AANP FNP Latest Certification Exam Prep
– Family Nurse Practitioner Practice Test
2026
Section 1: Cardiovascular (Questions 1-15)
Question 1: (Domain: DIAGNOSE | Cardiovascular)
A 68-year-old male with hypertension, diabetes, and 40-pack-year smoking history presents
with acute substernal chest pain radiating to the jaw. He is diaphoretic and short of breath. ECG
shows ST-segment elevation in leads V2-V4. What is the INITIAL management priority?
A) Administer sublingual nitroglycerin ×3 doses
B) Activate emergency response for percutaneous coronary intervention (PCI)
C) Order stat troponin and chest X-ray
D) Start heparin drip
Answer: B
*Rationale: Acute anterior STEMI (ST elevation in V2-V4) requires emergent reperfusion. Per
AHA/ACC guidelines, PCI within 90 minutes is the priority. "Door-to-balloon" time is critical.
Nitroglycerin, heparin, and diagnostic studies should not delay reperfusion activation.*
Question 2: (Domain: PLAN | Cardiovascular)
A 55-year-old female presents with intermittent palpitations, fatigue, and mild shortness of
breath. Holter monitor reveals episodes of atrial fibrillation lasting 2-4 hours. Her CHA₂DS₂-VASc
score is 4. What is the most appropriate management?
A) Aspirin 81 mg daily
B) Warfarin with target INR 2-3
C) Direct oral anticoagulant (apixaban or rivaroxaban)
D) No anticoagulation; rate control only
Answer: C
,*Rationale: CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high stroke risk requiring
oral anticoagulation. DOACs are preferred over warfarin for non-valvular AFib due to lower
bleeding risk and no INR monitoring. Aspirin is no longer recommended for stroke prevention in
AFib.*
Question 3: (Domain: EVALUATE | Cardiovascular)
A 72-year-old male with HFrEF presents with worsening dyspnea, 3-pillow orthopnea, and 3+
pitting edema. BP 110/70, HR 95. Exam reveals JVD to the angle of the mandible, crackles
halfway up, and an S3 gallop. Which medication should be INITIATED or adjusted FIRST?
A) Carvedilol increase
B) IV furosemide
C) Lisinopril increase
D) Spironolactone
Answer: B
Rationale: This patient is in acute decompensated heart failure with significant volume
overload. Loop diuretics (IV furosemide) are first-line to achieve decongestion. ACE inhibitors
and beta-blockers are chronic management and may be held in the acute setting.
Question 4: (Domain: ASSESS | Cardiovascular)
A 45-year-old female presents with episodes of severe, throbbing headache lasting 4-72 hours,
accompanied by nausea, photophobia, and phonophobia. Bright lights trigger these episodes.
What is the most likely diagnosis?
A) Cluster headache
B) Tension headache
C) Migraine without aura
D) Migraine with aura
Answer: C
*Rationale: Migraine without aura is characterized by unilateral, throbbing pain lasting 4-72
hours with nausea, photophobia, and phonophobia. Cluster headaches are shorter (15-180
minutes) with autonomic features. Tension headaches are bilateral, non-throbbing.*
Question 5: (Domain: PLAN | Cardiovascular/Geriatrics)
,A 78-year-old female with osteoporosis (T-score -2.7) and a prior vertebral compression
fracture is being managed in primary care. What is the FIRST-LINE pharmacologic therapy?
A) Denosumab (Prolia)
B) Alendronate (Fosamax)
C) Raloxifene (Evista)
D) Teriparatide (Forteo)
Answer: B
Rationale: Oral bisphosphonates (alendronate, risedronate) are first-line for osteoporosis due to
efficacy, safety profile, and cost. Denosumab is second-line. Teriparatide is reserved for severe
cases. Raloxifene is used primarily for prevention.
Question 6: (Domain: DIAGNOSE | Cardiovascular)
A 62-year-old male presents with acute onset of severe tearing chest pain radiating to his back.
BP is 180/95 in the right arm and 100/60 in the left arm. What is the priority diagnostic study?
A) ECG and troponin
B) Chest X-ray
C) CT angiography of chest
D) Transthoracic echocardiogram
Answer: C
Rationale: This presentation is concerning for aortic dissection (tearing pain, blood pressure
differential). CT angiography is the study of choice to confirm dissection, identify the site of tear,
and guide management.
