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AANP FNP Certification Exam Bank (2025/2026)
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Practice Examination - 85 Questions 2.25 pt Line width), Bottom: (Shadowed Single solid
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1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and dry skin. Thyroid
function tests show TSH of 8.5 mIU/L (normal 0.4-4.0) and free T4 of 0.6 ng/dL (normal 0.8-1.8). What
is the most appropriate initial management?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 100 mcg daily
C. Liothyronine 25 mcg daily
D. No treatment, recheck in 6 weeks
Answer: A
Rationale: This patient presents with overt hypothyroidism (elevated TSH with low free T4). The
recommended starting dose of levothyroxine for a healthy adult is 1.6 mcg/kg/day, but in patients over
40 or those with cardiac concerns, a lower starting dose of 25-50 mcg daily is recommended to avoid
precipitating angina or arrhythmias. Dose should be titrated upward every 6-8 weeks based on TSH
levels.
2. A 68-year-old male with type 2 diabetes and hypertension presents with a painless, non-healing
ulcer on the plantar surface of his right foot. The ulcer is 2 cm in diameter, has a yellowish base with
minimal surrounding erythema, and probes to bone. Which of the following is the most appropriate
next step?
A. Offloading with a cast boot and topical antibiotic
B. MRI of the foot
C. Surgical debridement in the clinic
D. Start empiric oral antibiotics and refer to wound care
Answer: B
Rationale: A plantar ulcer that probes to bone in a diabetic patient is highly suspicious for osteomyelitis.
MRI is the imaging modality of choice for diagnosing osteomyelitis in the diabetic foot, with sensitivity
and specificity exceeding 90%. Plain radiographs may be normal initially. Bone biopsy remains the gold
standard but is invasive. Empiric antibiotics without culture data are inappropriate until infection is
confirmed and causative organisms identified.
3. Which of the following immunizations is recommended for all adults aged 65 years and older?
A. Pneumococcal conjugate vaccine (PCV20)
B. Pneumococcal polysaccharide vaccine (PPSV23) alone
,C. Influenza vaccine (live attenuated)
D. Herpes zoster vaccine (RZV)
Answer: A
Rationale: The CDC recommends that all adults aged 65 years and older receive a single dose of PCV20 or
PCV15 followed by PPSV23 one year later. PCV20 is preferred for its broader serotype coverage. The live
attenuated influenza vaccine (LAIV) is not recommended for adults 65 and older. Herpes zoster vaccine
(RZV) is recommended for adults 50 and older but is not the primary immunization focus for this age
group.
4. A 32-year-old G2P1 woman at 28 weeks gestation presents with a blood pressure of 148/94 mmHg
on two occasions 4 hours apart. Urine dipstick shows 2+ protein. She reports a headache and
epigastric pain. What is the most appropriate next step?
A. Start labetalol 200 mg PO and send home
B. Admit to hospital for magnesium sulfate and antihypertensive therapy
C. Prescribe methyldopa and schedule a follow-up in 1 week
D. Recommend bed rest at home with daily blood pressure monitoring
Answer: B
Rationale: This patient has preeclampsia with severe features based on blood pressure ≥140/90,
proteinuria, headache, and epigastric pain. She requires immediate hospitalization for administration of
magnesium sulfate for seizure prophylaxis and antihypertensive therapy. Delivery is the definitive
treatment, but gestational age must be considered. Outpatient management with methyldopa or
labetalol may be appropriate for mild preeclampsia without severe features, but this patient has severe
features requiring inpatient management.
5. A 56-year-old male presents with complaints of gradual vision loss in his right eye over the past 3
months. He reports that straight lines appear wavy and objects seem smaller in that eye. He has a
history of hypertension and hyperlipidemia. Fundoscopic examination reveals drusen and pigmentary
changes in the macula. What is the most likely diagnosis?
A. Central retinal vein occlusion
B. Age-related macular degeneration, dry type
C. Diabetic retinopathy
D. Glaucoma
Answer: B
Rationale: The gradual onset of vision loss with metamorphopsia (wavy lines) and micropsia (objects
appearing smaller), along with fundoscopic findings of drusen and pigmentary changes in the macula,
are classic features of dry (non-exudative) age-related macular degeneration. Central retinal vein
occlusion typically presents with sudden, painless vision loss. Diabetic retinopathy would show
microaneurysms, dot-blot hemorrhages, and cotton-wool spots. Glaucoma causes gradual peripheral
vision loss and optic nerve cupping.
