AANP FNP CertiFiCAtioN exAm PrACtiCe
QuestioNs (2024–2025 BluePriNt) 100
QuestioNs AND ANsWers WitH DetAileD
DesCriPtioN lAtest uPDAte 2026 AlreADY
GrADeD A+
DOMAIN 1: ASSESS (Questions 1–32)
Question 1
A 62-year-old man with a 40-pack-year smoking history, who quit 3 years ago, presents for a
routine physical. According to USPSTF guidelines, which screening is most appropriate?
A) Annual low-dose CT for lung cancer
B) Abdominal aortic aneurysm screening with ultrasound
C) Colonoscopy every 10 years
D) PSA screening for prostate cancer
Answer: A
Rationale: The USPSTF recommends annual low-dose CT (LDCT) screening for lung cancer in
adults aged 50–80 years with a 20-pack-year smoking history who currently smoke or have quit
within the past 15 years. This patient meets the criteria (40 pack-years, quit within 3 years).
Abdominal aortic aneurysm screening (Choice B) is recommended for men aged 65–75 with a
smoking history, but this patient is 62. Colonoscopy (Choice C) is recommended starting at age
45 for average-risk individuals, but LDCT is the priority given his high pack-year history. PSA
screening (Choice D) is an individualized decision for men aged 55–69.
1
, Question 2
A 68-year-old woman is brought in by her daughter who is concerned about memory decline.
The patient scores 23/30 on the Mini-Mental State Examination (MMSE). What is the most
appropriate next step?
A) Diagnose Alzheimer's disease and start donepezil
B) Perform a functional assessment, including the patient's ability to manage finances and
medications
C) Order a CT scan of the head immediately
D) Refer to neurology for definitive diagnosis
Answer: B
Rationale: An MMSE score below 24 suggests cognitive impairment, but a diagnosis of
dementia requires evidence of functional decline in daily activities. The next step is to assess
functional status. Diagnosing Alzheimer's (Choice A) without functional assessment is
premature. Imaging (Choice C) is not the first step without focal neurological findings. Referral
to neurology (Choice D) may be appropriate but after initial functional assessment.
Question 3
A 32-year-old woman who is 14 weeks pregnant presents with dysuria and urinary frequency.
Urinalysis shows positive leukocyte esterase and nitrites. Which antibiotic is safe to prescribe
during pregnancy?
A) Ciprofloxacin
B) Doxycycline
C) Nitrofurantoin
D) Trimethoprim-sulfamethoxazole
Answer: C
Rationale: Nitrofurantoin is considered safe for use in pregnancy for the treatment of UTIs,
except near term (38–42 weeks) due to the risk of hemolytic anemia in the newborn.
Ciprofloxacin (Choice A) is generally avoided due to potential cartilage damage. Doxycycline
(Choice B) is contraindicated due to tooth discoloration and bone growth inhibition.
Trimethoprim-sulfamethoxazole (Choice D) should be avoided in the first trimester due to folate
antagonism.
2
, Question 4
A 55-year-old woman with a history of breast cancer (ER/PR positive) is on tamoxifen. She
reports new-onset vaginal spotting. What is the most important next step?
A) Annual mammogram
B) Endometrial biopsy
C) Bone density testing
D) Liver function tests
Answer: B
Rationale: Tamoxifen has estrogenic effects on the endometrium, increasing the risk of
endometrial hyperplasia and cancer. Any vaginal bleeding or spotting in a patient on tamoxifen
should prompt an endometrial biopsy. Annual mammogram (Choice A) is important for breast
cancer surveillance but is not the priority for new vaginal bleeding. Bone density testing (Choice
C) is relevant for aromatase inhibitors, not tamoxifen.
Question 5
A 7-year-old boy is brought in for a school physical. His BMI is at the 97th percentile for age
and sex. Which of the following is the most appropriate next step?
