AANP FAMILY NURSE PRACTITIONER (FNP) CERTIFICATION EXAM – 180
PRACTICE QUESTIONS WITH ANSWERS AND RATIONALES
DOMAIN 1 – ASSESS (Questions 1–58)
Question 1
A 58-year-old male with a 30-pack-year smoking history presents with a chronic cough
productive of blood-tinged sputum for the past 3 months. He reports unintentional weight loss
of 15 pounds over the same period. On examination, there is clubbing of the fingers. What is
the most appropriate initial diagnostic test?
A. Chest X-ray
B. CT scan of the chest with contrast
C. Sputum culture and sensitivity
D. Bronchoscopy with biopsy
Correct Answer: A. Chest X-ray
Rationale: A chest X-ray is the initial imaging study of choice for a patient presenting with
chronic cough, hemoptysis, weight loss, and clubbing, which are concerning for lung
malignancy. If the chest X-ray reveals a suspicious lesion, further imaging with CT or tissue
diagnosis via bronchoscopy would be indicated. Sputum culture is useful for infectious causes
but would not be the initial test in this scenario.
Question 2
A 45-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. On
examination, her thyroid is non-palpable, and deep tendon reflexes show a delayed relaxation
phase. Which laboratory test is most diagnostic?
A. Free T4
B. TSH
C. Thyroid peroxidase antibodies
D. Thyroid ultrasound
Correct Answer: B. TSH
Rationale: TSH is the single best screening test for thyroid dysfunction. In primary
hypothyroidism, TSH is elevated with a low free T4. While free T4 confirms the diagnosis, TSH is
the most sensitive initial test. Antibodies help determine autoimmune etiology but are not
diagnostic. Ultrasound evaluates structural abnormalities, not function.
Question 3
A 72-year-old male with a history of hypertension and diabetes presents with sudden onset of
severe, tearing chest pain radiating to the back. His blood pressure is 160/95 mmHg in the right
arm and 110/70 mmHg in the left arm. Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
,B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C. Aortic dissection
Rationale: The classic presentation of aortic dissection includes sudden, severe tearing chest
pain radiating to the back, with a difference in blood pressure between arms. This is a medical
emergency requiring immediate surgical consultation. Acute MI typically presents with crushing
chest pain without pulse differential. Pulmonary embolism presents with dyspnea and pleuritic
chest pain. Pericarditis pain is typically positional.
Question 4
A 6-month-old infant is brought in for a well-child visit. The parents report that the infant can
roll from tummy to back and back to tummy, sits with support, and reaches for objects. Which
developmental milestone should the FNP expect this infant to have achieved?
A. Walking independently
B. Pincer grasp
C. Transferring objects from hand to hand
D. Speaking single words
Correct Answer: C. Transferring objects from hand to hand
Rationale: At 6 months, infants typically can roll both ways, sit with support, reach for objects,
and transfer objects from hand to hand. Walking independently occurs around 12 months.
Pincer grasp develops around 9–10 months. Single words typically emerge around 12 months.
Question 5
A 34-year-old woman presents with a 3-day history of dysuria, urinary frequency, and
suprapubic pain. She has no fever, chills, or flank pain. Urinalysis reveals positive leukocyte
esterase and nitrites. What is the most appropriate management?
A. Urine culture and sensitivity before starting antibiotics
B. Empiric antibiotics with a 3-day course
C. Referral to urology
D. Renal ultrasound
Correct Answer: B. Empiric antibiotics with a 3-day course
Rationale: In a healthy, non-pregnant woman with uncomplicated cystitis, empiric antibiotics
are appropriate without routine culture. A 3-day course of antibiotics is standard. Urine culture
is reserved for complicated cases, pregnancy, recurrent infections, or treatment failure. Referral
and imaging are unnecessary for uncomplicated cystitis.
Question 6
A 16-year-old adolescent presents with a 2-week history of sore throat, fever, and fatigue. On
,examination, there is posterior cervical lymphadenopathy, pharyngeal erythema with exudates,
and splenomegaly. Which diagnostic test is most appropriate?
A. Rapid strep test
B. Monospot test
C. Throat culture
D. Complete blood count with differential
Correct Answer: B. Monospot test
Rationale: The presentation of sore throat, fever, fatigue, posterior cervical lymphadenopathy,
and splenomegaly is classic for infectious mononucleosis caused by Epstein-Barr virus. The
Monospot test detects heterophile antibodies and is the initial diagnostic test. Rapid strep and
throat culture would be negative since the etiology is viral. CBC is non-specific.
Question 7
A 65-year-old woman with osteoporosis presents for follow-up. She has been on alendronate for
3 years. She now reports new-onset heartburn and difficulty swallowing. What is the most
appropriate next step?
A. Continue alendronate and add a proton pump inhibitor
B. Switch to intravenous bisphosphonate
C. Perform an upper endoscopy
D. Discontinue alendronate and start raloxifene
Correct Answer: C. Perform an upper endoscopy
Rationale: Alendronate can cause esophageal irritation, esophagitis, and esophageal ulcers.
