1
FNP Exam Review: Comprehensive NP Study Guide
for AANP Boards (PASS YOUR FIRST TIME!)
AANP FNP Exam Review: 150 High-Yield Questions & Rationales
1. A 55-year-old male with a history of hypertension and type 2 diabetes presents for a routine follow-
up. His blood pressure today is 148/92 mmHg. He reports adherence to his lisinopril 10 mg daily and
metformin. What is the most appropriate next step in management according to current guidelines?
A. Recheck blood pressure in 3 months; no medication change needed.
B. Increase lisinopril to 20 mg daily.
C. Add hydrochlorothiazide 12.5 mg daily.
D. Discontinue lisinopril and start amlodipine 5 mg daily.
Answer: B. Increase lisinopril to 20 mg daily.
*Rationale: Current guidelines recommend treating to a target BP of <130/80 mmHg in patients with
diabetes. Since the patient is already on a moderate dose of an ACE inhibitor and is above target, the
next step is to titrate the current medication to the maximum tolerated dose before adding a second
agent.*
2. A 28-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic
discomfort. She is afebrile and has no costovertebral angle tenderness. A urine dipstick is positive for
leukocyte esterase and nitrites. She is not pregnant and has no known drug allergies. What is the first-
line antibiotic treatment?
A. Ciprofloxacin 500 mg BID for 7 days.
B. Nitrofurantoin monohydrate/macrocrystals 100 mg BID for 5 days.
C. Amoxicillin 500 mg TID for 7 days.
D. Doxycycline 100 mg BID for 7 days.
Answer: B. Nitrofurantoin monohydrate/macrocrystals 100 mg BID for 5 days.
*Rationale: For uncomplicated cystitis, first-line options include nitrofurantoin for 5 days, TMP-SMX for
3 days (if local resistance <20%), or fosfomycin as a single dose. Fluoroquinolones are not first-line due
to resistance and side effect concerns.*
3. A 4-year-old child is brought in for a well-child visit. The mother is concerned about his speech
development. Which of the following findings warrants immediate referral for a full developmental
evaluation?
A. The child has a vocabulary of about 500 words.
B. The child speaks in 3-word sentences.
C. The child's speech is 50% intelligible to strangers.
D. The child cannot follow a 2-step command.
pg. 1
,2
Answer: D. The child cannot follow a 2-step command.
*Rationale: By age 4, a child should be able to follow 2- to 3-step commands, speak in sentences of 4+
words, and be mostly intelligible. Inability to follow a 2-step command is a significant red flag for
receptive language delay or global developmental delay.*
4. A 68-year-old male with COPD presents with increased shortness of breath, cough productive of
green sputum, and low-grade fever for 2 days. He has wheezing and rhonchi on exam. He is in no
acute distress, with an O2 saturation of 90% on room air. What is the most appropriate initial
management?
A. Prescribe oral prednisone and levofloxacin.
B. Prescribe albuterol inhaler, oral prednisone, and azithromycin.
C. Admit to the hospital for IV steroids and antibiotics.
D. Increase his tiotropium and prescribe guaifenesin.
Answer: B. Prescribe albuterol inhaler, oral prednisone, and azithromycin.
Rationale: This is a mild-to-moderate COPD exacerbation meeting criteria for outpatient management
(increased dyspnea, sputum purulence). Treatment includes a short-acting bronchodilator, a course of
systemic corticosteroids, and an antibiotic given the purulent sputum (purulence being one of the
Anthonisen criteria for antibiotics).
5. Which of the following patients should be screened for hepatitis C according to current CDC
guidelines?
A. A 45-year-old with no risk factors born in 1978.
B. A 70-year-old born in 1950.
C. A 25-year-old with a history of intravenous drug use 10 years ago.
D. All of the above.
Answer: D. All of the above.
*Rationale: The CDC recommends one-time screening for all adults aged 18-79 regardless of risk factors.
Additionally, anyone with a history of injection drug use (ever) should be screened. Therefore, all three
patients meet criteria for screening.*
6. A 16-year-old female presents for a sports physical. She mentions she has not started her period
yet. On exam, she has breast buds and sparse, straight pubic hair. What is the most appropriate next
step?
