1
Barkley Family Nurse Practitioner (FNP) Certification
Exam | AANP & ANCC Board Review | 175 Actual Exam
Questions and Answers with Rationales
DOMAIN 1: Health Promotion, Disease Prevention, and Professional Role
(Questions 1–20)
1. A 55-year-old woman with no personal history of cancer asks when she
should begin colorectal cancer screening. According to the USPSTF, screening
should begin at age:
A. 40
B. 45
C. 50
D. 55
: Answer : B
Rationale: The USPSTF recommends colorectal cancer screening for average-risk
adults beginning at age 45 and continuing until age 75. Options include
colonoscopy every 10 years, FIT annually, or FIT-DNA every 3 years. For ages
76-85, screening is individualized.
2. A healthy 12-year-old girl presents for a well-child visit. According to the CDC
immunization schedule, which vaccines are recommended at this age?
A. Tdap, HPV, MCV4 (first dose)
B. MMR, varicella, hepatitis B
C. Influenza only
D. HPV, hepatitis A, MCV4
: Answer : A
Rationale: At age 11-12, the CDC recommends Tdap booster, HPV vaccine (first
dose; two-dose series if started before age 15), and meningococcal conjugate
vaccine (MenACWY) with a booster at age 16. MenB is recommended at age 16-18
based on shared decision-making.
pg. 1
,2
3. A 68-year-old man with a 30-pack-year smoking history, who quit 10 years
ago, asks about lung cancer screening. According to USPSTF, he:
A. Does not qualify because he quit more than 5 years ago
B. Qualifies for annual low-dose CT if he quit within the past 15 years and meets
age and pack-year criteria
C. Needs a chest X-ray first
D. Only qualifies if he is a current smoker
: Answer : B
Rationale: USPSTF recommends annual low-dose CT for adults aged 50-80 with a
≥20 pack-year history who currently smoke or quit within the past 15 years. This
patient meets criteria (age 68, 30 pack-years, quit 10 years ago).
4. A 32-year-old woman with a history of migraine with aura asks about
contraception. Which method is contraindicated?
A. Copper intrauterine device (IUD)
B. Levonorgestrel-releasing IUD
C. Combined oral contraceptive (ethinyl estradiol/norgestimate)
D. Etonogestrel implant
: Answer : C
Rationale: Combined hormonal contraceptives containing estrogen are
contraindicated in women with migraine with aura due to increased stroke risk.
Progestin-only methods, including the levonorgestrel IUD and implant, are safe.
Copper IUD is also safe.
5. A 70-year-old woman with a history of shingles 3 years ago asks if she should
receive the recombinant zoster vaccine (Shingrix). The FNP should:
A. Reassure her that prior infection provides lifelong immunity
B. Administer Shingrix as a two-dose series, 2-6 months apart
C. Administer the live zoster vaccine (Zostavax) instead
D. Check varicella titers first
pg. 2
,3
: Answer : B
Rationale: The CDC recommends two doses of Shingrix for immunocompetent
adults aged ≥50, regardless of prior shingles or Zostavax administration. Shingrix
is preferred due to higher efficacy. Prior infection does not preclude vaccination.
6. A 45-year-old man with hypertension and hyperlipidemia has a 10-year
ASCVD risk of 10.5%. He asks if he should take aspirin for primary prevention.
The FNP should:
A. Recommend aspirin 81 mg daily
B. Recommend aspirin 325 mg daily
C. Discuss that the bleeding risk likely outweighs the benefit; aspirin is not
routinely recommended
D. Start aspirin only if his family history is positive for MI
: Answer : C
Rationale: USPSTF recommends against routine low-dose aspirin for primary
prevention in adults ≥60 years. For adults 40-59 with a 10-year ASCVD risk ≥10%,
the decision is individualized (Grade C). The net benefit is small due to bleeding
risk. For this patient, shared decision-making is key, but the trend is away from
routine aspirin.
