FITZGERALD NP BOARD REVIEW EXAM v2 — 2026/2027 EDITION
FITZGERALD NP BOARD REVIEW EXAM v2
2026/2027 Edition | 75 Questions | Verified Questions & 100% Correct Answers
Nurse Practitioner Board Review | Grade A
Comprehensive Certification Preparation (AANP/ANCC FNP, AGNP, PNP, WHNP)
Core Domains: Health Promotion & Disease Prevention | Assessment & Diagnosis | Plan & Treatment |
Evaluation of Care | Professional Role & Policy | Clinical Judgment
Exam Structure
Questions 75 multiple-choice (single-best-answer, SATA, scenario-based)
Time Approximately 90–120 minutes for 75-question practice format
Passing Score Practice benchmark: 75–80% for readiness assessment
Content Validity AANP/ANCC test blueprints, Fitzgerald review materials, primary care
guidelines
Introduction
This Fitzgerald NP Board Review Exam v2 practice format for 2026/2027 reflects a comprehensive
competency assessment designed to evaluate proficiency in advanced primary care principles for nurse
practitioner candidates preparing for AANP or ANCC certification. The exam measures knowledge of health
promotion, assessment/diagnosis, treatment planning, care evaluation, and professional role integration
across the lifespan. Content integrates Fitzgerald review frameworks, evidence-based clinical guidelines
(USPSTF, CDC, ADA, ACC/AHA, IDSA), and scenario-based decision-making essential for safe, effective NP
practice and certification success. The 75-question format provides extensive coverage of high-yield board
review domains for study, preparation, and clinical mastery purposes.
Fitzgerald NP Board Review Practice Questions (Exact Count: 75)
1. According to USPSTF guidelines, at what age should average-risk adults begin colorectal
cancer screening?
A. 40 years
B. 45 years
C. 50 years
D. 55 years
Answer: B. 45 years
Rationale: USPSTF (2021 update) recommends colorectal cancer screening beginning at age 45 for
average-risk adults. Options include colonoscopy every 10 years, FIT annually, or other approved
modalities. Starting at 50 (C) reflects outdated guidelines; 40 (A) is for high-risk populations.
2. A 58-year-old patient with hypertension has a BP of 148/92 mmHg on two visits. According
to ACC/AHA guidelines, what is the first-line pharmacologic treatment?
A. Beta-blocker
B. ACE inhibitor or ARB
C. Calcium channel blocker or thiazide diuretic
D. Alpha-blocker
Answer: C. Calcium channel blocker or thiazide diuretic
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, FITZGERALD NP BOARD REVIEW EXAM v2 — 2026/2027 EDITION
Rationale: ACC/AHA 2017 guidelines recommend thiazide diuretics, CCBs, ACE inhibitors, or ARBs as first-
line for most adults with hypertension. For non-Black patients without CKD/DM, any of the four classes
are appropriate; for Black patients, thiazide or CCB is preferred. Beta-blockers (A) are not first-line unless
compelling indication (CAD, HF).
3. Which finding is MOST suggestive of bacterial versus viral pharyngitis?
A. Cough and rhinorrhea
B. Tonsillar exudates and tender anterior cervical lymphadenopathy
C. Hoarseness and conjunctivitis
D. Low-grade fever and fatigue
Answer: B. Tonsillar exudates and tender anterior cervical lymphadenopathy
Rationale: Centor criteria for streptococcal pharyngitis include tonsillar exudates, tender anterior cervical
lymphadenopathy, fever, and absence of cough. Cough/rhinorrhea (A), hoarseness (C), and mild symptoms
(D) suggest viral etiology.
4. A patient with Type 2 Diabetes has an HbA1c of 8.5%. According to ADA guidelines, what is
the next step if metformin monotherapy is insufficient?
A. Add a second agent based on comorbidities (e.g., SGLT2i for CVD/CKD, GLP-1 RA for weight/CVD)
B. Switch to insulin immediately
C. Double the metformin dose
D. Add a sulfonylurea as first add-on
Answer: A. Add a second agent based on comorbidities (e.g., SGLT2i for CVD/CKD, GLP-1 RA
for weight/CVD)
Rationale: ADA Standards of Care (2026) recommend individualized add-on therapy based on
comorbidities: SGLT2 inhibitors or GLP-1 RAs for patients with ASCVD, HF, or CKD; GLP-1 RAs for weight
management. Insulin (B) is reserved for significant hyperglycemia or symptoms; doubling metformin (C)
has limited efficacy; sulfonylureas (D) are less preferred due to hypoglycemia/weight gain.
