AANP FNP Certification Exam Practice
Questions 100 questions and answers +
rationales already graded A+
Exam Overview
The AANP FNP certification exam consists of 150 questions, with 135 scored items and 15
pretest questions that do not count toward your score. You have 3 hours to complete the exam.
The exam is divided into four content domains:
Domain Number of Items Percentage
Assess 43 32%
Diagnose 36 26.5%
Plan 36 26.5%
Evaluate 20 15%
Domain 1: Assess (Questions 1-32)
1. A 58-year-old male presents for a routine physical. He has a history of hypertension and
smokes one pack of cigarettes per day. He reports no current complaints. According to the
USPSTF guidelines, which screening recommendation is appropriate?
1
, A) Screening for abdominal aortic aneurysm (AAA) with ultrasonography, performed once
B) Annual screening for lung cancer with low-dose computed tomography (LDCT)
C) Screening for carotid artery stenosis with duplex ultrasound
D) Screening for coronary artery disease with an exercise stress test
Answer: B
Rationale: The USPSTF recommends annual LDCT screening for lung cancer in adults aged 50-80
years who have a 20 pack-year smoking history and currently smoke or have quit within the past
15 years. This patient meets the age and pack-year criteria (1 pack/day × years smoking = 20+
pack-years). AAA screening (Choice A) is recommended for men aged 65-75 who have ever
smoked. Screening for carotid artery stenosis (Choice C) and CAD with stress testing (Choice D)
are not recommended for asymptomatic individuals at average risk.
2. A 72-year-old female is brought in by her daughter who is concerned about memory loss.
The patient scores a 25 on the Montreal Cognitive Assessment (MoCA). What is the most
appropriate next step?
A) Diagnose the patient with Mild Cognitive Impairment (MCI) and schedule a follow-up in 6
months
B) Order a CT scan of the head to rule out a mass lesion
C) Perform a functional assessment, including the patient's ability to manage finances and
medications
D) Refer the patient immediately to a neurologist for a definitive diagnosis
Answer: C
Rationale: A score of 25 on the MoCA is below the normal threshold (typically 26), indicating
possible cognitive impairment. Before making a diagnosis or ordering expensive imaging, it is
essential to assess functional status. The diagnosis of dementia requires a decline in both
cognitive function and the ability to perform daily activities (functional impairment). Imaging
(Choice B) is not the first step without focal neurological signs. Referral (Choice D) is appropriate
but not the immediate next step without more data.
3. A 35-year-old woman presents with fatigue and cold intolerance. On physical exam, her
thyroid gland is diffusely enlarged, firm, and nontender. Which laboratory finding would be
most consistent with Hashimoto's thyroiditis?
2
, A) Elevated T3 with suppressed TSH
B) Elevated TSH with low free T4 and positive anti-thyroid peroxidase antibodies
C) Normal TSH with elevated T4
D) Low TSH with elevated T4 and T3
Answer: B
Rationale: Hashimoto's thyroiditis is an autoimmune disorder characterized by lymphocytic
infiltration of the thyroid gland. The classic presentation includes fatigue, cold intolerance,
weight gain, and a diffuse, firm, nontender goiter. Laboratory findings show elevated TSH (due
to primary hypothyroidism), low free T4, and positive anti-thyroid peroxidase (TPO) antibodies.
Choice A describes hyperthyroidism (Graves' disease). Choice C is inconsistent with the
presentation. Choice D describes hyperthyroidism.
4. A 6-month-old infant is brought to the clinic for a well-child visit. The mother reports that
the infant has been exclusively breastfed since birth. Which supplement should the nurse
practitioner recommend?
A) Iron supplementation
B) Vitamin D supplementation
C) Fluoride supplementation
D) Vitamin B12 supplementation
Answer: B
Rationale: The American Academy of Pediatrics recommends vitamin D supplementation (400
IU/day) for all breastfed infants starting shortly after birth, as breast milk contains insufficient
vitamin D. Iron supplementation (Choice A) is typically recommended starting at 4-6 months for
breastfed infants, but vitamin D is the more immediate concern at this visit. Fluoride
supplementation (Choice C) depends on water fluoridation levels and is not routinely
recommended at this age. Vitamin B12 supplementation (Choice D) is only needed if the
mother is B12 deficient.
