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NP CERTIFICATION EXAM PREP 2025-2026 | COMPLETE AANP
& ANCC TEST BANK FOR FAMILY NURSE PRACTITIONER
(FNP) & ADULT-GERONTOLOGY NP | 100+ PRACTICE
QUESTIONS WITH RATIONALE
Question 1
A 42-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. On exam, her thyroid is firm and diffusely enlarged. TSH
is elevated, free T4 is low. Which is the most likely diagnosis?
A. Graves’ disease
B. Hashimoto’s thyroiditis
C. Subacute thyroiditis
D. Thyroid cancer
Answer: B. Hashimoto’s thyroiditis
Rationale: Classic hypothyroid symptoms with elevated TSH and low free
T4 indicate primary hypothyroidism. A firm, enlarged thyroid suggests
autoimmune Hashimoto’s thyroiditis, the most common cause.
Question 2
A 67-year-old male with a history of smoking presents with hematuria. He
has no pain or fever. Which diagnostic test is the gold standard for
evaluation?
A. Renal ultrasound
B. Cystoscopy
C. CT abdomen
D. Urinalysis
Answer: B. Cystoscopy
Rationale: In older adults with painless hematuria, bladder cancer must be
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ruled out. Cystoscopy allows direct visualization of the bladder mucosa and
is the diagnostic gold standard.
Question 3
A 29-year-old woman presents with dysuria, urinary frequency, and
suprapubic tenderness. Urinalysis shows positive leukocyte esterase and
nitrites. Which antibiotic is first-line?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin-clavulanate
D. Trimethoprim-sulfamethoxazole (TMP-SMX)
Answer: B. Nitrofurantoin
Rationale: For uncomplicated cystitis in women, nitrofurantoin or TMP-
SMX are first-line. Ciprofloxacin is reserved for complicated UTIs due to
resistance concerns.
Question 4
A 58-year-old man has hypertension and diabetes. His current BP is 148/92
despite lifestyle changes. Which is the best first-line antihypertensive?
A. Thiazide diuretic
B. ACE inhibitor
C. Calcium channel blocker
D. Beta-blocker
Answer: B. ACE inhibitor
Rationale: For diabetic patients with hypertension, ACE inhibitors (or
ARBs) are preferred because they provide renal protection by reducing
intraglomerular pressure.
Question 5
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A 22-year-old female presents with a vesicular rash in a dermatomal
distribution on her left trunk. She reports severe pain. Which is the most
likely diagnosis?
A. Varicella
B. Herpes zoster
C. Contact dermatitis
D. Psoriasis
Answer: B. Herpes zoster
Rationale: A unilateral, dermatomal vesicular rash with neuropathic pain is
classic for herpes zoster (shingles), caused by reactivation of varicella-zoster
virus.
Question 6
A 15-year-old presents with a sore throat, fever, and anterior cervical
lymphadenopathy. A rapid strep test is positive. Which is the best treatment?
A. Azithromycin
B. Penicillin V
C. Ciprofloxacin
D. Doxycycline
Answer: B. Penicillin V
Rationale: Group A Streptococcus pharyngitis should be treated with
penicillin or amoxicillin as first-line therapy. Macrolides are reserved for
penicillin-allergic patients.
Question 7
A 71-year-old woman presents with new-onset memory loss, difficulty
managing finances, and getting lost in familiar places. MMSE score is
21/30. What is the most likely diagnosis?
A. Normal aging
B. Mild cognitive impairment
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C. Alzheimer’s disease
D. Vascular dementia
Answer: C. Alzheimer’s disease
Rationale: Progressive memory decline and impaired executive function
interfering with daily life indicate Alzheimer’s disease rather than normal
aging or mild impairment.
Question 8
A 64-year-old man with COPD has worsening dyspnea, chronic cough, and
sputum production. O2 sat is 90%. Which medication should be added first
for maintenance therapy?
A. Oral steroids
B. Short-acting beta agonist (SABA)
C. Long-acting muscarinic antagonist (LAMA)
D. Antibiotics
Answer: C. Long-acting muscarinic antagonist (LAMA)
Rationale: For stable COPD with persistent symptoms, LAMAs (e.g.,
tiotropium) are first-line maintenance therapy. SABAs are for rescue only.
Question 9
A 34-year-old female with a BMI of 31 is diagnosed with type 2 diabetes.
Her HbA1c is 8.4%. What is the first-line pharmacologic treatment?
A. Sulfonylurea
B. Metformin
C. Insulin
D. GLP-1 agonist
Answer: B. Metformin
Rationale: Metformin is the first-line therapy for type 2 diabetes unless
contraindicated (e.g., renal insufficiency). It improves insulin sensitivity and
lowers HbA1c.
