FNP Certification Exam by AANPCB New 2025
Versions with All 150 Questions with 100%
Correct Answers and Rationales
Question 1
A 45-year-old male presents with unilateral knee pain and swelling after a fall. What is the most
likely diagnosis?
A) Osteoarthritis
B) Meniscal tear
C) Gout
D) Rheumatoid arthritis
Correct Answer: B) Meniscal tear
Rationale: Acute unilateral knee pain and swelling post-trauma suggest a meniscal tear.
Osteoarthritis is chronic, gout involves crystals (often with redness), and rheumatoid arthritis is
bilateral and systemic.
Question 2
What is the first-line treatment for a 20-year-old with mild persistent asthma?
A) Albuterol PRN
B) Inhaled corticosteroid (ICS)
C) Montelukast
D) Long-acting beta-agonist (LABA)
Correct Answer: B) Inhaled corticosteroid (ICS)
Rationale: GINA guidelines recommend low-dose ICS as first-line for mild persistent asthma to
control inflammation. Albuterol is rescue only, montelukast is an alternative, and LABAs are
adjunctive.
Question 3
A 55-year-old female with type 2 diabetes has a blood pressure of 145/90 mmHg. What is the
most appropriate initial medication?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Chlorthalidone
Correct Answer: A) Lisinopril
Rationale: ACE inhibitors like lisinopril are first-line in diabetes with hypertension due to renal
protection (ADA guidelines). The others are options but lack the same renoprotective benefit.
Question 4
Which finding in a newborn requires immediate evaluation?
A) Jaundice on day 3
B) Heart rate of 180 bpm
C) Single palmar crease
,D) Umbilical hernia
Correct Answer: B) Heart rate of 180 bpm
Rationale: A heart rate > 160 bpm at rest in a newborn suggests tachycardia (e.g., SVT),
requiring urgent evaluation. Jaundice on day 3 is physiologic, and the others are benign or
screened later.
Question 5
A 30-year-old male reports a painless penile ulcer. What is the most likely diagnosis?
A) Herpes simplex
B) Syphilis
C) Chancroid
D) Gonorrhea
Correct Answer: B) Syphilis
Rationale: A painless ulcer (chancre) is classic for primary syphilis (Treponema pallidum).
Herpes is painful, chancroid is painful with ragged edges, and gonorrhea causes discharge, not
ulcers.
Question 6
What is the recommended screening age to begin mammography in average-risk women?
A) 40
B) 45
C) 50
D) 55
Correct Answer: C) 50
Rationale: The USPSTF recommends biennial mammography starting at age 50 for average-risk
women. ACS suggests 45, but AANPCB aligns with USPSTF for certification purposes.
Question 7
A 65-year-old male with COPD presents with dyspnea and fever. What is the most appropriate
initial antibiotic?
A) Amoxicillin
B) Azithromycin
C) Levofloxacin
D) Doxycycline
Correct Answer: C) Levofloxacin
Rationale: Fluoroquinolones like levofloxacin are preferred for COPD exacerbations with
infection due to broader coverage (S. pneumoniae, H. influenzae). Azithromycin and
doxycycline are alternatives, and amoxicillin is too narrow.
Question 8
Which lab result confirms hyperthyroidism in a 40-year-old female with palpitations?
A) TSH 0.2 mIU/L, Free T4 2.5 ng/dL
B) TSH 5.0 mIU/L, Free T4 0.8 ng/dL
C) TSH 1.5 mIU/L, Free T4 1.0 ng/dL
D) TSH 0.5 mIU/L, Free T4 0.9 ng/dL
Correct Answer: A) TSH 0.2 mIU/L, Free T4 2.5 ng/dL
,Rationale: Low TSH and high Free T4 indicate hyperthyroidism (e.g., Graves’ disease). High
TSH/low T4 is hypothyroidism, and normal ranges rule out thyroid dysfunction.
Question 9
A 25-year-old female reports fatigue and heavy menstrual bleeding. What is the most likely
cause?
A) Iron-deficiency anemia
B) Vitamin B12 deficiency
C) Hypothyroidism
D) Chronic fatigue syndrome
Correct Answer: A) Iron-deficiency anemia
Rationale: Heavy menses and fatigue suggest iron-deficiency anemia due to blood loss. B12
deficiency involves neuropathy, hypothyroidism lacks bleeding, and CFS is a diagnosis of
exclusion.
Question 10
What is the most appropriate management for a 12-year-old with a first unprovoked seizure?
A) Start levetiracetam
B) Order an EEG and MRI
C) Prescribe lorazepam PRN
D) Reassure and discharge
Correct Answer: B) Order an EEG and MRI
Rationale: A first unprovoked seizure requires EEG and MRI to evaluate etiology (AAN
guidelines). Medication isn’t started until recurrence, and reassurance alone skips necessary
workup.
Question 11
A 50-year-old male with dyslipidemia has an LDL of 150 mg/dL. What is the most appropriate
initial treatment?
