AANP Family Nurse Practitioner Certification Exam (FNP-C) — Questions and Answers

Question 1: A 55-year-old patient with gout has a serum uric acid of 9.8 mg/dL and two gout flares in the past year. He is not on urate-lowering therapy. What is the appropriate treatment goal?

Serum uric acid < 7 mg/dL with colchicine monotherapy
Serum uric acid < 6 mg/dL with allopurinol (Correct answer)
No pharmacologic treatment until the next acute flare
Serum uric acid < 5 mg/dL with high-dose NSAIDs

Correct answer: Serum uric acid < 6 mg/dL with allopurinol

ACR guidelines recommend initiating urate-lowering therapy (first-line allopurinol) in patients with ≥2 flares/year, with a target serum urate < 6 mg/dL to prevent crystal deposition and flares.

Question 2: Which condition is characterized by heavy, irregular menstrual bleeding due to absence of ovulation with no structural pathology?

Leiomyomas (uterine fibroids)
Anovulatory dysfunctional uterine bleeding (Correct answer)
Cervical stenosis
Endometrial polyps

Correct answer: Anovulatory dysfunctional uterine bleeding

Anovulatory DUB results from unopposed estrogen stimulation without progesterone, causing irregular proliferation and unpredictable shedding of the endometrium.

Question 3: A unilateral, painful, vesicular rash following a dermatomal distribution in an elderly patient is most consistent with:

Herpes zoster (shingles) (Correct answer)
Herpes simplex infection
Impetigo
Contact dermatitis

Correct answer: Herpes zoster (shingles)

Herpes zoster results from reactivation of varicella-zoster virus in a dorsal root ganglion, presenting as a unilateral vesicular rash in a dermatomal pattern with pain.

Question 4: Which ECG finding indicates ST-elevation myocardial infarction (STEMI) requiring emergent intervention?

ST depression in V1–V4
New ST elevation ≥1 mm in two contiguous leads (Correct answer)
PR interval prolongation
T-wave inversion in III and aVF

Correct answer: New ST elevation ≥1 mm in two contiguous leads

STEMI is defined by new ST elevation ≥1 mm in two or more contiguous leads (or ≥2 mm in V1–V3), indicating transmural ischemia requiring emergent PCI or thrombolytics.

Question 5: Which skin finding is most associated with systemic lupus erythematosus (SLE)?

Butterfly (malar) rash across the nose and cheeks (Correct answer)
Erythema chronicum migrans
Acanthosis nigricans
Port-wine stain

Correct answer: Butterfly (malar) rash across the nose and cheeks

The malar (butterfly) rash of SLE spares the nasolabial folds and is triggered or worsened by UV light exposure, representing a classic diagnostic criterion.

Question 6: How does an ACNP contribute to patient care during a medical emergency?

By taking the lead in assessing the situation, performing necessary procedures, and coordinating care (Correct answer)
By delegating all tasks to other healthcare providers
By referring the patient to outpatient services
By only providing administrative support

Correct answer: By taking the lead in assessing the situation, performing necessary procedures, and coordinating care

During a medical emergency, ACNPs are highly skilled in quickly assessing patient status, implementing immediate life-saving interventions, and coordinating the efforts of the healthcare team. Their advanced clinical judgment and procedural skills are vital for stabilizing patients and optimizing outcomes in critical situations. They often take a leadership role in managing the emergency response.

Question 7: Tzanck smear revealing multinucleated giant cells is consistent with infection caused by which organism?

Staphylococcus aureus
Candida albicans
Herpes simplex virus (Correct answer)
Human papillomavirus

Correct answer: Herpes simplex virus

Multinucleated giant cells (Tzanck cells) on smear are pathognomonic for herpesvirus infections, including HSV-1, HSV-2, and varicella-zoster virus.

Question 8: Which of the following is a typical responsibility of an ACNP in a hospital setting?

Providing long-term counseling services
Conducting routine wellness exams
Administering vaccinations to children
Diagnosing and managing acute illnesses, performing invasive procedures, and stabilizing patients (Correct answer)

Correct answer: Diagnosing and managing acute illnesses, performing invasive procedures, and stabilizing patients

In a hospital setting, ACNPs are critical in managing complex patient needs, including rapid diagnosis of acute conditions, initiating and adjusting life-sustaining treatments, and performing invasive procedures. Their role involves stabilizing patients, managing acute illnesses, and performing procedures like central line insertions or intubations. They are essential for guiding patients through critical phases of illness and injury.

Question 9: A 72-year-old patient with hypertension and stage 3a CKD has a blood pressure of 148/88 mmHg on amlodipine 10 mg. Which antihypertensive class should be added first?

Beta-blocker
Alpha-1 blocker
Thiazide diuretic
ACE inhibitor or ARB (Correct answer)

Correct answer: ACE inhibitor or ARB

ACE inhibitors and ARBs are preferred add-on agents in CKD with hypertension because they reduce proteinuria and slow progression of kidney disease.

Question 10: A patient with asthma is classified as having moderate persistent disease. He is currently on a low-dose inhaled corticosteroid (ICS) with persistent symptoms. What is the next step per NAEPP guidelines?

Step up to low-dose ICS plus a long-acting beta-agonist (LABA) (Correct answer)
Add an oral leukotriene receptor antagonist and keep same ICS dose
Add an oral corticosteroid for 2 weeks then reassess
Switch to a high-dose ICS monotherapy

Correct answer: Step up to low-dose ICS plus a long-acting beta-agonist (LABA)

NAEPP Step 3 therapy for moderate persistent asthma is low-dose ICS combined with a LABA, which improves symptom control compared to ICS monotherapy.

Question 11: Which medication is the recommended pharmacological treatment for postmenopausal osteoporosis prevention as first-line therapy?

Teriparatide
Calcitonin
Selective estrogen receptor modulators alone
Bisphosphonates (e.g., alendronate) (Correct answer)

Correct answer: Bisphosphonates (e.g., alendronate)

Bisphosphonates such as alendronate are the first-line pharmacological treatment for postmenopausal osteoporosis due to their proven efficacy in reducing fracture risk.

Question 12: Which diagnostic test is the gold standard for diagnosing endometriosis?

Laparoscopy with biopsy (Correct answer)
MRI of the pelvis
Transvaginal ultrasound
Serum CA-125 level

Correct answer: Laparoscopy with biopsy

Laparoscopy with direct visualization and biopsy of ectopic endometrial implants remains the gold standard for definitive diagnosis of endometriosis.

Question 13: Which medication is FDA-approved as a first-line pharmacological treatment for PTSD?

Olanzapine
Sertraline (Correct answer)
Alprazolam
Propranolol

Correct answer: Sertraline

Sertraline and paroxetine are the only FDA-approved medications for PTSD; benzodiazepines are not recommended due to risk of dependence and potential worsening of PTSD.

Question 14: A patient with stable angina is found to have an LDL of 98 mg/dL on high-intensity statin therapy. His 10-year ASCVD risk is 28%. What is the most appropriate next step?

Add niacin for additional LDL lowering
No additional intervention is needed
Add ezetimibe to further reduce LDL (Correct answer)
Switch to a moderate-intensity statin

Correct answer: Add ezetimibe to further reduce LDL

In very high-risk ASCVD patients with LDL ≥70 mg/dL despite maximally tolerated statin, adding ezetimibe is the recommended next step to further reduce cardiovascular risk.

Question 15: In what setting do Acute Care Nurse Practitioners most often practice?

Outpatient family practice clinics
Intensive care units (ICUs) and emergency departments (Correct answer)
Community health centers
School health clinics

Correct answer: Intensive care units (ICUs) and emergency departments

ACNPs primarily practice in high-acuity settings where patients require intensive monitoring, rapid intervention, and complex medical management. Intensive care units (ICUs) and emergency departments are prime examples, as these environments demand the specialized skills of ACNPs to stabilize and treat critically ill individuals. Their expertise is crucial in these fast-paced and life-threatening situations.

Question 16: What is the mechanism of action of metformin in type 2 diabetes?

