AANP FNP Certification Exam Bank
(2025/2026)
Practice Examination Questions
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Physical
exam reveals bradycardia and dry skin. Which laboratory finding would be most consistent with this
presentation?
A) Elevated T3 with decreased TSH
B) Decreased T4 with elevated TSH
C) Elevated T4 with decreased TSH
D) Normal T4 with elevated TSH
Answer: B) Decreased T4 with elevated TSH
Rationale: Primary hypothyroidism is characterized by decreased thyroid hormone production (low T4)
with loss of negative feedback inhibition on the pituitary, resulting in elevated TSH. This patient's
symptoms of fatigue, weight gain, cold intolerance, constipation, bradycardia, and dry skin are classic
manifestations of hypothyroidism. Elevated T3 with decreased TSH would suggest hyperthyroidism, while
elevated T4 with decreased TSH suggests Graves' disease.
2. A 68-year-old male with a history of hypertension and type 2 diabetes presents with sudden onset
of right-sided weakness and difficulty speaking. His symptoms began 2 hours ago. Blood pressure is
165/95 mmHg. Which of the following is the most appropriate initial management?
A) Aspirin 325 mg orally
B) IV tissue plasminogen activator (tPA) if no contraindications
C) Heparin drip and admit to ICU
D) Observation with serial neurological exams
Answer: B) IV tissue plasminogen activator (tPA) if no contraindications
Rationale: This patient presents with acute ischemic stroke symptoms within the 4.5-hour window for IV
tPA administration. The National Institute of Neurological Disorders and Stroke (NINDS) criteria support
tPA use in eligible patients presenting within 3 hours, and more recent guidelines extend to 4.5 hours in
select patients. Blood pressure of 165/95 mmHg is acceptable for tPA administration (requires <185/110
mmHg). Aspirin should be delayed for 24 hours after tPA administration. Heparin is not first-line therapy
for acute ischemic stroke.
,3. A 32-year-old pregnant woman at 28 weeks gestation presents with elevated blood pressure
(150/95 mmHg) and proteinuria (2+ on dipstick). She reports headache and visual disturbances. Which
of the following is the most appropriate next step?
A) Start methyldopa and continue outpatient monitoring
B) Admit to hospital for magnesium sulfate and blood pressure management
C) Prescribe labetalol and schedule follow-up in 1 week
D) Recommend bed rest and low-sodium diet
Answer: B) Admit to hospital for magnesium sulfate and blood pressure management
Rationale: This patient meets criteria for severe preeclampsia with blood pressure ≥160/110 mmHg (or in
this case 150/95 with symptoms) and proteinuria with end-organ symptoms (headache, visual
disturbances). Admission for magnesium sulfate seizure prophylaxis and blood pressure control is
indicated. Methyldopa and labetalol are antihypertensives used in pregnancy but outpatient
management is inappropriate given severe features. Bed rest and dietary modifications have not been
shown to prevent progression of preeclampsia.
4. A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough producing
blood-tinged sputum over the past 2 months. He has lost 15 pounds unintentionally. Chest X-ray
reveals a right hilar mass. Which of the following diagnostic tests would provide the definitive
diagnosis?
A) CT scan of the chest with contrast
B) PET-CT scan
C) Bronchoscopy with biopsy
D) Sputum cytology
Answer: C) Bronchoscopy with biopsy
Rationale: Bronchoscopy with tissue biopsy provides histologic diagnosis, which is the gold standard for
confirming lung cancer. While CT and PET-CT scans are important for staging and assessing extent of
disease, they cannot definitively diagnose malignancy. Sputum cytology has low sensitivity and cannot
provide definitive diagnosis. Tissue sampling is essential for confirming malignancy and determining
histologic type, which guides treatment decisions.
5. A 28-year-old female presents with palpitations, heat intolerance, and weight loss despite
increased appetite. On examination, she has tachycardia, fine tremor, and a diffusely enlarged thyroid
gland. Which of the following is the most likely diagnosis?
A) Hashimoto's thyroiditis
B) Graves' disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
Answer: B) Graves' disease
,Rationale: Graves' disease is the most common cause of hyperthyroidism in young women and is
characterized by diffuse goiter, tachycardia, heat intolerance, weight loss, and fine tremor. Hashimoto's
thyroiditis typically causes hypothyroidism, not hyperthyroidism. Subacute thyroiditis typically presents
with painful thyroid and follows a viral illness. Toxic multinodular goiter is more common in older
patients and presents with palpable nodules.
