FNP EXAM REVIEW 2026 | COMPREHENSIVE
NP STUDY GUIDE FOR AANP BOARD EXAM |
PASS ON FIRST ATTEMPT WITH VERIFIED
PRACTICE QUESTIONS & RATIONALES
FNP EXAM REVIEW 2026 - COMPREHENSIVE STUDY GUIDE
• This document contains verified practice questions with detailed EXPERT
RATIONALE covering all major FNP/AANP Board Exam domains including primary
care management, pharmacology, health promotion, and clinical decision-making
• Study approach: Work through questions systematically, focus on understanding
EXPERT RATIONALE rather than memorizing answers, identify weak content areas,
and revisit those topics before your exam
QUESTION 1
A 45-year-old male presents with hypertension and elevated cholesterol.
Which medication combination is contraindicated?
A) Lisinopril and chlorthalidone
B) Atorvastatin and ezetimibe
C) ACE inhibitor and potassium-sparing diuretic
D) Amlodipine and metoprolol
E) Olmesartan and hydrochlorothiazide
CORRECT ANSWER: C - ACE inhibitor and potassium-sparing diuretic
EXPERT RATIONALE: ACE inhibitors cause potassium retention by blocking
aldosterone production. When combined with potassium-sparing diuretics
(spironolactone, amiloride), there is significant risk of hyperkalemia, which can
cause dangerous cardiac arrhythmias. This combination requires careful
monitoring and is generally contraindicated unless serum potassium is very closely
monitored.
QUESTION 2
,A 32-year-old woman with type 2 diabetes is on metformin monotherapy. Her
HbA1c is 8.2%. What is the most appropriate next step in medication
management?
A) Increase metformin dose to maximum
B) Add a GLP-1 receptor agonist
C) Add a sulfonylurea
D) Start insulin therapy immediately
E) Switch to pioglitazone
CORRECT ANSWER: B - Add a GLP-1 receptor agonist
EXPERT RATIONALE: Current ADA guidelines recommend adding a second agent
when HbA1c exceeds 7-8% on monotherapy. GLP-1 agonists offer cardiovascular
and weight loss benefits, making them preferred second-line agents. They are
superior to sulfonylureas which increase hypoglycemia risk, and insulin is typically
reserved for later stages or specific indications.
QUESTION 3
A 58-year-old male with COPD presents with acute dyspnea. His oxygen
saturation is 88% on room air. Which finding would most suggest acute
exacerbation requiring hospitalization?
A) Mild wheezing on auscultation
B) Oxygen saturation 92% with supplemental oxygen
C) Accessory muscle use with altered mental status
D) Cough productive of clear sputum
E) Increased exercise limitation over 2 weeks
CORRECT ANSWER: C - Accessory muscle use with altered mental status
EXPERT RATIONALE: Altered mental status (hypercapnia or hypoxia) combined
with significant respiratory effort indicates severe airway obstruction with
,inadequate ventilation. This represents respiratory failure requiring hospitalization
and likely intensive monitoring. The other findings suggest milder exacerbations
manageable in outpatient settings.
QUESTION 4
A 28-year-old primigravida at 20 weeks gestation presents for routine
prenatal care. What is the most critical screening test at this visit?
A) Glucose tolerance test
B) Quad screen/cell-free DNA testing
C) Group B Streptococcus culture
D) Amniocentesis for karyotyping
E) Fetal fibronectin testing
CORRECT ANSWER: B - Quad screen/cell-free DNA testing
EXPERT RATIONALE: The second trimester (15-22 weeks) is the optimal time for
nuchal translucency ultrasound and quad screening (AFP, hCG, uE3, inhibin A) to
detect chromosomal abnormalities. Cell-free DNA testing is also offered at this
time. GBS screening occurs at 35-37 weeks, glucose tolerance at 24-28 weeks, and
amniocentesis is typically diagnostic rather than screening.
QUESTION 5
A 67-year-old woman with history of atrial fibrillation on warfarin presents
with INR of 8.5 and no bleeding. What is the appropriate management?
A) Administer fresh frozen plasma immediately
B) Administer oral vitamin K1 and recheck INR in 24 hours
C) Administer IV vitamin K1 immediately
D) Hold warfarin dose and recheck INR in 24 hours
, E) Administer protamine sulfate
CORRECT ANSWER: B - Administer oral vitamin K1 and recheck INR in 24 hours
EXPERT RATIONALE: For INR 8.5 without bleeding, oral vitamin K1 (phytonadione)
is the treatment of choice. The dose is 2.5-5 mg orally. Fresh frozen plasma and IV
vitamin K are reserved for serious bleeding or INR >20. Warfarin should be held.
Protamine is used for heparin overdose.
QUESTION 6
A 42-year-old male presents with pleuritic chest pain and dyspnea. Chest X-
ray shows unilateral pleural effusion. Which finding would most suggest
malignancy?
A) Pleural fluid pH 7.35
B) Pleural fluid LDH greater than serum LDH
C) Pleural fluid protein 2.5 g/dL
D) Exudative characteristics only
E) Absence of pleural thickening
CORRECT ANSWER: B - Pleural fluid LDH greater than serum LDH
EXPERT RATIONALE: While this finding alone is not specific, pleural LDH greater
than serum LDH suggests exudate. Malignancy typically presents with exudative
effusions. Additionally, bloody effusions, low glucose (<60 mg/dL), and low pH (<7.3)
are more suggestive of malignancy or empyema. Simple exudates alone can be
seen with various benign conditions.
QUESTION 7
A 51-year-old woman presents with hot flashes and night sweats for 6
months. She is in her late reproductive years. Which hormone level would
confirm perimenopause?