Inhibits hepatic glucose production and improves insulin sensitivity (Correct answer)
Stimulates pancreatic insulin secretion
Blocks intestinal glucose absorption
Increases renal glucose excretion

Correct answer: Inhibits hepatic glucose production and improves insulin sensitivity

Metformin primarily works by inhibiting hepatic gluconeogenesis and improving peripheral insulin sensitivity without causing hypoglycemia.

Question 17: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, nausea, and blood glucose of 480 mg/dL. What is the most likely diagnosis?

Lactic acidosis
Diabetic ketoacidosis (DKA) (Correct answer)
Hyperosmolar hyperglycemic state
Hyperglycemic hyperosmolar syndrome

Correct answer: Diabetic ketoacidosis (DKA)

DKA presents with hyperglycemia, Kussmaul breathing (compensating for metabolic acidosis), fruity breath from ketones, and is more common in type 1 diabetes.

Question 18: Which of the following is a common setting for PNPs to practice?

Pediatric outpatient clinics and hospitals (Correct answer)
Geriatric care centers
Long-term care facilities
Adult intensive care units (ICUs)

Correct answer: Pediatric outpatient clinics and hospitals

PNPs are commonly found in settings dedicated to children's health, such as pediatric primary care clinics, specialty clinics, and children's hospitals. They provide both preventive care and manage acute and chronic conditions specific to the pediatric population in these environments. Their presence ensures that children receive specialized and age-appropriate medical attention.

Question 19: What is the antidote for acetaminophen overdose?

N-acetylcysteine (Correct answer)
Flumazenil
Naloxone
Activated charcoal alone

Correct answer: N-acetylcysteine

N-acetylcysteine replenishes glutathione stores in the liver, neutralizing the toxic metabolite NAPQI that causes hepatotoxicity in acetaminophen overdose.

Question 20: Which certification is typically required for a Family Nurse Practitioner?

Certified Nurse Midwife (CNM)
Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
Neonatal Nurse Practitioner (NNP)
Family Nurse Practitioner (FNP) Certification (Correct answer)

Correct answer: Family Nurse Practitioner (FNP) Certification

To become a practicing Family Nurse Practitioner, individuals must successfully complete a specialized FNP program and obtain specific certification that validates their expertise in providing care across the lifespan. The Family Nurse Practitioner (FNP) Certification is the primary credential for this role. This certification ensures they meet the rigorous standards required for their broad scope of practice, encompassing all age groups.

Question 21: A patient presents with bilateral lower extremity edema, elevated JVP, and crackles at lung bases. What is the most likely diagnosis?

Nephrotic syndrome
Decompensated congestive heart failure (Correct answer)
Deep vein thrombosis
Cirrhosis with portal hypertension

Correct answer: Decompensated congestive heart failure

The triad of bilateral peripheral edema, elevated JVP, and pulmonary crackles is classic for fluid overload from decompensated congestive heart failure.

Question 22: Which patient population is NOT typically within the scope of practice for an FNP?

Adults
Newborns
Adolescents
None; FNPs care for patients across the lifespan (Correct answer)

Correct answer: None; FNPs care for patients across the lifespan

The defining characteristic of a Family Nurse Practitioner (FNP) is their ability to provide care to individuals of all ages, from infancy through geriatrics. Therefore, no specific age group is excluded from their typical scope of practice. FNPs are trained to address the unique health needs of newborns, adolescents, and adults, making them versatile healthcare providers for the entire family.

Question 23: Which screening tool is validated for detecting depression in the primary care setting?

CAGE questionnaire
GAD-7
AUDIT-C
PHQ-9 (Correct answer)

Correct answer: PHQ-9

The PHQ-9 (Patient Health Questionnaire-9) is a validated, widely used screening and severity assessment tool for major depressive disorder in primary care.

Question 24: Which psychotherapy has the strongest evidence base for treating major depressive disorder?

Eye movement desensitization and reprocessing (EMDR)
Supportive therapy
Psychodynamic therapy
Cognitive behavioral therapy (CBT) (Correct answer)

Correct answer: Cognitive behavioral therapy (CBT)

CBT has the most robust evidence base for treating major depressive disorder, with multiple randomized controlled trials demonstrating efficacy comparable to antidepressants.

Question 25: Which class of medication is first-line for panic disorder with or without agoraphobia?

Benzodiazepines
SSRIs/SNRIs (Correct answer)
Beta-blockers
Anticonvulsants

Correct answer: SSRIs/SNRIs

SSRIs and SNRIs are first-line for panic disorder due to their efficacy, tolerability, and lack of dependence; benzodiazepines may be used short-term as adjuncts.

Question 26: A patient on lithium develops nausea, tremor, and polyuria. Which action is most appropriate?

Discontinue lithium immediately without checking levels
Add a diuretic to manage polyuria
Increase sodium intake and check lithium level (Correct answer)
Reduce caffeine intake only

Correct answer: Increase sodium intake and check lithium level

Lithium toxicity can be precipitated by sodium depletion; increasing sodium intake helps renal lithium excretion, and checking the serum level guides further management.

Question 27: What is a key responsibility of an AGNP in a primary care setting?

Managing chronic diseases such as diabetes and hypertension (Correct answer)
Conducting psychiatric evaluations
Providing neonatal care
Performing surgeries

Correct answer: Managing chronic diseases such as diabetes and hypertension

AGNPs in primary care settings play a crucial role in the long-term management of chronic conditions prevalent in adult and older adult populations. They develop comprehensive treatment plans, monitor patient progress, educate on self-management strategies, and adjust therapies to optimize health outcomes for complex diseases like diabetes and hypertension. This focus is central to improving the quality of life for their patients.

Question 28: Which topical medication is the treatment of choice for tinea pedis (athlete's foot)?

Topical mupirocin
Topical acyclovir
Topical clotrimazole or terbinafine (Correct answer)
Topical corticosteroids

Correct answer: Topical clotrimazole or terbinafine

Tinea pedis is a dermatophyte fungal infection treated with topical antifungals such as clotrimazole (azole) or terbinafine (allylamine) applied for 2–4 weeks.

Question 29: A patient with fair skin has a pearly, translucent nodule with telangiectasias on the nose. What is the most likely diagnosis?

Actinic keratosis
Squamous cell carcinoma
Basal cell carcinoma (Correct answer)
Melanoma

Correct answer: Basal cell carcinoma

Basal cell carcinoma typically presents as a pearly or translucent papule or nodule with rolled borders and telangiectasias, most commonly on sun-exposed areas of the face.

Question 30: A patient with heart failure with reduced ejection fraction (HFrEF, EF 35%) is already on an ACE inhibitor and beta-blocker at target doses. Which additional medication has been shown to reduce mortality in this patient?

Amlodipine
Hydralazine alone
Spironolactone (Correct answer)
Digoxin

Correct answer: Spironolactone

Aldosterone antagonists such as spironolactone reduce mortality in HFrEF when added to ACE inhibitor and beta-blocker therapy, per the RALES trial.

Question 31: A patient with a history of atopy presents with intensely pruritic, flexural rashes since childhood. What is the most likely diagnosis?

Rosacea
Psoriasis
Contact dermatitis
Atopic dermatitis (eczema) (Correct answer)

Correct answer: Atopic dermatitis (eczema)

Atopic dermatitis typically begins in childhood, is associated with the atopic triad (asthma, allergic rhinitis, eczema), and preferentially affects flexural areas.

Question 32: A nurse practitioner diagnoses a patient with actinic keratosis. Why is treatment recommended even for asymptomatic lesions?

They are premalignant lesions that can progress to squamous cell carcinoma (Correct answer)
They are associated with autoimmune disease
They can spread as a viral infection
They cause significant pain

Correct answer: They are premalignant lesions that can progress to squamous cell carcinoma

Actinic keratoses are premalignant lesions caused by UV damage that can progress to invasive squamous cell carcinoma, justifying treatment even when asymptomatic.

Question 33: A patient with osteoporosis has a T-score of -2.6 at the lumbar spine. She is already taking calcium and vitamin D. What is the first-line pharmacologic treatment?

Denosumab
Calcitonin nasal spray
Alendronate (Correct answer)
Raloxifene

Correct answer: Alendronate

Bisphosphonates such as alendronate are first-line pharmacologic therapy for osteoporosis due to their proven efficacy in reducing vertebral and hip fractures.

