,AANP FNP CERTIFICATION ACTUAL EXAM
Question 1:
A 65-year-old woman presents for a follow-up examination after a new patient visit. She
has not seen a healthcare provider for several years. She is a smoker and her
hypertension is now adequately controlled with medication. Her mother died at age 40
from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30,
and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse
practitioner should start the patient on:
A) Bile acid sequestrant
B) A statin drug
C) A cholesterol absorption inhibitor
D) Low-dose aspirin
Answer: B) A statin drug
Rationale: This patient has multiple risk factors including smoking, hypertension, family
history of early heart attack, and elevated LDL >190 mg/dL. According to ACC/AHA
guidelines, patients with LDL ≥190 mg/dL should be started on high-intensity statin
therapy regardless of risk score.
Question 2:
An adult male presents as the first patient of the day after awakening about 5:00 AM
with indigestion and chest pressure. On checking his pulse, he found no change from
previous measurements. He states that, while waiting for the nurse practitioner to arrive,
he began to feel a little clammy. A 12-lead EKG records the following patterns. On the
basis of these EKG readings, the diagnosis is:
A) Anterior-septal acute myocardial infarction
B) Lateral acute myocardial infarction
C) Inferior acute myocardial infarction
D) Anterior acute myocardial infarction
,Answer: C) Inferior acute myocardial infarction
Rationale: Early morning onset with indigestion-like chest pressure and diaphoresis
suggests an acute coronary event. Inferior STEMI involves leads II, III, and aVF, commonly
presenting with associated nausea, diaphoresis, and vagal symptoms.
Question 3:
During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to
the back. The patient also reports several episodes of nausea and vomiting, a low-grade
temperature, and a history of excessive drinking. Physical examination reveals a
distended abdomen. Laboratory serum values indicate elevated alkaline phosphatase,
amylase, and serum lipase. The most likely diagnosis is:
A) Alcoholic liver disease
B) Acute mesenteric ischemia
C) Viral hepatitis
D) Acute pancreatitis
Answer: D) Acute pancreatitis
Rationale: The classic triad of acute pancreatitis includes epigastric pain radiating to the
back, nausea/vomiting, and elevated pancreatic enzymes (amylase and lipase). The history
of excessive alcohol use is a major risk factor.
Question 4:
Which of the following is the most appropriate screening test for cervical cancer in a 25-
year-old woman who is sexually active?
A) HPV DNA testing alone
B) Pap smear alone every 3 years
C) Co-testing (Pap + HPV) every 5 years
D) Annual pelvic examination
Answer: B) Pap smear alone every 3 years
Rationale: For women aged 21-29, the USPSTF and ACOG recommend cervical cytology
(Pap smear) alone every 3 years. HPV testing is not recommended in this age group due to
high prevalence of transient infections.
, Question 5:
A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough,
hemoptysis, and weight loss. Chest X-ray shows a solitary pulmonary nodule. The most
appropriate next step is:
A) Repeat chest X-ray in 6 months
B) CT-guided biopsy
C) Positron emission tomography (PET) scan
D) Bronchoscopy with biopsy
Answer: D) Bronchoscopy with biopsy
Rationale: The combination of chronic cough, hemoptysis, weight loss, and a smoking
history is highly suspicious for lung cancer. Bronchoscopy with biopsy is the definitive
diagnostic procedure for central lesions.
Question 6:
A 45-year-old woman presents with fatigue, cold intolerance, weight gain, and
constipation. Physical examination reveals a bradycardia, dry skin, and delayed
relaxation of deep tendon reflexes. The most likely diagnosis is:
A) Hyperthyroidism
B) Hypothyroidism
C) Adrenal insufficiency
D) Anemia
Answer: B) Hypothyroidism
Rationale: The classic symptoms of hypothyroidism include fatigue, cold intolerance,
weight gain, constipation, bradycardia, dry skin, and delayed deep tendon reflexes.