5. A 45-year-old man with a 10-year history of type 2 diabetes presents for a routine follow-
up. His HbA1c is 8.2%. He reports adherence to metformin 1000 mg BID. Which of the
following is the most appropriate next step in management?
A) Add a GLP-1 receptor agonist
B) Add insulin glargine
3
, C) Add a DPP-4 inhibitor
D) Increase metformin to 2000 mg BID
Answer: A
Rationale: For a patient with type 2 diabetes who is not at goal (HbA1c <7%) on metformin
monotherapy, the ADA recommends adding a second agent. GLP-1 receptor agonists (Choice A)
are preferred due to their favorable cardiovascular and weight loss benefits. Insulin glargine
(Choice B) is an option but typically reserved for more advanced disease or when HbA1c is
significantly elevated. DPP-4 inhibitors (Choice C) are less potent than GLP-1 agonists.
Metformin (Choice D) should not be increased beyond 2000 mg total daily dose (usually 1000
mg BID is the maximum).
6. A 16-year-old female presents with a 3-day history of sore throat, fever, and headache. On
exam, she has tonsillar exudates, palatal petechiae, and tender anterior cervical
lymphadenopathy. No cough is present. What is the most appropriate diagnostic test?
A) Throat culture
B) Rapid antigen detection test (RADT) for group A Streptococcus
C) Monospot test
D) Complete blood count
Answer: B
Rationale: This patient has a high probability of streptococcal pharyngitis based on the Centor
criteria (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough).
The rapid antigen detection test (RADT) is the recommended initial test due to its high
specificity and rapid results. A throat culture (Choice A) is the gold standard but takes 24-48
hours; it is typically reserved for negative RADT in children and adolescents. Monospot (Choice
C) is for infectious mononucleosis, which is less likely given the exudates and petechiae.
7. A 68-year-old woman with a history of osteoporosis is started on alendronate. Which
instruction should be included in patient education?
A) Take the medication with food to reduce gastrointestinal upset
B) Take the medication first thing in the morning with a full glass of water and remain upright
for 30 minutes
C) Take the medication at bedtime to promote bone remodeling during sleep
D) Take the medication with calcium supplements to enhance absorption
4
Questions 100 questions and answers +
rationales already graded A+
Exam Overview
The AANP FNP certification exam consists of 150 questions, with 135 scored items and 15
pretest questions that do not count toward your score. You have 3 hours to complete the exam.
The exam is divided into four content domains:
Domain Number of Items Percentage
Assess 43 32%
Diagnose 36 26.5%
Plan 36 26.5%
Evaluate 20 15%
Domain 1: Assess (Questions 1-32)
1. A 58-year-old male presents for a routine physical. He has a history of hypertension and
smokes one pack of cigarettes per day. He reports no current complaints. According to the
USPSTF guidelines, which screening recommendation is appropriate?
1
, A) Screening for abdominal aortic aneurysm (AAA) with ultrasonography, performed once
B) Annual screening for lung cancer with low-dose computed tomography (LDCT)
C) Screening for carotid artery stenosis with duplex ultrasound
D) Screening for coronary artery disease with an exercise stress test
Answer: B
Rationale: The USPSTF recommends annual LDCT screening for lung cancer in adults aged 50-80
years who have a 20 pack-year smoking history and currently smoke or have quit within the past
15 years. This patient meets the age and pack-year criteria (1 pack/day × years smoking = 20+
pack-years). AAA screening (Choice A) is recommended for men aged 65-75 who have ever
smoked. Screening for carotid artery stenosis (Choice C) and CAD with stress testing (Choice D)
are not recommended for asymptomatic individuals at average risk.
2. A 72-year-old female is brought in by her daughter who is concerned about memory loss.
The patient scores a 25 on the Montreal Cognitive Assessment (MoCA). What is the most
appropriate next step?
A) Diagnose the patient with Mild Cognitive Impairment (MCI) and schedule a follow-up in 6
months
B) Order a CT scan of the head to rule out a mass lesion
C) Perform a functional assessment, including the patient's ability to manage finances and
medications
D) Refer the patient immediately to a neurologist for a definitive diagnosis
Answer: C
Rationale: A score of 25 on the MoCA is below the normal threshold (typically 26), indicating
possible cognitive impairment. Before making a diagnosis or ordering expensive imaging, it is
essential to assess functional status. The diagnosis of dementia requires a decline in both
cognitive function and the ability to perform daily activities (functional impairment). Imaging
(Choice B) is not the first step without focal neurological signs. Referral (Choice D) is appropriate
but not the immediate next step without more data.