Question 34: A 55-year-old male with hyperlipidemia has an LDL of 145 mg/dL. He has a 10-year ASCVD risk of 12% calculated by the Pooled Cohort Equations. Which intervention is indicated?

Lifestyle modification alone for 6 months
Ezetimibe monotherapy
High-intensity statin therapy
Moderate-intensity statin therapy (Correct answer)

Correct answer: Moderate-intensity statin therapy

ACC/AHA guidelines recommend moderate-intensity statin therapy for intermediate-risk patients (10-year ASCVD risk 7.5–20%) to lower LDL by 30–49%.

Question 35: What type of care is most commonly provided by FNPs?

Specialty care only
Intensive care unit (ICU) care
Surgical care
Primary care, including preventive care and management of common acute and chronic conditions (Correct answer)

Correct answer: Primary care, including preventive care and management of common acute and chronic conditions

FNPs are foundational to primary care, offering a wide range of services from health promotion and disease prevention to diagnosing and managing common acute illnesses and chronic conditions. They serve as a patient's first point of contact for healthcare, providing continuous and comprehensive care for individuals and families. This includes routine check-ups, immunizations, and ongoing management of health issues.

Question 36: A patient presents with acute urinary retention. After placement of a Foley catheter, which complication should the NP monitor for?

Bladder perforation from urethral trauma
Hyperkalemia only
Post-obstructive diuresis with electrolyte imbalances (Correct answer)
Hematuria only

Correct answer: Post-obstructive diuresis with electrolyte imbalances

Rapid decompression of a chronically obstructed bladder can cause post-obstructive diuresis with large urine output, leading to dehydration and electrolyte disturbances requiring careful monitoring.

Question 37: The most common cause of vaginal discharge with a thin, gray, fishy-smelling discharge and clue cells on wet mount is:

Bacterial vaginosis (Correct answer)
Chlamydia trachomatis
Candida albicans
Trichomonas vaginalis

Correct answer: Bacterial vaginosis

Bacterial vaginosis is caused by an overgrowth of anaerobic bacteria, presenting with a fishy-smelling, thin gray discharge and clue cells (epithelial cells studded with bacteria).

Question 38: What is the primary focus of the Adult-Gerontology Nurse Practitioner (AGNP) role?

Emergency nursing
Mental health services
Care of adolescents, adults, and older adults (Correct answer)
Pediatric care

Correct answer: Care of adolescents, adults, and older adults

The Adult-Gerontology Nurse Practitioner (AGNP) role is specifically designed to provide comprehensive healthcare services to individuals across the adult lifespan. This includes health promotion, disease prevention, and the management of acute and chronic conditions for patients ranging from adolescence through advanced old age. Their specialized training focuses on the unique health needs of this broad demographic.

Question 39: Which of the following is a key responsibility of FNPs in family practice?

Performing diagnostic tests, such as ordering blood work and imaging (Correct answer)
Providing only mental health counseling
Assisting in surgeries as the lead surgeon
Delivering babies

Correct answer: Performing diagnostic tests, such as ordering blood work and imaging

FNPs are authorized to order and interpret a variety of diagnostic tests, including laboratory blood work, urine tests, and imaging studies like X-rays or ultrasounds. This capability is essential for accurately diagnosing conditions, monitoring disease progression, and developing appropriate treatment plans for their patients. Their ability to utilize these tools is critical for comprehensive patient assessment and management in family practice.

Question 40: Which drug class is first-line for treating hypertension in patients with diabetes and microalbuminuria?

Loop diuretics
Calcium channel blockers
ACE inhibitors (Correct answer)
Beta-blockers

Correct answer: ACE inhibitors

ACE inhibitors provide renoprotective effects in diabetic patients with microalbuminuria, making them the preferred antihypertensive class.

Question 41: A 62-year-old patient with type 2 diabetes and established cardiovascular disease has an HbA1c of 8.2%. He is on metformin. Which agent should be added for its proven cardiovascular mortality benefit?

Glimepiride (sulfonylurea)
Empagliflozin (SGLT-2 inhibitor) (Correct answer)
Sitagliptin (DPP-4 inhibitor)
Acarbose (alpha-glucosidase inhibitor)

Correct answer: Empagliflozin (SGLT-2 inhibitor)

SGLT-2 inhibitors such as empagliflozin have demonstrated cardiovascular mortality reduction in patients with T2DM and established ASCVD in landmark trials (EMPA-REG OUTCOME).

Question 42: What is the first-line treatment for mild-to-moderate acne vulgaris characterized by comedones and a few inflammatory papules?

Oral isotretinoin
Intralesional corticosteroids
Oral doxycycline alone
Topical retinoids and/or benzoyl peroxide (Correct answer)

Correct answer: Topical retinoids and/or benzoyl peroxide

Topical retinoids normalize follicular keratinization and benzoyl peroxide has antimicrobial properties; both are recommended as first-line agents for mild-to-moderate acne.

Question 43: A patient presents with a target-like skin lesion with central blistering after starting a new antibiotic. What condition should be suspected?

Fixed drug eruption
Erythema multiforme (Correct answer)
Cellulitis
Urticaria

Correct answer: Erythema multiforme

Erythema multiforme is characterized by target lesions (three concentric zones) and is commonly triggered by HSV infection or medications such as sulfonamides and penicillins.

Question 44: A woman presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia. Pelvic exam reveals a fixed, retroverted uterus. What is the most likely diagnosis?

Pelvic inflammatory disease
Ovarian torsion
Uterine fibroids
Endometriosis (Correct answer)

Correct answer: Endometriosis

Endometriosis classically causes cyclic pelvic pain, dysmenorrhea, dyspareunia, and can cause a fixed, retroverted uterus due to adhesions from ectopic endometrial tissue.

Question 45: Which screening test is currently recommended for cervical cancer detection in average-risk women aged 21–29?

Pap smear alone every 3 years (Correct answer)
Annual Pap smear
HPV testing alone every 5 years
Co-testing (Pap + HPV) every 5 years

Correct answer: Pap smear alone every 3 years

Current USPSTF and ASCCP guidelines recommend Pap smear alone every 3 years for women aged 21–29; HPV co-testing is not recommended until age 30.

Question 46: Which medication requires monitoring of thyroid function tests due to risk of hypothyroidism or hyperthyroidism?

Amiodarone (Correct answer)
Lisinopril
Metoprolol
Atorvastatin

Correct answer: Amiodarone

Amiodarone contains a large amount of iodine and can cause both hypothyroidism and hyperthyroidism, requiring regular thyroid function monitoring.

Question 47: A patient with schizophrenia develops muscle rigidity, high fever, altered consciousness, and autonomic instability after starting haloperidol. What is this complication?

Acute dystonic reaction
Serotonin syndrome
Tardive dyskinesia
Neuroleptic malignant syndrome (NMS) (Correct answer)

Correct answer: Neuroleptic malignant syndrome (NMS)

NMS is a rare, life-threatening reaction to dopamine-blocking antipsychotics, characterized by the tetrad of fever, rigidity, altered consciousness, and autonomic instability.

Question 48: Which antibiotic class is contraindicated in children under 8 years due to tooth discoloration and bone growth inhibition?

Cephalosporins
Tetracyclines (Correct answer)
Macrolides
Penicillins

Correct answer: Tetracyclines

Tetracyclines bind calcium and deposit in developing teeth and bones, causing permanent discoloration and potential growth retardation in children under 8.

Question 49: Which sexually transmitted infection is the most common reportable infectious disease in the United States?

Syphilis
Herpes simplex virus
Chlamydia (Correct answer)
Gonorrhea

Correct answer: Chlamydia

Chlamydia trachomatis infection is the most frequently reported notifiable STI in the US, with over 1.6 million cases annually, affecting primarily young women.

Question 50: Which analgesic is contraindicated in a patient with known G6PD deficiency presenting with pain?

Ibuprofen
Aspirin in high doses causing oxidative hemolysis (Correct answer)
Primaquine (not an analgesic; which NSAID triggers hemolysis)
Acetaminophen

Correct answer: Aspirin in high doses causing oxidative hemolysis

High-dose aspirin can cause oxidative hemolysis in G6PD-deficient patients because it increases oxidative stress that G6PD normally protects against; acetaminophen is generally safe.

