AANP FNP CERTIFICATION EXAM REVIEW 2026 | Questions
& Verified Answers | Family Nurse Practitioner Board Prep |
Pass Guaranteed - A+ Graded
Domain 1: Assessment and Diagnosis
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea for 45 minutes. Vital signs: BP 88/56 mmHg, HR 48 bpm,
RR 22, SpO2 92% on room air. EKG shows 3 mm ST-segment elevation in leads II, III, and
aVF with reciprocal changes in I and aVL. Which immediate intervention is most
appropriate?
A. Administer aspirin 325 mg and arrange for outpatient stress testing within 72 hours
B. Initiate nitroglycerin drip and heparin bolus, admit to telemetry
C. Activate emergency cardiac catheterization lab for primary PCI [CORRECT]
D. Administer fibrinolytic therapy (tenecteplase) immediately in the ED
Correct Answer: C
Rationale: This patient presents with inferior wall STEMI (ST elevation in II, III, aVF with
reciprocal depression in I, aVL) complicated by cardiogenic shock (hypotension,
bradycardia likely from RV involvement). According to the 2021 ACC/AHA/SCAI
Guideline for Coronary Artery Revascularization and 2022 AHA/ACC/HFSA Heart Failure
Guidelines, primary PCI is the preferred reperfusion strategy when available within 90
,minutes of first medical contact, especially in cardiogenic shock where fibrinolysis is
contraindicated and less effective. The hypotension and bradycardia suggest right
ventricular infarction (common with inferior MI), making nitrates potentially dangerous
due to preload reduction. Option A is incorrect because outpatient management of
STEMI is never appropriate and violates standard of care. Option B is incorrect because
while medical management is indicated as adjunct, nitroglycerin could worsen
hypotension in RV infarction, and definitive reperfusion is required. Option D is incorrect
because fibrinolysis is relatively contraindicated in cardiogenic shock (Class III harm
recommendation) and has inferior outcomes compared to PCI in this setting.
Door-to-balloon time should be <90 minutes.
Q2: A 24-year-old female presents with 3 days of dysuria, frequency, urgency, and
suprapubic pain. She is afebrile with no flank pain. Urinalysis shows positive nitrites,
leukocyte esterase, and 50-100 WBC/hpf. She has no drug allergies and is not pregnant.
According to current IDSA guidelines, which empiric antibiotic regimen is most
appropriate?
A. Ciprofloxacin 500 mg BID for 7 days
B. Nitrofurantoin 100 mg BID for 5 days [CORRECT]
C. Trimethoprim-sulfamethoxazole DS BID for 3 days
D. Amoxicillin 500 mg TID for 7 days
Correct Answer: B
Rationale: This patient has uncomplicated lower urinary tract infection (cystitis) in a
young non-pregnant female. The 2023 IDSA/ESCMID guidelines for uncomplicated UTI
,recommend nitrofurantoin for 5 days as first-line therapy due to excellent efficacy
against common uropathogens (E. coli, Staphylococcus saprophyticus) and low
resistance rates. Nitrofurantoin achieves high urinary concentrations but should be
avoided if pyelonephritis is suspected (poor tissue penetration). Option A is incorrect
because fluoroquinolones are no longer recommended as first-line for uncomplicated
UTI due to safety concerns (tendon rupture, peripheral neuropathy, aortic aneurysm risk)
and rising resistance; they are reserved for complicated infections or when other agents
cannot be used. Option C is incorrect because while TMP-SMX is effective, local E. coli
resistance often exceeds 20% (the threshold for empiric use), and 3-day regimens are
less effective than 5-day nitrofurantoin. Option D is incorrect because amoxicillin has
high resistance rates (>30%) and is not recommended for empiric therapy.