5. Which vaccine is recommended for adults aged ≥65 years to prevent pneumococcal
disease?
A. PCV15 followed by PPSV23 one year later
B. PPSV23 alone
C. PCV20 alone
D. Either A or C
Answer: D. Either A or C
Rationale: CDC (2026) recommends adults ≥65 receive either: (1) PCV20 alone, OR (2) PCV15 followed by
PPSV23 ≥1 year later. Both options provide comprehensive serotype coverage. PPSV23 alone (B) is no
longer preferred for immunocompetent adults ≥65.
6. A 45-year-old woman presents with hot flashes, irregular menses, and sleep disturbance.
What is the most appropriate initial management for vasomotor symptoms?
A. Prescribe hormone therapy immediately
B. Recommend lifestyle modifications and non-hormonal options first
C. Order FSH level to confirm menopause
D. Refer to gynecology for evaluation
Answer: B. Recommend lifestyle modifications and non-hormonal options first
Rationale: NAMS guidelines recommend starting with lifestyle changes (cooling techniques, avoiding
triggers) and non-hormonal options (SSRIs, gabapentin) for mild-moderate symptoms. Hormone therapy
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, FITZGERALD NP BOARD REVIEW EXAM v2 — 2026/2027 EDITION
(A) is reserved for moderate-severe symptoms after risk-benefit discussion. FSH testing (C) is not required
for diagnosis in symptomatic women >45; referral (D) is unnecessary for uncomplicated perimenopause.
7. Which finding is a RED FLAG for back pain requiring immediate imaging?
A. Pain lasting >2 weeks
B. History of trauma, unexplained weight loss, or neurologic deficit
C. Pain radiating to the leg
D. Age >50 years
Answer: B. History of trauma, unexplained weight loss, or neurologic deficit
Rationale: Red flags for serious pathology (fracture, malignancy, infection, cauda equina) include trauma,
weight loss, fever, neurologic deficits, or bowel/bladder dysfunction. Duration >2 weeks (A), radicular pain
(C), and age >50 (D) are common in mechanical back pain and do not alone warrant imaging.
8. A patient with asthma has daytime symptoms twice weekly and nighttime symptoms twice
monthly. According to GINA guidelines, what is the preferred treatment?
A. SABA alone as needed
B. Low-dose ICS-formoterol as needed
C. Medium-dose ICS daily
D. Oral corticosteroids
Answer: B. Low-dose ICS-formoterol as needed
Rationale: GINA 2026 recommends against SABA-only treatment. For mild asthma (symptoms <2x/week),
preferred treatment is low-dose ICS-formoterol as needed for symptom relief and prevention. SABA alone
(A) increases exacerbation risk; medium-dose ICS (C) is for moderate persistent asthma; oral steroids (D)
are for acute exacerbations.
9. Which laboratory finding is diagnostic for hypothyroidism?
A. Low TSH, low T4
B. High TSH, low T4
C. High TSH, normal T4
D. Low TSH, high T4
Answer: B. High TSH, low T4
Rationale: Primary hypothyroidism is diagnosed by elevated TSH with low free T4. High TSH with normal
T4 (C) indicates subclinical hypothyroidism. Low TSH with low T4 (A) suggests central hypothyroidism;
low TSH with high T4 (D) indicates hyperthyroidism.
10. A 65-year-old man with BPH has moderate symptoms (IPSS 12). What is first-line
pharmacologic treatment?
A. 5-alpha reductase inhibitor
B. Alpha-1 blocker
C. Anticholinergic
D. Phosphodiesterase-5 inhibitor
Answer: B. Alpha-1 blocker
Rationale: AUA guidelines recommend alpha-1 blockers (tamsulosin, alfuzosin) as first-line for moderate-
severe LUTS due to BPH. 5-ARIs (A) are for enlarged prostates (>30g) or high PSA; anticholinergics (C)
are for overactive bladder; PDE5 inhibitors (D) are adjunctive or for ED comorbidity.
