NP Certification Practice Exam
120 Original Practice Questions with Answers & Rationales
1. According to current USPSTF guidelines, at what age should average-risk
adults begin colorectal cancer screening?
A. 40 years
B. 45 years
C. 50 years
D. 55 years
Correct Answer: B
Rationale: The USPSTF lowered the recommended starting age for average-risk
colorectal cancer screening to 45 years due to rising incidence in younger adults.
Screening continues through age 75, with individualized decisions from 76-85.
2. A healthy 66-year-old with no prior pneumococcal vaccination presents for
routine care. Which vaccination strategy is currently recommended?
A. PPSV23 alone
B. A single dose of PCV20
C. PCV13 followed by PPSV23 in one year
D. No pneumococcal vaccine is indicated at this age
Correct Answer: B
Rationale: Current ACIP guidance allows a single dose of PCV20 (or PCV15 followed
by PPSV23 at least one year later) for adults ≥65 with no prior pneumococcal
vaccination, simplifying the previous two-vaccine sequential regimen.
,3. A pregnant patient at 30 weeks gestation asks about the Tdap vaccine. What is
the appropriate recommendation?
A. Tdap is contraindicated during pregnancy
B. Tdap should be given between 27-36 weeks of every pregnancy
C. Tdap is only needed if the patient was never vaccinated as a child
D. Tdap should be deferred until the postpartum period
Correct Answer: B
Rationale: Tdap is recommended during every pregnancy, ideally between 27 and 36
weeks gestation, to maximize passive antibody transfer to the newborn for protection
against pertussis before the infant can be vaccinated.
4. A one-time abdominal aortic aneurysm screening ultrasound is recommended
by the USPSTF for which patient?
A. A 70-year-old woman who has never smoked
B. A 68-year-old man who has ever smoked
C. A 50-year-old man with hypertension
D. A 55-year-old woman with a family history of AAA
Correct Answer: B
Rationale: The USPSTF recommends one-time AAA screening with ultrasound in men
aged 65-75 who have ever smoked, as this population has the highest prevalence of
clinically significant aneurysms.
5. A 60-year-old postmenopausal woman with no additional risk factors asks
when she should have bone density (DEXA) screening. What is the correct
answer?
A. Screening should begin now at age 60
B. Screening should begin at age 65
C. Screening is not indicated unless she has a fracture
D. Screening should begin at age 70
Correct Answer: B
Rationale: USPSTF recommends osteoporosis screening in women ≥65 years old.
Screening may begin earlier in postmenopausal women under 65 only if their
estimated fracture risk (via FRAX) is equal to or greater than that of a 65-year-old white
woman.
,6. Which patient meets USPSTF criteria for annual low-dose CT lung cancer
screening?
A. A 45-year-old with a 15 pack-year history who quit 5 years ago
B. A 55-year-old current smoker with a 20 pack-year history
C. A 60-year-old former smoker with a 10 pack-year history who quit 20 years ago
D. A 52-year-old lifetime nonsmoker with occupational asbestos exposure
Correct Answer: B
Rationale: Current guidelines recommend annual low-dose CT screening for adults
age 50-80 with at least a 20 pack-year smoking history who currently smoke or quit
within the past 15 years.
7. A 26-year-old woman with a normal Pap smear history is due for cervical
cancer screening. What is the appropriate interval and method at her age?
A. HPV co-testing every 5 years
B. Cytology alone every 3 years
C. HPV testing alone every 3 years
D. No further screening needed until age 30
Correct Answer: B
Rationale: For women aged 21-29, cytology (Pap smear) alone every 3 years is
recommended. HPV co-testing or primary HPV testing is preferred starting at age 30
because high-risk HPV infection is common and often transient in younger women.
8. Which statement about statin therapy for primary prevention of
atherosclerotic cardiovascular disease (ASCVD) is most accurate?