Question 7: (Domain: EVALUATE | Cardiovascular)
A 72-year-old female with dementia is brought in by her daughter. The daughter reports that
her mother has fallen twice in the past month. Which intervention is MOST effective for fall
prevention?
A) Physical therapy evaluation and multifactorial risk assessment
B) Soft restraints during sleep hours
C) Sedating medications to reduce nighttime wandering
D) Bed alarm only
Answer: A
, Rationale: CDC STEADI guidelines recommend multifactorial fall risk assessment including
medication review, home safety evaluation, gait/balance training, and vitamin D
supplementation. Restraints and sedatives increase fall risk.
Question 8: (Domain: PLAN | Cardiovascular)
A 68-year-old male presents with progressively worsening urinary frequency, nocturia (4-5
times nightly), weak stream, and sensation of incomplete emptying. AUA symptom score is 18
(moderate-severe). What is the FIRST-LINE pharmacologic therapy?
A) Alpha-blocker (tamsulosin)
B) 5-alpha reductase inhibitor (finasteride)
C) Anticholinergic (oxybutynin)
D) Phosphodiesterase-5 inhibitor (tadalafil)
Answer: A
*Rationale: Alpha-blockers are first-line for symptomatic BPH, providing rapid symptom relief
by relaxing prostatic smooth muscle. 5-ARIs are reserved for larger prostates and take 6-12
months for effect.*
Question 9: (Domain: DIAGNOSE | Cardiovascular)
A 55-year-old female presents with iron deficiency anemia (Hgb 10.2, MCV 78, ferritin 8). She
reports occasional heartburn. After a trial of oral iron and PPI fails to improve her anemia, what
is the most appropriate NEXT step?
A) Continue PPI and iron for 6 more months
B) Refer for colonoscopy and upper endoscopy
C) Order fecal occult blood testing
D) Switch to IV iron
Answer: B
Rationale: In postmenopausal women with iron deficiency anemia without obvious source,
bidirectional endoscopy (colonoscopy and EGD) is indicated to evaluate for GI malignancy per
ACG guidelines.
Question 10: (Domain: PLAN | Cardiovascular)
A 28-year-old female with migraine with aura is requesting contraception. Which method is
CONTRAINDICATED due to increased stroke risk?
– Family Nurse Practitioner Practice Test
2026
Section 1: Cardiovascular (Questions 1-15)
Question 1: (Domain: DIAGNOSE | Cardiovascular)
A 68-year-old male with hypertension, diabetes, and 40-pack-year smoking history presents
with acute substernal chest pain radiating to the jaw. He is diaphoretic and short of breath. ECG
shows ST-segment elevation in leads V2-V4. What is the INITIAL management priority?
A) Administer sublingual nitroglycerin ×3 doses
B) Activate emergency response for percutaneous coronary intervention (PCI)
C) Order stat troponin and chest X-ray
D) Start heparin drip
Answer: B
*Rationale: Acute anterior STEMI (ST elevation in V2-V4) requires emergent reperfusion. Per
AHA/ACC guidelines, PCI within 90 minutes is the priority. "Door-to-balloon" time is critical.
Nitroglycerin, heparin, and diagnostic studies should not delay reperfusion activation.*
Question 2: (Domain: PLAN | Cardiovascular)
A 55-year-old female presents with intermittent palpitations, fatigue, and mild shortness of
breath. Holter monitor reveals episodes of atrial fibrillation lasting 2-4 hours. Her CHA₂DS₂-VASc
score is 4. What is the most appropriate management?
A) Aspirin 81 mg daily
B) Warfarin with target INR 2-3
C) Direct oral anticoagulant (apixaban or rivaroxaban)
D) No anticoagulation; rate control only
Answer: C
,*Rationale: CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high stroke risk requiring
oral anticoagulation. DOACs are preferred over warfarin for non-valvular AFib due to lower
bleeding risk and no INR monitoring. Aspirin is no longer recommended for stroke prevention in
AFib.*
Question 3: (Domain: EVALUATE | Cardiovascular)
A 72-year-old male with HFrEF presents with worsening dyspnea, 3-pillow orthopnea, and 3+
pitting edema. BP 110/70, HR 95. Exam reveals JVD to the angle of the mandible, crackles
halfway up, and an S3 gallop. Which medication should be INITIATED or adjusted FIRST?