3. A 35-year-old woman presents with fatigue and cold intolerance. On physical exam, her
thyroid gland is diffusely enlarged, firm, and nontender. Which laboratory finding would be
most consistent with Hashimoto's thyroiditis?
2
, A) Elevated T3 with suppressed TSH
B) Elevated TSH with low free T4 and positive anti-thyroid peroxidase antibodies
C) Normal TSH with elevated T4
D) Low TSH with elevated T4 and T3
Answer: B
Rationale: Hashimoto's thyroiditis is an autoimmune disorder characterized by lymphocytic
infiltration of the thyroid gland. The classic presentation includes fatigue, cold intolerance,
weight gain, and a diffuse, firm, nontender goiter. Laboratory findings show elevated TSH (due
to primary hypothyroidism), low free T4, and positive anti-thyroid peroxidase (TPO) antibodies.
Choice A describes hyperthyroidism (Graves' disease). Choice C is inconsistent with the
presentation. Choice D describes hyperthyroidism.
4. A 6-month-old infant is brought to the clinic for a well-child visit. The mother reports that
the infant has been exclusively breastfed since birth. Which supplement should the nurse
practitioner recommend?
A) Iron supplementation
B) Vitamin D supplementation
C) Fluoride supplementation
D) Vitamin B12 supplementation
Answer: B
Rationale: The American Academy of Pediatrics recommends vitamin D supplementation (400
IU/day) for all breastfed infants starting shortly after birth, as breast milk contains insufficient
vitamin D. Iron supplementation (Choice A) is typically recommended starting at 4-6 months for
breastfed infants, but vitamin D is the more immediate concern at this visit. Fluoride
supplementation (Choice C) depends on water fluoridation levels and is not routinely
recommended at this age. Vitamin B12 supplementation (Choice D) is only needed if the
mother is B12 deficient.
5. A 45-year-old man with a 10-year history of type 2 diabetes presents for a routine follow-
up. His HbA1c is 8.2%. He reports adherence to metformin 1000 mg BID. Which of the
following is the most appropriate next step in management?
A) Add a GLP-1 receptor agonist
B) Add insulin glargine
3
, C) Add a DPP-4 inhibitor
D) Increase metformin to 2000 mg BID
Answer: A
Rationale: For a patient with type 2 diabetes who is not at goal (HbA1c <7%) on metformin
monotherapy, the ADA recommends adding a second agent. GLP-1 receptor agonists (Choice A)
are preferred due to their favorable cardiovascular and weight loss benefits. Insulin glargine
(Choice B) is an option but typically reserved for more advanced disease or when HbA1c is
significantly elevated. DPP-4 inhibitors (Choice C) are less potent than GLP-1 agonists.
Metformin (Choice D) should not be increased beyond 2000 mg total daily dose (usually 1000
mg BID is the maximum).
6. A 16-year-old female presents with a 3-day history of sore throat, fever, and headache. On
exam, she has tonsillar exudates, palatal petechiae, and tender anterior cervical
lymphadenopathy. No cough is present. What is the most appropriate diagnostic test?
A) Throat culture
B) Rapid antigen detection test (RADT) for group A Streptococcus
C) Monospot test
D) Complete blood count
Answer: B
Rationale: This patient has a high probability of streptococcal pharyngitis based on the Centor
criteria (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough).
The rapid antigen detection test (RADT) is the recommended initial test due to its high
specificity and rapid results. A throat culture (Choice A) is the gold standard but takes 24-48
hours; it is typically reserved for negative RADT in children and adolescents. Monospot (Choice
C) is for infectious mononucleosis, which is less likely given the exudates and petechiae.
7. A 68-year-old woman with a history of osteoporosis is started on alendronate. Which
instruction should be included in patient education?
A) Take the medication with food to reduce gastrointestinal upset
B) Take the medication first thing in the morning with a full glass of water and remain upright
for 30 minutes
C) Take the medication at bedtime to promote bone remodeling during sleep
D) Take the medication with calcium supplements to enhance absorption
4