Question 51: A patient is brought in after intentional overdose of tricyclic antidepressants (TCAs). Which ECG finding is most concerning for cardiac toxicity?

Peaked T waves
QRS widening greater than 100 ms (Correct answer)
Short QT interval
Sinus bradycardia

Correct answer: QRS widening greater than 100 ms

TCA overdose causes sodium channel blockade leading to QRS widening; a QRS >100 ms predicts ventricular arrhythmias and >160 ms predicts ventricular fibrillation.

Question 52: A patient with hypothyroidism has been stable on levothyroxine 100 mcg for 2 years. A repeat TSH returns at 6.8 mIU/L (reference 0.4–4.0). She reports fatigue and cold intolerance. What is the most appropriate action?

Add liothyronine (T3) to current dose
Increase levothyroxine dose by 12.5–25 mcg (Correct answer)
Recheck TSH in 6 months without dose change
Switch to combination T3/T4 therapy

Correct answer: Increase levothyroxine dose by 12.5–25 mcg

A mildly elevated TSH with symptoms consistent with hypothyroidism indicates under-replacement; the standard approach is a small incremental increase in levothyroxine dose.

Question 53: Which topical agent is used as first-line treatment for rosacea with predominantly inflammatory papules and pustules?

Topical metronidazole or azelaic acid (Correct answer)
Topical corticosteroids
Topical salicylic acid
Topical antifungals

Correct answer: Topical metronidazole or azelaic acid

Topical metronidazole and azelaic acid have anti-inflammatory properties and are first-line treatments for papulopustular rosacea; topical steroids can worsen rosacea.

Question 54: Which blood pressure medication class is absolutely contraindicated in pregnancy due to teratogenicity?

Methyldopa
Nifedipine
Labetalol
ACE inhibitors (Correct answer)

Correct answer: ACE inhibitors

ACE inhibitors are teratogenic, particularly in the second and third trimesters, causing fetal renal malformations, oligohydramnios, and skull hypoplasia.

Question 55: A patient with a history of alcohol use disorder presents with tremors, diaphoresis, and hallucinations 24 hours after his last drink. What is the priority treatment?

Oral acamprosate
IV benzodiazepines (e.g., lorazepam, diazepam) (Correct answer)
Oral naltrexone
Oral disulfiram

Correct answer: IV benzodiazepines (e.g., lorazepam, diazepam)

Alcohol withdrawal can be life-threatening; IV benzodiazepines are the standard of care for moderate-to-severe withdrawal, preventing progression to seizures and delirium tremens.

Question 56: A nurse practitioner prescribes trimethoprim-sulfamethoxazole to a patient on methotrexate. What serious risk exists?

Serotonin syndrome
Hepatotoxicity only
QT prolongation
Bone marrow suppression and pancytopenia (Correct answer)

Correct answer: Bone marrow suppression and pancytopenia

TMP-SMX inhibits dihydrofolate reductase and can potentiate methotrexate toxicity, leading to severe bone marrow suppression and pancytopenia.

Question 57: Which condition is characterized by salmon-colored patches in skin folds (axilla, groin) with fine scale that fluoresce coral-red under Wood's lamp?

Tinea versicolor
Inverse psoriasis
Erythrasma (Correct answer)
Intertrigo

Correct answer: Erythrasma

Erythrasma is a superficial bacterial infection caused by Corynebacterium minutissimum that produces coral-red fluorescence under Wood's lamp due to porphyrin production.

Question 58: The AUDIT-C questionnaire is used to screen for which behavioral health condition?

Hazardous or harmful alcohol use (Correct answer)
Depression
Substance use disorder (opioids)
Tobacco dependence

Correct answer: Hazardous or harmful alcohol use

The AUDIT-C (Alcohol Use Disorders Identification Test-Concise) is a validated 3-question screen for hazardous or harmful alcohol consumption in primary care.

Question 59: What is the hallmark feature that distinguishes bipolar II disorder from bipolar I disorder?

Hypomanic rather than full manic episodes (Correct answer)
Presence of depressive episodes only
Psychotic features during mood episodes
Rapid cycling between episodes

Correct answer: Hypomanic rather than full manic episodes

Bipolar II disorder is defined by hypomanic episodes (less severe, less than 4–7 days, no functional impairment) rather than the full manic episodes of bipolar I.

Question 60: Which certification is required for an Adult-Gerontology Nurse Practitioner?

Family Nurse Practitioner (FNP) Certification
Certified Registered Nurse Anesthetist (CRNA)
Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) Certification (Correct answer)
Certified Pediatric Nurse Practitioner (CPNP)

Correct answer: Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) Certification

To practice as an Adult-Gerontology Nurse Practitioner, individuals must obtain specific certification that validates their specialized knowledge and skills in this population. The Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) Certification, or its acute care counterpart (AGACNP), directly aligns with the scope of practice for this role. This credential ensures they meet rigorous standards for providing comprehensive care to adolescents, adults, and older adults.

Question 61: A 58-year-old patient with type 2 diabetes has an HbA1c of 8.9%. Current treatment is metformin 1000 mg twice daily. Which is the most appropriate next step?

Reduce metformin dose and recheck in 6 months
Add a GLP-1 receptor agonist (Correct answer)
Refer to endocrinology before any change
Switch to insulin glargine monotherapy

Correct answer: Add a GLP-1 receptor agonist

Adding a GLP-1 receptor agonist to metformin is guideline-recommended when HbA1c remains above goal; it provides cardiovascular and weight benefits with low hypoglycemia risk.

Question 62: Which SSRI has the longest half-life and is least likely to cause discontinuation syndrome?

Citalopram
Sertraline
Fluoxetine (Correct answer)
Paroxetine

Correct answer: Fluoxetine

Fluoxetine has a half-life of 2–6 days (with active metabolite norfluoxetine at 4–16 days), which effectively tapers itself and minimizes discontinuation symptoms.

Question 63: A patient presents with sudden dyspnea, pleuritic chest pain, and hypoxia after a long flight. Which test is most appropriate to confirm the diagnosis?

CT pulmonary angiography (CTPA) (Correct answer)
Chest X-ray
ECG
D-dimer alone

Correct answer: CT pulmonary angiography (CTPA)

CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, directly visualizing clots in the pulmonary vasculature.

Question 64: A patient diagnosed with bipolar I disorder should be educated that untreated manic episodes last approximately how long?

1–3 days
1–3 months without treatment (Correct answer)
6–12 months
3–7 days

Correct answer: 1–3 months without treatment

Untreated manic episodes in bipolar I disorder typically last 3 months or longer; proper mood stabilizer therapy significantly shortens episode duration.

Question 65: According to USPSTF, depression screening is recommended for which population group?

Adults aged 18–65 only
Adolescents aged 12–17 only
Adults over age 50 only
All adults aged 18 and older, including pregnant and postpartum women (Correct answer)

Correct answer: All adults aged 18 and older, including pregnant and postpartum women

The USPSTF recommends depression screening for all adults 18 and older, including pregnant and postpartum women, as part of routine primary care.

Question 66: A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 86% at rest on room air. Which intervention has been shown to improve survival in COPD?

Mucolytics such as N-acetylcysteine
Theophylline for bronchodilation
Long-term supplemental oxygen therapy ≥15 hours/day (Correct answer)
Systemic corticosteroids daily

Correct answer: Long-term supplemental oxygen therapy ≥15 hours/day

The NOTT and MRC trials demonstrated that long-term oxygen therapy ≥15 hours/day improves survival in COPD patients with resting hypoxemia (PaO₂ ≤55 mmHg or SpO₂ ≤88%).

Question 67: What is an important consideration when prescribing medications for older adults?

Drug interactions are less likely
Age-related changes in drug metabolism (Correct answer)
Higher doses are always required
Prescribe the same medications as for younger adults

Correct answer: Age-related changes in drug metabolism

When prescribing medications for older adults, it is crucial to consider age-related changes in drug metabolism and excretion. As individuals age, physiological changes can impact how drugs are processed by the body, often leading to increased sensitivity or slower elimination. This necessitates careful dosage adjustments, thorough medication reviews for potential interactions, and close monitoring to ensure safety and efficacy.

