NU 577 / AANP EXAM PEARLS:
COMPREHENSIVE PRACTICE EXAM 150
QUESTIONS wITH VERIfIEd ANSwERS &
dETAILEd RATIONALES LATTEST
VERSIONS ALREAdY GRAdEd A+
EXAM INSTRUCTIONS
This practice examination integrates the latest "exam pearls" and high-yield content for the
AANP FNP certification exam. Each question reflects the 2025-2026 exam blueprint and testing
strategies.
Exam Format:
• Total Questions: 150 (135 scored, 15 pretest)
• Time Limit: 3 hours (1.2 minutes per question)
• Passing Score: Scaled score of 500
Content Domains:
• Assess (32%) - 43 questions
• Diagnose (26.5%) - 36 questions
• Plan (26.5%) - 36 questions
• Evaluate (15%) - 20 questions
DOMAIN 1: ASSESSMENT (Questions 1-50)
Question 1
,An 88-year-old male presents with right-side weakness after being unable to rise unassisted
following a fall. History includes aphasia and noncompliance with hypertension medication.
What is the most likely diagnosis?
A) Right-sided CVA
B) Left-sided CVA
C) Transient ischemic attack
D) Subdural hematoma
Correct Answer: B) Left-sided CVA
Rationale: A left-sided CVA presents with right-sided weakness and aphasia because the left
hemisphere controls language and right-sided motor function. Noncompliance with
antihypertensives is a significant risk factor. Pearl: Remember "Left = Language" and "Right =
Neglect" .
Question 2
A 72-year-old patient presents with headache, jaw claudication, and scalp tenderness. ESR is 85
mm/hr. What is the most likely diagnosis?
A) Migraine
B) Temporal arteritis (Giant cell arteritis)
C) Trigeminal neuralgia
D) Stroke
Correct Answer: B) Temporal arteritis (Giant cell arteritis)
Rationale: Temporal arteritis presents with headache, jaw claudication, scalp tenderness, and
markedly elevated ESR. Pearl: ESR is the screening test; temporal artery biopsy is the gold
standard. This is a medical emergency requiring immediate high-dose corticosteroids to prevent
vision loss .
Question 3
A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular
R-R interval. This arrhythmia is:
A) Atrial flutter
B) Atrial fibrillation
,C) Second-degree heart block
D) Wolff-Parkinson-White Syndrome
Correct Answer: B) Atrial fibrillation
Rationale: AFib is characterized by an undulating baseline (fibrillatory waves), absence of P
waves, and irregularly irregular ventricular response. Pearl: AFib is the most common sustained
arrhythmia in older adults and a major stroke risk factor; CHA₂DS₂-VASc score guides
anticoagulation .
Question 4
Which of the following is a common presenting feature of hyperthyroidism in the elderly?
A) Elevated TSH
B) Thyroid enlargement
C) Atrial fibrillation
D) Abnormal T3 suppression
Correct Answer: C) Atrial fibrillation
Rationale: Elderly patients with hyperthyroidism often present with "apathetic" symptoms
including atrial fibrillation, weight loss, depression, and fatigue rather than classic
symptoms. Pearl: Older adults may not have classic heat intolerance or tachycardia; consider
"apathetic hyperthyroidism" .
Question 5
Fundoscopic exam of a hypertensive patient would reveal:
A) Nicking of arterioles and veins, and small retinal hemorrhages
B) Drusen bodies and pale retina
C) Pale macula and swollen disk margins
D) Microaneurysms and optic disc cupping
Correct Answer: A) Nicking of arterioles and veins, and small retinal hemorrhages
Rationale: Hypertensive retinopathy features AV nicking, retinal hemorrhages, cotton-wool
spots, and papilledema in severe cases. Pearl: AV nicking = hypertensive retinopathy;
microaneurysms = diabetic retinopathy .
, Question 6
A patient presents with "bag of worms" on scrotal examination. This indicates:
A) Hydrocele
B) Varicocele
C) Spermatocele
D) Testicular torsion
Correct Answer: B) Varicocele
Rationale: A varicocele is described as a "bag of worms" on palpation due to dilated tortuous
veins. Pearl: More common on the left side; associated with infertility .
Question 7
A patient with a headache after trauma most likely has:
A) Migraine
B) Subdural hematoma
C) Tension headache
D) Cluster headache
Correct Answer: B) Subdural hematoma
Rationale: Subdural hematoma should be suspected in patients with headache following head
trauma, especially elderly patients on anticoagulants. Pearl: CT head without contrast is first-
line imaging .
