AANP FNP CERTIFICATION EXAM 2026/2027 | Family Nurse
Practitioner Board Review | Questions & Verified Answers |
Complete Q&A | Pass Guaranteed - A+ Graded
Q1: A 58-year-old male with a history of hypertension and hyperlipidemia presents for
follow-up. His BP today is 142/88 mmHg (average of three readings). He is currently
taking lisinopril 20 mg daily. His home BP log shows readings between 138-145/85-90
mmHg over the past month. Labs from last week: K+ 4.2 mEq/L, Cr 1.1 mg/dL, eGFR
>60. According to the 2017 ACC/AHA Hypertension Guidelines, what is the most
appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily [CORRECT]
C. Continue current regimen and recheck in 3 months
D. Switch to chlorthalidone 25 mg daily
Correct Answer: B
Rationale: According to the 2017 ACC/AHA guidelines, the target BP for most adults is
<130/80 mmHg. This patient has uncontrolled Stage 2 hypertension (BP ≥140/90) on
monotherapy. The guideline recommends initiating two agents of different classes for
Stage 2 hypertension, or adding a second agent if already on monotherapy. Adding
amlodipine (dihydropyridine CCB) to lisinopril (ACE-I) follows the principle of
complementary mechanisms: ACE-I blocks RAAS and amlodipine reduces peripheral
vascular resistance via calcium channel blockade. This combination is also preferred in
Black patients (though not specified here, the combination is effective broadly).
,Increasing lisinopril to 40 mg (Option A) provides minimal additional BP reduction
(approximately 20% of initial effect) with increased risk of hyperkalemia and cough.
Continuing current therapy (Option C) is inappropriate given persistent Stage 2
hypertension and elevated cardiovascular risk. Switching to chlorthalidone (Option D) is
not first-line as monotherapy replacement when RAAS blockade is already tolerated;
thiazide-like diuretics are excellent options but switching rather than adding leaves the
patient with suboptimal BP control during the transition. Additionally, chlorthalidone
may cause more electrolyte disturbances than HCTZ.
Q2: A 24-year-old female presents requesting contraception. She has no medical
problems, does not smoke, and has a BMI of 22. She reports heavy, painful periods and
acne. She desires the most effective reversible method. Which option is most
appropriate?
A. Combined oral contraceptive pills (COCs)
B. Levonorgestrel intrauterine system (IUD) [CORRECT]
C. Depot medroxyprogesterone acetate (DMPA) injection
D. Copper IUD
Correct Answer: B
Rationale: The levonorgestrel IUD (52mg, 5-year) is the most appropriate choice for this
patient. It is highly effective (0.1-0.4% failure rate), reversible, and provides significant
non-contraceptive benefits: reduces menstrual bleeding by 90% at 12 months, alleviates
dysmenorrhea, and improves acne through local progestin effects and systemic
absorption. The CDC Medical Eligibility Criteria (MEC) 2016 (updated 2020) classifies
levonorgestrel IUD as Category 1 (no restriction) for this patient. COCs (Option A) are
,effective but require daily adherence (typical use failure 7%) and while they improve
acne and regulate cycles, they are less effective than IUDs. DMPA (Option C) is highly
effective but associated with bone mineral density loss (black box warning), weight
gain, and irregular bleeding initially—not optimal for a nulliparous young woman without
contraindications to estrogen. Copper IUD (Option D) is non-hormonal and highly
effective but would likely worsen her heavy, painful periods (causes heavier, longer,
more painful menses initially) and does not address acne.
Q3: A 6-year-old male is brought to the clinic with a 3-day history of cough, low-grade
fever, and rhinorrhea. Today he developed a hoarse voice and "barky" cough. He appears
well-hydrated, afebrile, with mild intercostal retractions and stridor at rest. Oxygen
saturation is 94% on room air. Which management is most appropriate?