Question 7:
The most common cause of community-acquired pneumonia in adults is:
Question 1:
A 65-year-old woman presents for a follow-up examination after a new patient visit. She
has not seen a healthcare provider for several years. She is a smoker and her
hypertension is now adequately controlled with medication. Her mother died at age 40
from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30,
and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse
practitioner should start the patient on:
A) Bile acid sequestrant
B) A statin drug
C) A cholesterol absorption inhibitor
D) Low-dose aspirin
Answer: B) A statin drug
Rationale: This patient has multiple risk factors including smoking, hypertension, family
history of early heart attack, and elevated LDL >190 mg/dL. According to ACC/AHA
guidelines, patients with LDL ≥190 mg/dL should be started on high-intensity statin
therapy regardless of risk score.
Question 2:
An adult male presents as the first patient of the day after awakening about 5:00 AM
with indigestion and chest pressure. On checking his pulse, he found no change from
previous measurements. He states that, while waiting for the nurse practitioner to arrive,
he began to feel a little clammy. A 12-lead EKG records the following patterns. On the
basis of these EKG readings, the diagnosis is:
A) Anterior-septal acute myocardial infarction
B) Lateral acute myocardial infarction
C) Inferior acute myocardial infarction
D) Anterior acute myocardial infarction
,Answer: C) Inferior acute myocardial infarction
Rationale: Early morning onset with indigestion-like chest pressure and diaphoresis
suggests an acute coronary event. Inferior STEMI involves leads II, III, and aVF, commonly
presenting with associated nausea, diaphoresis, and vagal symptoms.
Question 3:
During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to
the back. The patient also reports several episodes of nausea and vomiting, a low-grade
temperature, and a history of excessive drinking. Physical examination reveals a
distended abdomen. Laboratory serum values indicate elevated alkaline phosphatase,
amylase, and serum lipase. The most likely diagnosis is:
A) Alcoholic liver disease
B) Acute mesenteric ischemia
C) Viral hepatitis
D) Acute pancreatitis
Answer: D) Acute pancreatitis
Rationale: The classic triad of acute pancreatitis includes epigastric pain radiating to the
back, nausea/vomiting, and elevated pancreatic enzymes (amylase and lipase). The history
of excessive alcohol use is a major risk factor.
Question 4:
Which of the following is the most appropriate screening test for cervical cancer in a 25-
year-old woman who is sexually active?
A) HPV DNA testing alone
B) Pap smear alone every 3 years
C) Co-testing (Pap + HPV) every 5 years
D) Annual pelvic examination
Answer: B) Pap smear alone every 3 years
Rationale: For women aged 21-29, the USPSTF and ACOG recommend cervical cytology
(Pap smear) alone every 3 years. HPV testing is not recommended in this age group due to
high prevalence of transient infections.
, Question 5:
A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough,
hemoptysis, and weight loss. Chest X-ray shows a solitary pulmonary nodule. The most
appropriate next step is:
A) Repeat chest X-ray in 6 months
B) CT-guided biopsy
C) Positron emission tomography (PET) scan
D) Bronchoscopy with biopsy
Answer: D) Bronchoscopy with biopsy
Rationale: The combination of chronic cough, hemoptysis, weight loss, and a smoking
history is highly suspicious for lung cancer. Bronchoscopy with biopsy is the definitive
diagnostic procedure for central lesions.
Question 6:
A 45-year-old woman presents with fatigue, cold intolerance, weight gain, and
constipation. Physical examination reveals a bradycardia, dry skin, and delayed
relaxation of deep tendon reflexes. The most likely diagnosis is:
A) Hyperthyroidism
B) Hypothyroidism
C) Adrenal insufficiency
D) Anemia
Answer: B) Hypothyroidism
Rationale: The classic symptoms of hypothyroidism include fatigue, cold intolerance,
weight gain, constipation, bradycardia, dry skin, and delayed deep tendon reflexes.
Question 7:
The most common cause of community-acquired pneumonia in adults is:
