically has prominent mood symptoms.
15.
A 45-year-old female presents with recurrent episodes of vertigo, tinnitus, and hearing loss. What is
the most likely diagnosis?
A. Benign paroxysmal positional vertigo (BPPV)
B. Ménière’s disease
C. Vestibular neuritis
D. Acoustic neuroma
Rationale: The triad of episodic vertigo, sensorineural hearing loss, and tinnitus is
diagnostic of Ménière’s disease. BPPV causes brief vertigo with position change but no hearing
loss; vestibular neuritis causes prolonged vertigo without auditory symptoms.
16.
A 55-year-old male with GERD unresponsive to lifestyle changes and omeprazole 20 mg daily reports
persistent heartburn. What is the next best step?
AANP FNP TEST BANK QUESTIONS AND CORRECT ANSWERS RATED A+
Exam: American Association of Nurse Practitioners (AANP) Family Nurse Practitioner
Certification Examination
Core Domains: Health Promotion & Disease Prevention, Assessment & Diagnosis, Pharmacologic
& Non-Pharmacologic Management, Professional Role & Ethical Practice, Health Care Systems &
Policy, Research & Evidence-Based Practice, and Special Populations Across the Lifespan
National FNP Certification Focus | Comprehensive Certification Exam Format
Exam Structure
The AANP FNP Certification Exam for the 2026/2027 certification cycle is a 150-question, multiple-
choice question (MCQ) examination.
Answer Format: All correct answers and clinical management strategies are presented in bold and
green, followed by detailed rationales that integrate AANP competencies, apply evidence-based
clinical guidelines, justify pharmacologic and non-pharmacologic interventions, and reflect the FNP
scope of practice.
1.
A 45-year-old male with no significant past medical history presents for an annual physical. He
smokes one pack per day and has a BMI of 32. His blood pressure is 142/88 mmHg on two readings.
What is the most appropriate next step?
A. Prescribe hydrochlorothiazide
B. Diagnose stage 2 hypertension and initiate lifestyle modifications with follow-up in 1
month
C. Order ambulatory blood pressure monitoring
D. Recheck BP in 6 months
Rationale: Per ACC/AHA 2023 guidelines, BP ≥140/90 mmHg defines stage 2 hypertension. In a
patient with multiple risk factors (smoking, obesity), lifestyle modifications (DASH diet,
weight loss, smoking cessation) should begin immediately, with pharmacotherapy
considered within 1 month if BP remains elevated. Ambulatory monitoring is not needed
when office readings are consistently high.
2.
A 62-year-old female presents with fatigue, weight gain, and cold intolerance. TSH is 12.5 mIU/L
(normal 0.4–4.0), and free T4 is low. What is the most likely diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Pituitary adenoma
D. Thyroiditis
Rationale: Elevated TSH with low free T4 confirms primary hypothyroidism, most commonly
due to Hashimoto’s thyroiditis. Subclinical hypothyroidism has elevated TSH but normal T4.
Pituitary causes would show low or normal TSH with low T4.
3.
,A 30-year-old pregnant woman at 12 weeks gestation asks about vaccinations. Which vaccine is
contraindicated during pregnancy?
A. Influenza (inactivated)
B. Tdap
C. MMR (measles, mumps, rubella)
D. Hepatitis B
Rationale: MMR is a live attenuated vaccine and is contraindicated during pregnancy due to
theoretical fetal risk. Influenza (inactivated), Tdap (recommended between 27–36 weeks), and
hepatitis B are safe and recommended as indicated.
4.
A 55-year-old male with type 2 diabetes has an HbA1c of 8.6%. He is currently on metformin 1000 mg
BID. He has a history of myocardial infarction 2 years ago. What is the most appropriate add-on
therapy?
A. Glipizide
B. Sitagliptin
C. Empagliflozin
D. Pioglitazone
Rationale: For patients with T2DM and established ASCVD, ADA/EASD guidelines recommend
adding an agent with proven cardiovascular benefit. SGLT2 inhibitors like empagliflozin
reduce MACE, heart failure hospitalizations, and CKD progression. Sulfonylureas
(glipizide) increase hypoglycemia risk; pioglitazone may worsen heart failure.
5.
A 7-year-old child presents with fever, sore throat, and tender anterior cervical lymphadenopathy.
Rapid strep test is positive. What is the first-line treatment?
A. Azithromycin
B. Cephalexin
C. Penicillin V
D. Amoxicillin-clavulanate
Rationale: Group A strep pharyngitis is treated with penicillin V (or amoxicillin) as first-line
due to narrow spectrum, efficacy, and low cost. Macrolides are reserved for true penicillin
allergy. Cephalosporins are alternatives but broader spectrum.
6.
A 68-year-old male presents with new-onset atrial fibrillation. CHA₂DS₂-VASc score is 4. What is the
most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Clopidogrel
C. Apixaban
D. No anticoagulation needed
Rationale: CHA₂DS₂-VASc ≥2 in men indicates high stroke risk. DOACs (e.g., apixaban) are
preferred over warfarin for non-valvular AF. Aspirin is ineffective for stroke prevention in
AF and increases bleeding risk without benefit.