A. Immediate nebulized racemic epinephrine and observation
B. Oral dexamethasone 0.6 mg/kg (max 10 mg) single dose [CORRECT]
C. Chest X-ray to rule out pneumonia
D. Albuterol nebulizer treatment
Correct Answer: B
Rationale: This patient presents with classic croup (laryngotracheobronchitis): barky
cough, hoarseness, inspiratory stridor, and viral prodrome. The Westley Croup Score
would likely classify this as moderate (stridor at rest, mild retractions). First-line
treatment is a single dose of oral dexamethasone 0.6 mg/kg (maximum 10 mg), which
reduces airway edema via anti-inflammatory effects and has been shown to reduce
return visits and hospitalizations (NNT = 5-17). Nebulized racemic epinephrine (Option
A) is indicated for moderate to severe croup with significant respiratory distress or
, hypoxia; while this child has stridor at rest, he is well-appearing without significant
distress, making epinephrine unnecessary initially. Chest X-ray (Option C) is not
indicated unless the diagnosis is uncertain or the child fails to improve; the "steeple
sign" on X-ray is supportive but not diagnostic. Albuterol (Option D) is ineffective for
croup as the pathology is upper airway edema, not bronchospasm, and may actually
cause tachycardia without benefit.
Q4: A 45-year-old female with type 2 diabetes (A1C 8.2% on metformin 2000 mg daily)
presents for diabetes management. She has BMI 34, eGFR 65, no cardiovascular
disease. According to the 2024 ADA Standards of Care, what is the most appropriate
addition to her regimen?
A. Add basal insulin (glargine)
B. Add GLP-1 receptor agonist (semaglutide) [CORRECT]
C. Add sulfonylurea (glipizide)
D. Add DPP-4 inhibitor (sitagliptin)
Correct Answer: B
Rationale: The 2024 ADA Standards of Care recommend for patients with T2DM and
BMI ≥27 (or ≥25 with Asian ancestry) who need glycemic lowering and weight loss,
GLP-1 receptor agonists or SGLT2 inhibitors with demonstrated cardiovascular benefit
are preferred as second-line agents after metformin. Semaglutide (GLP-1 RA) provides
robust A1C reduction (1.5-1.8%), significant weight loss (10-15% body weight), and
cardiovascular benefits (SUSTAIN-6 trial showed 26% reduction in major adverse
cardiovascular events). Given her BMI of 34, weight loss is a priority. Basal insulin
(Option A) is not indicated at this A1C level per ADA guidelines; insulin is typically
Practitioner Board Review | Questions & Verified Answers |
Complete Q&A | Pass Guaranteed - A+ Graded
Q1: A 58-year-old male with a history of hypertension and hyperlipidemia presents for
follow-up. His BP today is 142/88 mmHg (average of three readings). He is currently
taking lisinopril 20 mg daily. His home BP log shows readings between 138-145/85-90
mmHg over the past month. Labs from last week: K+ 4.2 mEq/L, Cr 1.1 mg/dL, eGFR
>60. According to the 2017 ACC/AHA Hypertension Guidelines, what is the most
appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add amlodipine 5 mg daily [CORRECT]
C. Continue current regimen and recheck in 3 months
D. Switch to chlorthalidone 25 mg daily
Correct Answer: B
Rationale: According to the 2017 ACC/AHA guidelines, the target BP for most adults is
<130/80 mmHg. This patient has uncontrolled Stage 2 hypertension (BP ≥140/90) on
monotherapy. The guideline recommends initiating two agents of different classes for
Stage 2 hypertension, or adding a second agent if already on monotherapy. Adding
amlodipine (dihydropyridine CCB) to lisinopril (ACE-I) follows the principle of
complementary mechanisms: ACE-I blocks RAAS and amlodipine reduces peripheral
vascular resistance via calcium channel blockade. This combination is also preferred in
Black patients (though not specified here, the combination is effective broadly).
,Increasing lisinopril to 40 mg (Option A) provides minimal additional BP reduction
(approximately 20% of initial effect) with increased risk of hyperkalemia and cough.
Continuing current therapy (Option C) is inappropriate given persistent Stage 2
hypertension and elevated cardiovascular risk. Switching to chlorthalidone (Option D) is
not first-line as monotherapy replacement when RAAS blockade is already tolerated;
thiazide-like diuretics are excellent options but switching rather than adding leaves the
patient with suboptimal BP control during the transition. Additionally, chlorthalidone
may cause more electrolyte disturbances than HCTZ.