11. Which finding suggests heart failure with reduced ejection fraction (HFrEF)?
A. Preserved EF >50%, diastolic dysfunction
B. EF ≤40%, elevated BNP, cardiomegaly on CXR
Page 3
FITZGERALD NP BOARD REVIEW EXAM v2
2026/2027 Edition | 75 Questions | Verified Questions & 100% Correct Answers
Nurse Practitioner Board Review | Grade A
Comprehensive Certification Preparation (AANP/ANCC FNP, AGNP, PNP, WHNP)
Core Domains: Health Promotion & Disease Prevention | Assessment & Diagnosis | Plan & Treatment |
Evaluation of Care | Professional Role & Policy | Clinical Judgment
Exam Structure
Questions 75 multiple-choice (single-best-answer, SATA, scenario-based)
Time Approximately 90–120 minutes for 75-question practice format
Passing Score Practice benchmark: 75–80% for readiness assessment
Content Validity AANP/ANCC test blueprints, Fitzgerald review materials, primary care
guidelines
Introduction
This Fitzgerald NP Board Review Exam v2 practice format for 2026/2027 reflects a comprehensive
competency assessment designed to evaluate proficiency in advanced primary care principles for nurse
practitioner candidates preparing for AANP or ANCC certification. The exam measures knowledge of health
promotion, assessment/diagnosis, treatment planning, care evaluation, and professional role integration
across the lifespan. Content integrates Fitzgerald review frameworks, evidence-based clinical guidelines
(USPSTF, CDC, ADA, ACC/AHA, IDSA), and scenario-based decision-making essential for safe, effective NP
practice and certification success. The 75-question format provides extensive coverage of high-yield board
review domains for study, preparation, and clinical mastery purposes.
Fitzgerald NP Board Review Practice Questions (Exact Count: 75)
1. According to USPSTF guidelines, at what age should average-risk adults begin colorectal
cancer screening?
A. 40 years
B. 45 years
C. 50 years
D. 55 years
Answer: B. 45 years
Rationale: USPSTF (2021 update) recommends colorectal cancer screening beginning at age 45 for
average-risk adults. Options include colonoscopy every 10 years, FIT annually, or other approved
modalities. Starting at 50 (C) reflects outdated guidelines; 40 (A) is for high-risk populations.
2. A 58-year-old patient with hypertension has a BP of 148/92 mmHg on two visits. According
to ACC/AHA guidelines, what is the first-line pharmacologic treatment?
A. Beta-blocker
B. ACE inhibitor or ARB
C. Calcium channel blocker or thiazide diuretic
D. Alpha-blocker
Answer: C. Calcium channel blocker or thiazide diuretic
Page 1
, FITZGERALD NP BOARD REVIEW EXAM v2 — 2026/2027 EDITION
Rationale: ACC/AHA 2017 guidelines recommend thiazide diuretics, CCBs, ACE inhibitors, or ARBs as first-
line for most adults with hypertension. For non-Black patients without CKD/DM, any of the four classes
are appropriate; for Black patients, thiazide or CCB is preferred. Beta-blockers (A) are not first-line unless
compelling indication (CAD, HF).
3. Which finding is MOST suggestive of bacterial versus viral pharyngitis?
A. Cough and rhinorrhea
B. Tonsillar exudates and tender anterior cervical lymphadenopathy
C. Hoarseness and conjunctivitis
D. Low-grade fever and fatigue
Answer: B. Tonsillar exudates and tender anterior cervical lymphadenopathy
Rationale: Centor criteria for streptococcal pharyngitis include tonsillar exudates, tender anterior cervical
lymphadenopathy, fever, and absence of cough. Cough/rhinorrhea (A), hoarseness (C), and mild symptoms
(D) suggest viral etiology.
4. A patient with Type 2 Diabetes has an HbA1c of 8.5%. According to ADA guidelines, what is
the next step if metformin monotherapy is insufficient?
A. Add a second agent based on comorbidities (e.g., SGLT2i for CVD/CKD, GLP-1 RA for weight/CVD)
B. Switch to insulin immediately
C. Double the metformin dose
D. Add a sulfonylurea as first add-on
Answer: A. Add a second agent based on comorbidities (e.g., SGLT2i for CVD/CKD, GLP-1 RA
for weight/CVD)
Rationale: ADA Standards of Care (2026) recommend individualized add-on therapy based on
comorbidities: SGLT2 inhibitors or GLP-1 RAs for patients with ASCVD, HF, or CKD; GLP-1 RAs for weight
management. Insulin (B) is reserved for significant hyperglycemia or symptoms; doubling metformin (C)
has limited efficacy; sulfonylureas (D) are less preferred due to hypoglycemia/weight gain.