7. A 24-year-old woman at 12 weeks gestation has a positive rubella IgG. Which
of the following is correct?
A. She is susceptible and needs vaccination postpartum
B. She is immune, and no further action is needed
C. She has an active rubella infection
D. She should receive MMR vaccine now
: Answer : B
Rationale: Positive rubella IgG indicates immunity, either from vaccination or prior
infection. No action is needed. MMR is contraindicated in pregnancy because it is
a live vaccine. Susceptible women should be vaccinated postpartum.
pg. 3
, 4
8. A 16-year-old presents for a sports physical. He received his first dose of
MenACWY at age 12. According to the CDC, he should:
A. Receive a booster dose of MenACWY now
B. Start the MenB series
C. No further meningococcal vaccines are needed
D. Receive MenACWY booster and discuss MenB
: Answer : D
Rationale: A booster dose of MenACWY is recommended at age 16. MenB vaccine
is recommended for adolescents aged 16-23 based on shared clinical
decision-making, with a preferred age of 16-18.
9. A 50-year-old woman with a BMI of 32 kg/m² and a sedentary lifestyle asks
about diabetes screening. According to the USPSTF, screening should be
performed:
A. Only if she has symptoms
B. Starting at age 45, or earlier if she has risk factors (overweight/obesity)
C. Annually with a fasting glucose only
D. Only with an A1c every 5 years
: Answer : B
Rationale: The USPSTF recommends screening for prediabetes and type 2 diabetes
in adults aged 35-70 who are overweight or obese. The ADA recommends
screening all adults ≥35, and earlier if risk factors (overweight, family history, etc.)
are present.
10. A 62-year-old woman has a DEXA scan showing a T-score of –2.7 at the
femoral neck. She has no history of fractures. What is the most appropriate
initial pharmacotherapy?
A. Calcium and vitamin D alone
B. Bisphosphonate (e.g., alendronate)
C. Denosumab
D. Teriparatide
pg. 4
Barkley Family Nurse Practitioner (FNP) Certification
Exam | AANP & ANCC Board Review | 175 Actual Exam
Questions and Answers with Rationales
DOMAIN 1: Health Promotion, Disease Prevention, and Professional Role
(Questions 1–20)
1. A 55-year-old woman with no personal history of cancer asks when she
should begin colorectal cancer screening. According to the USPSTF, screening
should begin at age:
A. 40
B. 45
C. 50
D. 55
: Answer : B
Rationale: The USPSTF recommends colorectal cancer screening for average-risk
adults beginning at age 45 and continuing until age 75. Options include
colonoscopy every 10 years, FIT annually, or FIT-DNA every 3 years. For ages
76-85, screening is individualized.
2. A healthy 12-year-old girl presents for a well-child visit. According to the CDC
immunization schedule, which vaccines are recommended at this age?
A. Tdap, HPV, MCV4 (first dose)
B. MMR, varicella, hepatitis B
C. Influenza only
D. HPV, hepatitis A, MCV4
: Answer : A
Rationale: At age 11-12, the CDC recommends Tdap booster, HPV vaccine (first
dose; two-dose series if started before age 15), and meningococcal conjugate
vaccine (MenACWY) with a booster at age 16. MenB is recommended at age 16-18
based on shared decision-making.
pg. 1
,2
3. A 68-year-old man with a 30-pack-year smoking history, who quit 10 years
ago, asks about lung cancer screening. According to USPSTF, he:
A. Does not qualify because he quit more than 5 years ago
B. Qualifies for annual low-dose CT if he quit within the past 15 years and meets
age and pack-year criteria
C. Needs a chest X-ray first
D. Only qualifies if he is a current smoker
: Answer : B
Rationale: USPSTF recommends annual low-dose CT for adults aged 50-80 with a
≥20 pack-year history who currently smoke or quit within the past 15 years. This
patient meets criteria (age 68, 30 pack-years, quit 10 years ago).
