AANP FNP CERTIFICATION EXAM 2025/2026 – 250+
VERIFIED PRACTICE QUESTIONS & ANSWERS |
FULL FAMILY NURSE PRACTITIONER BOARD
A 23-year-old man is brought to the emergency department after being found
obtunded on the street. The history suggests that he may have ingested 180 mg
of his friend's methadone during a suicide attempt. On arrival he has a Glasgow
Coma Scale (GCS) score of 6, with hypoactive bowel sounds and pinpoint pupils.
His initial vital signs are temperature 36C, heart rate 56/min, blood pressure
103/70 mm Hg, respiratory rate 6, and oxygen saturation 84% on room air. Blood
glucose is 4.6 mmol/L. Initially, his ventilation was supported through bag-valve-
mask (BVM) apparatus but after three doses of 0.4 mg IV naloxone there is
improvement in his respiratory effort. He is transferred to the ICU. What is the
most appropriate management?
A. Intubation for airway protection
B. Naloxone boluses as needed plus activated charcoal
C. Naloxone infusion at 0.4 mg/h
D. Naloxone infusion at 0.8 mg/h - ANS -The correct answer is D.
Rationale: This patient's presentation is consistent with opioid toxicity.
Immediate resuscitation and administration of antidotal therapy are the most
important initial steps in management. Given the hypoxia and bradypnea,
supplemental oxygen without assisted ventilation is of minimal benefit. As a
disease of hypoventilation, opioid toxicity requires ventilation. This is achieved
through BVM and administration of opioid antagonists. Methadone is a long-
acting opioid, with expected clinical toxicity to last beyond 24 hours. The proper
dosing of a naloxone infusion per hour is 2/3 the dose required to adequately
reverse the patient. This patient responded to 1.2 mg IV naloxone, so the infusion
dose should start at 0.8 mg/h (choice D is correct). If naloxone was not available,
intubation would be an option, but there is no need to do so at this time (choice A
,is incorrect). Methadone is a liquid product with rapid absorption, so activated
charcoal would be of no benefit and potentially harmful as the fluctuating level of
consciousness may result in aspiration, and lower doses of naloxone would be
insufficient (choices B and C are incorrect).
A 48-year-old woman is brought in after being found unconscious in a house fire.
She was intubated in the emergency department and transferred to the ICU for
further management. She received 2L IV Ringer lactate and is now on a
norepinephrine infusion. Her Glasgow Coma Scale (GCS) score has remained at 3
since arrival. Her vitals are temperature 37.2 C, HR 120/min, BP 70/50 mm Hg,
respiratory rate 18 set by ventilator, and oxygen saturation 95% on 100% FiO2.
Blood glucose is 8.5 mmol/L. Initial laboratory testing reveals pH 6.98,
pCO2 34 mm Hg, bicarbonate 6 mmol/L, and lactate 17 mmol/L. What is the most
appropriate next step in management?
A. Dantrolene
B. Hydroxocobalamin
C. Hyperbaric oxygenation
D. Methylene Blue - ANS -The correct answer is B.
Rationale: This clinical presentation is highly suggestive of cyanide toxicity.
Patients with hyperlactatemia after a fire should be assumed to have inhaled
cyanide. Obtundation, hypotension, and tachycardia all support the diagnosis.
Treatment of cyanide toxicity is prompt administration of hydroxocobalamin
(choice B is correct). Dantrolene would be used in patients with significant
hyperthermia and muscle rigidity secondary to malignant hyperthermia (choice A
is incorrect). Carbon monoxide toxicity is also a concern after a fire, and a
carboxyhemoglobin level should certainly be obtained. However, given the
elevated lactate and hemodynamic instability, management of suspected cyanide
takes precedence over transfer to a hyperbaric chamber for carbon monoxide
toxicity (choice C is incorrect). Methylene blue is therapy for methemoglobinemia
(choice D is incorrect).
,A 38-year-old man is admitted to the ICU after being intubated for severe
agitation. He was brought to the emergency department after being detained at
an international airport for aggressive behavior. He required prehospital sedation
with intramuscular midazolam to facilitate transport. On arrival, his vital signs
were temperature 40.2 C, HR 165/min, BP 180/100 mm Hg, respiratory rate 24,
and oxygen saturation 96% on room air. Blood glucose 10.5 mmol/L
(189 mg/dL). He was intubated using rocuronium and was started on a propofol
infusion at 4 mg/kg/hr. Vitals signs have not significantly changed. What is the
most appropriate management?
A. Active cooling
B. Active cooling, increased sedation
C. Active cooling, increased sedation, and β-blockade
D. Active cooling, increased sedation, and paralysis - ANS -The correct answer is D.
Rationale: This patient's presentation is consistent with significant toxicity
from sympathomimetic agents (such as cocaine or amphetamines). His most
immediate life-threatening problem is his hyperthermia, and goal is to cool the
patient, which will be facilitated by a neuromuscular blocker (choice D is correct).
