F N P B OAR D PR E P — ST U DY G U I D E
Family Nurse Practitioner
Certification Exam Review
2026 update
250 Questions & ANSWERs for Exam
Readiness
A comprehensive self-study exam covering assessment,
pharmacology, clinical management, and health promotion
across the lifespan. Designed for active recall and board-
style reasoning, this single continuous exam mirrors the
clinical decision-making expected on FNP certification
day.
T O TAL Q U E S T I O N S F O R M AT E
250 Q&A
C L I N I C AL R E VI E W S E R I E S F N P · 250 Q
,FNP CERTIFICATION EXAM REVIEW 250 Open-Ended Questions &
ANSWERs
Certification Examination
250 Open-Ended Questions — Self-Study Edition
Question 1
A 58-year-old African American male presents for a routine physical. His BP
is 148/96 mmHg on two separate visits. What is your diagnosis and what
lifestyle modifications should be initiated?
ANSWER
Stage 2 hypertension. Lifestyle modifications include the DASH diet, sodium
restriction (<1500 mg/day), regular aerobic exercise (≥150 min/week), moderate
alcohol use, and weight loss if BMI ≥25. African American patients have a higher
prevalence of HTN and increased risk of target organ damage, so aggressive
lifestyle modification plus pharmacologic therapy should be started. He should
also be evaluated for end-organ damage including ECG, BMP, urinalysis, and
lipid panel.
Question 2
A 62-year-old female with type 2 diabetes has BP 146/92 mmHg on two
readings. Per current ADA and ACC/AHA guidelines, what is the BP target
and first-line pharmacologic therapy?
ANSWER
Target BP is <130/80 mmHg for patients with diabetes. First-line agents are ACE
inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) because they provide renal
protective effects in diabetic patients. A thiazide diuretic or dihydropyridine CCB
can be added as second-line if target not reached. Monitor renal function and
potassium 1-2 weeks after starting ACE/ARB therapy.
Question 3
Define hypertensive emergency vs. urgency and describe the management of
each.
ANSWER
Hypertensive emergency is severe BP elevation (typically >180/120) WITH acute
end-organ damage (chest pain, neurologic deficits, pulmonary edema, AKI).
Requires IV antihypertensive therapy (labetalol, nicardipine, nitroprusside) in an
ICU, lowering MAP by no more than 25% in the first hour. Hypertensive urgency
is severe BP elevation WITHOUT end-organ damage; managed with oral agents
(labetalol, captopril, clonidine) and close outpatient follow-up within 24-72 hours.
Self-Study Edition 2 Family Nurse Practitioner Board Prep
,FNP CERTIFICATION EXAM REVIEW 250 Open-Ended Questions &
ANSWERs
Question 4
An 80-year-old male presents with isolated systolic hypertension (BP
168/72). What is the recommended treatment and why is diastolic BP a
concern?
ANSWER
First-line treatment is a thiazide diuretic (chlorthalidone) or dihydropyridine CCB
(amlodipine), with a target SBP <130 mmHg if tolerated. Caution is needed
because older adults often have wide pulse pressure and low DBP; DBP <60
mmHg is associated with increased cardiac events (J-curve phenomenon) due to
reduced coronary perfusion. Titrate slowly and monitor for orthostatic
hypotension and dizziness.
Self-Study Edition 3 Family Nurse Practitioner Board Prep
, FNP CERTIFICATION EXAM REVIEW 250 Open-Ended Questions &
ANSWERs
Question 5
A 26-year-old G1P0 at 28 weeks gestation presents with BP 152/98 and 2+
proteinuria. What is the diagnosis, expected workup, and management?
ANSWER
This is preeclampsia, defined as new-onset HTN (>140/90) after 20 weeks with
proteinuria or end-organ dysfunction. Workup includes CBC, CMP, uric acid,
LDH, peripheral smear, and 24-hour urine or protein/creatinine ratio.
Management includes hospital admission, IV magnesium sulfate for seizure
prophylaxis, and antihypertensive therapy with labetalol, hydralazine, or
nifedipine. Definitive treatment is delivery once maternal/fetal status is stabilized
or term is reached.
Question 6
A 55-year-old male with no prior CVD has LDL 165 mg/dL, HDL 38, and a
10-year ASCVD risk of 9%. What is your approach to lipid management?
ANSWER
Calculate ASCVD risk; for borderline risk (5-7.5%) consider statin if risk-
enhancers present, and for intermediate risk (7.5-20%) statin is recommended
after clinician-patient discussion. This patient's LDL ≥190 automatically qualifies
him for high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
regardless of ASCVD score. Recheck lipid panel in 4-12 weeks to assess response
and adherence, and reinforce lifestyle modifications.
Question 7
A 65-year-old male with known CAD reports new-onset chest pressure that
occurs with exertion and resolves with rest, lasting 2-5 minutes. What is the
likely diagnosis, initial workup, and treatment?
ANSWER
Stable angina pectoris due to obstructive CAD. Initial workup includes ECG (look
for ischemic changes, Q waves, or normal tracing), troponin to rule out ACS, and
stress testing or coronary angiography if troponin is negative. Treatment includes
aspirin 81 mg daily, a high-intensity statin, beta-blocker (metoprolol), sublingual
nitroglycerin PRN, and risk factor modification (smoking cessation, BP and
diabetes control).
