AANP FNP Certification Exam 2026:
200 Practice Questions with Detailed
Rationales
1. A 65-year-old patient with a history of heavy tobacco use undergoes
spirometry. FEV1/FVC ratio is 0.55, FEV1 is 55% predicted, and FVC is
75% predicted. After bronchodilator, FEV1 improves by 10% and 200
mL. Which pattern is most consistent?
A) Reversible obstructive disease with normal diffusing capacity
B) Irreversible obstructive disease with hyperinflation
C) Restrictive lung disease with reduced total lung capacity
D) Mixed obstructive-restrictive pattern
Answer: B
Rationale: FEV1/FVC < 0.70 indicates obstruction. The bronchodilator
response does not meet ATS criteria for significant reversibility (12% and
200 mL), suggesting fixed obstruction typical of COPD. Hyperinflation is
common in COPD. FVC is not low enough to indicate restriction, and
FEV1/FVC ratio points to obstruction .
2. A 58-year-old patient presents with dyspnea on exertion and a
holosystolic murmur at the apex radiating to the axilla.
Echocardiogram shows left atrial enlargement. Which hemodynamic
change is the primary driver of symptoms?
, A) Acute decrease in afterload
B) Left atrial pressure overload from regurgitant volume
C) Pulmonary hypertension
D) Left ventricular outflow tract obstruction
Answer: B
Rationale: The holosystolic murmur at the apex radiating to the axilla is
classic for mitral regurgitation. Regurgitation causes volume overload in the
left atrium, leading to left atrial enlargement and pulmonary congestion,
which drives dyspnea. Pulmonary hypertension is a late complication .
3. A 72-year-old patient with hypertension, depression, and diabetes is
experiencing intermittent confusion. Current medications: aspirin,
lisinopril, atorvastatin, metformin, sertraline, diphenhydramine as
needed for sleep, and acetaminophen as needed for pain. Cognitive
assessment shows no impairment. What is the best action?
A) Discontinue sertraline
B) Increase sertraline
C) Prescribe donepezil
D) Discontinue diphenhydramine
Answer: D
Rationale: Diphenhydramine is an anticholinergic medication that can cause
confusion and cognitive impairment in older adults, especially those with
multiple comorbidities. It is considered potentially inappropriate for elderly
patients. The first step is to discontinue the offending medication before
considering dementia treatment .
,4. A 55-year-old patient with new-onset hypertension and flank pain
has a family history of kidney disease. Urinalysis shows 3+ protein.
What is the next appropriate step?
A) Refer for genetic testing
B) Restrict all dietary protein
C) Repeat urinalysis in 3 months
D) Begin ACE inhibitor therapy
Answer: A
Rationale: The combination of hypertension, proteinuria, and family history
of kidney disease suggests possible polycystic kidney disease or other
hereditary nephropathy. Genetic testing and renal imaging are appropriate
next steps for diagnosis .
5. A patient presents with fever, hemorrhages on nail beds, painful
raised red nodules on fingers, and a rash on palms and soles. Which
diagnosis is most likely?
A) Rheumatoid arthritis
B) Endocarditis
C) Systemic lupus erythematosus
D) Gonococcemia
Answer: B
Rationale: The presentation of fever, nail bed hemorrhages, Osler's nodes
(painful red spots on fingers), and Janeway lesions (rash on palms/soles) is
, classic for infective endocarditis. These are peripheral manifestations of
immune complex deposition and microemboli .
6. A patient with a holosystolic or pansystolic murmur is most likely to
have which condition?
A) Aortic stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Pulmonary stenosis
Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur
best heard at the apex (5th intercostal space, midclavicular line) radiating to
the axilla. Aortic stenosis produces a midsystolic murmur radiating to the
neck .
7. Coarctation of the aorta is characterized by which finding?
A) Bounding pulses in all extremities
B) Bounding radial pulse and weak femoral pulse
C) Weak pulses in upper and lower extremities
D) Equal blood pressure in arms and legs
Answer: B
Rationale: Coarctation of the aorta causes narrowing of the aorta, resulting
in bounding radial pulses (increased blood pressure in arms) and
200 Practice Questions with Detailed
Rationales
1. A 65-year-old patient with a history of heavy tobacco use undergoes
spirometry. FEV1/FVC ratio is 0.55, FEV1 is 55% predicted, and FVC is
75% predicted. After bronchodilator, FEV1 improves by 10% and 200
mL. Which pattern is most consistent?