A) Atorvastatin
B) Niacin
C) Fenofibrate
D) Omega-3 fatty acids
Correct Answer: A) Atorvastatin
Rationale: Statins like atorvastatin are first-line for elevated LDL per ACC/AHA guidelines due
to cardiovascular risk reduction. Others target triglycerides or have less evidence.
Question 12
Which condition is a contraindication to live vaccines?
A) Diabetes mellitus
B) HIV with CD4 < 200
C) Hypertension
D) Asthma
Correct Answer: B) HIV with CD4 < 200
Rationale: Severe immunosuppression (e.g., HIV with CD4 < 200) contraindicates live vaccines
(e.g., MMR, varicella) due to infection risk (CDC). Chronic conditions like diabetes or asthma
, do not.
Question 13
A 35-year-old female reports unilateral breast pain and a lump. What is the next step?
A) Reassure and follow up in 6 months
B) Order a diagnostic mammogram and ultrasound
C) Prescribe antibiotics
D) Refer for biopsy immediately
Correct Answer: B) Order a diagnostic mammogram and ultrasound
Rationale: A lump with pain warrants imaging (mammogram and ultrasound) to rule out
malignancy or cyst. Antibiotics are for infection, and biopsy or reassurance waits on imaging
results.
Question 14
What is the most common cause of acute pancreatitis?
A) Alcohol use
B) Gallstones
C) Hypertriglyceridemia
D) Medications
Correct Answer: B) Gallstones
Rationale: Gallstones are the leading cause of acute pancreatitis (40–70% of cases), obstructing
the pancreatic duct. Alcohol is second, followed by triglycerides and drugs.
Question 15
A 6-month-old has a fever of 102°F and no clear source. What is the next step?
A) Order a urine culture
B) Prescribe amoxicillin
C) Reassure and monitor
D) Refer to the ER
Correct Answer: A) Order a urine culture
Rationale: Fever without source in infants < 36 months requires evaluation for occult UTI
(common in this age). Antibiotics await results, and ER referral depends on severity.
Question 16
Which finding suggests tension headache in a 30-year-old female?
A) Unilateral throbbing pain
B) Bilateral band-like pressure
C) Pain worse with light
D) Nausea and vomiting
Correct Answer: B) Bilateral band-like pressure
Rationale: Tension headaches feature bilateral, tight, band-like pain. Unilateral throbbing,
photophobia, and nausea suggest migraine.
Question 17
A 70-year-old female reports urinary incontinence with coughing. What is the most likely
diagnosis?
Versions with All 150 Questions with 100%
Correct Answers and Rationales
Question 1
A 45-year-old male presents with unilateral knee pain and swelling after a fall. What is the most
likely diagnosis?
A) Osteoarthritis
B) Meniscal tear
C) Gout
D) Rheumatoid arthritis
Correct Answer: B) Meniscal tear
Rationale: Acute unilateral knee pain and swelling post-trauma suggest a meniscal tear.
Osteoarthritis is chronic, gout involves crystals (often with redness), and rheumatoid arthritis is
bilateral and systemic.
Question 2
What is the first-line treatment for a 20-year-old with mild persistent asthma?
A) Albuterol PRN
B) Inhaled corticosteroid (ICS)
C) Montelukast
D) Long-acting beta-agonist (LABA)
Correct Answer: B) Inhaled corticosteroid (ICS)
Rationale: GINA guidelines recommend low-dose ICS as first-line for mild persistent asthma to
control inflammation. Albuterol is rescue only, montelukast is an alternative, and LABAs are
adjunctive.
Question 3
A 55-year-old female with type 2 diabetes has a blood pressure of 145/90 mmHg. What is the
most appropriate initial medication?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Chlorthalidone
Correct Answer: A) Lisinopril
Rationale: ACE inhibitors like lisinopril are first-line in diabetes with hypertension due to renal
protection (ADA guidelines). The others are options but lack the same renoprotective benefit.
Question 4
Which finding in a newborn requires immediate evaluation?
A) Jaundice on day 3
B) Heart rate of 180 bpm
C) Single palmar crease
,D) Umbilical hernia
Correct Answer: B) Heart rate of 180 bpm
Rationale: A heart rate > 160 bpm at rest in a newborn suggests tachycardia (e.g., SVT),
requiring urgent evaluation. Jaundice on day 3 is physiologic, and the others are benign or
screened later.
Question 5
A 30-year-old male reports a painless penile ulcer. What is the most likely diagnosis?
A) Herpes simplex
B) Syphilis
C) Chancroid
D) Gonorrhea
Correct Answer: B) Syphilis
Rationale: A painless ulcer (chancre) is classic for primary syphilis (Treponema pallidum).
Herpes is painful, chancroid is painful with ragged edges, and gonorrhea causes discharge, not
ulcers.
Question 6
What is the recommended screening age to begin mammography in average-risk women?