NP CERTIFICATION EXAM PREP 2025-2026 | COMPLETE AANP
& ANCC TEST BANK FOR FAMILY NURSE PRACTITIONER
(FNP) & ADULT-GERONTOLOGY NP | 100+ PRACTICE
QUESTIONS WITH RATIONALE
Question 1
A 42-year-old woman presents with fatigue, weight gain, cold intolerance,
and constipation. On exam, her thyroid is firm and diffusely enlarged. TSH
is elevated, free T4 is low. Which is the most likely diagnosis?
A. Graves’ disease
B. Hashimoto’s thyroiditis
C. Subacute thyroiditis
D. Thyroid cancer
Answer: B. Hashimoto’s thyroiditis
Rationale: Classic hypothyroid symptoms with elevated TSH and low free
T4 indicate primary hypothyroidism. A firm, enlarged thyroid suggests
autoimmune Hashimoto’s thyroiditis, the most common cause.
Question 2
A 67-year-old male with a history of smoking presents with hematuria. He
has no pain or fever. Which diagnostic test is the gold standard for
evaluation?
A. Renal ultrasound
B. Cystoscopy
C. CT abdomen
D. Urinalysis
Answer: B. Cystoscopy
Rationale: In older adults with painless hematuria, bladder cancer must be
,2|Page
ruled out. Cystoscopy allows direct visualization of the bladder mucosa and
is the diagnostic gold standard.
Question 3
A 29-year-old woman presents with dysuria, urinary frequency, and
suprapubic tenderness. Urinalysis shows positive leukocyte esterase and
nitrites. Which antibiotic is first-line?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin-clavulanate
D. Trimethoprim-sulfamethoxazole (TMP-SMX)
Answer: B. Nitrofurantoin
Rationale: For uncomplicated cystitis in women, nitrofurantoin or TMP-
SMX are first-line. Ciprofloxacin is reserved for complicated UTIs due to
resistance concerns.
Question 4
A 58-year-old man has hypertension and diabetes. His current BP is 148/92
despite lifestyle changes. Which is the best first-line antihypertensive?
A. Thiazide diuretic
B. ACE inhibitor
C. Calcium channel blocker
D. Beta-blocker
Answer: B. ACE inhibitor
Rationale: For diabetic patients with hypertension, ACE inhibitors (or
ARBs) are preferred because they provide renal protection by reducing
intraglomerular pressure.
Question 5
,3|Page
A 22-year-old female presents with a vesicular rash in a dermatomal
distribution on her left trunk. She reports severe pain. Which is the most
likely diagnosis?
A. Varicella
B. Herpes zoster
C. Contact dermatitis
D. Psoriasis
Answer: B. Herpes zoster
Rationale: A unilateral, dermatomal vesicular rash with neuropathic pain is
classic for herpes zoster (shingles), caused by reactivation of varicella-zoster
virus.
Question 6
A 15-year-old presents with a sore throat, fever, and anterior cervical
lymphadenopathy. A rapid strep test is positive. Which is the best treatment?
A. Azithromycin
B. Penicillin V
C. Ciprofloxacin
D. Doxycycline
Answer: B. Penicillin V
Rationale: Group A Streptococcus pharyngitis should be treated with
penicillin or amoxicillin as first-line therapy. Macrolides are reserved for
penicillin-allergic patients.
Question 7
A 71-year-old woman presents with new-onset memory loss, difficulty
managing finances, and getting lost in familiar places. MMSE score is
21/30. What is the most likely diagnosis?
A. Normal aging
B. Mild cognitive impairment
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C. Alzheimer’s disease
D. Vascular dementia
Answer: C. Alzheimer’s disease
Rationale: Progressive memory decline and impaired executive function
interfering with daily life indicate Alzheimer’s disease rather than normal
aging or mild impairment.
Question 8
A 64-year-old man with COPD has worsening dyspnea, chronic cough, and
sputum production. O2 sat is 90%. Which medication should be added first
for maintenance therapy?
A. Oral steroids
B. Short-acting beta agonist (SABA)
C. Long-acting muscarinic antagonist (LAMA)
D. Antibiotics
Answer: C. Long-acting muscarinic antagonist (LAMA)
Rationale: For stable COPD with persistent symptoms, LAMAs (e.g.,
tiotropium) are first-line maintenance therapy. SABAs are for rescue only.
Question 9
A 34-year-old female with a BMI of 31 is diagnosed with type 2 diabetes.
Her HbA1c is 8.4%. What is the first-line pharmacologic treatment?
A. Sulfonylurea
B. Metformin
C. Insulin
D. GLP-1 agonist
Answer: B. Metformin
Rationale: Metformin is the first-line therapy for type 2 diabetes unless
contraindicated (e.g., renal insufficiency). It improves insulin sensitivity and
lowers HbA1c.