A) Diagnose obesity and provide dietary counseling only
B) Order a lipid panel and fasting glucose
C) Screen for hypertension and perform a focused physical exam
D) Refer to an endocrinologist
Answer: C
Rationale: A BMI at or above the 95th percentile is classified as obesity in children. The initial
evaluation should include screening for comorbidities, including hypertension (blood pressure
measurement), assessment of acanthosis nigricans (indicating insulin resistance), and evaluation
for other obesity-related conditions. A lipid panel and fasting glucose (Choice B) are
recommended but typically part of a more comprehensive evaluation after initial screening.
Diagnosis (Choice A) is appropriate but should include a systematic evaluation.
Question 6
A 58-year-old man with a 35-pack-year smoking history presents with a new cough and
hemoptysis. What is the most appropriate initial imaging study?
3
, A) Chest X-ray
B) CT scan of the chest without contrast
C) CT scan of the chest with contrast
D) MRI of the chest
Answer: A
Rationale: A chest X-ray is the initial imaging study of choice for evaluating a patient with cough
and hemoptysis, especially with a significant smoking history. It is readily available, cost-
effective, and can identify masses, infiltrates, or other abnormalities. If the chest X-ray is
abnormal or suspicious, a CT scan (Choice B or C) would be the next step for further
characterization. MRI (Choice D) is not typically used for initial pulmonary evaluation.
Question 7
A 65-year-old woman with no history of cardiovascular disease has a 10-year ASCVD risk score
of 15%. What is the most appropriate lipid-lowering therapy according to ACC/AHA
guidelines?
A) Lifestyle modifications only
B) Moderate-intensity statin
C) High-intensity statin
D) Ezetimibe
Answer: B
Rationale: The ACC/AHA guidelines recommend moderate-intensity statin therapy for primary
prevention in patients with an estimated 10-year ASCVD risk of 7.5% to <20%. High-intensity
statin (Choice C) is recommended for patients with ASCVD risk ≥20% or those with clinical
ASCVD. Lifestyle modifications alone (Choice A) are insufficient for a 15% risk. Ezetimibe (Choice
D) is an adjunctive therapy, not first-line.
Question 8
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On physical
exam, she has a delayed relaxation phase of her deep tendon reflexes. Which laboratory test
is most appropriate to order initially?
A) TSH and free T4
B) Complete blood count
4
QuestioNs (2024–2025 BluePriNt) 100
QuestioNs AND ANsWers WitH DetAileD
DesCriPtioN lAtest uPDAte 2026 AlreADY
GrADeD A+
DOMAIN 1: ASSESS (Questions 1–32)
Question 1
A 62-year-old man with a 40-pack-year smoking history, who quit 3 years ago, presents for a
routine physical. According to USPSTF guidelines, which screening is most appropriate?
A) Annual low-dose CT for lung cancer
B) Abdominal aortic aneurysm screening with ultrasound
C) Colonoscopy every 10 years
D) PSA screening for prostate cancer
Answer: A
Rationale: The USPSTF recommends annual low-dose CT (LDCT) screening for lung cancer in
adults aged 50–80 years with a 20-pack-year smoking history who currently smoke or have quit
within the past 15 years. This patient meets the criteria (40 pack-years, quit within 3 years).
Abdominal aortic aneurysm screening (Choice B) is recommended for men aged 65–75 with a
smoking history, but this patient is 62. Colonoscopy (Choice C) is recommended starting at age
45 for average-risk individuals, but LDCT is the priority given his high pack-year history. PSA
screening (Choice D) is an individualized decision for men aged 55–69.
1
, Question 2
A 68-year-old woman is brought in by her daughter who is concerned about memory decline.
The patient scores 23/30 on the Mini-Mental State Examination (MMSE). What is the most
appropriate next step?
A) Diagnose Alzheimer's disease and start donepezil
B) Perform a functional assessment, including the patient's ability to manage finances and
medications
C) Order a CT scan of the head immediately
D) Refer to neurology for definitive diagnosis
Answer: B
Rationale: An MMSE score below 24 suggests cognitive impairment, but a diagnosis of
dementia requires evidence of functional decline in daily activities. The next step is to assess
functional status. Diagnosing Alzheimer's (Choice A) without functional assessment is
premature. Imaging (Choice C) is not the first step without focal neurological findings. Referral
to neurology (Choice D) may be appropriate but after initial functional assessment.