Question 68: What is the first-line treatment for community-acquired pneumonia (CAP) in an otherwise healthy outpatient adult?

Levofloxacin
Azithromycin or doxycycline (Correct answer)
Ceftriaxone
Amoxicillin-clavulanate

Correct answer: Azithromycin or doxycycline

IDSA/ATS guidelines recommend azithromycin or doxycycline monotherapy for healthy outpatients with CAP and no comorbidities or antibiotic use in the past 3 months.

Question 69: A patient with a 40-pack-year smoking history, age 58, is seen for an annual visit. He currently smokes 1 PPD. Which lung cancer screening recommendation applies?

Annual low-dose CT scan of the chest (Correct answer)
Sputum cytology every 6 months
Annual chest X-ray
No screening is indicated until symptoms develop

Correct answer: Annual low-dose CT scan of the chest

USPSTF recommends annual low-dose CT (LDCT) for adults aged 50–80 with a 20+ pack-year history who currently smoke or quit within the past 15 years.

Question 70: A patient with rheumatoid arthritis has inadequate response after 3 months of methotrexate monotherapy. She has no comorbidities. What is the most appropriate next step per current guidelines?

Switch to hydroxychloroquine monotherapy
Add a TNF inhibitor or other biologic DMARD (Correct answer)
Increase methotrexate to maximum dose before adding another agent
Add prednisone 20 mg daily indefinitely

Correct answer: Add a TNF inhibitor or other biologic DMARD

ACR guidelines recommend adding a biologic or targeted synthetic DMARD (such as a TNF inhibitor) after 3 months of inadequate response to methotrexate monotherapy.

Question 71: What is the primary focus of an Acute Care Nurse Practitioner (ACNP)?

Pediatric wellness
Long-term care for the elderly
Primary care and routine check-ups
Management of patients with acute, critical, and complex chronic conditions (Correct answer)

Correct answer: Management of patients with acute, critical, and complex chronic conditions

Acute Care Nurse Practitioners (ACNPs) specialize in providing advanced care to patients experiencing severe, sudden illnesses, critical conditions, or complex exacerbations of chronic diseases. Their expertise lies in rapid assessment, diagnosis, and intervention to stabilize and manage these high-acuity patients, often in hospital settings. Their primary focus is on managing complex, life-threatening health issues.

Question 72: A patient with schizophrenia is non-adherent to oral antipsychotics due to forgetfulness. What formulation would improve adherence?

Supervised daily oral dosing only
Long-acting injectable (LAI) antipsychotic (Correct answer)
Higher dose oral antipsychotic once daily
Liquid formulation antipsychotic

Correct answer: Long-acting injectable (LAI) antipsychotic

Long-acting injectable antipsychotics given every 2–4 weeks or monthly eliminate the need for daily compliance and significantly improve adherence in schizophrenia.

Question 73: A 65-year-old with COPD is on a short-acting bronchodilator PRN. Spirometry shows FEV1/FVC < 0.70 and FEV1 55% predicted. He reports two exacerbations in the past year. What is the most appropriate maintenance therapy?

Inhaled corticosteroid (ICS) monotherapy
Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) (Correct answer)
Oral theophylline
Short-acting beta-agonist scheduled four times daily

Correct answer: Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA)

GOLD guidelines recommend dual bronchodilation with LAMA+LABA for COPD group E patients (high symptom burden and ≥2 exacerbations), with ICS added only if eosinophils are elevated.

Question 74: A patient with stage 3 chronic kidney disease (eGFR 42 mL/min) and type 2 diabetes asks about medication adjustments. Which agent requires dose reduction or avoidance at this eGFR?

Metformin (Correct answer)
Dulaglutide
Sitagliptin
Glipizide

Correct answer: Metformin

Metformin is contraindicated when eGFR falls below 30 and requires caution/dose reduction between 30–45 mL/min due to risk of lactic acidosis.

Question 75: Which USPSTF-recommended screening is appropriate for a 40-year-old average-risk woman with no family history of breast cancer?

No screening until age 50 per USPSTF 2024 guidelines
Annual mammogram starting at age 40
Biennial mammogram starting at age 40 (Correct answer)
Mammogram starting at age 50 only

Correct answer: Biennial mammogram starting at age 40

The 2024 USPSTF guidelines recommend that average-risk women begin biennial mammography screening at age 40, updated from the prior recommendation of age 50.

Question 76: What is the most common cause of bacterial impetigo in children in the United States?

Group A Streptococcus alone
Staphylococcus aureus (including MRSA) (Correct answer)
Pseudomonas aeruginosa
Haemophilus influenzae

Correct answer: Staphylococcus aureus (including MRSA)

Staphylococcus aureus is the predominant cause of impetigo in the US, with MRSA increasingly common; it presents as honey-crusted lesions on the face and extremities.

Question 77: A patient presents with a well-demarcated, silvery-scaled plaque on the extensor surface of the elbow. What is the most likely diagnosis?

Seborrheic dermatitis
Psoriasis (Correct answer)
Atopic dermatitis
Tinea corporis

Correct answer: Psoriasis

Psoriasis classically presents as well-demarcated erythematous plaques with silvery scales on extensor surfaces such as the elbows and knees.

Question 78: What is a key responsibility of a PNP during well-child visits?

Managing geriatric care plans
Diagnosing adult chronic conditions
Monitoring growth and development, administering vaccines, and providing anticipatory guidance (Correct answer)
Providing prenatal care

Correct answer: Monitoring growth and development, administering vaccines, and providing anticipatory guidance

During well-child visits, PNPs are crucial in tracking a child's physical and cognitive development, ensuring they receive appropriate immunizations, and educating parents on upcoming developmental milestones and safety measures. This preventive care is vital for promoting healthy childhoods, identifying potential issues early, and providing families with the guidance needed for optimal child development.

Question 79: A patient taking warfarin begins a course of fluconazole. What is the expected interaction?

No clinically significant interaction
Decreased INR due to reduced warfarin absorption
Increased INR due to CYP2C9 inhibition (Correct answer)
Decreased INR due to CYP induction

Correct answer: Increased INR due to CYP2C9 inhibition

Fluconazole inhibits CYP2C9, the primary enzyme that metabolizes warfarin, leading to elevated warfarin levels and increased INR.

Question 80: A patient asks about taking St. John's Wort for mild depression while on oral contraceptives. What is the key concern?

Increased risk of serotonin syndrome
No clinical concern
Increased sedation risk
Reduced OCP efficacy leading to potential pregnancy (Correct answer)

Correct answer: Reduced OCP efficacy leading to potential pregnancy

St. John's Wort induces CYP3A4 and P-glycoprotein, increasing the metabolism of ethinyl estradiol and progestins, thereby reducing oral contraceptive effectiveness.

Question 81: A patient presents with a deep laceration requiring irrigation. What is the recommended method to reduce infection risk?

Dry wound packing only
Hydrogen peroxide lavage
Betadine-soaked gauze packing
High-pressure irrigation with normal saline (Correct answer)

Correct answer: High-pressure irrigation with normal saline

High-pressure saline irrigation (using a 35 mL syringe with an 18-gauge catheter) mechanically removes bacteria and debris, significantly reducing wound infection rates.

Question 82: A 68-year-old patient with atrial fibrillation and a CHA₂DS₂-VASc score of 4 is not on anticoagulation. He has no contraindications. What is the appropriate management?

Prescribe aspirin 325 mg daily
Initiate rate control only
Initiate oral anticoagulation with a DOAC (Correct answer)
Observe and reassess in 6 months

Correct answer: Initiate oral anticoagulation with a DOAC

A CHA₂DS₂-VASc score ≥2 in males indicates high stroke risk, and oral anticoagulation with a DOAC is recommended over aspirin, which is no longer guideline-supported for AF stroke prevention.

Question 83: A perimenopausal woman reports hot flushes, vaginal dryness, and mood changes. Which first-line non-hormonal intervention can reduce vasomotor symptoms?