6. A 62-year-old female with osteoporosis presents for follow-up. She has been taking alendronate 70
mg weekly for 3 years. Which of the following findings on routine monitoring is most concerning?
A) Serum calcium 9.5 mg/dL (normal 8.5-10.2)
B) Serum creatinine 1.0 mg/dL (normal 0.6-1.2)
C) Alkaline phosphatase 120 U/L (normal 44-147)
D) Severe thigh pain with weight-bearing
Answer: D) Severe thigh pain with weight-bearing
Rationale: Severe thigh or groin pain with weight-bearing in a patient on bisphosphonate therapy should
raise concern for atypical femoral fractures. This is a rare but serious complication associated with long-
term bisphosphonate use. Patients should be evaluated with imaging to rule out impending or completed
fracture. Serum calcium, creatinine, and alkaline phosphatase are not specific for this complication.
7. A 45-year-old male with a history of alcoholism presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is most likely responsible for this presentation?
A) Vitamin B12
B) Vitamin B1 (Thiamine)
C) Vitamin B6 (Pyridoxine)
D) Vitamin B3 (Niacin)
Answer: B) Vitamin B1 (Thiamine)
Rationale: Wernicke's encephalopathy, characterized by the classic triad of confusion, ataxia, and
ophthalmoplegia, is caused by thiamine (vitamin B1) deficiency. This condition is commonly seen in
patients with chronic alcoholism due to poor nutritional intake and impaired absorption. Prompt
administration of thiamine is critical to prevent progression to Korsakoff syndrome. Vitamin B12
deficiency causes subacute combined degeneration with sensory ataxia and myelopathy. Niacin
deficiency causes pellagra (dermatitis, diarrhea, dementia).
8. A 72-year-old male with benign prostatic hyperplasia presents with acute onset of inability to void
for 12 hours. On examination, he has a palpable distended bladder and suprapubic tenderness. What
is the most appropriate initial management?
A) Alpha-blocker therapy and outpatient follow-up
B) Antibiotics and observation
, C) Placement of a Foley catheter
D) 5-alpha-reductase inhibitor therapy
Answer: C) Placement of a Foley catheter
Rationale: Acute urinary retention in patients with BPH requires immediate bladder decompression with
a Foley catheter. This relieves patient discomfort, prevents bladder damage, and allows for
measurement of post-void residual volume. Alpha-blockers and 5-alpha-reductase inhibitors are long-
term management options but do not provide immediate relief in acute retention. Antibiotics are not
indicated unless there are signs of urinary tract infection.
9. A 58-year-old female with a history of coronary artery disease presents with palpitations and
lightheadedness. ECG shows a narrow complex tachycardia with irregularly irregular rhythm and no
discernible P waves. Which of the following is the most likely diagnosis?
A) Atrial flutter
B) Atrial fibrillation
C) Multifocal atrial tachycardia
D) Sinus tachycardia
Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm, narrow QRS complexes,
and absent P waves on ECG. The atria contract at a very rapid rate (300-600/min) with irregular
ventricular response. This patient with underlying coronary artery disease is at increased risk for
thromboembolic events related to atrial fibrillation. Rate control and anticoagulation are important
management considerations. Atrial flutter typically shows a "sawtooth" pattern and regular or regularly
irregular rhythm. Sinus tachycardia has regular rhythm with identifiable P waves.
10. A 35-year-old male presents with acute-onset severe right lower quadrant abdominal pain,
nausea, and fever. On examination, he has rebound tenderness and guarding in the right lower
quadrant. Which of the following is the most appropriate next step?
A) Outpatient oral antibiotics and follow-up
B) CT scan of the abdomen and pelvis
C) Observation for 24 hours
D) Immediate surgical consultation
Answer: D) Immediate surgical consultation
Rationale: This patient presents with signs and symptoms consistent with acute appendicitis, including
right lower quadrant pain, rebound tenderness, guarding, nausea, and fever. Given the acute surgical
abdomen presentation, immediate surgical consultation is the most appropriate next step. While CT scan
may confirm the diagnosis, it should not delay surgical consultation in a patient with peritonitis.
Observation is inappropriate in patients with signs of peritoneal irritation.