4. A 32-year-old woman with a history of migraine with aura asks about
contraception. Which method is contraindicated?
A. Copper intrauterine device (IUD)
B. Levonorgestrel-releasing IUD
C. Combined oral contraceptive (ethinyl estradiol/norgestimate)
D. Etonogestrel implant
: Answer : C
Rationale: Combined hormonal contraceptives containing estrogen are
contraindicated in women with migraine with aura due to increased stroke risk.
Progestin-only methods, including the levonorgestrel IUD and implant, are safe.
Copper IUD is also safe.
5. A 70-year-old woman with a history of shingles 3 years ago asks if she should
receive the recombinant zoster vaccine (Shingrix). The FNP should:
A. Reassure her that prior infection provides lifelong immunity
B. Administer Shingrix as a two-dose series, 2-6 months apart
C. Administer the live zoster vaccine (Zostavax) instead
D. Check varicella titers first
pg. 2
,3
: Answer : B
Rationale: The CDC recommends two doses of Shingrix for immunocompetent
adults aged ≥50, regardless of prior shingles or Zostavax administration. Shingrix
is preferred due to higher efficacy. Prior infection does not preclude vaccination.
6. A 45-year-old man with hypertension and hyperlipidemia has a 10-year
ASCVD risk of 10.5%. He asks if he should take aspirin for primary prevention.
The FNP should:
A. Recommend aspirin 81 mg daily
B. Recommend aspirin 325 mg daily
C. Discuss that the bleeding risk likely outweighs the benefit; aspirin is not
routinely recommended
D. Start aspirin only if his family history is positive for MI
: Answer : C
Rationale: USPSTF recommends against routine low-dose aspirin for primary
prevention in adults ≥60 years. For adults 40-59 with a 10-year ASCVD risk ≥10%,
the decision is individualized (Grade C). The net benefit is small due to bleeding
risk. For this patient, shared decision-making is key, but the trend is away from
routine aspirin.
7. A 24-year-old woman at 12 weeks gestation has a positive rubella IgG. Which
of the following is correct?
A. She is susceptible and needs vaccination postpartum
B. She is immune, and no further action is needed
C. She has an active rubella infection
D. She should receive MMR vaccine now
: Answer : B
Rationale: Positive rubella IgG indicates immunity, either from vaccination or prior
infection. No action is needed. MMR is contraindicated in pregnancy because it is
a live vaccine. Susceptible women should be vaccinated postpartum.
pg. 3
, 4
8. A 16-year-old presents for a sports physical. He received his first dose of
MenACWY at age 12. According to the CDC, he should:
A. Receive a booster dose of MenACWY now
B. Start the MenB series
C. No further meningococcal vaccines are needed
D. Receive MenACWY booster and discuss MenB
: Answer : D
Rationale: A booster dose of MenACWY is recommended at age 16. MenB vaccine
is recommended for adolescents aged 16-23 based on shared clinical
decision-making, with a preferred age of 16-18.
9. A 50-year-old woman with a BMI of 32 kg/m² and a sedentary lifestyle asks
about diabetes screening. According to the USPSTF, screening should be
performed:
A. Only if she has symptoms
B. Starting at age 45, or earlier if she has risk factors (overweight/obesity)
C. Annually with a fasting glucose only
D. Only with an A1c every 5 years
: Answer : B
Rationale: The USPSTF recommends screening for prediabetes and type 2 diabetes
in adults aged 35-70 who are overweight or obese. The ADA recommends
screening all adults ≥35, and earlier if risk factors (overweight, family history, etc.)
are present.
10. A 62-year-old woman has a DEXA scan showing a T-score of –2.7 at the
femoral neck. She has no history of fractures. What is the most appropriate
initial pharmacotherapy?
A. Calcium and vitamin D alone
B. Bisphosphonate (e.g., alendronate)
C. Denosumab
D. Teriparatide
pg. 4
