AANP FNP ACTUAL EXAM – QUESTIONS
AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES
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UPDATE 2026/2027
Question 1
A 65-year-old man with a history of hypertension and a 40-pack-year smoking
history presents for a routine physical. He is asymptomatic. His blood pressure is
128/76 mmHg. Which of the following is the most appropriate screening test to
order?
A) Yearly chest X-ray
B) Spirometry
C) Abdominal aortic aneurysm (AAA) ultrasound
D) Exercise stress test
Correct Answer: C
Rationale: The U.S. Preventive Services Task Force (USPSTF) recommends a one-
time screening for AAA with ultrasonography in men aged 65 to 75 years who have
ever smoked. This patient meets the criteria. The other options are not
recommended for routine screening in an asymptomatic patient with this history.
,Question 2
A 78-year-old female presents for a "check-up." She lives alone and reports
occasionally forgetting to take her medications. Her MMSE score is 26/30, with
points lost for date and recall. She is independent in basic ADLs but her daughter
reports she has stopped paying bills and the electricity was recently shut off. What
is the priority assessment at this time?
A) A CT scan of the head without contrast
B) A comprehensive evaluation of functional status, including IADLs
C) Ordering a vitamin B12 level and TSH
D) Referring her to a neurologist for further testing
Correct Answer: B
Rationale: The daughter's report of difficulty managing finances (an instrumental
activity of daily living, IADL) is a key indicator of functional decline, which is a
critical component of assessing older adults. While ruling out reversible causes (C)
and neuroimaging (A) may be indicated, the priority is to fully assess the extent of
functional impairment to ensure the patient's safety and ability to live
independently.
Question 3
A 25-year-old woman presents with acute onset of severe, sharp, right lower
quadrant abdominal pain. She is nauseated and vomited once. She reports her last
menstrual period was 6 weeks ago. Her temperature is 99.8°F (37.7°C). On
physical exam, she has rebound tenderness and guarding in the right lower
quadrant. What is the most appropriate initial diagnostic step?
,A) Order a CT scan of the abdomen and pelvis
B) Perform a urine pregnancy test
C) Obtain a CBC with differential
D) Schedule a pelvic ultrasound
Correct Answer: B
Rationale: In any female of childbearing age presenting with abdominal pain, a
urine pregnancy test is the first and most critical step to rule out ectopic pregnancy,
which can be a life-threatening emergency. This must be done before any other
diagnostic tests or imaging involving radiation.
Question 4
A 2-week-old infant is brought to the clinic for a weight check. The infant was born
at 39 weeks gestation with a birth weight of 3.5 kg (7 lbs 12 oz). The mother is
exclusively breastfeeding and concerned about adequate intake. Today, the infant
weighs 3.4 kg (7 lbs 8 oz). What is the most appropriate next step in assessment?
A) Supplement with formula immediately
B) Reassure the mother that this is normal
C) Obtain a detailed feeding history and observe a feeding
D) Refer to a pediatric gastroenterologist
Correct Answer: C
Rationale: A 100g weight loss (approximately 3% of birth weight) at 2 weeks of age
is below the expected return to birth weight (which should occur by 10-14 days).
The most appropriate next step is to obtain a detailed feeding history and observe a
feeding to assess latch, milk transfer, and maternal milk supply. This is a
breastfeeding assessment before considering supplementation.
, Question 5
During a well-child exam for a 6-month-old infant, which finding on the cardiac
exam is most concerning and warrants further investigation?
A) A soft, blowing, systolic murmur heard at the left sternal border that changes
with position
B) A continuous "machinery" murmur heard throughout systole and diastole
C) Sinus arrhythmia where the heart rate increases with inspiration and decreases
with expiration
D) An S3 heart sound
Correct Answer: B
Rationale: A continuous murmur is always pathological in an infant. This describes
a patent ductus arteriosus (PDA). An innocent murmur (A) is typically soft, short,
and varies with position. Sinus arrhythmia (C) and an S3 (D) are normal findings in
children.
Question 6
A 68-year-old woman with type 2 diabetes and hypertension is in the clinic for a
follow-up. Her blood pressure today is 138/88 mmHg. A urine dipstick is negative
for protein. According to current guidelines, what is the most appropriate test to
assess for early diabetic nephropathy?