(2025/2026)
Practice Examination Questions
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. Physical
exam reveals bradycardia and dry skin. Which laboratory finding would be most consistent with this
presentation?
A) Elevated T3 with decreased TSH
B) Decreased T4 with elevated TSH
C) Elevated T4 with decreased TSH
D) Normal T4 with elevated TSH
Answer: B) Decreased T4 with elevated TSH
Rationale: Primary hypothyroidism is characterized by decreased thyroid hormone production (low T4)
with loss of negative feedback inhibition on the pituitary, resulting in elevated TSH. This patient's
symptoms of fatigue, weight gain, cold intolerance, constipation, bradycardia, and dry skin are classic
manifestations of hypothyroidism. Elevated T3 with decreased TSH would suggest hyperthyroidism, while
elevated T4 with decreased TSH suggests Graves' disease.
2. A 68-year-old male with a history of hypertension and type 2 diabetes presents with sudden onset
of right-sided weakness and difficulty speaking. His symptoms began 2 hours ago. Blood pressure is
165/95 mmHg. Which of the following is the most appropriate initial management?
A) Aspirin 325 mg orally
B) IV tissue plasminogen activator (tPA) if no contraindications
C) Heparin drip and admit to ICU
D) Observation with serial neurological exams
Answer: B) IV tissue plasminogen activator (tPA) if no contraindications
Rationale: This patient presents with acute ischemic stroke symptoms within the 4.5-hour window for IV
tPA administration. The National Institute of Neurological Disorders and Stroke (NINDS) criteria support
tPA use in eligible patients presenting within 3 hours, and more recent guidelines extend to 4.5 hours in
select patients. Blood pressure of 165/95 mmHg is acceptable for tPA administration (requires <185/110
mmHg). Aspirin should be delayed for 24 hours after tPA administration. Heparin is not first-line therapy
for acute ischemic stroke.
,3. A 32-year-old pregnant woman at 28 weeks gestation presents with elevated blood pressure
(150/95 mmHg) and proteinuria (2+ on dipstick). She reports headache and visual disturbances. Which
of the following is the most appropriate next step?
A) Start methyldopa and continue outpatient monitoring
B) Admit to hospital for magnesium sulfate and blood pressure management
C) Prescribe labetalol and schedule follow-up in 1 week
D) Recommend bed rest and low-sodium diet
Answer: B) Admit to hospital for magnesium sulfate and blood pressure management
Rationale: This patient meets criteria for severe preeclampsia with blood pressure ≥160/110 mmHg (or in
this case 150/95 with symptoms) and proteinuria with end-organ symptoms (headache, visual
disturbances). Admission for magnesium sulfate seizure prophylaxis and blood pressure control is
indicated. Methyldopa and labetalol are antihypertensives used in pregnancy but outpatient
management is inappropriate given severe features. Bed rest and dietary modifications have not been
shown to prevent progression of preeclampsia.
4. A 55-year-old male with a 30-pack-year smoking history presents with a chronic cough producing
blood-tinged sputum over the past 2 months. He has lost 15 pounds unintentionally. Chest X-ray
reveals a right hilar mass. Which of the following diagnostic tests would provide the definitive
diagnosis?
A) CT scan of the chest with contrast
B) PET-CT scan
C) Bronchoscopy with biopsy
D) Sputum cytology
Answer: C) Bronchoscopy with biopsy
Rationale: Bronchoscopy with tissue biopsy provides histologic diagnosis, which is the gold standard for
confirming lung cancer. While CT and PET-CT scans are important for staging and assessing extent of
disease, they cannot definitively diagnose malignancy. Sputum cytology has low sensitivity and cannot
provide definitive diagnosis. Tissue sampling is essential for confirming malignancy and determining
histologic type, which guides treatment decisions.
5. A 28-year-old female presents with palpitations, heat intolerance, and weight loss despite
increased appetite. On examination, she has tachycardia, fine tremor, and a diffusely enlarged thyroid
gland. Which of the following is the most likely diagnosis?
A) Hashimoto's thyroiditis
B) Graves' disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
Answer: B) Graves' disease
,Rationale: Graves' disease is the most common cause of hyperthyroidism in young women and is
characterized by diffuse goiter, tachycardia, heat intolerance, weight loss, and fine tremor. Hashimoto's
thyroiditis typically causes hypothyroidism, not hyperthyroidism. Subacute thyroiditis typically presents
with painful thyroid and follows a viral illness. Toxic multinodular goiter is more common in older
patients and presents with palpable nodules.