A) Reversible obstructive disease with normal diffusing capacity
B) Irreversible obstructive disease with hyperinflation
C) Restrictive lung disease with reduced total lung capacity
D) Mixed obstructive-restrictive pattern
Answer: B
Rationale: FEV1/FVC < 0.70 indicates obstruction. The bronchodilator
response does not meet ATS criteria for significant reversibility (12% and
200 mL), suggesting fixed obstruction typical of COPD. Hyperinflation is
common in COPD. FVC is not low enough to indicate restriction, and
FEV1/FVC ratio points to obstruction .
2. A 58-year-old patient presents with dyspnea on exertion and a
holosystolic murmur at the apex radiating to the axilla.
Echocardiogram shows left atrial enlargement. Which hemodynamic
change is the primary driver of symptoms?
, A) Acute decrease in afterload
B) Left atrial pressure overload from regurgitant volume
C) Pulmonary hypertension
D) Left ventricular outflow tract obstruction
Answer: B
Rationale: The holosystolic murmur at the apex radiating to the axilla is
classic for mitral regurgitation. Regurgitation causes volume overload in the
left atrium, leading to left atrial enlargement and pulmonary congestion,
which drives dyspnea. Pulmonary hypertension is a late complication .
3. A 72-year-old patient with hypertension, depression, and diabetes is
experiencing intermittent confusion. Current medications: aspirin,
lisinopril, atorvastatin, metformin, sertraline, diphenhydramine as
needed for sleep, and acetaminophen as needed for pain. Cognitive
assessment shows no impairment. What is the best action?
A) Discontinue sertraline
B) Increase sertraline
C) Prescribe donepezil
D) Discontinue diphenhydramine
Answer: D
Rationale: Diphenhydramine is an anticholinergic medication that can cause
confusion and cognitive impairment in older adults, especially those with
multiple comorbidities. It is considered potentially inappropriate for elderly
patients. The first step is to discontinue the offending medication before
considering dementia treatment .
,4. A 55-year-old patient with new-onset hypertension and flank pain
has a family history of kidney disease. Urinalysis shows 3+ protein.
What is the next appropriate step?
A) Refer for genetic testing
B) Restrict all dietary protein
C) Repeat urinalysis in 3 months
D) Begin ACE inhibitor therapy
Answer: A
Rationale: The combination of hypertension, proteinuria, and family history
of kidney disease suggests possible polycystic kidney disease or other
hereditary nephropathy. Genetic testing and renal imaging are appropriate
next steps for diagnosis .
5. A patient presents with fever, hemorrhages on nail beds, painful
raised red nodules on fingers, and a rash on palms and soles. Which
diagnosis is most likely?
A) Rheumatoid arthritis
B) Endocarditis
C) Systemic lupus erythematosus
D) Gonococcemia
Answer: B
Rationale: The presentation of fever, nail bed hemorrhages, Osler's nodes
(painful red spots on fingers), and Janeway lesions (rash on palms/soles) is
, classic for infective endocarditis. These are peripheral manifestations of
immune complex deposition and microemboli .
6. A patient with a holosystolic or pansystolic murmur is most likely to
have which condition?
A) Aortic stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Pulmonary stenosis
Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur
best heard at the apex (5th intercostal space, midclavicular line) radiating to
the axilla. Aortic stenosis produces a midsystolic murmur radiating to the
neck .
7. Coarctation of the aorta is characterized by which finding?
A) Bounding pulses in all extremities
B) Bounding radial pulse and weak femoral pulse
C) Weak pulses in upper and lower extremities
D) Equal blood pressure in arms and legs
Answer: B
Rationale: Coarctation of the aorta causes narrowing of the aorta, resulting
in bounding radial pulses (increased blood pressure in arms) and