Question 8
A patient presents with a gradual onset of fever, hemorrhages on nail beds, painful raised red
nodules (Osler's nodes), and a rash on palms (Janeway lesions). This likely indicates:
A) Systemic lupus erythematosus
B) Endocarditis
C) Rheumatoid arthritis
D) Vasculitis
Correct Answer: B) Endocarditis
COMPREHENSIVE PRACTICE EXAM 150
QUESTIONS wITH VERIfIEd ANSwERS &
dETAILEd RATIONALES LATTEST
VERSIONS ALREAdY GRAdEd A+
EXAM INSTRUCTIONS
This practice examination integrates the latest "exam pearls" and high-yield content for the
AANP FNP certification exam. Each question reflects the 2025-2026 exam blueprint and testing
strategies.
Exam Format:
• Total Questions: 150 (135 scored, 15 pretest)
• Time Limit: 3 hours (1.2 minutes per question)
• Passing Score: Scaled score of 500
Content Domains:
• Assess (32%) - 43 questions
• Diagnose (26.5%) - 36 questions
• Plan (26.5%) - 36 questions
• Evaluate (15%) - 20 questions
DOMAIN 1: ASSESSMENT (Questions 1-50)
Question 1
,An 88-year-old male presents with right-side weakness after being unable to rise unassisted
following a fall. History includes aphasia and noncompliance with hypertension medication.
What is the most likely diagnosis?
A) Right-sided CVA
B) Left-sided CVA
C) Transient ischemic attack
D) Subdural hematoma
Correct Answer: B) Left-sided CVA
Rationale: A left-sided CVA presents with right-sided weakness and aphasia because the left
hemisphere controls language and right-sided motor function. Noncompliance with
antihypertensives is a significant risk factor. Pearl: Remember "Left = Language" and "Right =
Neglect" .
Question 2
A 72-year-old patient presents with headache, jaw claudication, and scalp tenderness. ESR is 85
mm/hr. What is the most likely diagnosis?
A) Migraine
B) Temporal arteritis (Giant cell arteritis)
C) Trigeminal neuralgia
D) Stroke
Correct Answer: B) Temporal arteritis (Giant cell arteritis)
Rationale: Temporal arteritis presents with headache, jaw claudication, scalp tenderness, and
markedly elevated ESR. Pearl: ESR is the screening test; temporal artery biopsy is the gold
standard. This is a medical emergency requiring immediate high-dose corticosteroids to prevent
vision loss .
Question 3
A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular
R-R interval. This arrhythmia is:
A) Atrial flutter
B) Atrial fibrillation
,C) Second-degree heart block
D) Wolff-Parkinson-White Syndrome
Correct Answer: B) Atrial fibrillation
Rationale: AFib is characterized by an undulating baseline (fibrillatory waves), absence of P
waves, and irregularly irregular ventricular response. Pearl: AFib is the most common sustained
arrhythmia in older adults and a major stroke risk factor; CHA₂DS₂-VASc score guides
anticoagulation .
Question 4
Which of the following is a common presenting feature of hyperthyroidism in the elderly?
A) Elevated TSH
B) Thyroid enlargement
C) Atrial fibrillation
D) Abnormal T3 suppression
Correct Answer: C) Atrial fibrillation
Rationale: Elderly patients with hyperthyroidism often present with "apathetic" symptoms
including atrial fibrillation, weight loss, depression, and fatigue rather than classic
symptoms. Pearl: Older adults may not have classic heat intolerance or tachycardia; consider
"apathetic hyperthyroidism" .
Question 5
Fundoscopic exam of a hypertensive patient would reveal:
A) Nicking of arterioles and veins, and small retinal hemorrhages
B) Drusen bodies and pale retina
C) Pale macula and swollen disk margins
D) Microaneurysms and optic disc cupping
Correct Answer: A) Nicking of arterioles and veins, and small retinal hemorrhages
Rationale: Hypertensive retinopathy features AV nicking, retinal hemorrhages, cotton-wool
spots, and papilledema in severe cases. Pearl: AV nicking = hypertensive retinopathy;
microaneurysms = diabetic retinopathy .
, Question 6
A patient presents with "bag of worms" on scrotal examination. This indicates:
A) Hydrocele
B) Varicocele
C) Spermatocele
D) Testicular torsion
Correct Answer: B) Varicocele
Rationale: A varicocele is described as a "bag of worms" on palpation due to dilated tortuous
veins. Pearl: More common on the left side; associated with infertility .
Question 7
A patient with a headache after trauma most likely has:
A) Migraine
B) Subdural hematoma
C) Tension headache
D) Cluster headache
Correct Answer: B) Subdural hematoma
Rationale: Subdural hematoma should be suspected in patients with headache following head
trauma, especially elderly patients on anticoagulants. Pearl: CT head without contrast is first-
line imaging .
Question 8
A patient presents with a gradual onset of fever, hemorrhages on nail beds, painful raised red
nodules (Osler's nodes), and a rash on palms (Janeway lesions). This likely indicates:
A) Systemic lupus erythematosus
B) Endocarditis
C) Rheumatoid arthritis
D) Vasculitis
Correct Answer: B) Endocarditis
