AANP FNP CERTIFICATION EXAM BOARD REVIEW
2026/2027 | Latest Questions & Verified Answers | Complete
Q&A | A+ Grade | Pass Guaranteed - A+ Graded
Q1: A 58-year-old male with type 2 diabetes mellitus presents for follow-up. His HbA1c
is 8.2% despite metformin 1000mg BID. His eGFR is 45 mL/min/1.73m². According to
the 2024 ADA Standards of Care, which medication should be added next?
A. Glipizide
B. Empagliflozin [CORRECT]
C. Pioglitazone
D. Acarbose
Correct Answer: B
Rationale: The ADA Standards of Care recommend adding an SGLT2 inhibitor
(empagliflozin) for patients with T2DM and eGFR ≥20 mL/min/1.73m² who have
established cardiovascular disease, heart failure, or chronic kidney disease, or who need
to minimize hypoglycemia risk. Empagliflozin provides cardiovascular and renal benefits
independent of glycemic control. Glipizide (A) causes hypoglycemia and weight gain.
Pioglitazone (C) causes weight gain and fluid retention, contraindicated in heart failure.
Acarbose (D) has modest efficacy and significant GI side effects.
Q2: A 35-year-old female presents with fatigue, weight gain, constipation, and dry skin.
TSH is 8.5 mIU/L (normal 0.4-4.0), free T4 is 0.9 ng/dL (normal 0.8-1.8). Which is the
most appropriate initial treatment?
A. Levothyroxine 125 mcg daily
B. Levothyroxine 25-50 mcg daily [CORRECT]
,C. Liothyronine 25 mcg daily
D. Observation with repeat testing in 6 months
Correct Answer: B
Rationale: This patient has subclinical hypothyroidism (elevated TSH, normal free T4)
with symptoms. The AACE/ATA guidelines recommend starting levothyroxine at 25-50
mcg daily (lower dose for older patients or cardiac disease), with gradual titration based
on TSH. Starting at 125 mcg (A) risks cardiac complications. Liothyronine (C) is not
first-line for hypothyroidism. Observation (D) is inappropriate given symptomatic
presentation.
Q3: A 45-year-old male with hypertension is currently on lisinopril 20mg daily. His BP
remains 148/92 mmHg. According to JNC-8 guidelines, what is the next best step?
A. Increase lisinopril to 40mg daily
B. Add amlodipine 5mg daily [CORRECT]
C. Switch to losartan 50mg daily
D. Add hydrochlorothiazide 25mg daily
Correct Answer: B
Rationale: JNC-8 recommends thiazide-type diuretics, CCBs, ACE-I, or ARBs as first-line.
For stage 1 hypertension uncontrolled on ACE-I, adding a CCB (amlodipine) is preferred
over maximizing ACE-I dose due to better outcomes and reduced adverse effects.
Thiazides are also acceptable but CCBs have better cardiovascular protection in Black
patients. Switching to ARB (C) offers no advantage over ACE-I.
Q4: A 6-year-old presents with fever of 102°F, sore throat, and tender anterior cervical
lymphadenopathy. Rapid strep test is negative. What is the most appropriate
management?
,A. Start amoxicillin immediately
B. Throat culture and symptomatic treatment pending results [CORRECT]
C. Order monospot test
D. CT scan of the neck
Correct Answer: B
Rationale: IDSA guidelines recommend throat culture for children/adolescents with
negative rapid strep tests due to 5-10% false negative rate. Antibiotics (A) should not be
started without confirmed streptococcal infection. Monospot (C) tests for infectious
mononucleosis but is less sensitive in children <12 years. CT scan (D) is unnecessary
without signs of peritonsillar abscess or deep space infection.
Q5: A 28-year-old female presents with dysuria, frequency, and urgency. Urinalysis
shows positive nitrites and leukocyte esterase. She has no fever or flank pain. Which
antibiotic is first-line per IDSA guidelines?
