AANP FNP CERTIFICATION EXAM 2026/2027 | Family Nurse
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Domain 1: Assessment and Diagnosis (30 Questions)
Q1: A 58-year-old male presents with chest pain described as "pressure" radiating to his
left arm, onset 30 minutes ago while mowing the lawn. He is diaphoretic and nauseated.
Vital signs: BP 168/94, HR 98, RR 22, O2 sat 94% on room air. Which is the priority
diagnostic intervention?
A. Chest X-ray to rule out pneumonia
B. CT pulmonary angiogram to assess for pulmonary embolism
C. 12-lead EKG within 10 minutes of arrival [CORRECT]
D. D-dimer to assess for thrombotic events
Correct Answer: C
Rationale: According to the 2021 ACC/AHA/SCAI Guideline for Coronary Artery
Revascularization and ACS guidelines, a 12-lead EKG must be obtained within 10
minutes of arrival for all patients presenting with chest pain suspicious for acute
coronary syndrome (ACS). This patient exhibits classic ACS symptoms:
crushing/substernal pressure, radiation to left arm, diaphoresis, nausea, and exertional
onset. The EKG will identify STEMI requiring immediate reperfusion therapy. Option A is
incorrect because pneumonia typically presents with fever, cough, and pleuritic pain, not
pressure-like pain with radiation. Option B is incorrect because PE usually presents with
pleuritic pain, dyspnea, and tachypnea without the classic radiation pattern; CT
angiogram would delay ACS diagnosis. Option D is incorrect because D-dimer is
nonspecific and inappropriate when high suspicion for ACS exists; it would delay
definitive diagnosis and treatment.
,Q2: A 42-year-old female presents with fatigue, weight gain, constipation, and dry skin.
Laboratory studies show TSH 12.5 mIU/L (normal 0.4-4.0) and free T4 0.6 ng/dL
(normal 0.8-1.8). Which additional finding would be most consistent with this
diagnosis?
A. Exophthalmos and pretibial myxedema
B. Bradycardia and delayed relaxation phase of deep tendon reflexes [CORRECT]
C. Tremor and heat intolerance
D. Tachycardia and widened pulse pressure
Correct Answer: B
Rationale: This patient has primary hypothyroidism (elevated TSH, low free T4).
Bradycardia and delayed relaxation of deep tendon reflexes (hung-up reflexes) are
classic physical findings in hypothyroidism due to reduced metabolic rate and
decreased beta-adrenergic receptor expression. Option A describes Graves' disease
(hyperthyroidism). Options C and D describe hyperthyroidism (tremor, heat intolerance,
tachycardia, widened pulse pressure from increased cardiac output and decreased
systemic vascular resistance). The metabolic slowing in hypothyroidism produces
opposite findings: cold intolerance, bradycardia, and delayed reflexes.
Q3: A 6-month-old infant is brought to the clinic for a well-child visit. The mother reports
the baby can roll from prone to supine, babbles with consonant sounds, and reaches for
toys. Which developmental milestone is delayed?
A. Rolling from prone to supine (expected 4-6 months)
B. Babbling with consonants (expected 6-8 months)
C. Sitting without support (expected 6-8 months) [CORRECT]
D. Reaching for toys (expected 4-6 months)
Correct Answer: C
Rationale: According to the CDC 2022 Developmental Milestones, sitting without
support is expected by 6-8 months. At 6 months, an infant should be attempting to sit
with support or tripod sitting, but independent sitting typically emerges by 7-8 months.
,Rolling (Option A) is appropriate for 4-6 months. Babbling with consonants (Option B) is
appropriate for 6-8 months. Reaching (Option D) is appropriate for 4-6 months. The FNP
should counsel the mother on tummy time and sitting practice, with follow-up in 2
months to assess sitting progress.
Q4: A 35-year-old male with type 1 diabetes presents with nausea, vomiting, abdominal
pain, and fruity breath odor. Laboratory studies show glucose 450 mg/dL, pH 7.25,
bicarbonate 12 mEq/L, and positive serum ketones. Which additional finding would be
expected?
A. Potassium 6.8 mEq/L despite total body potassium depletion [CORRECT]
B. Potassium 3.2 mEq/L with total body potassium excess
C. Sodium 150 mEq/L due to free water excess
D. Anion gap of 8 mEq/L
Correct Answer: A
Rationale: Diabetic ketoacidosis (DKA) is characterized by hyperkalemia on
presentation despite total body potassium depletion. Acidosis drives potassium
extracellularly in exchange for hydrogen ions, causing elevated serum potassium
despite intracellular and total body deficits from osmotic diuresis. Option B is incorrect
because hypokalemia indicates severe depletion and is dangerous. Option C is incorrect
because hypernatremia indicates free water loss, not excess; pseudohyponatremia may
occur due to hyperglycemia (corrected Na = measured Na + 0.016[glucose-100]). Option
D is incorrect because DKA produces high anion gap metabolic acidosis (expected >12,
typically 20-30).