Gabapentin alone is first-line
Clonidine is first-line
Low-dose SSRI/SNRI (e.g., paroxetine, venlafaxine) (Correct answer)
Black cohosh is evidence-based first-line

Correct answer: Low-dose SSRI/SNRI (e.g., paroxetine, venlafaxine)

Low-dose SSRIs and SNRIs, particularly paroxetine (FDA-approved for hot flashes) and venlafaxine, are the most effective non-hormonal pharmacological options for vasomotor symptoms.

Question 84: Which medication used for gout prevention requires monitoring for ocular toxicity, including retinal damage?

Hydroxychloroquine (Correct answer)
Colchicine
Probenecid
Allopurinol

Correct answer: Hydroxychloroquine

Hydroxychloroquine (used for RA and lupus, sometimes related to inflammatory arthritis) can deposit in the retina, causing irreversible retinopathy with prolonged use.

Question 85: A patient with heart failure with preserved ejection fraction (HFpEF, EF 58%) presents with dyspnea and lower extremity edema. What is the primary pharmacologic treatment for symptom relief?

Loop diuretics (Correct answer)
ACE inhibitor
Ivabradine
Digoxin

Correct answer: Loop diuretics

Loop diuretics are the cornerstone of symptomatic treatment in HFpEF by reducing volume overload, as no therapy has yet demonstrated mortality reduction in HFpEF.

Question 86: A patient with a bee sting develops urticaria, throat tightness, and hypotension. What is the first-line treatment?

IV diphenhydramine
Albuterol nebulizer treatment
Oral corticosteroids
Epinephrine 0.3 mg IM in the anterolateral thigh (Correct answer)

Correct answer: Epinephrine 0.3 mg IM in the anterolateral thigh

IM epinephrine is the life-saving first-line treatment for anaphylaxis; it reverses bronchoconstriction and vasodilation and prevents progression to cardiovascular collapse.

Question 87: A woman at 10 weeks gestation reports heavy bleeding and passage of tissue. Ultrasound shows no intrauterine pregnancy. Quantitative hCG is falling. What type of miscarriage is this?

Incomplete abortion
Inevitable abortion
Complete abortion (Correct answer)
Threatened abortion

Correct answer: Complete abortion

A complete abortion is characterized by complete expulsion of all products of conception, confirmed by falling hCG and no intrauterine pregnancy on ultrasound.

Question 88: What is the primary focus of a Family Nurse Practitioner (FNP)?

Geriatric care exclusively
Emergency care only
Care of individuals across the lifespan, from infancy to older adulthood (Correct answer)
Care of only pediatric patients

Correct answer: Care of individuals across the lifespan, from infancy to older adulthood

The defining characteristic of a Family Nurse Practitioner (FNP) is their ability to provide comprehensive primary healthcare services to patients of all ages. Their scope of practice spans the entire lifespan, from newborns and infants through adolescents, adults, and the elderly. This broad focus allows FNPs to care for entire families, addressing diverse health needs across generations within a single practice.

Question 89: A patient with known COPD presents with increased dyspnea, productive cough, and wheezing. Oxygen saturation is 88%. What is the appropriate oxygen target?

Maintain SpO2 at 98–100%
Administer high-flow oxygen regardless of SpO2
Withhold oxygen to avoid CO2 retention
Maintain SpO2 at 88–92% (Correct answer)

Correct answer: Maintain SpO2 at 88–92%

In COPD exacerbations, oxygen should be titrated to maintain SpO2 at 88–92% to relieve hypoxemia without suppressing the hypoxic respiratory drive and causing hypercapnia.

Question 90: Which medication is most appropriate for smoking cessation in a patient with a history of seizures?

Nicotine patch
Varenicline (Correct answer)
Clonidine
Bupropion

Correct answer: Varenicline

Bupropion lowers the seizure threshold and is contraindicated in patients with seizure disorders; varenicline does not have this risk and is preferred.

Question 91: A patient presents with confusion, fever, neck stiffness, and photophobia. Lumbar puncture is planned. Which action should precede the LP?

Observe for 6 hours before any intervention
Perform LP immediately without any imaging
Obtain CT head to rule out mass effect if indicated, and do not delay antibiotics (Correct answer)
Start antibiotics only after LP results

Correct answer: Obtain CT head to rule out mass effect if indicated, and do not delay antibiotics

If bacterial meningitis is suspected, antibiotics must NOT be delayed for LP or CT; CT is obtained first only if there is concern for increased ICP (focal deficits, papilledema), and antibiotics should be started immediately.

Question 92: A patient on lithium for bipolar disorder develops coarse tremor, confusion, and vomiting after starting a new NSAID. What is the most likely cause?

Neuroleptic malignant syndrome
Serotonin syndrome
NSAID hypersensitivity reaction
Lithium toxicity due to reduced renal clearance (Correct answer)

Correct answer: Lithium toxicity due to reduced renal clearance

NSAIDs decrease renal prostaglandin synthesis and reduce renal lithium excretion, leading to lithium accumulation and toxicity.

Question 93: A patient on a biologic therapy for psoriasis should be screened for which infection before initiating treatment?

Streptococcal infection
Hepatitis A
Helicobacter pylori
Latent tuberculosis (Correct answer)

Correct answer: Latent tuberculosis

TNF-alpha inhibitors and other biologics used for psoriasis increase the risk of reactivating latent TB; a tuberculin skin test or IGRA must be performed before initiation.

Question 94: What is the treatment of choice for uncomplicated vulvovaginal candidiasis?

Topical azole antifungals (e.g., clotrimazole) or single-dose oral fluconazole (Correct answer)
Oral metronidazole for 7 days
Oral azithromycin
Topical clindamycin

Correct answer: Topical azole antifungals (e.g., clotrimazole) or single-dose oral fluconazole

Uncomplicated vulvovaginal candidiasis is effectively treated with topical azole antifungals applied intravaginally or a single oral dose of fluconazole 150 mg.

Question 95: A pregnant woman at 28 weeks with no blood type antibodies has Rh-negative blood. What intervention is indicated?

Transfusion of Rh-positive blood to induce tolerance
No treatment needed until delivery
Amniocentesis to determine fetal blood type
Rh immunoglobulin (RhoGAM) injection now and after delivery (Correct answer)

Correct answer: Rh immunoglobulin (RhoGAM) injection now and after delivery

Rh-negative women receive RhoGAM at 28 weeks and again within 72 hours of delivery to prevent sensitization that could cause hemolytic disease in future Rh-positive fetuses.

Question 96: A 25-year-old woman has a positive urine pregnancy test and unilateral pelvic pain with vaginal spotting. What must be ruled out first?

Appendicitis
Ectopic pregnancy (Correct answer)
Miscarriage
Ovarian cyst

Correct answer: Ectopic pregnancy

Unilateral pelvic pain with vaginal bleeding in early pregnancy is ectopic pregnancy until proven otherwise, as rupture can cause life-threatening hemorrhage.

Question 97: A patient with inflammatory bowel disease (Crohn's disease) on long-term corticosteroids presents for a routine visit. Which monitoring intervention is most important?

Bone density scan (DEXA) (Correct answer)
Serum ferritin only
Pulmonary function testing
Colonoscopy every 6 months

Correct answer: Bone density scan (DEXA)

Long-term corticosteroid use significantly increases osteoporosis risk; DEXA scan is recommended for patients on chronic steroid therapy to assess bone density and guide preventive treatment.

Question 98: A patient with darkening, velvety, hyperpigmented skin in the axillae and neck creases most likely has which underlying condition?

Addison's disease
Cushing's syndrome
Insulin resistance or type 2 diabetes (Correct answer)
Hypothyroidism

Correct answer: Insulin resistance or type 2 diabetes

Acanthosis nigricans is strongly associated with insulin resistance and hyperinsulinemia, which stimulate keratinocyte and fibroblast proliferation via IGF-1 receptors.

Question 99: A 70-year-old patient with stage 3b CKD (eGFR 38) and hyperkalemia (K+ 5.8 mEq/L) is on an ACE inhibitor for diabetic nephropathy. What is the most appropriate immediate management?

Start high-dose furosemide immediately
Add a potassium supplement to correct imbalance
Reduce ACE inhibitor dose and add a potassium binder if needed (Correct answer)
Discontinue the ACE inhibitor permanently

Correct answer: Reduce ACE inhibitor dose and add a potassium binder if needed

In mild-to-moderate hyperkalemia with clear indication for ACE inhibitor (diabetic nephropathy), dose reduction combined with potassium binders (e.g., patiromer) allows continuation of renoprotective therapy.