Q3: A 45-year-old male with type 2 diabetes presents for follow-up. His current regimen
is metformin 1000 mg BID. His HbA1c is 8.2% (target <7%). He has no cardiovascular
disease, eGFR >60 mL/min/1.73m², and no history of hypoglycemia. According to the
2024 ADA Standards of Care, which addition to his regimen is most appropriate?
A. Add insulin glargine at bedtime
B. Add glipizide 5 mg daily
C. Add empagliflozin 10 mg daily [CORRECT]
D. Add pioglitazone 30 mg daily
Correct Answer: C
Rationale: The 2024 ADA Standards of Medical Care recommend that for patients with
T2DM and established ASCVD (or high risk), an SGLT2 inhibitor or GLP-1 RA with proven
, cardiovascular benefit should be added to metformin. For patients without ASCVD but
with inadequate glycemic control on metformin (HbA1c ≥1.5% above target), any of
several agents may be added, with consideration of comorbidities. Empagliflozin
(SGLT2 inhibitor) offers HbA1c reduction of ~0.5-1.0%, weight loss, blood pressure
reduction, and renal protection. Option A is incorrect because insulin is typically
reserved for HbA1c >10%, symptomatic hyperglycemia, or failure of 2-3 oral agents; it
carries hypoglycemia risk and weight gain. Option B is incorrect because sulfonylureas
cause hypoglycemia and weight gain, and are generally avoided as second-line agents
in contemporary practice. Option D is incorrect because thiazolidinediones cause
weight gain, fluid retention, and increased fracture risk; while effective, they are not
preferred over SGLT2 inhibitors or GLP-1 RAs.
Q4: A 6-month-old infant is brought to the clinic for a well-child visit. The parents report
the infant can roll from prone to supine, sits with support, reaches for objects, and
laughs out loud. Which developmental milestone should the FNP expect to assess at
this visit?
A. Walking with support ("cruising")
B. Pincer grasp and waving bye-bye
C. Transferring objects hand-to-hand and babbling [CORRECT]
D. Speaking 2-3 word sentences and running
Correct Answer: C
Rationale: At 6 months, expected developmental milestones include: gross motor (rolls
both ways, sits with support), fine motor (reaches and grasps, transfers objects
& Verified Answers | Family Nurse Practitioner Board Prep |
Pass Guaranteed - A+ Graded
Domain 1: Assessment and Diagnosis
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea for 45 minutes. Vital signs: BP 88/56 mmHg, HR 48 bpm,
RR 22, SpO2 92% on room air. EKG shows 3 mm ST-segment elevation in leads II, III, and
aVF with reciprocal changes in I and aVL. Which immediate intervention is most
appropriate?
A. Administer aspirin 325 mg and arrange for outpatient stress testing within 72 hours
B. Initiate nitroglycerin drip and heparin bolus, admit to telemetry
C. Activate emergency cardiac catheterization lab for primary PCI [CORRECT]
D. Administer fibrinolytic therapy (tenecteplase) immediately in the ED
Correct Answer: C
Rationale: This patient presents with inferior wall STEMI (ST elevation in II, III, aVF with
reciprocal depression in I, aVL) complicated by cardiogenic shock (hypotension,
bradycardia likely from RV involvement). According to the 2021 ACC/AHA/SCAI
Guideline for Coronary Artery Revascularization and 2022 AHA/ACC/HFSA Heart Failure
Guidelines, primary PCI is the preferred reperfusion strategy when available within 90
,minutes of first medical contact, especially in cardiogenic shock where fibrinolysis is
contraindicated and less effective. The hypotension and bradycardia suggest right
ventricular infarction (common with inferior MI), making nitrates potentially dangerous
due to preload reduction. Option A is incorrect because outpatient management of
STEMI is never appropriate and violates standard of care. Option B is incorrect because
while medical management is indicated as adjunct, nitroglycerin could worsen
hypotension in RV infarction, and definitive reperfusion is required. Option D is incorrect
because fibrinolysis is relatively contraindicated in cardiogenic shock (Class III harm
recommendation) and has inferior outcomes compared to PCI in this setting.
Door-to-balloon time should be <90 minutes.