,6. A 42-year-old woman presents with a 3-month history of episodic palpitations, sweating, tremors,
and anxiety. During one episode in the office, her heart rate is 145 bpm, blood pressure is 160/90
mmHg, and she appears pale and diaphoretic. What is the most appropriate diagnostic test to confirm
the suspected diagnosis?
A. 24-hour urine collection for metanephrines and catecholamines
B. Serum cortisol level
C. Thyroid function tests
D. Electrocardiogram (ECG)
Answer: A
Rationale: The episodic symptoms of palpitations, sweating, tremors, anxiety, and hypertension suggest
pheochromocytoma, a catecholamine-secreting tumor. The gold standard for diagnosis is measurement
of fractionated plasma-free metanephrines or 24-hour urinary metanephrines and catecholamines.
Serum cortisol would evaluate for Cushing's syndrome. Thyroid function tests would assess for
hyperthyroidism. ECG may show tachycardia but is not diagnostic for the underlying cause.
7. A 28-year-old female presents with a 2-day history of right lower quadrant abdominal pain, nausea,
vomiting, and fever of 101.2°F. On examination, she has rebound tenderness and guarding in the right
lower quadrant. Which of the following is the most appropriate initial imaging study?
A. CT scan of the abdomen and pelvis with IV contrast
B. Ultrasound of the abdomen
C. MRI of the abdomen
D. Plain abdominal X-ray
Answer: A
Rationale: In a young adult with suspected acute appendicitis, CT scan of the abdomen and pelvis with IV
contrast is the most sensitive and specific imaging modality. While ultrasound is often used first in
children and pregnant women to avoid radiation, CT is preferred in non-pregnant adults for its superior
diagnostic accuracy. Plain abdominal X-rays are not sensitive for appendicitis. MRI is less readily
available and more costly.
8. A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough productive
of blood-tinged sputum, weight loss of 15 pounds over 6 months, and hoarseness. Chest X-ray reveals
a left hilar mass. What is the most appropriate initial diagnostic procedure?
A. Sputum cytology
B. Bronchoscopy with biopsy
C. CT-guided transthoracic needle biopsy
D. Positron emission tomography (PET) scan
, Answer: B
Rationale: Bronchoscopy with biopsy is the preferred initial diagnostic procedure for a central hilar mass
suspected to be lung cancer. It allows direct visualization of the lesion and tissue sampling for
histopathological diagnosis. Sputum cytology has low sensitivity. CT-guided biopsy is indicated for
peripheral lesions and carries a risk of pneumothorax. PET scan is useful for staging but does not provide
a tissue diagnosis.
9. A 34-year-old man presents with a 6-month history of progressive weakness in his lower
extremities, difficulty walking, and urinary urgency. Neurological examination reveals spastic
paraparesis, hyperreflexia, and bilateral Babinski signs. What is the most likely diagnosis?
A. Multiple sclerosis
B. Amyotrophic lateral sclerosis
C. Spinal cord compression
D. Guillain-Barré syndrome
Answer: C
Rationale: Progressive spastic paraparesis with sensory findings and urinary symptoms suggests spinal
cord compression. The hyperreflexia and bilateral Babinski signs indicate an upper motor neuron lesion.
Multiple sclerosis typically presents with relapsing-remitting symptoms and may affect multiple CNS
areas. Amyotrophic lateral sclerosis affects both upper and lower motor neurons. Guillain-Barré
syndrome presents with ascending flaccid paralysis and areflexia.
10. A 65-year-old woman with osteoporosis is started on alendronate 70 mg weekly. What is the most
important patient education regarding the administration of this medication?
A. Take with a full glass of water upon awakening, and remain upright for 30 minutes
B. Take with food to minimize gastrointestinal upset
C. Take at bedtime with a light snack
D. Take with orange juice to enhance absorption
Answer: A
Rationale: Alendronate must be taken with a full glass of water upon awakening, and the patient must
remain upright (sitting or standing) for at least 30 minutes to prevent esophageal irritation and
ulceration. Taking with food or other beverages reduces absorption. Bedtime administration increases
the risk of esophageal irritation due to prolonged contact with the esophageal mucosa.
11. A 47-year-old female presents with a 4-month history of joint pain, stiffness, and swelling in her
hands, wrists, and knees. The stiffness is worse in the morning and lasts for over an hour. Laboratory
tests reveal elevated ESR and CRP, and positive rheumatoid factor. What is the most appropriate
initial disease-modifying antirheumatic drug (DMARD) for this patient?