5. Which vaccine is recommended for adults aged ≥65 years to prevent pneumococcal
disease?
A. PCV15 followed by PPSV23 one year later
B. PPSV23 alone
C. PCV20 alone
D. Either A or C
Answer: D. Either A or C
Rationale: CDC (2026) recommends adults ≥65 receive either: (1) PCV20 alone, OR (2) PCV15 followed by
PPSV23 ≥1 year later. Both options provide comprehensive serotype coverage. PPSV23 alone (B) is no
longer preferred for immunocompetent adults ≥65.
6. A 45-year-old woman presents with hot flashes, irregular menses, and sleep disturbance.
What is the most appropriate initial management for vasomotor symptoms?
A. Prescribe hormone therapy immediately
B. Recommend lifestyle modifications and non-hormonal options first
C. Order FSH level to confirm menopause
D. Refer to gynecology for evaluation
Answer: B. Recommend lifestyle modifications and non-hormonal options first
Rationale: NAMS guidelines recommend starting with lifestyle changes (cooling techniques, avoiding
triggers) and non-hormonal options (SSRIs, gabapentin) for mild-moderate symptoms. Hormone therapy
Page 2
, FITZGERALD NP BOARD REVIEW EXAM v2 — 2026/2027 EDITION
(A) is reserved for moderate-severe symptoms after risk-benefit discussion. FSH testing (C) is not required
for diagnosis in symptomatic women >45; referral (D) is unnecessary for uncomplicated perimenopause.
7. Which finding is a RED FLAG for back pain requiring immediate imaging?
A. Pain lasting >2 weeks
B. History of trauma, unexplained weight loss, or neurologic deficit
C. Pain radiating to the leg
D. Age >50 years
Answer: B. History of trauma, unexplained weight loss, or neurologic deficit
Rationale: Red flags for serious pathology (fracture, malignancy, infection, cauda equina) include trauma,
weight loss, fever, neurologic deficits, or bowel/bladder dysfunction. Duration >2 weeks (A), radicular pain
(C), and age >50 (D) are common in mechanical back pain and do not alone warrant imaging.
8. A patient with asthma has daytime symptoms twice weekly and nighttime symptoms twice
monthly. According to GINA guidelines, what is the preferred treatment?
A. SABA alone as needed
B. Low-dose ICS-formoterol as needed
C. Medium-dose ICS daily
D. Oral corticosteroids
Answer: B. Low-dose ICS-formoterol as needed
Rationale: GINA 2026 recommends against SABA-only treatment. For mild asthma (symptoms <2x/week),
preferred treatment is low-dose ICS-formoterol as needed for symptom relief and prevention. SABA alone
(A) increases exacerbation risk; medium-dose ICS (C) is for moderate persistent asthma; oral steroids (D)
are for acute exacerbations.
9. Which laboratory finding is diagnostic for hypothyroidism?
A. Low TSH, low T4
B. High TSH, low T4
C. High TSH, normal T4
D. Low TSH, high T4
Answer: B. High TSH, low T4
Rationale: Primary hypothyroidism is diagnosed by elevated TSH with low free T4. High TSH with normal
T4 (C) indicates subclinical hypothyroidism. Low TSH with low T4 (A) suggests central hypothyroidism;
low TSH with high T4 (D) indicates hyperthyroidism.
10. A 65-year-old man with BPH has moderate symptoms (IPSS 12). What is first-line
pharmacologic treatment?
A. 5-alpha reductase inhibitor
B. Alpha-1 blocker
C. Anticholinergic
D. Phosphodiesterase-5 inhibitor
Answer: B. Alpha-1 blocker
Rationale: AUA guidelines recommend alpha-1 blockers (tamsulosin, alfuzosin) as first-line for moderate-
severe LUTS due to BPH. 5-ARIs (A) are for enlarged prostates (>30g) or high PSA; anticholinergics (C)
are for overactive bladder; PDE5 inhibitors (D) are adjunctive or for ED comorbidity.
11. Which finding suggests heart failure with reduced ejection fraction (HFrEF)?
A. Preserved EF >50%, diastolic dysfunction
B. EF ≤40%, elevated BNP, cardiomegaly on CXR
Page 3