A. Reassure her that she is on track and will likely start her period within the next year.
B. Order serum FSH, LH, and estradiol levels.
C. Perform a pelvic ultrasound to evaluate for Müllerian anomalies.
D. Refer to pediatric endocrinology immediately.
Answer: A. Reassure her that she is on track and will likely start her period within the next year.
*Rationale: She is in Tanner Stage 2 (breast buds, sparse pubic hair). Menarche typically occurs 2-3 years
after thelarche (breast development), around Tanner Stage 3-4. No workup is needed at this time; she is
developing normally.*
7. A 72-year-old female with a history of osteoporosis is started on alendronate (Fosamax). Which of
the following instructions is most important for the nurse practitioner to provide?
pg. 2
,3
A. "Take this medication with a full glass of milk to prevent stomach upset."
B. "Take this medication on an empty stomach first thing in the morning and remain upright for at least
30 minutes."
C. "Take this medication at bedtime to minimize daytime side effects."
D. "You will need to have your calcium levels checked weekly for the first month."
Answer: B. "Take this medication on an empty stomach first thing in the morning and remain
upright for at least 30 minutes."
*Rationale: Bisphosphonates can cause severe esophageal irritation and ulceration. To minimize risk,
the patient must take it on an empty stomach with plain water only, and remain upright (sitting or
standing) for at least 30-60 minutes after ingestion.*
8. A 6-month-old infant is brought in for a well-child check. The mother reports he is breastfeeding
well and has started some pureed foods. Which of the following physical exam findings is most
concerning and requires further evaluation?
A. Presence of a palpable cervical lymph node < 1 cm.
B. Bilateral bowing of the lower legs.
C. A red reflex that is absent in one eye.
D. A soft, flat anterior fontanelle.
Answer: C. A red reflex that is absent in one eye.
Rationale: An absent red reflex is a red flag for serious conditions including congenital cataracts,
retinoblastoma, or retinal detachment and requires immediate ophthalmology referral. Bilateral leg
bowing is normal at this age. Small, shotty lymph nodes are common in infants.
9. A 45-year-old male construction worker presents with low back pain after lifting a heavy object 2
days ago. The pain is localized to the lumbar region, does not radiate, and there is no bowel or
bladder dysfunction. Straight leg raise test is negative. What is the most appropriate initial
management?
A. Order an MRI of the lumbar spine.
B. Prescribe oxycodone 5 mg every 4 hours as needed for pain.
C. Advise bed rest for the next 5-7 days.
D. Recommend acetaminophen or NSAIDs and encourage continued activity as tolerated.
Answer: D. Recommend acetaminophen or NSAIDs and encourage continued activity as tolerated.
*Rationale: This is acute mechanical low back pain without red flags. First-line treatment includes
NSAIDs or acetaminophen and advice to remain active (avoid bed rest). Imaging is not indicated in the
first 4-6 weeks unless red flags (e.g., neurologic deficit, history of cancer) are present.*
10. Which of the following is a contraindication to the use of combined oral contraceptives (COCs)?
A. Age 42 with no other medical history.
B. History of migraine without aura.
C. History of deep vein thrombosis (DVT) 5 years ago.
D. Current cigarette smoker, age 25.
Answer: C. History of deep vein thrombosis (DVT) 5 years ago.
Rationale: History of DVT or pulmonary embolism is an absolute contraindication (Category 4) for COCs
pg. 3
, 4
due to increased thrombotic risk. Smoking is a contraindication in women over 35, but at age 25 it is not.
Migraine without aura is Category 2 (advantages outweigh risks).
11. A 58-year-old female presents with fatigue, weight gain, and constipation. Labs reveal TSH 8.5
mIU/L (normal 0.4-4.0) and free T4 is low-normal. What is the most appropriate initial management?
A. Start levothyroxine 25 mcg daily.
B. Start methimazole 5 mg daily.
C. Recheck TSH in 6-12 months without treatment.
D. Order a thyroid ultrasound.
Answer: A. Start levothyroxine 25 mcg daily.
