American Association of Nurse Practitioners
(AANP) Family Nurse Practitioner Board
Certification Practice QUESTIONS AND
ANSWERS: 200 High-Yield Questions with
CORRECT DETAILED Answers & Evidence-Based
Rationales/pdf.
INTRODUCTION
Prepare for the American Association of Nurse Practitioners (AANP) Family Nurse
Practitioner certification exam with this comprehensive, high-yield practice
question bank. Designed to mirror the difficulty, style, and breadth of the actual
boards, this guide offers 200 original questions organized by clinical domain, each
paired with an italicized correct answer and a detailed, evidence-based rationales.
Domain I: Assessment & Diagnosis
1. A 45-year-old male presents with episodic retrosternal chest pressure during exertion,
relieved by rest. ECG is normal. What is the most likely diagnosis?
a. Stable angina
Rationale: Classic exertional chest pain relieved by rest suggests stable angina. Unstable
angina occurs at rest or with increasing frequency.
2. A 23-year-old female reports fatigue, weight gain, cold intolerance, and dry skin. TSH
is 12 mIU/L (normal 0.4–4.0). What is the next step?
a. Start levothyroxine
Rationale: Overt hypothyroidism with elevated TSH and symptoms requires levothyroxine
replacement.
,3. A 60-year-old with HTN and DM has a blood pressure of 148/90 mm Hg on lisinopril
20 mg/day. A1c is 7.2%. What is the best next step?
a. Add amlodipine
*Rationale: First-line add-on for HTN in DM is a CCB or thiazide; goal BP <130/80.*
4. A 55-year-old smoker presents with new-onset hoarseness for 6 weeks. Laryngoscopy
shows left vocal cord paralysis. What is the most concerning cause?
a. Lung cancer
Rationale: Left recurrent laryngeal nerve palsy can be caused by mediastinal mass, often
lung cancer.
5. A 30-year-old woman has a 3-cm, mobile, non-tender breast lump that
transilluminates. What is the most likely diagnosis?
a. Fibroadenoma
Rationale: Mobile, rubbery, transilluminating mass in young woman is classic for
fibroadenoma.
6. A 72-year-old presents with acute-onset right lower quadrant pain, fever, and
leukocytosis. CT shows a thickened appendix with periappendiceal fat stranding.
Diagnosis?
a. Acute appendicitis
Rationale: CT findings confirm appendicitis; elderly may present atypically.
7. A 28-year-old male has sudden onset of severe scrotal pain, nausea, and vomiting.
Cremasteric reflex is absent on the left. What is the priority?
a. Emergency surgery referral for testicular torsion
Rationale: Sudden pain with absent cremasteric reflex suggests torsion; do not delay for
ultrasound if high suspicion.
8. A 48-year-old female with palpitations, heat intolerance, and weight loss has TSH
<0.01 mIU/L and free T4 elevated. Best initial treatment?
a. Methimazole
Rationale: First-line for Graves’ disease in non-pregnant adults is methimazole.
,9. A 67-year-old with COPD presents with increased dyspnea, purulent sputum, and
fever. CXR shows no infiltrate. Diagnosis?
a. Acute exacerbation of COPD
Rationale: Increased sputum purulence and dyspnea without infiltrate = acute
exacerbation, likely infectious.
10. A 35-year-old G2P1 at 28 weeks gestation reports painless vaginal bleeding. What is
the most likely diagnosis?
a. Placenta previa
Rationale: Painless bleeding in third trimester = previa until proven otherwise; avoid
digital exam.
11. A 25-year-old presents with dysuria, frequency, and suprapubic pain. UA shows
positive nitrites and leukocyte esterase. Treatment?
a. Nitrofurantoin 100 mg BID x 5 days
Rationale: Uncomplicated cystitis in young woman – first-line: nitrofurantoin, TMP-SMX,
or fosfomycin.
12. A 50-year-old male with HTN and hyperlipidemia reports intermittent claudication
after walking one block. Ankle-brachial index (ABI) is 0.65. Diagnosis?
a. Peripheral artery disease (PAD)
Rationale: ABI <0.90 indicates PAD; management includes smoking cessation, antiplatelet,
statin.