A. Ciprofloxacin 250mg BID x 3 days
B. Nitrofurantoin 100mg BID x 5 days [CORRECT]
C. Amoxicillin 500mg TID x 7 days
D. Trimethoprim-sulfamethoxazole DS BID x 10 days
Correct Answer: B
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis with 5-day course per
2024 IDSA guidelines due to low resistance rates and minimal collateral damage.
Fluoroquinolones (A) are reserved for alternatives due to safety concerns. Amoxicillin
(C) has high E. coli resistance. TMP-SMX (D) duration is excessive (3 days sufficient)
and should be avoided if local resistance >20%.
, Q6: A 55-year-old female with COPD (FEV1 55% predicted) reports increased dyspnea
and sputum production. She uses albuterol PRN and tiotropium daily. What is the most
appropriate addition to her regimen?
A. Inhaled corticosteroid [CORRECT]
B. Oral theophylline
C. Oral prednisone daily
D. Ipratropium bromide
Correct Answer: A
Rationale: GOLD 2024 guidelines recommend adding inhaled corticosteroid to LAMA
(tiotropium) for patients with COPD and FEV1 50-80% with exacerbations or significant
symptoms. ICS reduces exacerbation frequency and improves lung function.
Theophylline (B) has narrow therapeutic index. Daily oral steroids (C) are not
maintenance therapy. Ipratropium (D) duplicates tiotropium's mechanism.
Q7: A 62-year-old male with atrial fibrillation (CHADS2-VASc score 4) is started on
anticoagulation. His creatinine clearance is 35 mL/min. Which anticoagulant is
contraindicated or requires significant dose reduction?
A. Apixaban
B. Rivaroxaban
C. Dabigatran [CORRECT]
D. Warfarin
Correct Answer: C
Rationale: Dabigatran is contraindicated in severe renal impairment (CrCl <30 mL/min)
due to renal elimination (80%). Apixaban (A) and rivaroxaban (B) require dose
adjustment but remain options at CrCl 35. Warfarin (D) is safe but requires monitoring.
For CrCl 15-30, apixaban 2.5mg BID or warfarin are preferred.
2026/2027 | Latest Questions & Verified Answers | Complete
Q&A | A+ Grade | Pass Guaranteed - A+ Graded
Q1: A 58-year-old male with type 2 diabetes mellitus presents for follow-up. His HbA1c
is 8.2% despite metformin 1000mg BID. His eGFR is 45 mL/min/1.73m². According to
the 2024 ADA Standards of Care, which medication should be added next?
A. Glipizide
B. Empagliflozin [CORRECT]
C. Pioglitazone
D. Acarbose
Correct Answer: B
Rationale: The ADA Standards of Care recommend adding an SGLT2 inhibitor
(empagliflozin) for patients with T2DM and eGFR ≥20 mL/min/1.73m² who have
established cardiovascular disease, heart failure, or chronic kidney disease, or who need
to minimize hypoglycemia risk. Empagliflozin provides cardiovascular and renal benefits
independent of glycemic control. Glipizide (A) causes hypoglycemia and weight gain.
Pioglitazone (C) causes weight gain and fluid retention, contraindicated in heart failure.
Acarbose (D) has modest efficacy and significant GI side effects.
Q2: A 35-year-old female presents with fatigue, weight gain, constipation, and dry skin.
TSH is 8.5 mIU/L (normal 0.4-4.0), free T4 is 0.9 ng/dL (normal 0.8-1.8). Which is the
most appropriate initial treatment?
A. Levothyroxine 125 mcg daily
B. Levothyroxine 25-50 mcg daily [CORRECT]
,C. Liothyronine 25 mcg daily
D. Observation with repeat testing in 6 months
Correct Answer: B
Rationale: This patient has subclinical hypothyroidism (elevated TSH, normal free T4)
with symptoms. The AACE/ATA guidelines recommend starting levothyroxine at 25-50
mcg daily (lower dose for older patients or cardiac disease), with gradual titration based
on TSH. Starting at 125 mcg (A) risks cardiac complications. Liothyronine (C) is not
first-line for hypothyroidism. Observation (D) is inappropriate given symptomatic
presentation.
Q3: A 45-year-old male with hypertension is currently on lisinopril 20mg daily. His BP
remains 148/92 mmHg. According to JNC-8 guidelines, what is the next best step?
A. Increase lisinopril to 40mg daily
B. Add amlodipine 5mg daily [CORRECT]
C. Switch to losartan 50mg daily
D. Add hydrochlorothiazide 25mg daily
Correct Answer: B
Rationale: JNC-8 recommends thiazide-type diuretics, CCBs, ACE-I, or ARBs as first-line.
For stage 1 hypertension uncontrolled on ACE-I, adding a CCB (amlodipine) is preferred
over maximizing ACE-I dose due to better outcomes and reduced adverse effects.
Thiazides are also acceptable but CCBs have better cardiovascular protection in Black
patients. Switching to ARB (C) offers no advantage over ACE-I.
Q4: A 6-year-old presents with fever of 102°F, sore throat, and tender anterior cervical
lymphadenopathy. Rapid strep test is negative. What is the most appropriate
management?
,A. Start amoxicillin immediately
B. Throat culture and symptomatic treatment pending results [CORRECT]
C. Order monospot test
D. CT scan of the neck
Correct Answer: B
Rationale: IDSA guidelines recommend throat culture for children/adolescents with
negative rapid strep tests due to 5-10% false negative rate. Antibiotics (A) should not be
started without confirmed streptococcal infection. Monospot (C) tests for infectious
mononucleosis but is less sensitive in children <12 years. CT scan (D) is unnecessary
without signs of peritonsillar abscess or deep space infection.
Q5: A 28-year-old female presents with dysuria, frequency, and urgency. Urinalysis
shows positive nitrites and leukocyte esterase. She has no fever or flank pain. Which
antibiotic is first-line per IDSA guidelines?
A. Ciprofloxacin 250mg BID x 3 days
B. Nitrofurantoin 100mg BID x 5 days [CORRECT]
C. Amoxicillin 500mg TID x 7 days
D. Trimethoprim-sulfamethoxazole DS BID x 10 days
Correct Answer: B
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis with 5-day course per
2024 IDSA guidelines due to low resistance rates and minimal collateral damage.
Fluoroquinolones (A) are reserved for alternatives due to safety concerns. Amoxicillin
(C) has high E. coli resistance. TMP-SMX (D) duration is excessive (3 days sufficient)
and should be avoided if local resistance >20%.
, Q6: A 55-year-old female with COPD (FEV1 55% predicted) reports increased dyspnea
and sputum production. She uses albuterol PRN and tiotropium daily. What is the most
appropriate addition to her regimen?
A. Inhaled corticosteroid [CORRECT]
B. Oral theophylline
C. Oral prednisone daily
D. Ipratropium bromide
Correct Answer: A
Rationale: GOLD 2024 guidelines recommend adding inhaled corticosteroid to LAMA
(tiotropium) for patients with COPD and FEV1 50-80% with exacerbations or significant
symptoms. ICS reduces exacerbation frequency and improves lung function.
Theophylline (B) has narrow therapeutic index. Daily oral steroids (C) are not
maintenance therapy. Ipratropium (D) duplicates tiotropium's mechanism.
Q7: A 62-year-old male with atrial fibrillation (CHADS2-VASc score 4) is started on
anticoagulation. His creatinine clearance is 35 mL/min. Which anticoagulant is
contraindicated or requires significant dose reduction?
A. Apixaban
B. Rivaroxaban
C. Dabigatran [CORRECT]
D. Warfarin
Correct Answer: C
Rationale: Dabigatran is contraindicated in severe renal impairment (CrCl <30 mL/min)
due to renal elimination (80%). Apixaban (A) and rivaroxaban (B) require dose
adjustment but remain options at CrCl 35. Warfarin (D) is safe but requires monitoring.
For CrCl 15-30, apixaban 2.5mg BID or warfarin are preferred.