Q5: A 28-year-old female presents with dysuria, frequency, and urgency for 2 days.
Urinalysis shows positive nitrites, positive leukocyte esterase, and 50 WBC/hpf. She has
no fever or flank pain. According to IDSA guidelines, which is the appropriate
management?
, A. Obtain urine culture before initiating empiric antibiotics
B. Prescribe fosfomycin 3g single dose or nitrofurantoin 100mg BID x 5 days [CORRECT]
C. Prescribe ciprofloxacin 500mg BID x 3 days as first-line
D. Prescribe amoxicillin-clavulanate 875/125mg BID x 7 days without culture
Correct Answer: B
Rationale: The 2010 IDSA/ESCMID guidelines for uncomplicated cystitis in women
recommend nitrofurantoin (5 days), fosfomycin (single dose), or
trimethoprim-sulfamethoxazole (3 days) as first-line agents. Nitrofurantoin is preferred
due to low resistance rates and minimal collateral damage. Option A is incorrect
because culture is not required for uncomplicated cystitis in non-pregnant women
before empiric therapy. Option C is incorrect because fluoroquinolones are reserved for
alternatives due to adverse effects and resistance promotion. Option D is incorrect
because amoxicillin-clavulanate is not first-line for uncomplicated UTI and 7 days is
longer than necessary.
Q6: A 65-year-old male with COPD presents with increased dyspnea, sputum volume,
and purulence. His baseline FEV1 is 45% predicted. He has had two exacerbations this
year. According to GOLD 2023 guidelines, which management is most appropriate?
A. Short-acting bronchodilator only as needed
B. LABA + LAMA + inhaled corticosteroid [CORRECT]
C. Add oral corticosteroids and antibiotics, escalate to triple therapy if frequent
exacerbations
D. Refer for lung transplant evaluation immediately
Correct Answer: B
Rationale: According to GOLD 2023, this patient has Group E (Exacerbation-prone)
COPD with FEV1 45% (GOLD 3) and ≥2 moderate exacerbations. Initial therapy should
be LABA + LAMA; if exacerbations persist, escalate to triple therapy (LABA + LAMA +
ICS). The ABCD assessment has been replaced by ABE in GOLD 2023. Option A is
insufficient for Group E. Option C describes acute exacerbation management, not
Practitioner Board Review | Latest Questions & Verified
Answers | Complete Q&A | Pass Guaranteed - A+ Graded
Domain 1: Assessment and Diagnosis (30 Questions)
Q1: A 58-year-old male presents with chest pain described as "pressure" radiating to his
left arm, onset 30 minutes ago while mowing the lawn. He is diaphoretic and nauseated.
Vital signs: BP 168/94, HR 98, RR 22, O2 sat 94% on room air. Which is the priority
diagnostic intervention?
A. Chest X-ray to rule out pneumonia
B. CT pulmonary angiogram to assess for pulmonary embolism
C. 12-lead EKG within 10 minutes of arrival [CORRECT]
D. D-dimer to assess for thrombotic events
Correct Answer: C
Rationale: According to the 2021 ACC/AHA/SCAI Guideline for Coronary Artery
Revascularization and ACS guidelines, a 12-lead EKG must be obtained within 10
minutes of arrival for all patients presenting with chest pain suspicious for acute
coronary syndrome (ACS). This patient exhibits classic ACS symptoms:
crushing/substernal pressure, radiation to left arm, diaphoresis, nausea, and exertional
onset. The EKG will identify STEMI requiring immediate reperfusion therapy. Option A is
incorrect because pneumonia typically presents with fever, cough, and pleuritic pain, not
pressure-like pain with radiation. Option B is incorrect because PE usually presents with
pleuritic pain, dyspnea, and tachypnea without the classic radiation pattern; CT
angiogram would delay ACS diagnosis. Option D is incorrect because D-dimer is
nonspecific and inappropriate when high suspicion for ACS exists; it would delay
definitive diagnosis and treatment.
,Q2: A 42-year-old female presents with fatigue, weight gain, constipation, and dry skin.
Laboratory studies show TSH 12.5 mIU/L (normal 0.4-4.0) and free T4 0.6 ng/dL
(normal 0.8-1.8). Which additional finding would be most consistent with this
diagnosis?
A. Exophthalmos and pretibial myxedema
B. Bradycardia and delayed relaxation phase of deep tendon reflexes [CORRECT]
C. Tremor and heat intolerance
D. Tachycardia and widened pulse pressure
Correct Answer: B
Rationale: This patient has primary hypothyroidism (elevated TSH, low free T4).