AANP FNP Certification Exam Bank (2025/2026)
Formatted: Centered
Formatted: Top: (Shadowed Single solid line, Auto,
Practice Examination - 85 Questions 2.25 pt Line width), Bottom: (Shadowed Single solid
line, Auto, 2.25 pt Line width), Left: (Shadowed Single
solid line, Auto, 2.25 pt Line width), Right: (Shadowed
Single solid line, Auto, 2.25 pt Line width)
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and dry skin. Thyroid
function tests show TSH of 8.5 mIU/L (normal 0.4-4.0) and free T4 of 0.6 ng/dL (normal 0.8-1.8). What
is the most appropriate initial management?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 100 mcg daily
C. Liothyronine 25 mcg daily
D. No treatment, recheck in 6 weeks
Answer: A
Rationale: This patient presents with overt hypothyroidism (elevated TSH with low free T4). The
recommended starting dose of levothyroxine for a healthy adult is 1.6 mcg/kg/day, but in patients over
40 or those with cardiac concerns, a lower starting dose of 25-50 mcg daily is recommended to avoid
precipitating angina or arrhythmias. Dose should be titrated upward every 6-8 weeks based on TSH
levels.
2. A 68-year-old male with type 2 diabetes and hypertension presents with a painless, non-healing
ulcer on the plantar surface of his right foot. The ulcer is 2 cm in diameter, has a yellowish base with
minimal surrounding erythema, and probes to bone. Which of the following is the most appropriate
next step?
A. Offloading with a cast boot and topical antibiotic
B. MRI of the foot
C. Surgical debridement in the clinic
D. Start empiric oral antibiotics and refer to wound care
Answer: B
Rationale: A plantar ulcer that probes to bone in a diabetic patient is highly suspicious for osteomyelitis.
MRI is the imaging modality of choice for diagnosing osteomyelitis in the diabetic foot, with sensitivity
and specificity exceeding 90%. Plain radiographs may be normal initially. Bone biopsy remains the gold
standard but is invasive. Empiric antibiotics without culture data are inappropriate until infection is
confirmed and causative organisms identified.
3. Which of the following immunizations is recommended for all adults aged 65 years and older?
A. Pneumococcal conjugate vaccine (PCV20)
B. Pneumococcal polysaccharide vaccine (PPSV23) alone
,C. Influenza vaccine (live attenuated)
D. Herpes zoster vaccine (RZV)
Answer: A
Rationale: The CDC recommends that all adults aged 65 years and older receive a single dose of PCV20 or
PCV15 followed by PPSV23 one year later. PCV20 is preferred for its broader serotype coverage. The live
attenuated influenza vaccine (LAIV) is not recommended for adults 65 and older. Herpes zoster vaccine
(RZV) is recommended for adults 50 and older but is not the primary immunization focus for this age
group.
4. A 32-year-old G2P1 woman at 28 weeks gestation presents with a blood pressure of 148/94 mmHg
on two occasions 4 hours apart. Urine dipstick shows 2+ protein. She reports a headache and
epigastric pain. What is the most appropriate next step?
A. Start labetalol 200 mg PO and send home
B. Admit to hospital for magnesium sulfate and antihypertensive therapy
C. Prescribe methyldopa and schedule a follow-up in 1 week
D. Recommend bed rest at home with daily blood pressure monitoring
Answer: B
Rationale: This patient has preeclampsia with severe features based on blood pressure ≥140/90,
proteinuria, headache, and epigastric pain. She requires immediate hospitalization for administration of
magnesium sulfate for seizure prophylaxis and antihypertensive therapy. Delivery is the definitive
treatment, but gestational age must be considered. Outpatient management with methyldopa or
labetalol may be appropriate for mild preeclampsia without severe features, but this patient has severe
features requiring inpatient management.
5. A 56-year-old male presents with complaints of gradual vision loss in his right eye over the past 3
months. He reports that straight lines appear wavy and objects seem smaller in that eye. He has a
history of hypertension and hyperlipidemia. Fundoscopic examination reveals drusen and pigmentary
changes in the macula. What is the most likely diagnosis?
A. Central retinal vein occlusion
B. Age-related macular degeneration, dry type
C. Diabetic retinopathy
D. Glaucoma
Answer: B
Rationale: The gradual onset of vision loss with metamorphopsia (wavy lines) and micropsia (objects
appearing smaller), along with fundoscopic findings of drusen and pigmentary changes in the macula,
are classic features of dry (non-exudative) age-related macular degeneration. Central retinal vein
occlusion typically presents with sudden, painless vision loss. Diabetic retinopathy would show
microaneurysms, dot-blot hemorrhages, and cotton-wool spots. Glaucoma causes gradual peripheral
vision loss and optic nerve cupping.
,6. A 42-year-old woman presents with a 3-month history of episodic palpitations, sweating, tremors,
and anxiety. During one episode in the office, her heart rate is 145 bpm, blood pressure is 160/90
mmHg, and she appears pale and diaphoretic. What is the most appropriate diagnostic test to confirm
the suspected diagnosis?
A. 24-hour urine collection for metanephrines and catecholamines
B. Serum cortisol level
C. Thyroid function tests
D. Electrocardiogram (ECG)
Answer: A
Rationale: The episodic symptoms of palpitations, sweating, tremors, anxiety, and hypertension suggest
pheochromocytoma, a catecholamine-secreting tumor. The gold standard for diagnosis is measurement
of fractionated plasma-free metanephrines or 24-hour urinary metanephrines and catecholamines.
Serum cortisol would evaluate for Cushing's syndrome. Thyroid function tests would assess for
hyperthyroidism. ECG may show tachycardia but is not diagnostic for the underlying cause.
7. A 28-year-old female presents with a 2-day history of right lower quadrant abdominal pain, nausea,
vomiting, and fever of 101.2°F. On examination, she has rebound tenderness and guarding in the right
lower quadrant. Which of the following is the most appropriate initial imaging study?
A. CT scan of the abdomen and pelvis with IV contrast
B. Ultrasound of the abdomen
C. MRI of the abdomen
D. Plain abdominal X-ray
Answer: A
Rationale: In a young adult with suspected acute appendicitis, CT scan of the abdomen and pelvis with IV
contrast is the most sensitive and specific imaging modality. While ultrasound is often used first in
children and pregnant women to avoid radiation, CT is preferred in non-pregnant adults for its superior
diagnostic accuracy. Plain abdominal X-rays are not sensitive for appendicitis. MRI is less readily
available and more costly.
8. A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough productive
of blood-tinged sputum, weight loss of 15 pounds over 6 months, and hoarseness. Chest X-ray reveals
a left hilar mass. What is the most appropriate initial diagnostic procedure?
A. Sputum cytology
B. Bronchoscopy with biopsy
C. CT-guided transthoracic needle biopsy
D. Positron emission tomography (PET) scan
, Answer: B
Rationale: Bronchoscopy with biopsy is the preferred initial diagnostic procedure for a central hilar mass
suspected to be lung cancer. It allows direct visualization of the lesion and tissue sampling for
histopathological diagnosis. Sputum cytology has low sensitivity. CT-guided biopsy is indicated for
peripheral lesions and carries a risk of pneumothorax. PET scan is useful for staging but does not provide
a tissue diagnosis.
9. A 34-year-old man presents with a 6-month history of progressive weakness in his lower
extremities, difficulty walking, and urinary urgency. Neurological examination reveals spastic
paraparesis, hyperreflexia, and bilateral Babinski signs. What is the most likely diagnosis?
A. Multiple sclerosis
B. Amyotrophic lateral sclerosis
C. Spinal cord compression
D. Guillain-Barré syndrome
Answer: C
Rationale: Progressive spastic paraparesis with sensory findings and urinary symptoms suggests spinal
cord compression. The hyperreflexia and bilateral Babinski signs indicate an upper motor neuron lesion.
Multiple sclerosis typically presents with relapsing-remitting symptoms and may affect multiple CNS
areas. Amyotrophic lateral sclerosis affects both upper and lower motor neurons. Guillain-Barré
syndrome presents with ascending flaccid paralysis and areflexia.
10. A 65-year-old woman with osteoporosis is started on alendronate 70 mg weekly. What is the most
important patient education regarding the administration of this medication?
A. Take with a full glass of water upon awakening, and remain upright for 30 minutes
B. Take with food to minimize gastrointestinal upset
C. Take at bedtime with a light snack
D. Take with orange juice to enhance absorption
Answer: A
Rationale: Alendronate must be taken with a full glass of water upon awakening, and the patient must
remain upright (sitting or standing) for at least 30 minutes to prevent esophageal irritation and
ulceration. Taking with food or other beverages reduces absorption. Bedtime administration increases
the risk of esophageal irritation due to prolonged contact with the esophageal mucosa.
11. A 47-year-old female presents with a 4-month history of joint pain, stiffness, and swelling in her
hands, wrists, and knees. The stiffness is worse in the morning and lasts for over an hour. Laboratory
tests reveal elevated ESR and CRP, and positive rheumatoid factor. What is the most appropriate
initial disease-modifying antirheumatic drug (DMARD) for this patient?