A) 40
B) 45
C) 50
D) 55
Correct Answer: C) 50
Rationale: The USPSTF recommends biennial mammography starting at age 50 for average-risk
women. ACS suggests 45, but AANPCB aligns with USPSTF for certification purposes.
Question 7
A 65-year-old male with COPD presents with dyspnea and fever. What is the most appropriate
initial antibiotic?
A) Amoxicillin
B) Azithromycin
C) Levofloxacin
D) Doxycycline
Correct Answer: C) Levofloxacin
Rationale: Fluoroquinolones like levofloxacin are preferred for COPD exacerbations with
infection due to broader coverage (S. pneumoniae, H. influenzae). Azithromycin and
doxycycline are alternatives, and amoxicillin is too narrow.
Question 8
Which lab result confirms hyperthyroidism in a 40-year-old female with palpitations?
A) TSH 0.2 mIU/L, Free T4 2.5 ng/dL
B) TSH 5.0 mIU/L, Free T4 0.8 ng/dL
C) TSH 1.5 mIU/L, Free T4 1.0 ng/dL
D) TSH 0.5 mIU/L, Free T4 0.9 ng/dL
Correct Answer: A) TSH 0.2 mIU/L, Free T4 2.5 ng/dL
,Rationale: Low TSH and high Free T4 indicate hyperthyroidism (e.g., Graves’ disease). High
TSH/low T4 is hypothyroidism, and normal ranges rule out thyroid dysfunction.
Question 9
A 25-year-old female reports fatigue and heavy menstrual bleeding. What is the most likely
cause?
A) Iron-deficiency anemia
B) Vitamin B12 deficiency
C) Hypothyroidism
D) Chronic fatigue syndrome
Correct Answer: A) Iron-deficiency anemia
Rationale: Heavy menses and fatigue suggest iron-deficiency anemia due to blood loss. B12
deficiency involves neuropathy, hypothyroidism lacks bleeding, and CFS is a diagnosis of
exclusion.
Question 10
What is the most appropriate management for a 12-year-old with a first unprovoked seizure?
A) Start levetiracetam
B) Order an EEG and MRI
C) Prescribe lorazepam PRN
D) Reassure and discharge
Correct Answer: B) Order an EEG and MRI
Rationale: A first unprovoked seizure requires EEG and MRI to evaluate etiology (AAN
guidelines). Medication isn’t started until recurrence, and reassurance alone skips necessary
workup.
Question 11
A 50-year-old male with dyslipidemia has an LDL of 150 mg/dL. What is the most appropriate
initial treatment?
A) Atorvastatin
B) Niacin
C) Fenofibrate
D) Omega-3 fatty acids
Correct Answer: A) Atorvastatin
Rationale: Statins like atorvastatin are first-line for elevated LDL per ACC/AHA guidelines due
to cardiovascular risk reduction. Others target triglycerides or have less evidence.
Question 12
Which condition is a contraindication to live vaccines?
A) Diabetes mellitus
B) HIV with CD4 < 200
C) Hypertension
D) Asthma
Correct Answer: B) HIV with CD4 < 200
Rationale: Severe immunosuppression (e.g., HIV with CD4 < 200) contraindicates live vaccines
(e.g., MMR, varicella) due to infection risk (CDC). Chronic conditions like diabetes or asthma
, do not.
Question 13
A 35-year-old female reports unilateral breast pain and a lump. What is the next step?
A) Reassure and follow up in 6 months
B) Order a diagnostic mammogram and ultrasound
C) Prescribe antibiotics
D) Refer for biopsy immediately
Correct Answer: B) Order a diagnostic mammogram and ultrasound
Rationale: A lump with pain warrants imaging (mammogram and ultrasound) to rule out
malignancy or cyst. Antibiotics are for infection, and biopsy or reassurance waits on imaging
results.
Question 14
What is the most common cause of acute pancreatitis?
A) Alcohol use
B) Gallstones
C) Hypertriglyceridemia
D) Medications
Correct Answer: B) Gallstones
Rationale: Gallstones are the leading cause of acute pancreatitis (40–70% of cases), obstructing
the pancreatic duct. Alcohol is second, followed by triglycerides and drugs.
Question 15
A 6-month-old has a fever of 102°F and no clear source. What is the next step?
A) Order a urine culture
B) Prescribe amoxicillin
C) Reassure and monitor
D) Refer to the ER
Correct Answer: A) Order a urine culture
Rationale: Fever without source in infants < 36 months requires evaluation for occult UTI
(common in this age). Antibiotics await results, and ER referral depends on severity.
Question 16
Which finding suggests tension headache in a 30-year-old female?
A) Unilateral throbbing pain
B) Bilateral band-like pressure
C) Pain worse with light
D) Nausea and vomiting
Correct Answer: B) Bilateral band-like pressure
Rationale: Tension headaches feature bilateral, tight, band-like pain. Unilateral throbbing,
photophobia, and nausea suggest migraine.
Question 17
A 70-year-old female reports urinary incontinence with coughing. What is the most likely
diagnosis?