Q2: A 24-year-old female presents requesting contraception. She has no medical
problems, does not smoke, and has a BMI of 22. She reports heavy, painful periods and
acne. She desires the most effective reversible method. Which option is most
appropriate?
A. Combined oral contraceptive pills (COCs)
B. Levonorgestrel intrauterine system (IUD) [CORRECT]
C. Depot medroxyprogesterone acetate (DMPA) injection
D. Copper IUD
Correct Answer: B
Rationale: The levonorgestrel IUD (52mg, 5-year) is the most appropriate choice for this
patient. It is highly effective (0.1-0.4% failure rate), reversible, and provides significant
non-contraceptive benefits: reduces menstrual bleeding by 90% at 12 months, alleviates
dysmenorrhea, and improves acne through local progestin effects and systemic
absorption. The CDC Medical Eligibility Criteria (MEC) 2016 (updated 2020) classifies
levonorgestrel IUD as Category 1 (no restriction) for this patient. COCs (Option A) are
,effective but require daily adherence (typical use failure 7%) and while they improve
acne and regulate cycles, they are less effective than IUDs. DMPA (Option C) is highly
effective but associated with bone mineral density loss (black box warning), weight
gain, and irregular bleeding initially—not optimal for a nulliparous young woman without
contraindications to estrogen. Copper IUD (Option D) is non-hormonal and highly
effective but would likely worsen her heavy, painful periods (causes heavier, longer,
more painful menses initially) and does not address acne.
Q3: A 6-year-old male is brought to the clinic with a 3-day history of cough, low-grade
fever, and rhinorrhea. Today he developed a hoarse voice and "barky" cough. He appears
well-hydrated, afebrile, with mild intercostal retractions and stridor at rest. Oxygen
saturation is 94% on room air. Which management is most appropriate?
A. Immediate nebulized racemic epinephrine and observation
B. Oral dexamethasone 0.6 mg/kg (max 10 mg) single dose [CORRECT]
C. Chest X-ray to rule out pneumonia
D. Albuterol nebulizer treatment
Correct Answer: B
Rationale: This patient presents with classic croup (laryngotracheobronchitis): barky
cough, hoarseness, inspiratory stridor, and viral prodrome. The Westley Croup Score
would likely classify this as moderate (stridor at rest, mild retractions). First-line
treatment is a single dose of oral dexamethasone 0.6 mg/kg (maximum 10 mg), which
reduces airway edema via anti-inflammatory effects and has been shown to reduce
return visits and hospitalizations (NNT = 5-17). Nebulized racemic epinephrine (Option
A) is indicated for moderate to severe croup with significant respiratory distress or
, hypoxia; while this child has stridor at rest, he is well-appearing without significant
distress, making epinephrine unnecessary initially. Chest X-ray (Option C) is not
indicated unless the diagnosis is uncertain or the child fails to improve; the "steeple
sign" on X-ray is supportive but not diagnostic. Albuterol (Option D) is ineffective for
croup as the pathology is upper airway edema, not bronchospasm, and may actually
cause tachycardia without benefit.
Q4: A 45-year-old female with type 2 diabetes (A1C 8.2% on metformin 2000 mg daily)
presents for diabetes management. She has BMI 34, eGFR 65, no cardiovascular
disease. According to the 2024 ADA Standards of Care, what is the most appropriate
addition to her regimen?
A. Add basal insulin (glargine)
B. Add GLP-1 receptor agonist (semaglutide) [CORRECT]
C. Add sulfonylurea (glipizide)
D. Add DPP-4 inhibitor (sitagliptin)
Correct Answer: B
Rationale: The 2024 ADA Standards of Care recommend for patients with T2DM and
BMI ≥27 (or ≥25 with Asian ancestry) who need glycemic lowering and weight loss,
GLP-1 receptor agonists or SGLT2 inhibitors with demonstrated cardiovascular benefit
are preferred as second-line agents after metformin. Semaglutide (GLP-1 RA) provides
robust A1C reduction (1.5-1.8%), significant weight loss (10-15% body weight), and
cardiovascular benefits (SUSTAIN-6 trial showed 26% reduction in major adverse
cardiovascular events). Given her BMI of 34, weight loss is a priority. Basal insulin
(Option A) is not indicated at this A1C level per ADA guidelines; insulin is typically