New-onset dysphagia and heartburn in a patient on alendronate warrant upper endoscopy to
evaluate for esophageal injury. Continuing the medication without evaluation could worsen the
condition. Switching to IV bisphosphonate may be considered after evaluation but is not the
first step.
Question 8
A 28-year-old pregnant woman at 28 weeks gestation presents with a blood pressure of 145/92
mmHg and 2+ protein on urine dipstick. She reports headache and visual changes. What is the
most likely diagnosis?
A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia with severe features
D. Essential hypertension
Correct Answer: C. Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when a pregnant woman has blood
pressure ≥140/90 mmHg with proteinuria and symptoms of end-organ involvement including
, headache and visual changes. Gestational hypertension is hypertension without proteinuria.
Chronic hypertension predates pregnancy or is diagnosed before 20 weeks.
Question 9
A 50-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is most likely responsible?
A. Vitamin B12
B. Vitamin B1 (Thiamine)
C. Vitamin B6
D. Folic acid
Correct Answer: B. Vitamin B1 (Thiamine)
Rationale: Wernicke encephalopathy presents with the classic triad of confusion, ataxia, and
ophthalmoplegia and is caused by thiamine (vitamin B1) deficiency, most commonly seen in
patients with alcohol use disorder. Vitamin B12 deficiency causes subacute combined
degeneration with sensory and motor deficits. Folic acid deficiency causes megaloblastic
anemia.
Question 10
A 3-year-old child presents with a barking cough, stridor, and hoarseness that began suddenly at
night. The child is afebrile and appears well between coughing episodes. What is the most likely
diagnosis?
A. Epiglottitis
B. Bacterial tracheitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
Correct Answer: C. Croup (laryngotracheobronchitis)
Rationale: Croup presents with a characteristic barking cough, stridor, and hoarseness, often
worsening at night. It is typically viral in origin, and children appear well between episodes.
Epiglottitis presents with high fever, drooling, and tripod positioning. Bacterial tracheitis
presents with high fever and toxic appearance. Foreign body aspiration presents with sudden
onset choking and wheezing.
Question 11
A 68-year-old male with a history of diabetes and hypertension presents with a non-healing
ulcer on his right great toe. The ulcer is well-demarcated, painless, and has a punched-out
appearance. The surrounding skin is cool to touch with diminished pulses. What is the most
likely diagnosis?
A. Venous stasis ulcer
B. Neuropathic ulcer
PRACTICE QUESTIONS WITH ANSWERS AND RATIONALES
DOMAIN 1 – ASSESS (Questions 1–58)
Question 1
A 58-year-old male with a 30-pack-year smoking history presents with a chronic cough
productive of blood-tinged sputum for the past 3 months. He reports unintentional weight loss
of 15 pounds over the same period. On examination, there is clubbing of the fingers. What is
the most appropriate initial diagnostic test?
A. Chest X-ray
B. CT scan of the chest with contrast
C. Sputum culture and sensitivity
D. Bronchoscopy with biopsy
Correct Answer: A. Chest X-ray
Rationale: A chest X-ray is the initial imaging study of choice for a patient presenting with
chronic cough, hemoptysis, weight loss, and clubbing, which are concerning for lung
malignancy. If the chest X-ray reveals a suspicious lesion, further imaging with CT or tissue
diagnosis via bronchoscopy would be indicated. Sputum culture is useful for infectious causes
but would not be the initial test in this scenario.
Question 2
A 45-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. On
examination, her thyroid is non-palpable, and deep tendon reflexes show a delayed relaxation
phase. Which laboratory test is most diagnostic?
A. Free T4
B. TSH
C. Thyroid peroxidase antibodies
D. Thyroid ultrasound
Correct Answer: B. TSH
Rationale: TSH is the single best screening test for thyroid dysfunction. In primary
hypothyroidism, TSH is elevated with a low free T4. While free T4 confirms the diagnosis, TSH is
the most sensitive initial test. Antibodies help determine autoimmune etiology but are not
diagnostic. Ultrasound evaluates structural abnormalities, not function.
Question 3
A 72-year-old male with a history of hypertension and diabetes presents with sudden onset of
severe, tearing chest pain radiating to the back. His blood pressure is 160/95 mmHg in the right
arm and 110/70 mmHg in the left arm. Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
,B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C. Aortic dissection
Rationale: The classic presentation of aortic dissection includes sudden, severe tearing chest
pain radiating to the back, with a difference in blood pressure between arms. This is a medical
emergency requiring immediate surgical consultation. Acute MI typically presents with crushing
chest pain without pulse differential. Pulmonary embolism presents with dyspnea and pleuritic
chest pain. Pericarditis pain is typically positional.
Question 4
A 6-month-old infant is brought in for a well-child visit. The parents report that the infant can
roll from tummy to back and back to tummy, sits with support, and reaches for objects. Which
developmental milestone should the FNP expect this infant to have achieved?
A. Walking independently
B. Pincer grasp
C. Transferring objects from hand to hand
D. Speaking single words
Correct Answer: C. Transferring objects from hand to hand
Rationale: At 6 months, infants typically can roll both ways, sit with support, reach for objects,
and transfer objects from hand to hand. Walking independently occurs around 12 months.
Pincer grasp develops around 9–10 months. Single words typically emerge around 12 months.
Question 5
A 34-year-old woman presents with a 3-day history of dysuria, urinary frequency, and
suprapubic pain. She has no fever, chills, or flank pain. Urinalysis reveals positive leukocyte
esterase and nitrites. What is the most appropriate management?
A. Urine culture and sensitivity before starting antibiotics
B. Empiric antibiotics with a 3-day course
C. Referral to urology
D. Renal ultrasound
Correct Answer: B. Empiric antibiotics with a 3-day course
Rationale: In a healthy, non-pregnant woman with uncomplicated cystitis, empiric antibiotics
are appropriate without routine culture. A 3-day course of antibiotics is standard. Urine culture
is reserved for complicated cases, pregnancy, recurrent infections, or treatment failure. Referral
and imaging are unnecessary for uncomplicated cystitis.
Question 6
A 16-year-old adolescent presents with a 2-week history of sore throat, fever, and fatigue. On
,examination, there is posterior cervical lymphadenopathy, pharyngeal erythema with exudates,
and splenomegaly. Which diagnostic test is most appropriate?
A. Rapid strep test
B. Monospot test
C. Throat culture
D. Complete blood count with differential
Correct Answer: B. Monospot test
Rationale: The presentation of sore throat, fever, fatigue, posterior cervical lymphadenopathy,
and splenomegaly is classic for infectious mononucleosis caused by Epstein-Barr virus. The
Monospot test detects heterophile antibodies and is the initial diagnostic test. Rapid strep and
throat culture would be negative since the etiology is viral. CBC is non-specific.
Question 7
A 65-year-old woman with osteoporosis presents for follow-up. She has been on alendronate for
3 years. She now reports new-onset heartburn and difficulty swallowing. What is the most
appropriate next step?
A. Continue alendronate and add a proton pump inhibitor
B. Switch to intravenous bisphosphonate
C. Perform an upper endoscopy
D. Discontinue alendronate and start raloxifene
Correct Answer: C. Perform an upper endoscopy
Rationale: Alendronate can cause esophageal irritation, esophagitis, and esophageal ulcers.
New-onset dysphagia and heartburn in a patient on alendronate warrant upper endoscopy to
evaluate for esophageal injury. Continuing the medication without evaluation could worsen the
condition. Switching to IV bisphosphonate may be considered after evaluation but is not the
first step.
Question 8
A 28-year-old pregnant woman at 28 weeks gestation presents with a blood pressure of 145/92
mmHg and 2+ protein on urine dipstick. She reports headache and visual changes. What is the
most likely diagnosis?
A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia with severe features
D. Essential hypertension
Correct Answer: C. Preeclampsia with severe features
Rationale: Preeclampsia with severe features is diagnosed when a pregnant woman has blood
pressure ≥140/90 mmHg with proteinuria and symptoms of end-organ involvement including
, headache and visual changes. Gestational hypertension is hypertension without proteinuria.
Chronic hypertension predates pregnancy or is diagnosed before 20 weeks.
Question 9
A 50-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is most likely responsible?
A. Vitamin B12
B. Vitamin B1 (Thiamine)
C. Vitamin B6
D. Folic acid
Correct Answer: B. Vitamin B1 (Thiamine)
Rationale: Wernicke encephalopathy presents with the classic triad of confusion, ataxia, and
ophthalmoplegia and is caused by thiamine (vitamin B1) deficiency, most commonly seen in
patients with alcohol use disorder. Vitamin B12 deficiency causes subacute combined
degeneration with sensory and motor deficits. Folic acid deficiency causes megaloblastic
anemia.
Question 10
A 3-year-old child presents with a barking cough, stridor, and hoarseness that began suddenly at
night. The child is afebrile and appears well between coughing episodes. What is the most likely
diagnosis?
A. Epiglottitis
B. Bacterial tracheitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
Correct Answer: C. Croup (laryngotracheobronchitis)
Rationale: Croup presents with a characteristic barking cough, stridor, and hoarseness, often
worsening at night. It is typically viral in origin, and children appear well between episodes.
Epiglottitis presents with high fever, drooling, and tripod positioning. Bacterial tracheitis
presents with high fever and toxic appearance. Foreign body aspiration presents with sudden
onset choking and wheezing.
Question 11
A 68-year-old male with a history of diabetes and hypertension presents with a non-healing
ulcer on his right great toe. The ulcer is well-demarcated, painless, and has a punched-out
appearance. The surrounding skin is cool to touch with diminished pulses. What is the most
likely diagnosis?
A. Venous stasis ulcer
B. Neuropathic ulcer