Cooling with sedation alone are insufficient (choices A and B are incorrect) and β-
Blockade is not indicated (choice C is incorrect). Sympathomimetic toxicity is a
centrally driven disease (symptoms are due to an increase in excitation in the
central nervous system). β-Blockade does not address this, as it only targets the
peripheral symptoms of that centrally mediated process. Furthermore, β-blockers
pharmacologically result in unopposed alpha stimulation, though the clinical
significance of this has been recently debated.
A 24-year-old woman presents 45 minutes after an intentional ingestion of
approximately 25 g of acetaminophen (APAP). She denies any other ingestions.
Her vital signs are heart rate 80 beats/min, blood pressure 128/62 mm Hg,
respiratory rate of 18/min, temperature of 37 °C, and oxygen saturation 99% on
, room air. Her physical examination is normal except for tearfulness. What is the
most appropriate next step in management?
A. Give activated charcoal
B. Give intravenous N-acetylcysteine (NAC) therapy
C Measure serum APAP level
D. Obtain ECG - ANS -The correct answer is A.
Rationale: This is a significant ingestion, and activated charcoal is indicated
as it has been less than 2 hours since ingestion (choice A is correct). There is no
indication or benefit to immediate treatment with oral or intravenous NAC at less
than 1 hour post ingestion (choice B is incorrect). While an APAP blood
concentration is needed, obtaining one within an hour is neither necessary nor
helpful (choice C is incorrect). An ECG is indicated after all intentional ingestions,
but at the time of presentation oral activated charcoal is of greater benefit than
an ECG (choice D is not the best answer). Not listed here as a choice, but in the
absence of severe liver injury or other prognostic factors that predict need for
liver transplantation, there is also no indication to transfer to a transplantation
center.
A 35-year-old man presents 5 hours after an overdose. He admits to ingesting
only atenolol and diphenhydramine (doses unknown). His vital signs are heart
rate 88 beats/min, blood pressure 134/72 mm Hg, respiratory rate of 20/min,
temperature of 36.8 °C, and oxygen saturation 99% on room air. Other than a
depressed sensorium, his physical examination is unremarkable. What is the most
appropriate next step in management?
A. Check serum acetaminophen (APAP) level
B. Give 2 mg physostigmine
C. Give 5 mg of IV glucagon
D. Monitor and consult psychiatry - ANS -The correct answer is A.
Rationale: Even if a patient denies having ingested APAP, every patient
VERIFIED PRACTICE QUESTIONS & ANSWERS |
FULL FAMILY NURSE PRACTITIONER BOARD
A 23-year-old man is brought to the emergency department after being found
obtunded on the street. The history suggests that he may have ingested 180 mg
of his friend's methadone during a suicide attempt. On arrival he has a Glasgow
Coma Scale (GCS) score of 6, with hypoactive bowel sounds and pinpoint pupils.
His initial vital signs are temperature 36C, heart rate 56/min, blood pressure
103/70 mm Hg, respiratory rate 6, and oxygen saturation 84% on room air. Blood
glucose is 4.6 mmol/L. Initially, his ventilation was supported through bag-valve-
mask (BVM) apparatus but after three doses of 0.4 mg IV naloxone there is
improvement in his respiratory effort. He is transferred to the ICU. What is the
most appropriate management?
A. Intubation for airway protection
B. Naloxone boluses as needed plus activated charcoal
C. Naloxone infusion at 0.4 mg/h
D. Naloxone infusion at 0.8 mg/h - ANS -The correct answer is D.
Rationale: This patient's presentation is consistent with opioid toxicity.
Immediate resuscitation and administration of antidotal therapy are the most
important initial steps in management. Given the hypoxia and bradypnea,
supplemental oxygen without assisted ventilation is of minimal benefit. As a
disease of hypoventilation, opioid toxicity requires ventilation. This is achieved
through BVM and administration of opioid antagonists. Methadone is a long-
acting opioid, with expected clinical toxicity to last beyond 24 hours. The proper
dosing of a naloxone infusion per hour is 2/3 the dose required to adequately
reverse the patient. This patient responded to 1.2 mg IV naloxone, so the infusion
dose should start at 0.8 mg/h (choice D is correct). If naloxone was not available,
intubation would be an option, but there is no need to do so at this time (choice A
,is incorrect). Methadone is a liquid product with rapid absorption, so activated
charcoal would be of no benefit and potentially harmful as the fluctuating level of
consciousness may result in aspiration, and lower doses of naloxone would be
insufficient (choices B and C are incorrect).
A 48-year-old woman is brought in after being found unconscious in a house fire.
She was intubated in the emergency department and transferred to the ICU for
further management. She received 2L IV Ringer lactate and is now on a
norepinephrine infusion. Her Glasgow Coma Scale (GCS) score has remained at 3
since arrival. Her vitals are temperature 37.2 C, HR 120/min, BP 70/50 mm Hg,
respiratory rate 18 set by ventilator, and oxygen saturation 95% on 100% FiO2.