Q2: A 24-year-old female presents with 3 days of dysuria, frequency, urgency, and
suprapubic pain. She is afebrile with no flank pain. Urinalysis shows positive nitrites,
leukocyte esterase, and 50-100 WBC/hpf. She has no drug allergies and is not pregnant.
According to current IDSA guidelines, which empiric antibiotic regimen is most
appropriate?
A. Ciprofloxacin 500 mg BID for 7 days
B. Nitrofurantoin 100 mg BID for 5 days [CORRECT]
C. Trimethoprim-sulfamethoxazole DS BID for 3 days
D. Amoxicillin 500 mg TID for 7 days
Correct Answer: B
Rationale: This patient has uncomplicated lower urinary tract infection (cystitis) in a
young non-pregnant female. The 2023 IDSA/ESCMID guidelines for uncomplicated UTI
,recommend nitrofurantoin for 5 days as first-line therapy due to excellent efficacy
against common uropathogens (E. coli, Staphylococcus saprophyticus) and low
resistance rates. Nitrofurantoin achieves high urinary concentrations but should be
avoided if pyelonephritis is suspected (poor tissue penetration). Option A is incorrect
because fluoroquinolones are no longer recommended as first-line for uncomplicated
UTI due to safety concerns (tendon rupture, peripheral neuropathy, aortic aneurysm risk)
and rising resistance; they are reserved for complicated infections or when other agents
cannot be used. Option C is incorrect because while TMP-SMX is effective, local E. coli
resistance often exceeds 20% (the threshold for empiric use), and 3-day regimens are
less effective than 5-day nitrofurantoin. Option D is incorrect because amoxicillin has
high resistance rates (>30%) and is not recommended for empiric therapy.
Q3: A 45-year-old male with type 2 diabetes presents for follow-up. His current regimen
is metformin 1000 mg BID. His HbA1c is 8.2% (target <7%). He has no cardiovascular
disease, eGFR >60 mL/min/1.73m², and no history of hypoglycemia. According to the
2024 ADA Standards of Care, which addition to his regimen is most appropriate?
A. Add insulin glargine at bedtime
B. Add glipizide 5 mg daily
C. Add empagliflozin 10 mg daily [CORRECT]
D. Add pioglitazone 30 mg daily
Correct Answer: C
Rationale: The 2024 ADA Standards of Medical Care recommend that for patients with
T2DM and established ASCVD (or high risk), an SGLT2 inhibitor or GLP-1 RA with proven
, cardiovascular benefit should be added to metformin. For patients without ASCVD but
with inadequate glycemic control on metformin (HbA1c ≥1.5% above target), any of
several agents may be added, with consideration of comorbidities. Empagliflozin
(SGLT2 inhibitor) offers HbA1c reduction of ~0.5-1.0%, weight loss, blood pressure
reduction, and renal protection. Option A is incorrect because insulin is typically
reserved for HbA1c >10%, symptomatic hyperglycemia, or failure of 2-3 oral agents; it
carries hypoglycemia risk and weight gain. Option B is incorrect because sulfonylureas
cause hypoglycemia and weight gain, and are generally avoided as second-line agents
in contemporary practice. Option D is incorrect because thiazolidinediones cause
weight gain, fluid retention, and increased fracture risk; while effective, they are not
preferred over SGLT2 inhibitors or GLP-1 RAs.
Q4: A 6-month-old infant is brought to the clinic for a well-child visit. The parents report
the infant can roll from prone to supine, sits with support, reaches for objects, and
laughs out loud. Which developmental milestone should the FNP expect to assess at
this visit?
A. Walking with support ("cruising")
B. Pincer grasp and waving bye-bye
C. Transferring objects hand-to-hand and babbling [CORRECT]
D. Speaking 2-3 word sentences and running
Correct Answer: C
Rationale: At 6 months, expected developmental milestones include: gross motor (rolls
both ways, sits with support), fine motor (reaches and grasps, transfers objects