*Rationale: TSH > 10 mIU/L is generally considered an indication for treatment even with normal free
T4. For TSH between 4.5-10 with symptoms, treatment is also reasonable. In an older adult or those
with cardiac history, start low (25 mcg) and titrate slowly.*
12. A 10-year-old child presents with a sore throat, fever of 101°F, and tender anterior cervical
lymphadenopathy. There is no cough or rhinorrhea. The Centor criteria score is 3. What is the most
appropriate next step?
A. Prescribe amoxicillin empirically without testing.
B. Perform a rapid strep test and prescribe antibiotics only if positive.
C. Recommend supportive care with fluids and acetaminophen.
D. Order a throat culture and start amoxicillin if culture is positive in 48 hours.
Answer: B. Perform a rapid strep test and prescribe antibiotics only if positive.
Rationale: Current IDSA guidelines recommend testing for Group A Strep (by rapid antigen test or
culture) rather than empiric treatment, even with a high Centor score. A positive test confirms the need
for antibiotics to prevent complications like rheumatic fever.
13. A 32-year-old woman presents with a solitary, tender, erythematous nodule in the right axilla. It is
approximately 2 cm in diameter and fluctuant on palpation. What is the most appropriate
management?
A. Prescribe a course of oral cephalexin and warm compresses.
B. Perform an incision and drainage (I&D).
C. Order an ultrasound of the axilla.
D. Refer to general surgery for excisional biopsy.
Answer: B. Perform an incision and drainage (I&D).
Rationale: A fluctuant nodule indicates an abscess. Antibiotics alone are insufficient for treatment;
incision and drainage is the definitive management. Antibiotics may be added if there is significant
cellulitis, systemic symptoms, or risk factors for MRSA.
14. A 65-year-old male smoker (40 pack-year history) presents for an annual exam. He has no
respiratory symptoms. What is the most appropriate screening test to order based on USPSTF
guidelines?
A. Chest X-ray.
B. Low-dose CT scan of the chest.
pg. 4
FNP Exam Review: Comprehensive NP Study Guide
for AANP Boards (PASS YOUR FIRST TIME!)
AANP FNP Exam Review: 150 High-Yield Questions & Rationales
1. A 55-year-old male with a history of hypertension and type 2 diabetes presents for a routine follow-
up. His blood pressure today is 148/92 mmHg. He reports adherence to his lisinopril 10 mg daily and
metformin. What is the most appropriate next step in management according to current guidelines?
A. Recheck blood pressure in 3 months; no medication change needed.
B. Increase lisinopril to 20 mg daily.
C. Add hydrochlorothiazide 12.5 mg daily.
D. Discontinue lisinopril and start amlodipine 5 mg daily.
Answer: B. Increase lisinopril to 20 mg daily.
*Rationale: Current guidelines recommend treating to a target BP of <130/80 mmHg in patients with
diabetes. Since the patient is already on a moderate dose of an ACE inhibitor and is above target, the
next step is to titrate the current medication to the maximum tolerated dose before adding a second
agent.*
2. A 28-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic
discomfort. She is afebrile and has no costovertebral angle tenderness. A urine dipstick is positive for
leukocyte esterase and nitrites. She is not pregnant and has no known drug allergies. What is the first-
line antibiotic treatment?
A. Ciprofloxacin 500 mg BID for 7 days.
B. Nitrofurantoin monohydrate/macrocrystals 100 mg BID for 5 days.
C. Amoxicillin 500 mg TID for 7 days.
D. Doxycycline 100 mg BID for 7 days.
Answer: B. Nitrofurantoin monohydrate/macrocrystals 100 mg BID for 5 days.
*Rationale: For uncomplicated cystitis, first-line options include nitrofurantoin for 5 days, TMP-SMX for
3 days (if local resistance <20%), or fosfomycin as a single dose. Fluoroquinolones are not first-line due
to resistance and side effect concerns.*
3. A 4-year-old child is brought in for a well-child visit. The mother is concerned about his speech
development. Which of the following findings warrants immediate referral for a full developmental
evaluation?