NP STUDY GUIDE FOR AANP BOARD EXAM |
PASS ON FIRST ATTEMPT WITH VERIFIED
PRACTICE QUESTIONS & RATIONALES
FNP EXAM REVIEW 2026 - COMPREHENSIVE STUDY GUIDE
• This document contains verified practice questions with detailed EXPERT
RATIONALE covering all major FNP/AANP Board Exam domains including primary
care management, pharmacology, health promotion, and clinical decision-making
• Study approach: Work through questions systematically, focus on understanding
EXPERT RATIONALE rather than memorizing answers, identify weak content areas,
and revisit those topics before your exam
QUESTION 1
A 45-year-old male presents with hypertension and elevated cholesterol.
Which medication combination is contraindicated?
A) Lisinopril and chlorthalidone
B) Atorvastatin and ezetimibe
C) ACE inhibitor and potassium-sparing diuretic
D) Amlodipine and metoprolol
E) Olmesartan and hydrochlorothiazide
CORRECT ANSWER: C - ACE inhibitor and potassium-sparing diuretic
EXPERT RATIONALE: ACE inhibitors cause potassium retention by blocking
aldosterone production. When combined with potassium-sparing diuretics
(spironolactone, amiloride), there is significant risk of hyperkalemia, which can
cause dangerous cardiac arrhythmias. This combination requires careful
monitoring and is generally contraindicated unless serum potassium is very closely
monitored.
QUESTION 2
,A 32-year-old woman with type 2 diabetes is on metformin monotherapy. Her
HbA1c is 8.2%. What is the most appropriate next step in medication
management?
A) Increase metformin dose to maximum
B) Add a GLP-1 receptor agonist
C) Add a sulfonylurea
D) Start insulin therapy immediately
E) Switch to pioglitazone
CORRECT ANSWER: B - Add a GLP-1 receptor agonist
EXPERT RATIONALE: Current ADA guidelines recommend adding a second agent
when HbA1c exceeds 7-8% on monotherapy. GLP-1 agonists offer cardiovascular
and weight loss benefits, making them preferred second-line agents. They are
superior to sulfonylureas which increase hypoglycemia risk, and insulin is typically
reserved for later stages or specific indications.
QUESTION 3
A 58-year-old male with COPD presents with acute dyspnea. His oxygen
saturation is 88% on room air. Which finding would most suggest acute
exacerbation requiring hospitalization?
A) Mild wheezing on auscultation
B) Oxygen saturation 92% with supplemental oxygen
C) Accessory muscle use with altered mental status
D) Cough productive of clear sputum
E) Increased exercise limitation over 2 weeks
CORRECT ANSWER: C - Accessory muscle use with altered mental status
EXPERT RATIONALE: Altered mental status (hypercapnia or hypoxia) combined
with significant respiratory effort indicates severe airway obstruction with
,inadequate ventilation. This represents respiratory failure requiring hospitalization
and likely intensive monitoring. The other findings suggest milder exacerbations
manageable in outpatient settings.
QUESTION 4
A 28-year-old primigravida at 20 weeks gestation presents for routine
prenatal care. What is the most critical screening test at this visit?
A) Glucose tolerance test
B) Quad screen/cell-free DNA testing
C) Group B Streptococcus culture
D) Amniocentesis for karyotyping
E) Fetal fibronectin testing
CORRECT ANSWER: B - Quad screen/cell-free DNA testing
EXPERT RATIONALE: The second trimester (15-22 weeks) is the optimal time for
nuchal translucency ultrasound and quad screening (AFP, hCG, uE3, inhibin A) to
detect chromosomal abnormalities. Cell-free DNA testing is also offered at this
time. GBS screening occurs at 35-37 weeks, glucose tolerance at 24-28 weeks, and
amniocentesis is typically diagnostic rather than screening.
QUESTION 5
A 67-year-old woman with history of atrial fibrillation on warfarin presents
with INR of 8.5 and no bleeding. What is the appropriate management?
A) Administer fresh frozen plasma immediately
B) Administer oral vitamin K1 and recheck INR in 24 hours
C) Administer IV vitamin K1 immediately
D) Hold warfarin dose and recheck INR in 24 hours
, E) Administer protamine sulfate
CORRECT ANSWER: B - Administer oral vitamin K1 and recheck INR in 24 hours
EXPERT RATIONALE: For INR 8.5 without bleeding, oral vitamin K1 (phytonadione)
is the treatment of choice. The dose is 2.5-5 mg orally. Fresh frozen plasma and IV
vitamin K are reserved for serious bleeding or INR >20. Warfarin should be held.
Protamine is used for heparin overdose.
QUESTION 6
A 42-year-old male presents with pleuritic chest pain and dyspnea. Chest X-
ray shows unilateral pleural effusion. Which finding would most suggest
malignancy?
A) Pleural fluid pH 7.35
B) Pleural fluid LDH greater than serum LDH
C) Pleural fluid protein 2.5 g/dL
D) Exudative characteristics only
E) Absence of pleural thickening
CORRECT ANSWER: B - Pleural fluid LDH greater than serum LDH
EXPERT RATIONALE: While this finding alone is not specific, pleural LDH greater
than serum LDH suggests exudate. Malignancy typically presents with exudative
effusions. Additionally, bloody effusions, low glucose (<60 mg/dL), and low pH (<7.3)
are more suggestive of malignancy or empyema. Simple exudates alone can be
seen with various benign conditions.
QUESTION 7
A 51-year-old woman presents with hot flashes and night sweats for 6
months. She is in her late reproductive years. Which hormone level would
confirm perimenopause?