A) Carvedilol increase
B) IV furosemide
C) Lisinopril increase
D) Spironolactone
Answer: B
Rationale: This patient is in acute decompensated heart failure with significant volume
overload. Loop diuretics (IV furosemide) are first-line to achieve decongestion. ACE inhibitors
and beta-blockers are chronic management and may be held in the acute setting.
Question 4: (Domain: ASSESS | Cardiovascular)
A 45-year-old female presents with episodes of severe, throbbing headache lasting 4-72 hours,
accompanied by nausea, photophobia, and phonophobia. Bright lights trigger these episodes.
What is the most likely diagnosis?
A) Cluster headache
B) Tension headache
C) Migraine without aura
D) Migraine with aura
Answer: C
*Rationale: Migraine without aura is characterized by unilateral, throbbing pain lasting 4-72
hours with nausea, photophobia, and phonophobia. Cluster headaches are shorter (15-180
minutes) with autonomic features. Tension headaches are bilateral, non-throbbing.*
Question 5: (Domain: PLAN | Cardiovascular/Geriatrics)
,A 78-year-old female with osteoporosis (T-score -2.7) and a prior vertebral compression
fracture is being managed in primary care. What is the FIRST-LINE pharmacologic therapy?
A) Denosumab (Prolia)
B) Alendronate (Fosamax)
C) Raloxifene (Evista)
D) Teriparatide (Forteo)
Answer: B
Rationale: Oral bisphosphonates (alendronate, risedronate) are first-line for osteoporosis due to
efficacy, safety profile, and cost. Denosumab is second-line. Teriparatide is reserved for severe
cases. Raloxifene is used primarily for prevention.
Question 6: (Domain: DIAGNOSE | Cardiovascular)
A 62-year-old male presents with acute onset of severe tearing chest pain radiating to his back.
BP is 180/95 in the right arm and 100/60 in the left arm. What is the priority diagnostic study?
A) ECG and troponin
B) Chest X-ray
C) CT angiography of chest
D) Transthoracic echocardiogram
Answer: C
Rationale: This presentation is concerning for aortic dissection (tearing pain, blood pressure
differential). CT angiography is the study of choice to confirm dissection, identify the site of tear,
and guide management.
Question 7: (Domain: EVALUATE | Cardiovascular)
A 72-year-old female with dementia is brought in by her daughter. The daughter reports that
her mother has fallen twice in the past month. Which intervention is MOST effective for fall
prevention?
A) Physical therapy evaluation and multifactorial risk assessment
B) Soft restraints during sleep hours
C) Sedating medications to reduce nighttime wandering
D) Bed alarm only
Answer: A
, Rationale: CDC STEADI guidelines recommend multifactorial fall risk assessment including
medication review, home safety evaluation, gait/balance training, and vitamin D
supplementation. Restraints and sedatives increase fall risk.
Question 8: (Domain: PLAN | Cardiovascular)
A 68-year-old male presents with progressively worsening urinary frequency, nocturia (4-5
times nightly), weak stream, and sensation of incomplete emptying. AUA symptom score is 18
(moderate-severe). What is the FIRST-LINE pharmacologic therapy?
A) Alpha-blocker (tamsulosin)
B) 5-alpha reductase inhibitor (finasteride)
C) Anticholinergic (oxybutynin)
D) Phosphodiesterase-5 inhibitor (tadalafil)
Answer: A
*Rationale: Alpha-blockers are first-line for symptomatic BPH, providing rapid symptom relief
by relaxing prostatic smooth muscle. 5-ARIs are reserved for larger prostates and take 6-12
months for effect.*
Question 9: (Domain: DIAGNOSE | Cardiovascular)
A 55-year-old female presents with iron deficiency anemia (Hgb 10.2, MCV 78, ferritin 8). She
reports occasional heartburn. After a trial of oral iron and PPI fails to improve her anemia, what
is the most appropriate NEXT step?
A) Continue PPI and iron for 6 more months
B) Refer for colonoscopy and upper endoscopy
C) Order fecal occult blood testing
D) Switch to IV iron
Answer: B
Rationale: In postmenopausal women with iron deficiency anemia without obvious source,
bidirectional endoscopy (colonoscopy and EGD) is indicated to evaluate for GI malignancy per
ACG guidelines.
Question 10: (Domain: PLAN | Cardiovascular)
A 28-year-old female with migraine with aura is requesting contraception. Which method is
CONTRAINDICATED due to increased stroke risk?