A. Statins should be started in all adults over age 40 regardless of risk
B. Statin initiation should be guided by a calculated 10-year ASCVD risk score in
adults 40-75
C. Statins are only indicated after a cardiovascular event has occurred
D. LDL level alone determines whether to initiate statin therapy
Correct Answer: B
Rationale: Primary prevention statin therapy decisions in adults aged 40-75 should be
guided by the pooled cohort equations to estimate 10-year ASCVD risk, combined with
a shared decision-making discussion, rather than age or LDL level alone.
, 9. A 45-year-old patient with no depressive symptoms asks whether depression
screening is necessary at this visit. What is the best response?
A. Screening is only needed if the patient reports symptoms
B. Universal screening for depression is recommended for all adults regardless of
symptoms
C. Depression screening is only recommended in postpartum women
D. Screening should be reserved for patients with chronic disease
Correct Answer: B
Rationale: The USPSTF recommends universal screening for depression in the
general adult population, using a validated tool such as the PHQ-2 or PHQ-9, with
systems in place to ensure accurate diagnosis, treatment, and follow-up.
10. Which is the most appropriate first-line intervention for an obese adult (BMI
32) with no comorbidities?
A. Immediate referral for bariatric surgery
B. Intensive, multicomponent behavioral counseling on diet and physical activity
C. Initiation of pharmacotherapy without behavioral intervention
D. No intervention needed until BMI exceeds 35
Correct Answer: B
Rationale: The USPSTF recommends offering or referring adults with obesity to
intensive, multicomponent behavioral interventions as first-line management;
pharmacotherapy and surgery are considered for higher BMI or when behavioral
measures are insufficient.
11. A patient started on lisinopril develops a persistent dry cough. What is the
most likely mechanism?
A. Direct bronchospasm from beta-blockade
B. Accumulation of bradykinin in the airways
C. Allergic reaction requiring immediate epinephrine
D. Hyperkalemia-induced airway irritation
Correct Answer: B
Rationale: ACE inhibitors block the breakdown of bradykinin, and its accumulation in
the respiratory tract is thought to cause the characteristic dry, nonproductive cough
seen in up to 20% of patients; switching to an ARB is the typical management.
120 Original Practice Questions with Answers & Rationales
1. According to current USPSTF guidelines, at what age should average-risk
adults begin colorectal cancer screening?
A. 40 years
B. 45 years
C. 50 years
D. 55 years
Correct Answer: B
Rationale: The USPSTF lowered the recommended starting age for average-risk
colorectal cancer screening to 45 years due to rising incidence in younger adults.
Screening continues through age 75, with individualized decisions from 76-85.
2. A healthy 66-year-old with no prior pneumococcal vaccination presents for
routine care. Which vaccination strategy is currently recommended?
A. PPSV23 alone
B. A single dose of PCV20
C. PCV13 followed by PPSV23 in one year
D. No pneumococcal vaccine is indicated at this age
Correct Answer: B
Rationale: Current ACIP guidance allows a single dose of PCV20 (or PCV15 followed
by PPSV23 at least one year later) for adults ≥65 with no prior pneumococcal
vaccination, simplifying the previous two-vaccine sequential regimen.
,3. A pregnant patient at 30 weeks gestation asks about the Tdap vaccine. What is
the appropriate recommendation?
A. Tdap is contraindicated during pregnancy
B. Tdap should be given between 27-36 weeks of every pregnancy
C. Tdap is only needed if the patient was never vaccinated as a child
D. Tdap should be deferred until the postpartum period
Correct Answer: B
Rationale: Tdap is recommended during every pregnancy, ideally between 27 and 36
weeks gestation, to maximize passive antibody transfer to the newborn for protection
against pertussis before the infant can be vaccinated.
4. A one-time abdominal aortic aneurysm screening ultrasound is recommended
by the USPSTF for which patient?
A. A 70-year-old woman who has never smoked
B. A 68-year-old man who has ever smoked
C. A 50-year-old man with hypertension
D. A 55-year-old woman with a family history of AAA
Correct Answer: B
Rationale: The USPSTF recommends one-time AAA screening with ultrasound in men
aged 65-75 who have ever smoked, as this population has the highest prevalence of
clinically significant aneurysms.