13. A 19-year-old female with sore throat, fever, and tender anterior cervical
lymphadenopathy. Rapid strep is negative. What is the next step?
a. Throat culture
Rationale: In young adults with pharyngitis and negative rapid test, culture is
recommended to rule out group A strep.
14. A 62-year-old with DM and HTN has a urine albumin-to-creatinine ratio of 350
mg/g. What is the best treatment to slow progression?
a. ACE inhibitor or ARB
Rationale: ACEi/ARB are renoprotective in diabetic kidney disease, even without HTN.
, 15. A 40-year-old female presents with episodic dizziness, palpitations, and sweating.
Blood glucose is 45 mg/dL. After treatment, what is the next step?
a. Evaluate for insulinoma (fasting insulin, C-peptide, proinsulin)
Rationale: Whipple’s triad (hypoglycemia symptoms, low glucose, relief with glucose) in
absence of diabetes suggests insulinoma.
16. A 33-year-old male with knee pain after twisting injury. Lachman test is positive.
Diagnosis?
a. ACL tear
Rationale: Lachman is most sensitive for ACL injury.
17. A 70-year-old with PMH of HFrEF presents with dyspnea, orthopnea, and +3 pitting
edema. What is the first-line medication to reduce mortality?
a. Beta-blocker (carvedilol or metoprolol succinate)
Rationale: Beta-blockers reduce mortality in HFrEF; start after hemodynamic stability.
18. A 55-year-old female with RA presents with a 3-day history of painful, red right eye.
Slit lamp shows ciliary flush and hypopyon. Diagnosis?
a. Anterior uveitis
Rationale: Uveitis is common in RA; needs urgent ophthalmology referral.
19. A 24-year-old male has a non-reducible, painful left inguinal bulge. What is the next
step?
a. Emergent surgical referral
Rationale: Non-reducible hernia with pain = incarcerated hernia, risk of strangulation.
20. A 38-year-old G0 with irregular menses, hirsutism, and acanthosis nigricans. Labs:
LH:FSH ratio 3:1, testosterone elevated. Diagnosis?
a. Polycystic ovary syndrome (PCOS)
Rationale: Rotterdam criteria: oligo-ovulation, hyperandrogenism, polycystic ovaries on
US.
(AANP) Family Nurse Practitioner Board
Certification Practice QUESTIONS AND
ANSWERS: 200 High-Yield Questions with
CORRECT DETAILED Answers & Evidence-Based
Rationales/pdf.
INTRODUCTION
Prepare for the American Association of Nurse Practitioners (AANP) Family Nurse
Practitioner certification exam with this comprehensive, high-yield practice
question bank. Designed to mirror the difficulty, style, and breadth of the actual
boards, this guide offers 200 original questions organized by clinical domain, each
paired with an italicized correct answer and a detailed, evidence-based rationales.
Domain I: Assessment & Diagnosis
1. A 45-year-old male presents with episodic retrosternal chest pressure during exertion,
relieved by rest. ECG is normal. What is the most likely diagnosis?
a. Stable angina
Rationale: Classic exertional chest pain relieved by rest suggests stable angina. Unstable
angina occurs at rest or with increasing frequency.
2. A 23-year-old female reports fatigue, weight gain, cold intolerance, and dry skin. TSH
is 12 mIU/L (normal 0.4–4.0). What is the next step?
a. Start levothyroxine
Rationale: Overt hypothyroidism with elevated TSH and symptoms requires levothyroxine
replacement.
,3. A 60-year-old with HTN and DM has a blood pressure of 148/90 mm Hg on lisinopril
20 mg/day. A1c is 7.2%. What is the best next step?
a. Add amlodipine
*Rationale: First-line add-on for HTN in DM is a CCB or thiazide; goal BP <130/80.*
4. A 55-year-old smoker presents with new-onset hoarseness for 6 weeks. Laryngoscopy
shows left vocal cord paralysis. What is the most concerning cause?
a. Lung cancer
Rationale: Left recurrent laryngeal nerve palsy can be caused by mediastinal mass, often
lung cancer.
5. A 30-year-old woman has a 3-cm, mobile, non-tender breast lump that
transilluminates. What is the most likely diagnosis?
a. Fibroadenoma
Rationale: Mobile, rubbery, transilluminating mass in young woman is classic for
fibroadenoma.