A) 24-hour urine collection for protein
B) Blood urea nitrogen (BUN) and creatinine
C) Urine albumin-to-creatinine ratio (UACR)
D) Renal ultrasound
AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES
| DOWNLOAD AND PASS | LATEST EXAM
UPDATE 2026/2027
Question 1
A 65-year-old man with a history of hypertension and a 40-pack-year smoking
history presents for a routine physical. He is asymptomatic. His blood pressure is
128/76 mmHg. Which of the following is the most appropriate screening test to
order?
A) Yearly chest X-ray
B) Spirometry
C) Abdominal aortic aneurysm (AAA) ultrasound
D) Exercise stress test
Correct Answer: C
Rationale: The U.S. Preventive Services Task Force (USPSTF) recommends a one-
time screening for AAA with ultrasonography in men aged 65 to 75 years who have
ever smoked. This patient meets the criteria. The other options are not
recommended for routine screening in an asymptomatic patient with this history.
,Question 2
A 78-year-old female presents for a "check-up." She lives alone and reports
occasionally forgetting to take her medications. Her MMSE score is 26/30, with
points lost for date and recall. She is independent in basic ADLs but her daughter
reports she has stopped paying bills and the electricity was recently shut off. What
is the priority assessment at this time?
A) A CT scan of the head without contrast
B) A comprehensive evaluation of functional status, including IADLs
C) Ordering a vitamin B12 level and TSH
D) Referring her to a neurologist for further testing
Correct Answer: B
Rationale: The daughter's report of difficulty managing finances (an instrumental
activity of daily living, IADL) is a key indicator of functional decline, which is a
critical component of assessing older adults. While ruling out reversible causes (C)
and neuroimaging (A) may be indicated, the priority is to fully assess the extent of
functional impairment to ensure the patient's safety and ability to live
independently.
Question 3
A 25-year-old woman presents with acute onset of severe, sharp, right lower
quadrant abdominal pain. She is nauseated and vomited once. She reports her last
menstrual period was 6 weeks ago. Her temperature is 99.8°F (37.7°C). On
physical exam, she has rebound tenderness and guarding in the right lower
quadrant. What is the most appropriate initial diagnostic step?
,A) Order a CT scan of the abdomen and pelvis
B) Perform a urine pregnancy test
C) Obtain a CBC with differential
D) Schedule a pelvic ultrasound
Correct Answer: B
Rationale: In any female of childbearing age presenting with abdominal pain, a
urine pregnancy test is the first and most critical step to rule out ectopic pregnancy,
which can be a life-threatening emergency. This must be done before any other
diagnostic tests or imaging involving radiation.
Question 4
A 2-week-old infant is brought to the clinic for a weight check. The infant was born
at 39 weeks gestation with a birth weight of 3.5 kg (7 lbs 12 oz). The mother is
exclusively breastfeeding and concerned about adequate intake. Today, the infant
weighs 3.4 kg (7 lbs 8 oz). What is the most appropriate next step in assessment?
A) Supplement with formula immediately
B) Reassure the mother that this is normal
C) Obtain a detailed feeding history and observe a feeding
D) Refer to a pediatric gastroenterologist
Correct Answer: C
Rationale: A 100g weight loss (approximately 3% of birth weight) at 2 weeks of age
is below the expected return to birth weight (which should occur by 10-14 days).
The most appropriate next step is to obtain a detailed feeding history and observe a
feeding to assess latch, milk transfer, and maternal milk supply. This is a
breastfeeding assessment before considering supplementation.
, Question 5
During a well-child exam for a 6-month-old infant, which finding on the cardiac
exam is most concerning and warrants further investigation?
A) A soft, blowing, systolic murmur heard at the left sternal border that changes
with position
B) A continuous "machinery" murmur heard throughout systole and diastole
C) Sinus arrhythmia where the heart rate increases with inspiration and decreases
with expiration
D) An S3 heart sound
Correct Answer: B
Rationale: A continuous murmur is always pathological in an infant. This describes
a patent ductus arteriosus (PDA). An innocent murmur (A) is typically soft, short,
and varies with position. Sinus arrhythmia (C) and an S3 (D) are normal findings in
children.
Question 6
A 68-year-old woman with type 2 diabetes and hypertension is in the clinic for a
follow-up. Her blood pressure today is 138/88 mmHg. A urine dipstick is negative
for protein. According to current guidelines, what is the most appropriate test to
assess for early diabetic nephropathy?
A) 24-hour urine collection for protein
B) Blood urea nitrogen (BUN) and creatinine
C) Urine albumin-to-creatinine ratio (UACR)
D) Renal ultrasound