Bradycardia and delayed relaxation of deep tendon reflexes (hung-up reflexes) are
classic physical findings in hypothyroidism due to reduced metabolic rate and
decreased beta-adrenergic receptor expression. Option A describes Graves' disease
(hyperthyroidism). Options C and D describe hyperthyroidism (tremor, heat intolerance,
tachycardia, widened pulse pressure from increased cardiac output and decreased
systemic vascular resistance). The metabolic slowing in hypothyroidism produces
opposite findings: cold intolerance, bradycardia, and delayed reflexes.
Q3: A 6-month-old infant is brought to the clinic for a well-child visit. The mother reports
the baby can roll from prone to supine, babbles with consonant sounds, and reaches for
toys. Which developmental milestone is delayed?
A. Rolling from prone to supine (expected 4-6 months)
B. Babbling with consonants (expected 6-8 months)
C. Sitting without support (expected 6-8 months) [CORRECT]
D. Reaching for toys (expected 4-6 months)
Correct Answer: C
Rationale: According to the CDC 2022 Developmental Milestones, sitting without
support is expected by 6-8 months. At 6 months, an infant should be attempting to sit
with support or tripod sitting, but independent sitting typically emerges by 7-8 months.
,Rolling (Option A) is appropriate for 4-6 months. Babbling with consonants (Option B) is
appropriate for 6-8 months. Reaching (Option D) is appropriate for 4-6 months. The FNP
should counsel the mother on tummy time and sitting practice, with follow-up in 2
months to assess sitting progress.
Q4: A 35-year-old male with type 1 diabetes presents with nausea, vomiting, abdominal
pain, and fruity breath odor. Laboratory studies show glucose 450 mg/dL, pH 7.25,
bicarbonate 12 mEq/L, and positive serum ketones. Which additional finding would be
expected?
A. Potassium 6.8 mEq/L despite total body potassium depletion [CORRECT]
B. Potassium 3.2 mEq/L with total body potassium excess
C. Sodium 150 mEq/L due to free water excess
D. Anion gap of 8 mEq/L
Correct Answer: A
Rationale: Diabetic ketoacidosis (DKA) is characterized by hyperkalemia on
presentation despite total body potassium depletion. Acidosis drives potassium
extracellularly in exchange for hydrogen ions, causing elevated serum potassium
despite intracellular and total body deficits from osmotic diuresis. Option B is incorrect
because hypokalemia indicates severe depletion and is dangerous. Option C is incorrect
because hypernatremia indicates free water loss, not excess; pseudohyponatremia may
occur due to hyperglycemia (corrected Na = measured Na + 0.016[glucose-100]). Option
D is incorrect because DKA produces high anion gap metabolic acidosis (expected >12,
typically 20-30).
Q5: A 28-year-old female presents with dysuria, frequency, and urgency for 2 days.
Urinalysis shows positive nitrites, positive leukocyte esterase, and 50 WBC/hpf. She has
no fever or flank pain. According to IDSA guidelines, which is the appropriate
management?
, A. Obtain urine culture before initiating empiric antibiotics
B. Prescribe fosfomycin 3g single dose or nitrofurantoin 100mg BID x 5 days [CORRECT]
C. Prescribe ciprofloxacin 500mg BID x 3 days as first-line
D. Prescribe amoxicillin-clavulanate 875/125mg BID x 7 days without culture
Correct Answer: B
Rationale: The 2010 IDSA/ESCMID guidelines for uncomplicated cystitis in women
recommend nitrofurantoin (5 days), fosfomycin (single dose), or
trimethoprim-sulfamethoxazole (3 days) as first-line agents. Nitrofurantoin is preferred
due to low resistance rates and minimal collateral damage. Option A is incorrect
because culture is not required for uncomplicated cystitis in non-pregnant women
before empiric therapy. Option C is incorrect because fluoroquinolones are reserved for
alternatives due to adverse effects and resistance promotion. Option D is incorrect
because amoxicillin-clavulanate is not first-line for uncomplicated UTI and 7 days is
longer than necessary.
Q6: A 65-year-old male with COPD presents with increased dyspnea, sputum volume,
and purulence. His baseline FEV1 is 45% predicted. He has had two exacerbations this
year. According to GOLD 2023 guidelines, which management is most appropriate?
A. Short-acting bronchodilator only as needed
B. LABA + LAMA + inhaled corticosteroid [CORRECT]
C. Add oral corticosteroids and antibiotics, escalate to triple therapy if frequent
exacerbations
D. Refer for lung transplant evaluation immediately
Correct Answer: B
Rationale: According to GOLD 2023, this patient has Group E (Exacerbation-prone)
COPD with FEV1 45% (GOLD 3) and ≥2 moderate exacerbations. Initial therapy should
be LABA + LAMA; if exacerbations persist, escalate to triple therapy (LABA + LAMA +
ICS). The ABCD assessment has been replaced by ABE in GOLD 2023. Option A is
insufficient for Group E. Option C describes acute exacerbation management, not