A. The child has a vocabulary of about 500 words.
B. The child speaks in 3-word sentences.
C. The child's speech is 50% intelligible to strangers.
D. The child cannot follow a 2-step command.
pg. 1
,2
Answer: D. The child cannot follow a 2-step command.
*Rationale: By age 4, a child should be able to follow 2- to 3-step commands, speak in sentences of 4+
words, and be mostly intelligible. Inability to follow a 2-step command is a significant red flag for
receptive language delay or global developmental delay.*
4. A 68-year-old male with COPD presents with increased shortness of breath, cough productive of
green sputum, and low-grade fever for 2 days. He has wheezing and rhonchi on exam. He is in no
acute distress, with an O2 saturation of 90% on room air. What is the most appropriate initial
management?
A. Prescribe oral prednisone and levofloxacin.
B. Prescribe albuterol inhaler, oral prednisone, and azithromycin.
C. Admit to the hospital for IV steroids and antibiotics.
D. Increase his tiotropium and prescribe guaifenesin.
Answer: B. Prescribe albuterol inhaler, oral prednisone, and azithromycin.
Rationale: This is a mild-to-moderate COPD exacerbation meeting criteria for outpatient management
(increased dyspnea, sputum purulence). Treatment includes a short-acting bronchodilator, a course of
systemic corticosteroids, and an antibiotic given the purulent sputum (purulence being one of the
Anthonisen criteria for antibiotics).
5. Which of the following patients should be screened for hepatitis C according to current CDC
guidelines?
A. A 45-year-old with no risk factors born in 1978.
B. A 70-year-old born in 1950.
C. A 25-year-old with a history of intravenous drug use 10 years ago.
D. All of the above.
Answer: D. All of the above.
*Rationale: The CDC recommends one-time screening for all adults aged 18-79 regardless of risk factors.
Additionally, anyone with a history of injection drug use (ever) should be screened. Therefore, all three
patients meet criteria for screening.*
6. A 16-year-old female presents for a sports physical. She mentions she has not started her period
yet. On exam, she has breast buds and sparse, straight pubic hair. What is the most appropriate next
step?
A. Reassure her that she is on track and will likely start her period within the next year.
B. Order serum FSH, LH, and estradiol levels.
C. Perform a pelvic ultrasound to evaluate for Müllerian anomalies.
D. Refer to pediatric endocrinology immediately.
Answer: A. Reassure her that she is on track and will likely start her period within the next year.
*Rationale: She is in Tanner Stage 2 (breast buds, sparse pubic hair). Menarche typically occurs 2-3 years
after thelarche (breast development), around Tanner Stage 3-4. No workup is needed at this time; she is
developing normally.*
7. A 72-year-old female with a history of osteoporosis is started on alendronate (Fosamax). Which of
the following instructions is most important for the nurse practitioner to provide?
pg. 2
,3
A. "Take this medication with a full glass of milk to prevent stomach upset."
B. "Take this medication on an empty stomach first thing in the morning and remain upright for at least
30 minutes."
C. "Take this medication at bedtime to minimize daytime side effects."
D. "You will need to have your calcium levels checked weekly for the first month."
Answer: B. "Take this medication on an empty stomach first thing in the morning and remain
upright for at least 30 minutes."
*Rationale: Bisphosphonates can cause severe esophageal irritation and ulceration. To minimize risk,
the patient must take it on an empty stomach with plain water only, and remain upright (sitting or
standing) for at least 30-60 minutes after ingestion.*
8. A 6-month-old infant is brought in for a well-child check. The mother reports he is breastfeeding
well and has started some pureed foods. Which of the following physical exam findings is most
concerning and requires further evaluation?
A. Presence of a palpable cervical lymph node < 1 cm.
B. Bilateral bowing of the lower legs.
C. A red reflex that is absent in one eye.
D. A soft, flat anterior fontanelle.
Answer: C. A red reflex that is absent in one eye.
Rationale: An absent red reflex is a red flag for serious conditions including congenital cataracts,
retinoblastoma, or retinal detachment and requires immediate ophthalmology referral. Bilateral leg
bowing is normal at this age. Small, shotty lymph nodes are common in infants.