Blood glucose is 8.5 mmol/L. Initial laboratory testing reveals pH 6.98,
pCO2 34 mm Hg, bicarbonate 6 mmol/L, and lactate 17 mmol/L. What is the most
appropriate next step in management?
A. Dantrolene
B. Hydroxocobalamin
C. Hyperbaric oxygenation
D. Methylene Blue - ANS -The correct answer is B.
Rationale: This clinical presentation is highly suggestive of cyanide toxicity.
Patients with hyperlactatemia after a fire should be assumed to have inhaled
cyanide. Obtundation, hypotension, and tachycardia all support the diagnosis.
Treatment of cyanide toxicity is prompt administration of hydroxocobalamin
(choice B is correct). Dantrolene would be used in patients with significant
hyperthermia and muscle rigidity secondary to malignant hyperthermia (choice A
is incorrect). Carbon monoxide toxicity is also a concern after a fire, and a
carboxyhemoglobin level should certainly be obtained. However, given the
elevated lactate and hemodynamic instability, management of suspected cyanide
takes precedence over transfer to a hyperbaric chamber for carbon monoxide
toxicity (choice C is incorrect). Methylene blue is therapy for methemoglobinemia
(choice D is incorrect).
,A 38-year-old man is admitted to the ICU after being intubated for severe
agitation. He was brought to the emergency department after being detained at
an international airport for aggressive behavior. He required prehospital sedation
with intramuscular midazolam to facilitate transport. On arrival, his vital signs
were temperature 40.2 C, HR 165/min, BP 180/100 mm Hg, respiratory rate 24,
and oxygen saturation 96% on room air. Blood glucose 10.5 mmol/L
(189 mg/dL). He was intubated using rocuronium and was started on a propofol
infusion at 4 mg/kg/hr. Vitals signs have not significantly changed. What is the
most appropriate management?
A. Active cooling
B. Active cooling, increased sedation
C. Active cooling, increased sedation, and β-blockade
D. Active cooling, increased sedation, and paralysis - ANS -The correct answer is D.
Rationale: This patient's presentation is consistent with significant toxicity
from sympathomimetic agents (such as cocaine or amphetamines). His most
immediate life-threatening problem is his hyperthermia, and goal is to cool the
patient, which will be facilitated by a neuromuscular blocker (choice D is correct).
Cooling with sedation alone are insufficient (choices A and B are incorrect) and β-
Blockade is not indicated (choice C is incorrect). Sympathomimetic toxicity is a
centrally driven disease (symptoms are due to an increase in excitation in the
central nervous system). β-Blockade does not address this, as it only targets the
peripheral symptoms of that centrally mediated process. Furthermore, β-blockers
pharmacologically result in unopposed alpha stimulation, though the clinical
significance of this has been recently debated.
A 24-year-old woman presents 45 minutes after an intentional ingestion of
approximately 25 g of acetaminophen (APAP). She denies any other ingestions.
Her vital signs are heart rate 80 beats/min, blood pressure 128/62 mm Hg,
respiratory rate of 18/min, temperature of 37 °C, and oxygen saturation 99% on
, room air. Her physical examination is normal except for tearfulness. What is the
most appropriate next step in management?
A. Give activated charcoal
B. Give intravenous N-acetylcysteine (NAC) therapy
C Measure serum APAP level
D. Obtain ECG - ANS -The correct answer is A.
Rationale: This is a significant ingestion, and activated charcoal is indicated
as it has been less than 2 hours since ingestion (choice A is correct). There is no
indication or benefit to immediate treatment with oral or intravenous NAC at less
than 1 hour post ingestion (choice B is incorrect). While an APAP blood
concentration is needed, obtaining one within an hour is neither necessary nor
helpful (choice C is incorrect). An ECG is indicated after all intentional ingestions,
but at the time of presentation oral activated charcoal is of greater benefit than
an ECG (choice D is not the best answer). Not listed here as a choice, but in the
absence of severe liver injury or other prognostic factors that predict need for
liver transplantation, there is also no indication to transfer to a transplantation
center.
A 35-year-old man presents 5 hours after an overdose. He admits to ingesting
only atenolol and diphenhydramine (doses unknown). His vital signs are heart
rate 88 beats/min, blood pressure 134/72 mm Hg, respiratory rate of 20/min,
temperature of 36.8 °C, and oxygen saturation 99% on room air. Other than a
depressed sensorium, his physical examination is unremarkable. What is the most
appropriate next step in management?
A. Check serum acetaminophen (APAP) level
B. Give 2 mg physostigmine
C. Give 5 mg of IV glucagon
D. Monitor and consult psychiatry - ANS -The correct answer is A.
Rationale: Even if a patient denies having ingested APAP, every patient