Question 8
A 58-year-old male presents with crushing substernal chest pain, diaphoresis,
and dyspnea. ECG shows ST elevations in leads II, III, and aVF. What is the
Self-Study Edition 4 Family Nurse Practitioner Board Prep
Family Nurse Practitioner
Certification Exam Review
2026 update
250 Questions & ANSWERs for Exam
Readiness
A comprehensive self-study exam covering assessment,
pharmacology, clinical management, and health promotion
across the lifespan. Designed for active recall and board-
style reasoning, this single continuous exam mirrors the
clinical decision-making expected on FNP certification
day.
T O TAL Q U E S T I O N S F O R M AT E
250 Q&A
C L I N I C AL R E VI E W S E R I E S F N P · 250 Q
,FNP CERTIFICATION EXAM REVIEW 250 Open-Ended Questions &
ANSWERs
Certification Examination
250 Open-Ended Questions — Self-Study Edition
Question 1
A 58-year-old African American male presents for a routine physical. His BP
is 148/96 mmHg on two separate visits. What is your diagnosis and what
lifestyle modifications should be initiated?
ANSWER
Stage 2 hypertension. Lifestyle modifications include the DASH diet, sodium
restriction (<1500 mg/day), regular aerobic exercise (≥150 min/week), moderate
alcohol use, and weight loss if BMI ≥25. African American patients have a higher
prevalence of HTN and increased risk of target organ damage, so aggressive
lifestyle modification plus pharmacologic therapy should be started. He should
also be evaluated for end-organ damage including ECG, BMP, urinalysis, and
lipid panel.
Question 2
A 62-year-old female with type 2 diabetes has BP 146/92 mmHg on two
readings. Per current ADA and ACC/AHA guidelines, what is the BP target
and first-line pharmacologic therapy?
ANSWER
Target BP is <130/80 mmHg for patients with diabetes. First-line agents are ACE
inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) because they provide renal
protective effects in diabetic patients. A thiazide diuretic or dihydropyridine CCB
can be added as second-line if target not reached. Monitor renal function and
potassium 1-2 weeks after starting ACE/ARB therapy.
Question 3
Define hypertensive emergency vs. urgency and describe the management of
each.
ANSWER
Hypertensive emergency is severe BP elevation (typically >180/120) WITH acute
end-organ damage (chest pain, neurologic deficits, pulmonary edema, AKI).
Requires IV antihypertensive therapy (labetalol, nicardipine, nitroprusside) in an
ICU, lowering MAP by no more than 25% in the first hour. Hypertensive urgency
is severe BP elevation WITHOUT end-organ damage; managed with oral agents
(labetalol, captopril, clonidine) and close outpatient follow-up within 24-72 hours.
Self-Study Edition 2 Family Nurse Practitioner Board Prep
,FNP CERTIFICATION EXAM REVIEW 250 Open-Ended Questions &
ANSWERs
Question 4
An 80-year-old male presents with isolated systolic hypertension (BP
168/72). What is the recommended treatment and why is diastolic BP a
concern?
ANSWER
First-line treatment is a thiazide diuretic (chlorthalidone) or dihydropyridine CCB
(amlodipine), with a target SBP <130 mmHg if tolerated. Caution is needed
because older adults often have wide pulse pressure and low DBP; DBP <60
mmHg is associated with increased cardiac events (J-curve phenomenon) due to
reduced coronary perfusion. Titrate slowly and monitor for orthostatic
hypotension and dizziness.
Self-Study Edition 3 Family Nurse Practitioner Board Prep
, FNP CERTIFICATION EXAM REVIEW 250 Open-Ended Questions &
ANSWERs
Question 5
A 26-year-old G1P0 at 28 weeks gestation presents with BP 152/98 and 2+
proteinuria. What is the diagnosis, expected workup, and management?
ANSWER
This is preeclampsia, defined as new-onset HTN (>140/90) after 20 weeks with
proteinuria or end-organ dysfunction. Workup includes CBC, CMP, uric acid,
LDH, peripheral smear, and 24-hour urine or protein/creatinine ratio.
Management includes hospital admission, IV magnesium sulfate for seizure
prophylaxis, and antihypertensive therapy with labetalol, hydralazine, or
nifedipine. Definitive treatment is delivery once maternal/fetal status is stabilized
or term is reached.
Question 6
A 55-year-old male with no prior CVD has LDL 165 mg/dL, HDL 38, and a
10-year ASCVD risk of 9%. What is your approach to lipid management?
ANSWER
Calculate ASCVD risk; for borderline risk (5-7.5%) consider statin if risk-
enhancers present, and for intermediate risk (7.5-20%) statin is recommended
after clinician-patient discussion. This patient's LDL ≥190 automatically qualifies
him for high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
regardless of ASCVD score. Recheck lipid panel in 4-12 weeks to assess response
and adherence, and reinforce lifestyle modifications.
Question 7
A 65-year-old male with known CAD reports new-onset chest pressure that
occurs with exertion and resolves with rest, lasting 2-5 minutes. What is the
likely diagnosis, initial workup, and treatment?
ANSWER
Stable angina pectoris due to obstructive CAD. Initial workup includes ECG (look
for ischemic changes, Q waves, or normal tracing), troponin to rule out ACS, and
stress testing or coronary angiography if troponin is negative. Treatment includes
aspirin 81 mg daily, a high-intensity statin, beta-blocker (metoprolol), sublingual
nitroglycerin PRN, and risk factor modification (smoking cessation, BP and
diabetes control).
Question 8
A 58-year-old male presents with crushing substernal chest pain, diaphoresis,
and dyspnea. ECG shows ST elevations in leads II, III, and aVF. What is the
Self-Study Edition 4 Family Nurse Practitioner Board Prep