5. A 60-year-old postmenopausal woman with no additional risk factors asks
when she should have bone density (DEXA) screening. What is the correct
answer?
A. Screening should begin now at age 60
B. Screening should begin at age 65
C. Screening is not indicated unless she has a fracture
D. Screening should begin at age 70
Correct Answer: B
Rationale: USPSTF recommends osteoporosis screening in women ≥65 years old.
Screening may begin earlier in postmenopausal women under 65 only if their
estimated fracture risk (via FRAX) is equal to or greater than that of a 65-year-old white
woman.
,6. Which patient meets USPSTF criteria for annual low-dose CT lung cancer
screening?
A. A 45-year-old with a 15 pack-year history who quit 5 years ago
B. A 55-year-old current smoker with a 20 pack-year history
C. A 60-year-old former smoker with a 10 pack-year history who quit 20 years ago
D. A 52-year-old lifetime nonsmoker with occupational asbestos exposure
Correct Answer: B
Rationale: Current guidelines recommend annual low-dose CT screening for adults
age 50-80 with at least a 20 pack-year smoking history who currently smoke or quit
within the past 15 years.
7. A 26-year-old woman with a normal Pap smear history is due for cervical
cancer screening. What is the appropriate interval and method at her age?
A. HPV co-testing every 5 years
B. Cytology alone every 3 years
C. HPV testing alone every 3 years
D. No further screening needed until age 30
Correct Answer: B
Rationale: For women aged 21-29, cytology (Pap smear) alone every 3 years is
recommended. HPV co-testing or primary HPV testing is preferred starting at age 30
because high-risk HPV infection is common and often transient in younger women.
8. Which statement about statin therapy for primary prevention of
atherosclerotic cardiovascular disease (ASCVD) is most accurate?
A. Statins should be started in all adults over age 40 regardless of risk
B. Statin initiation should be guided by a calculated 10-year ASCVD risk score in
adults 40-75
C. Statins are only indicated after a cardiovascular event has occurred
D. LDL level alone determines whether to initiate statin therapy
Correct Answer: B
Rationale: Primary prevention statin therapy decisions in adults aged 40-75 should be
guided by the pooled cohort equations to estimate 10-year ASCVD risk, combined with
a shared decision-making discussion, rather than age or LDL level alone.
, 9. A 45-year-old patient with no depressive symptoms asks whether depression
screening is necessary at this visit. What is the best response?
A. Screening is only needed if the patient reports symptoms
B. Universal screening for depression is recommended for all adults regardless of
symptoms
C. Depression screening is only recommended in postpartum women
D. Screening should be reserved for patients with chronic disease
Correct Answer: B
Rationale: The USPSTF recommends universal screening for depression in the
general adult population, using a validated tool such as the PHQ-2 or PHQ-9, with
systems in place to ensure accurate diagnosis, treatment, and follow-up.
10. Which is the most appropriate first-line intervention for an obese adult (BMI
32) with no comorbidities?
A. Immediate referral for bariatric surgery
B. Intensive, multicomponent behavioral counseling on diet and physical activity
C. Initiation of pharmacotherapy without behavioral intervention
D. No intervention needed until BMI exceeds 35
Correct Answer: B
Rationale: The USPSTF recommends offering or referring adults with obesity to
intensive, multicomponent behavioral interventions as first-line management;
pharmacotherapy and surgery are considered for higher BMI or when behavioral
measures are insufficient.
11. A patient started on lisinopril develops a persistent dry cough. What is the
most likely mechanism?
A. Direct bronchospasm from beta-blockade
B. Accumulation of bradykinin in the airways
C. Allergic reaction requiring immediate epinephrine
D. Hyperkalemia-induced airway irritation
Correct Answer: B
Rationale: ACE inhibitors block the breakdown of bradykinin, and its accumulation in
the respiratory tract is thought to cause the characteristic dry, nonproductive cough
seen in up to 20% of patients; switching to an ARB is the typical management.