Question 3
A 32-year-old woman who is 14 weeks pregnant presents with dysuria and urinary frequency.
Urinalysis shows positive leukocyte esterase and nitrites. Which antibiotic is safe to prescribe
during pregnancy?
A) Ciprofloxacin
B) Doxycycline
C) Nitrofurantoin
D) Trimethoprim-sulfamethoxazole
Answer: C
Rationale: Nitrofurantoin is considered safe for use in pregnancy for the treatment of UTIs,
except near term (38–42 weeks) due to the risk of hemolytic anemia in the newborn.
Ciprofloxacin (Choice A) is generally avoided due to potential cartilage damage. Doxycycline
(Choice B) is contraindicated due to tooth discoloration and bone growth inhibition.
Trimethoprim-sulfamethoxazole (Choice D) should be avoided in the first trimester due to folate
antagonism.
2
, Question 4
A 55-year-old woman with a history of breast cancer (ER/PR positive) is on tamoxifen. She
reports new-onset vaginal spotting. What is the most important next step?
A) Annual mammogram
B) Endometrial biopsy
C) Bone density testing
D) Liver function tests
Answer: B
Rationale: Tamoxifen has estrogenic effects on the endometrium, increasing the risk of
endometrial hyperplasia and cancer. Any vaginal bleeding or spotting in a patient on tamoxifen
should prompt an endometrial biopsy. Annual mammogram (Choice A) is important for breast
cancer surveillance but is not the priority for new vaginal bleeding. Bone density testing (Choice
C) is relevant for aromatase inhibitors, not tamoxifen.
Question 5
A 7-year-old boy is brought in for a school physical. His BMI is at the 97th percentile for age
and sex. Which of the following is the most appropriate next step?
A) Diagnose obesity and provide dietary counseling only
B) Order a lipid panel and fasting glucose
C) Screen for hypertension and perform a focused physical exam
D) Refer to an endocrinologist
Answer: C
Rationale: A BMI at or above the 95th percentile is classified as obesity in children. The initial
evaluation should include screening for comorbidities, including hypertension (blood pressure
measurement), assessment of acanthosis nigricans (indicating insulin resistance), and evaluation
for other obesity-related conditions. A lipid panel and fasting glucose (Choice B) are
recommended but typically part of a more comprehensive evaluation after initial screening.
Diagnosis (Choice A) is appropriate but should include a systematic evaluation.
Question 6
A 58-year-old man with a 35-pack-year smoking history presents with a new cough and
hemoptysis. What is the most appropriate initial imaging study?
3
, A) Chest X-ray
B) CT scan of the chest without contrast
C) CT scan of the chest with contrast
D) MRI of the chest
Answer: A
Rationale: A chest X-ray is the initial imaging study of choice for evaluating a patient with cough
and hemoptysis, especially with a significant smoking history. It is readily available, cost-
effective, and can identify masses, infiltrates, or other abnormalities. If the chest X-ray is
abnormal or suspicious, a CT scan (Choice B or C) would be the next step for further
characterization. MRI (Choice D) is not typically used for initial pulmonary evaluation.
Question 7
A 65-year-old woman with no history of cardiovascular disease has a 10-year ASCVD risk score
of 15%. What is the most appropriate lipid-lowering therapy according to ACC/AHA
guidelines?
A) Lifestyle modifications only
B) Moderate-intensity statin
C) High-intensity statin
D) Ezetimibe
Answer: B
Rationale: The ACC/AHA guidelines recommend moderate-intensity statin therapy for primary
prevention in patients with an estimated 10-year ASCVD risk of 7.5% to <20%. High-intensity
statin (Choice C) is recommended for patients with ASCVD risk ≥20% or those with clinical
ASCVD. Lifestyle modifications alone (Choice A) are insufficient for a 15% risk. Ezetimibe (Choice
D) is an adjunctive therapy, not first-line.
Question 8
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On physical
exam, she has a delayed relaxation phase of her deep tendon reflexes. Which laboratory test
is most appropriate to order initially?
A) TSH and free T4
B) Complete blood count
4