7.
A 24-year-old female presents with dysuria, frequency, and suprapubic tenderness. Urinalysis shows
>50 WBCs/hpf and positive nitrites. She has no drug allergies. What is the best empiric antibiotic
choice?
,A. Ciprofloxacin
B. Amoxicillin-clavulanate
C. Nitrofurantoin
D. Doxycycline
Rationale: For uncomplicated cystitis in a non-pregnant woman, nitrofurantoin is first-line
due to low resistance rates and minimal systemic absorption. Fluoroquinolones
(ciprofloxacin) are reserved for complicated UTIs due to risks of C. diff and tendon rupture.
8.
A 50-year-old male with chronic hepatitis C (genotype 1) and no cirrhosis is seeking treatment. What
is the recommended regimen?
A. Pegylated interferon + ribavirin
B. Glecaprevir/pibrentasvir for 8 weeks
C. Sofosbuvir/velpatasvir for 24 weeks
D. Ribavirin monotherapy
Rationale: Current AASLD guidelines recommend glecaprevir/pibrentasvir (Mavyret) for 8
weeks in treatment-naïve patients without cirrhosis. Interferon-based regimens are
obsolete due to toxicity and lower efficacy.
9.
A 40-year-old female presents with bilateral wrist pain, morning stiffness lasting 2 hours, and fatigue.
Rheumatoid factor is positive. What is the most appropriate initial disease-modifying therapy?
A. Prednisone
B. Ibuprofen
C. Methotrexate
D. Hydroxychloroquine
Rationale: Methotrexate is the anchor DMARD for rheumatoid arthritis, shown to slow
radiographic progression and improve function. NSAIDs and steroids provide symptomatic relief
but do not alter disease course.
10.
A 65-year-old male with a 40-pack-year smoking history presents for lung cancer screening. What is
the current USPSTF recommendation?
A. Annual chest X-ray
B. Annual low-dose CT scan if aged 50–80, quit within past 15 years, and ≥20 pack-year
history
C. Sputum cytology yearly
D. No screening recommended
Rationale: USPSTF (2023) recommends annual LDCT for adults aged 50–80 with ≥20 pack-
year history who currently smoke or quit within the past 15 years. Chest X-ray is not
effective for mortality reduction.
11.
A 32-year-old female presents with amenorrhea for 3 months. Pregnancy test is negative. TSH and
prolactin are normal. What is the next best diagnostic step?
A. Pelvic ultrasound
B. Progesterone challenge test
C. FSH and LH levels
D. Endometrial biopsy
, Rationale: In secondary amenorrhea with normal TSH/prolactin, the progesterone challenge
(medroxyprogesterone 10 mg × 10 days) assesses estrogen status. Withdrawal bleed
indicates adequate estrogen; no bleed suggests hypoestrogenism or outflow tract obstruction.
12.
A 58-year-old male presents with acute onset of right-sided weakness and slurred speech. Symptoms
began 60 minutes ago. CT head shows no hemorrhage. What is the most time-sensitive intervention?
A. Start aspirin
B. Administer IV alteplase within 4.5 hours of symptom onset
C. Order MRI brain
D. Begin statin therapy
Rationale: For ischemic stroke within 4.5 hours, IV alteplase improves functional outcomes if
no contraindications exist. Door-to-needle time should be ≤60 minutes. Aspirin is given after
alteplase or if thrombolysis is contraindicated.
13.
A 28-year-old pregnant woman at 28 weeks gestation has a 1-hour glucose challenge test result of 190
mg/dL. What is the next step?
A. Diagnose gestational diabetes
B. Order 3-hour oral glucose tolerance test (OGTT)
C. Start insulin therapy
D. Repeat fasting glucose
Rationale: A 1-hour glucose ≥190 mg/dL is abnormal, but diagnosis requires a 3-hour OGTT with
two or more abnormal values (fasting ≥95, 1-hr ≥180, 2-hr ≥155, 3-hr ≥140 mg/dL).
14.
A 70-year-old male presents with progressive memory loss, getting lost in familiar places, and
difficulty managing medications. MMSE score is 20/30. What is the most likely diagnosis?
A. Delirium
B. Alzheimer’s disease
C. Depression
D. Vitamin B12 deficiency
Rationale: Insidious onset of memory impairment with disorientation and functional decline is
classic for Alzheimer’s disease. Delirium is acute and fluctuating; depression may mimic
dementia (“pseudodementia”) but typically has prominent mood symptoms.
15.
A 45-year-old female presents with recurrent episodes of vertigo, tinnitus, and hearing loss. What is
the most likely diagnosis?
A. Benign paroxysmal positional vertigo (BPPV)
B. Ménière’s disease
C. Vestibular neuritis
D. Acoustic neuroma
Rationale: The triad of episodic vertigo, sensorineural hearing loss, and tinnitus is
diagnostic of Ménière’s disease. BPPV causes brief vertigo with position change but no hearing
loss; vestibular neuritis causes prolonged vertigo without auditory symptoms.
16.
A 55-year-old male with GERD unresponsive to lifestyle changes and omeprazole 20 mg daily reports
persistent heartburn. What is the next best step?