Question 100: Which contraceptive method has the highest typical-use failure rate?

Combined oral contraceptive pills
Intrauterine device (IUD)
Depot medroxyprogesterone acetate (DMPA)
Male condoms (Correct answer)

Correct answer: Male condoms

Male condoms have a typical-use failure rate of approximately 13–18% due to inconsistent or incorrect use, compared to less than 1% for IUDs.

Question 101: A woman in her third trimester is diagnosed with gestational diabetes. Which dietary change is the cornerstone of initial management?

Caloric restriction below 1,200 kcal/day
Eliminate all carbohydrates from the diet
High-protein, ketogenic diet
Carbohydrate-controlled diet with consistent meal spacing (Correct answer)

Correct answer: Carbohydrate-controlled diet with consistent meal spacing

Medical nutrition therapy with a carbohydrate-controlled diet distributed evenly across meals is the first-line treatment for gestational diabetes, aiming for euglycemia without ketosis.

Question 102: Which drug interaction can occur when combining an MAOI with meperidine (pethidine)?

Anticholinergic toxicity
Hypertensive crisis only
Serotonin syndrome, potentially fatal (Correct answer)
Neuroleptic malignant syndrome

Correct answer: Serotonin syndrome, potentially fatal

MAOIs inhibit monoamine oxidase, and meperidine blocks serotonin reuptake, causing dangerous serotonin accumulation that can lead to fatal serotonin syndrome.

Question 103: A patient presents with sudden-onset unilateral weakness, facial droop, and slurred speech that resolved in 30 minutes. This presentation is most consistent with:

Migraine with aura
Transient ischemic attack (TIA) (Correct answer)
Bell's palsy
Todd's paralysis

Correct answer: Transient ischemic attack (TIA)

TIA presents with sudden-onset focal neurological deficits that resolve within 24 hours (typically minutes) and requires urgent evaluation for stroke prevention.

Question 104: A 35-year-old woman who smokes more than 15 cigarettes per day asks about oral contraceptives. What is the appropriate response?

Prescribe combined oral contraceptives with close monitoring
Combined OCP is safe in smokers under age 40
Prescribe progestin-only pills as a safer alternative (Correct answer)
No contraception is needed as risk is minimal

Correct answer: Prescribe progestin-only pills as a safer alternative

Women over 35 who smoke have a significantly increased risk of thromboembolic events with estrogen-containing contraceptives; progestin-only methods are a safer alternative.

Question 105: A pregnant patient is found to have group B Streptococcus (GBS) colonization at 36 weeks. What is the standard management?

Administer IV penicillin G during labor (Correct answer)
Treat with oral amoxicillin immediately
Treat with oral clindamycin throughout pregnancy
No treatment; GBS colonization is normal

Correct answer: Administer IV penicillin G during labor

GBS colonization during pregnancy is managed with intrapartum IV penicillin G to prevent neonatal GBS sepsis, not antenatal antibiotic treatment.

Question 106: A patient prescribed a fluoroquinolone antibiotic reports new-onset tendon pain. What should the NP do?

Reduce the dose and monitor
Continue the antibiotic and add NSAIDs for pain
Discontinue the fluoroquinolone and switch to an alternative antibiotic (Correct answer)
Order an MRI before any medication change

Correct answer: Discontinue the fluoroquinolone and switch to an alternative antibiotic

Fluoroquinolones carry a black box warning for tendinopathy and tendon rupture; the drug should be discontinued immediately and an alternative antibiotic selected.

Question 107: What is the primary focus of a Pediatric Nurse Practitioner (PNP)?

Care for elderly patients
Care for pregnant women
Care for infants, children, and adolescents (Correct answer)
Care for adult patients

Correct answer: Care for infants, children, and adolescents

Pediatric Nurse Practitioners (PNPs) are specialized advanced practice nurses dedicated to providing comprehensive healthcare to the pediatric population. Their scope of practice covers individuals from birth through young adulthood, focusing on their unique developmental, physical, and emotional health needs. They are experts in promoting the health and well-being of children and adolescents.

Question 108: What role does a PNP play in the management of common pediatric illnesses?

Providing only surgical care
Diagnosing and treating conditions such as ear infections, asthma, and allergies (Correct answer)
Referring all cases to a specialist
Managing only the nutritional needs of children

Correct answer: Diagnosing and treating conditions such as ear infections, asthma, and allergies

PNPs are highly skilled in diagnosing and managing a wide range of common pediatric illnesses, from acute conditions like ear infections and strep throat to chronic issues such as asthma and allergies. They provide evidence-based treatment, monitor progress, and educate families on managing these conditions effectively. Their expertise ensures children receive appropriate and timely care for their health concerns.

Question 109: A patient presents with a 2-week history of depressed mood, anhedonia, hypersomnia, psychomotor retardation, and suicidal ideation. What is the minimum duration criterion for major depressive disorder?

2 weeks (Correct answer)
6 months
1 month
1 week

Correct answer: 2 weeks

DSM-5 requires symptoms of major depressive disorder to be present for at least 2 weeks and represent a change from previous functioning for the diagnosis.

Question 110: What finding on skin examination is most suggestive of scabies infestation?

Target lesions on palms
Burrows in finger web spaces with intense nocturnal pruritus (Correct answer)
Silvery scales on extensor surfaces
Umbilicated papules on the trunk

Correct answer: Burrows in finger web spaces with intense nocturnal pruritus

Sarcoptes scabiei mites create linear burrows in thin-skinned areas like finger webs, with intense itching that worsens at night due to mite activity.

Question 111: A patient reports a skin lesion that began as a papule and developed a central depression with umbilication. What is the most likely diagnosis?

Molluscum contagiosum (Correct answer)
Basal cell carcinoma
Sebaceous cyst
Keratoacanthoma

Correct answer: Molluscum contagiosum

Molluscum contagiosum, caused by a poxvirus, produces dome-shaped papules with a characteristic central umbilication (depression) that distinguish it from other skin lesions.

Question 112: A woman reports galactorrhea and amenorrhea. What is the most important initial laboratory test?

Serum prolactin level (Correct answer)
TSH and free T4
FSH and LH levels
Beta-hCG

Correct answer: Serum prolactin level

Galactorrhea with amenorrhea strongly suggests hyperprolactinemia; serum prolactin is the initial test, and an elevated level warrants pituitary imaging to rule out prolactinoma.

Question 113: Which of the following is a common setting where AGNPs practice?

Long-term care facilities (Correct answer)
Neonatal intensive care units
Labor and delivery units
Pediatric clinics

Correct answer: Long-term care facilities

Given their focus on older adults and chronic disease management, AGNPs are frequently found in long-term care facilities, nursing homes, and assisted living centers. In these settings, they provide essential medical care, manage complex health needs, and coordinate care for residents. Their expertise is vital for maintaining the health and well-being of the elderly population in these environments.

Question 114: In a patient with suspected sepsis, what intervention should be initiated within the first hour per Surviving Sepsis guidelines?

Blood cultures and wait for results before antibiotics
Broad-spectrum antibiotics and 30 mL/kg IV crystalloid (Correct answer)
CT scan before any treatment
Vasopressors immediately without fluids

Correct answer: Broad-spectrum antibiotics and 30 mL/kg IV crystalloid

The 1-hour sepsis bundle includes blood cultures, broad-spectrum antibiotics, and 30 mL/kg IV crystalloid for hypotension or lactate ≥4, with reassessment for vasopressors.

Question 115: A patient who survived a serious car accident 2 months ago now has nightmares, hypervigilance, avoidance of driving, and emotional numbing. What is the most likely diagnosis?

Acute stress disorder
Adjustment disorder
Generalized anxiety disorder
Post-traumatic stress disorder (PTSD) (Correct answer)

Correct answer: Post-traumatic stress disorder (PTSD)

PTSD is diagnosed when trauma-related symptoms including intrusion, avoidance, negative cognitions, and hyperarousal persist for more than 1 month after a traumatic event.