6. A 62-year-old female with osteoporosis presents for follow-up. She has been taking alendronate 70
mg weekly for 3 years. Which of the following findings on routine monitoring is most concerning?
A) Serum calcium 9.5 mg/dL (normal 8.5-10.2)
B) Serum creatinine 1.0 mg/dL (normal 0.6-1.2)
C) Alkaline phosphatase 120 U/L (normal 44-147)
D) Severe thigh pain with weight-bearing
Answer: D) Severe thigh pain with weight-bearing
Rationale: Severe thigh or groin pain with weight-bearing in a patient on bisphosphonate therapy should
raise concern for atypical femoral fractures. This is a rare but serious complication associated with long-
term bisphosphonate use. Patients should be evaluated with imaging to rule out impending or completed
fracture. Serum calcium, creatinine, and alkaline phosphatase are not specific for this complication.
7. A 45-year-old male with a history of alcoholism presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is most likely responsible for this presentation?
A) Vitamin B12
B) Vitamin B1 (Thiamine)
C) Vitamin B6 (Pyridoxine)
D) Vitamin B3 (Niacin)
Answer: B) Vitamin B1 (Thiamine)
Rationale: Wernicke's encephalopathy, characterized by the classic triad of confusion, ataxia, and
ophthalmoplegia, is caused by thiamine (vitamin B1) deficiency. This condition is commonly seen in
patients with chronic alcoholism due to poor nutritional intake and impaired absorption. Prompt
administration of thiamine is critical to prevent progression to Korsakoff syndrome. Vitamin B12
deficiency causes subacute combined degeneration with sensory ataxia and myelopathy. Niacin
deficiency causes pellagra (dermatitis, diarrhea, dementia).
8. A 72-year-old male with benign prostatic hyperplasia presents with acute onset of inability to void
for 12 hours. On examination, he has a palpable distended bladder and suprapubic tenderness. What
is the most appropriate initial management?
A) Alpha-blocker therapy and outpatient follow-up
B) Antibiotics and observation
, C) Placement of a Foley catheter
D) 5-alpha-reductase inhibitor therapy
Answer: C) Placement of a Foley catheter
Rationale: Acute urinary retention in patients with BPH requires immediate bladder decompression with
a Foley catheter. This relieves patient discomfort, prevents bladder damage, and allows for
measurement of post-void residual volume. Alpha-blockers and 5-alpha-reductase inhibitors are long-
term management options but do not provide immediate relief in acute retention. Antibiotics are not
indicated unless there are signs of urinary tract infection.
9. A 58-year-old female with a history of coronary artery disease presents with palpitations and
lightheadedness. ECG shows a narrow complex tachycardia with irregularly irregular rhythm and no
discernible P waves. Which of the following is the most likely diagnosis?
A) Atrial flutter
B) Atrial fibrillation
C) Multifocal atrial tachycardia
D) Sinus tachycardia
Answer: B) Atrial fibrillation
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm, narrow QRS complexes,
and absent P waves on ECG. The atria contract at a very rapid rate (300-600/min) with irregular
ventricular response. This patient with underlying coronary artery disease is at increased risk for
thromboembolic events related to atrial fibrillation. Rate control and anticoagulation are important
management considerations. Atrial flutter typically shows a "sawtooth" pattern and regular or regularly
irregular rhythm. Sinus tachycardia has regular rhythm with identifiable P waves.
10. A 35-year-old male presents with acute-onset severe right lower quadrant abdominal pain,
nausea, and fever. On examination, he has rebound tenderness and guarding in the right lower
quadrant. Which of the following is the most appropriate next step?
A) Outpatient oral antibiotics and follow-up
B) CT scan of the abdomen and pelvis
C) Observation for 24 hours
D) Immediate surgical consultation
Answer: D) Immediate surgical consultation
Rationale: This patient presents with signs and symptoms consistent with acute appendicitis, including
right lower quadrant pain, rebound tenderness, guarding, nausea, and fever. Given the acute surgical
abdomen presentation, immediate surgical consultation is the most appropriate next step. While CT scan
may confirm the diagnosis, it should not delay surgical consultation in a patient with peritonitis.
Observation is inappropriate in patients with signs of peritoneal irritation.