9. A 45-year-old male construction worker presents with low back pain after lifting a heavy object 2
days ago. The pain is localized to the lumbar region, does not radiate, and there is no bowel or
bladder dysfunction. Straight leg raise test is negative. What is the most appropriate initial
management?
A. Order an MRI of the lumbar spine.
B. Prescribe oxycodone 5 mg every 4 hours as needed for pain.
C. Advise bed rest for the next 5-7 days.
D. Recommend acetaminophen or NSAIDs and encourage continued activity as tolerated.
Answer: D. Recommend acetaminophen or NSAIDs and encourage continued activity as tolerated.
*Rationale: This is acute mechanical low back pain without red flags. First-line treatment includes
NSAIDs or acetaminophen and advice to remain active (avoid bed rest). Imaging is not indicated in the
first 4-6 weeks unless red flags (e.g., neurologic deficit, history of cancer) are present.*
10. Which of the following is a contraindication to the use of combined oral contraceptives (COCs)?
A. Age 42 with no other medical history.
B. History of migraine without aura.
C. History of deep vein thrombosis (DVT) 5 years ago.
D. Current cigarette smoker, age 25.
Answer: C. History of deep vein thrombosis (DVT) 5 years ago.
Rationale: History of DVT or pulmonary embolism is an absolute contraindication (Category 4) for COCs
pg. 3
, 4
due to increased thrombotic risk. Smoking is a contraindication in women over 35, but at age 25 it is not.
Migraine without aura is Category 2 (advantages outweigh risks).
11. A 58-year-old female presents with fatigue, weight gain, and constipation. Labs reveal TSH 8.5
mIU/L (normal 0.4-4.0) and free T4 is low-normal. What is the most appropriate initial management?
A. Start levothyroxine 25 mcg daily.
B. Start methimazole 5 mg daily.
C. Recheck TSH in 6-12 months without treatment.
D. Order a thyroid ultrasound.
Answer: A. Start levothyroxine 25 mcg daily.
*Rationale: TSH > 10 mIU/L is generally considered an indication for treatment even with normal free
T4. For TSH between 4.5-10 with symptoms, treatment is also reasonable. In an older adult or those
with cardiac history, start low (25 mcg) and titrate slowly.*
12. A 10-year-old child presents with a sore throat, fever of 101°F, and tender anterior cervical
lymphadenopathy. There is no cough or rhinorrhea. The Centor criteria score is 3. What is the most
appropriate next step?
A. Prescribe amoxicillin empirically without testing.
B. Perform a rapid strep test and prescribe antibiotics only if positive.
C. Recommend supportive care with fluids and acetaminophen.
D. Order a throat culture and start amoxicillin if culture is positive in 48 hours.
Answer: B. Perform a rapid strep test and prescribe antibiotics only if positive.
Rationale: Current IDSA guidelines recommend testing for Group A Strep (by rapid antigen test or
culture) rather than empiric treatment, even with a high Centor score. A positive test confirms the need
for antibiotics to prevent complications like rheumatic fever.
13. A 32-year-old woman presents with a solitary, tender, erythematous nodule in the right axilla. It is
approximately 2 cm in diameter and fluctuant on palpation. What is the most appropriate
management?
A. Prescribe a course of oral cephalexin and warm compresses.
B. Perform an incision and drainage (I&D).
C. Order an ultrasound of the axilla.
D. Refer to general surgery for excisional biopsy.
Answer: B. Perform an incision and drainage (I&D).
Rationale: A fluctuant nodule indicates an abscess. Antibiotics alone are insufficient for treatment;
incision and drainage is the definitive management. Antibiotics may be added if there is significant
cellulitis, systemic symptoms, or risk factors for MRSA.
14. A 65-year-old male smoker (40 pack-year history) presents for an annual exam. He has no
respiratory symptoms. What is the most appropriate screening test to order based on USPSTF
guidelines?
A. Chest X-ray.
B. Low-dose CT scan of the chest.
pg. 4