Question 116: A patient on an SSRI for depression develops agitation, hyperthermia, diaphoresis, clonus, and hyperreflexia after starting tramadol for pain. What is the most likely diagnosis?

Malignant hyperthermia
Serotonin syndrome (Correct answer)
Stimulant toxicity
Neuroleptic malignant syndrome

Correct answer: Serotonin syndrome

Serotonin syndrome results from excess serotonergic activity; tramadol inhibits serotonin reuptake and when combined with an SSRI can trigger the syndrome.

Question 117: A patient with an open femur fracture and blood pressure of 80/50 mmHg after trauma needs fluid resuscitation. What principle guides initial fluid management?

Colloid infusion only
Permissive hypotension with 1:1:1 blood product transfusion (Correct answer)
Aggressive 4L normal saline bolus immediately
D5W infusion to maintain glucose levels

Correct answer: Permissive hypotension with 1:1:1 blood product transfusion

Damage control resuscitation for hemorrhagic shock uses permissive hypotension (MAP 50–65 mmHg) and balanced blood products (pRBC:FFP:platelets in 1:1:1 ratio) to prevent dilutional coagulopathy.

Question 118: A 48-year-old patient with type 2 diabetes has an eGFR of 68 and urine albumin-to-creatinine ratio (UACR) of 180 mg/g. He is on metformin and linagliptin. Which medication should be added for renoprotection?

A loop diuretic
A calcium channel blocker
A GLP-1 receptor agonist
An SGLT-2 inhibitor (Correct answer)

Correct answer: An SGLT-2 inhibitor

SGLT-2 inhibitors (e.g., empagliflozin, dapagliflozin) have demonstrated significant renoprotective benefits in diabetic kidney disease with albuminuria, reducing CKD progression and cardiovascular events.

Question 119: A patient is found unresponsive with agonal breathing. What is the FIRST action per current AHA guidelines?

Apply an AED immediately
Administer naloxone
Call for help and begin high-quality CPR (Correct answer)
Check blood glucose

Correct answer: Call for help and begin high-quality CPR

Current AHA guidelines prioritize calling for emergency assistance and initiating high-quality chest compressions immediately for an unresponsive patient with absent or abnormal breathing.

Question 120: Which certification is required for a Pediatric Nurse Practitioner?

Family Nurse Practitioner (FNP) Certification
Certified Nurse Midwife (CNM) Certification
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification
Pediatric Nurse Practitioner (PNP) Certification (Correct answer)

Correct answer: Pediatric Nurse Practitioner (PNP) Certification

To practice as a Pediatric Nurse Practitioner, individuals must obtain specific certification that validates their specialized knowledge and skills in pediatric healthcare. The Pediatric Nurse Practitioner (PNP) Certification is the primary credential for this role. This certification ensures they are qualified to provide expert, age-appropriate care to infants, children, and adolescents, meeting rigorous professional standards.

Question 121: A patient with poorly controlled hypertension (BP 162/96) is on lisinopril 20 mg. He has no edema, normal renal function, and no diabetes. What is the best addition to his regimen?

Doxazosin
Chlorthalidone (thiazide-type diuretic) (Correct answer)
Clonidine
Hydralazine

Correct answer: Chlorthalidone (thiazide-type diuretic)

Thiazide-type diuretics such as chlorthalidone are the preferred second agent added to an ACE inhibitor for hypertension management per JNC and AHA/ACC guidelines.

Question 122: Which medication is FDA-approved for maintenance treatment to reduce alcohol cravings in patients with alcohol use disorder?

Methadone
Bupropion
Diazepam
Naltrexone (Correct answer)

Correct answer: Naltrexone

Naltrexone blocks opioid receptors involved in the reinforcing effects of alcohol, reducing cravings and the risk of relapse; it is FDA-approved for alcohol use disorder.

Question 123: A patient bitten by a dog requires wound care. Under which circumstance is rabies post-exposure prophylaxis (PEP) NOT necessary?

The dog is healthy, vaccinated, and available for observation (Correct answer)
The dog is wild and unvaccinated
The patient is immunocompromised
The bite occurred on the face or hands

Correct answer: The dog is healthy, vaccinated, and available for observation

If the biting dog is healthy, appropriately vaccinated, and can be observed for 10 days with no signs of rabies, PEP is not needed but should be initiated if signs develop.

Question 124: Which certification is typically required for an Acute Care Nurse Practitioner?

Family Nurse Practitioner (FNP) Certification
Certified Pediatric Nurse Practitioner (CPNP)
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification (Correct answer)
Neonatal Nurse Practitioner (NNP) Certification

Correct answer: Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification

To become an Acute Care Nurse Practitioner, individuals must obtain specific certification that validates their specialized knowledge and skills in managing acutely ill or critically ill adult and older adult patients. The Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Certification is the primary credential for this advanced practice role. This certification ensures they are qualified to provide expert care in high-acuity settings.

Question 125: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What must be immediately ruled out?

Subarachnoid hemorrhage (Correct answer)
Migraine with aura
Cluster headache
Tension headache

Correct answer: Subarachnoid hemorrhage

A thunderclap headache (sudden, severe, worst of life) is subarachnoid hemorrhage until proven otherwise; immediate non-contrast CT head is required.

Question 126: What is the most appropriate initial intervention for a patient who discloses active suicidal ideation with a plan and access to a firearm?

Initiate an emergency psychiatric evaluation or involuntary hold (Correct answer)
Prescribe an antidepressant and monitor
Refer to outpatient therapy
Schedule a follow-up appointment next week

Correct answer: Initiate an emergency psychiatric evaluation or involuntary hold

Active suicidal ideation with a specific plan and means (firearm access) represents an acute psychiatric emergency requiring immediate intervention and safety evaluation.

Question 127: Which opioid analgesic has active metabolites that can accumulate in renal failure, causing CNS toxicity?

Fentanyl
Buprenorphine
Morphine (Correct answer)
Methadone

Correct answer: Morphine

Morphine-6-glucuronide, an active metabolite of morphine, accumulates in renal failure and can cause prolonged sedation and respiratory depression.

Question 128: A patient with generalized anxiety disorder (GAD) asks about non-benzodiazepine pharmacotherapy. Which agent is FDA-approved for GAD?

Buspirone (Correct answer)
Hydroxyzine
Diphenhydramine
Propranolol

Correct answer: Buspirone

Buspirone is FDA-approved for GAD, has no abuse potential, does not cause sedation acutely, and is effective for chronic anxiety but takes 2–4 weeks to work.

Question 129: Which acid-base disturbance is most consistent with a patient who has been vomiting profusely for several days?

Respiratory acidosis
Metabolic alkalosis with elevated bicarbonate and low chloride (Correct answer)
Metabolic acidosis with low bicarbonate
Mixed respiratory and metabolic alkalosis

Correct answer: Metabolic alkalosis with elevated bicarbonate and low chloride

Persistent vomiting causes loss of hydrochloric acid from the stomach, resulting in metabolic alkalosis with elevated bicarbonate, hypokalemia, and hypochloremia.

Question 130: A patient on warfarin is started on rifampin. How does this affect warfarin dosing?

Warfarin dose must be increased due to CYP induction (Correct answer)
No dose change is needed
Warfarin dose must be decreased due to reduced metabolism
Warfarin should be permanently discontinued

Correct answer: Warfarin dose must be increased due to CYP induction

Rifampin is a potent CYP450 inducer that significantly increases warfarin metabolism, reducing its anticoagulant effect and requiring a substantially higher warfarin dose.

Question 131: Which finding is most associated with a melanoma rather than a benign nevus?

Irregular border and multiple colors (Correct answer)
Symmetric shape and uniform color
Diameter less than 6 mm
Smooth, well-defined margins

Correct answer: Irregular border and multiple colors

The ABCDE criteria for melanoma include Asymmetry, Border irregularity, Color variation, Diameter >6mm, and Evolution—irregular borders and multiple colors are hallmarks.

AANP Family Nurse Practitioner Certification Exam (FNP-C)

The AANP FNP-C certification exam evaluates entry-level family nurse practitioner competency across four clinical domains in primary care settings, testing the ability to assess, diagnose, plan, and implement patient-centered care across the lifespan.

150

Questions

180 min

Time Limit

70%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds