1|P a g e
AANP FNP CERTIFICATION EXAM 2026 |
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS |RATED A + |NEW
AND REVISED
1. A 52-year-old man with type 2 diabetes presents for routine
follow-up. His A1C is 8.9% despite metformin at
maximum dose. He has no history of cardiovascular disease
and normal renal function. Which medication is most
appropriate to add next?
A. Glyburide
B. Sitagliptin
C. GLP-1 receptor agonist
D. Regular insulin
Rationale: GLP-1 receptor agonists improve glycemic
control, promote weight loss, and have low hypoglycemia
risk, making them preferred second-line agents after
metformin.
2. A 6-month-old infant presents for a well-child visit. Which
developmental milestone should the FNP expect?
A. Walks independently
B. Uses two-word phrases
C. Sits without support
D. Copies a circle
Rationale: By 6 months, infants typically sit
independently; walking and speech milestones occur
later.
,2|P a g e
3. A 34-year-old woman presents with dysuria and urinary
frequency. Urinalysis shows positive nitrites and leukocyte
esterase. She is not pregnant and has no allergies. First-line
treatment is:
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin
D. Trimethoprim alone
Rationale: Nitrofurantoin is a first-line agent for
uncomplicated cystitis in non-pregnant women.
4. A patient with hypertension is prescribed lisinopril. Which
laboratory value should be monitored most closely after
initiation?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
Rationale: ACE inhibitors can cause hyperkalemia by
reducing aldosterone secretion.
5. A 68-year-old man reports sudden painless loss of vision in
one eye. Fundoscopy reveals a cherry-red spot. The most
likely diagnosis is:
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute glaucoma
D. Macular degeneration
Rationale: A cherry-red spot is classic for central retinal
artery occlusion, an ophthalmic emergency.
6. A 22-year-old college student presents with fever, sore
throat, and posterior cervical lymphadenopathy. Which test
is most appropriate?
,3|P a g e
A. Throat culture
B. Heterophile antibody (Monospot) test
C. Rapid influenza test
D. Chest X-ray
Rationale: These findings are classic for infectious
mononucleosis caused by EBV.
7. A 45-year-old woman with obesity asks about colorectal
cancer screening. She has no family history. When should
routine screening begin?
A. Age 40
B. Age 45
C. Age 45–50 depending on guideline
D. Age 60
Rationale: Current guidelines recommend initiating
screening at age 45 for average-risk adults.
8. A child presents with barking cough, inspiratory stridor,
and hoarseness. Which is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Asthma
Rationale: Croup causes a characteristic barking cough
and stridor, usually viral in origin.
9. A patient with atrial fibrillation is started on warfarin.
Which test is used to monitor therapy?
A. aPTT
B. Platelet count
C. INR
D. D-dimer
Rationale: Warfarin therapy is monitored using the INR.
, 4|P a g e
10. A 70-year-old woman reports bone pain and height
loss. Which test best confirms osteoporosis?
A. Serum calcium
B. X-ray
C. DEXA scan
D. Bone biopsy
Rationale: DEXA scanning is the gold standard for
diagnosing osteoporosis.
11. A 28-year-old pregnant woman at 28 weeks gestation
has a positive glucose tolerance test. The most appropriate
initial management is:
A. Insulin therapy
B. Oral hypoglycemics
C. Dietary modification and exercise
D. Immediate hospitalization
Rationale: Gestational diabetes is initially managed with
lifestyle modification.
12. A patient presents with unilateral leg swelling,
warmth, and pain. Which diagnostic test is most
appropriate?
A. MRI
B. Venous Doppler ultrasound
C. CT scan
D. X-ray
Rationale: Venous Doppler ultrasound is first-line for
suspected DVT.
13. A 55-year-old smoker presents with chronic
productive cough for 3 months over 2 consecutive years.
Diagnosis?
A. Asthma
B. Bronchiectasis
AANP FNP CERTIFICATION EXAM 2026 |
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS |RATED A + |NEW
AND REVISED
1. A 52-year-old man with type 2 diabetes presents for routine
follow-up. His A1C is 8.9% despite metformin at
maximum dose. He has no history of cardiovascular disease
and normal renal function. Which medication is most
appropriate to add next?
A. Glyburide
B. Sitagliptin
C. GLP-1 receptor agonist
D. Regular insulin
Rationale: GLP-1 receptor agonists improve glycemic
control, promote weight loss, and have low hypoglycemia
risk, making them preferred second-line agents after
metformin.
2. A 6-month-old infant presents for a well-child visit. Which
developmental milestone should the FNP expect?
A. Walks independently
B. Uses two-word phrases
C. Sits without support
D. Copies a circle
Rationale: By 6 months, infants typically sit
independently; walking and speech milestones occur
later.
,2|P a g e
3. A 34-year-old woman presents with dysuria and urinary
frequency. Urinalysis shows positive nitrites and leukocyte
esterase. She is not pregnant and has no allergies. First-line
treatment is:
A. Ciprofloxacin
B. Amoxicillin
C. Nitrofurantoin
D. Trimethoprim alone
Rationale: Nitrofurantoin is a first-line agent for
uncomplicated cystitis in non-pregnant women.
4. A patient with hypertension is prescribed lisinopril. Which
laboratory value should be monitored most closely after
initiation?
A. Sodium
B. Calcium
C. Potassium
D. Magnesium
Rationale: ACE inhibitors can cause hyperkalemia by
reducing aldosterone secretion.
5. A 68-year-old man reports sudden painless loss of vision in
one eye. Fundoscopy reveals a cherry-red spot. The most
likely diagnosis is:
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute glaucoma
D. Macular degeneration
Rationale: A cherry-red spot is classic for central retinal
artery occlusion, an ophthalmic emergency.
6. A 22-year-old college student presents with fever, sore
throat, and posterior cervical lymphadenopathy. Which test
is most appropriate?
,3|P a g e
A. Throat culture
B. Heterophile antibody (Monospot) test
C. Rapid influenza test
D. Chest X-ray
Rationale: These findings are classic for infectious
mononucleosis caused by EBV.
7. A 45-year-old woman with obesity asks about colorectal
cancer screening. She has no family history. When should
routine screening begin?
A. Age 40
B. Age 45
C. Age 45–50 depending on guideline
D. Age 60
Rationale: Current guidelines recommend initiating
screening at age 45 for average-risk adults.
8. A child presents with barking cough, inspiratory stridor,
and hoarseness. Which is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Asthma
Rationale: Croup causes a characteristic barking cough
and stridor, usually viral in origin.
9. A patient with atrial fibrillation is started on warfarin.
Which test is used to monitor therapy?
A. aPTT
B. Platelet count
C. INR
D. D-dimer
Rationale: Warfarin therapy is monitored using the INR.
, 4|P a g e
10. A 70-year-old woman reports bone pain and height
loss. Which test best confirms osteoporosis?
A. Serum calcium
B. X-ray
C. DEXA scan
D. Bone biopsy
Rationale: DEXA scanning is the gold standard for
diagnosing osteoporosis.
11. A 28-year-old pregnant woman at 28 weeks gestation
has a positive glucose tolerance test. The most appropriate
initial management is:
A. Insulin therapy
B. Oral hypoglycemics
C. Dietary modification and exercise
D. Immediate hospitalization
Rationale: Gestational diabetes is initially managed with
lifestyle modification.
12. A patient presents with unilateral leg swelling,
warmth, and pain. Which diagnostic test is most
appropriate?
A. MRI
B. Venous Doppler ultrasound
C. CT scan
D. X-ray
Rationale: Venous Doppler ultrasound is first-line for
suspected DVT.
13. A 55-year-old smoker presents with chronic
productive cough for 3 months over 2 consecutive years.
Diagnosis?
A. Asthma
B. Bronchiectasis