6. A 72-year-old presents with acute-onset right lower quadrant pain, fever, and
leukocytosis. CT shows a thickened appendix with periappendiceal fat stranding.
Diagnosis?
a. Acute appendicitis
Rationale: CT findings confirm appendicitis; elderly may present atypically.
7. A 28-year-old male has sudden onset of severe scrotal pain, nausea, and vomiting.
Cremasteric reflex is absent on the left. What is the priority?
a. Emergency surgery referral for testicular torsion
Rationale: Sudden pain with absent cremasteric reflex suggests torsion; do not delay for
ultrasound if high suspicion.
8. A 48-year-old female with palpitations, heat intolerance, and weight loss has TSH
<0.01 mIU/L and free T4 elevated. Best initial treatment?
a. Methimazole
Rationale: First-line for Graves’ disease in non-pregnant adults is methimazole.
,9. A 67-year-old with COPD presents with increased dyspnea, purulent sputum, and
fever. CXR shows no infiltrate. Diagnosis?
a. Acute exacerbation of COPD
Rationale: Increased sputum purulence and dyspnea without infiltrate = acute
exacerbation, likely infectious.
10. A 35-year-old G2P1 at 28 weeks gestation reports painless vaginal bleeding. What is
the most likely diagnosis?
a. Placenta previa
Rationale: Painless bleeding in third trimester = previa until proven otherwise; avoid
digital exam.
11. A 25-year-old presents with dysuria, frequency, and suprapubic pain. UA shows
positive nitrites and leukocyte esterase. Treatment?
a. Nitrofurantoin 100 mg BID x 5 days
Rationale: Uncomplicated cystitis in young woman – first-line: nitrofurantoin, TMP-SMX,
or fosfomycin.
12. A 50-year-old male with HTN and hyperlipidemia reports intermittent claudication
after walking one block. Ankle-brachial index (ABI) is 0.65. Diagnosis?
a. Peripheral artery disease (PAD)
Rationale: ABI <0.90 indicates PAD; management includes smoking cessation, antiplatelet,
statin.
13. A 19-year-old female with sore throat, fever, and tender anterior cervical
lymphadenopathy. Rapid strep is negative. What is the next step?
a. Throat culture
Rationale: In young adults with pharyngitis and negative rapid test, culture is
recommended to rule out group A strep.
14. A 62-year-old with DM and HTN has a urine albumin-to-creatinine ratio of 350
mg/g. What is the best treatment to slow progression?
a. ACE inhibitor or ARB
Rationale: ACEi/ARB are renoprotective in diabetic kidney disease, even without HTN.
, 15. A 40-year-old female presents with episodic dizziness, palpitations, and sweating.
Blood glucose is 45 mg/dL. After treatment, what is the next step?
a. Evaluate for insulinoma (fasting insulin, C-peptide, proinsulin)
Rationale: Whipple’s triad (hypoglycemia symptoms, low glucose, relief with glucose) in
absence of diabetes suggests insulinoma.
16. A 33-year-old male with knee pain after twisting injury. Lachman test is positive.
Diagnosis?
a. ACL tear
Rationale: Lachman is most sensitive for ACL injury.
17. A 70-year-old with PMH of HFrEF presents with dyspnea, orthopnea, and +3 pitting
edema. What is the first-line medication to reduce mortality?
a. Beta-blocker (carvedilol or metoprolol succinate)
Rationale: Beta-blockers reduce mortality in HFrEF; start after hemodynamic stability.
18. A 55-year-old female with RA presents with a 3-day history of painful, red right eye.
Slit lamp shows ciliary flush and hypopyon. Diagnosis?
a. Anterior uveitis
Rationale: Uveitis is common in RA; needs urgent ophthalmology referral.
19. A 24-year-old male has a non-reducible, painful left inguinal bulge. What is the next
step?
a. Emergent surgical referral
Rationale: Non-reducible hernia with pain = incarcerated hernia, risk of strangulation.
20. A 38-year-old G0 with irregular menses, hirsutism, and acanthosis nigricans. Labs:
LH:FSH ratio 3:1, testosterone elevated. Diagnosis?
a. Polycystic ovary syndrome (PCOS)
Rationale: Rotterdam criteria: oligo-ovulation, hyperandrogenism, polycystic ovaries on
US.
