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FNP Certification Exam Questions
ACCURATE TESTED VERSIONS OF THE
EXAM FROM 2025 TO 2026 | ACCURATE
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1. A 68-year-old woman reports fatigue and dyspnea on exertion. Labs: Hb=8.7 g/dL, Hct=27%, MCV=70 fL, RDW=18%. What is a critical diagnosis to consider? A. Vitamin B12 deficiency B. Folic acid deficiency C. Renal insufficiency D. Gastrointestinal blood loss ✅ Rationale: The low hemoglobin, hematocrit, and MCV point to microcytic anemia, most commonly caused by chronic blood loss—often from the gastrointestinal tract. Vitamin B12 and folate deficiencies cause macrocytic anemia. 2. When injecting insulin aspart (short-acting), the greatest risk time for hypoglycemia is: A. 15–60 minutes after injection B. 1–3 hours after injection ✅ C. 3–4 hours after injection D. 4–5 hours after injection Rationale: Insulin aspart peaks about 1 hour after injection, making 1–3 hours the most likely window for hypoglycemia. 3. A 66-year-old man with a 40-pack-year smoking history comes for a check-up. Which finding supports a COPD diagnosis? A. Markedly increased chest AP diameter B. Pleuritic chest pain C. FEV1:FVC ratio <0.70 post SABA use ✅ D. FEV1 improves by 50% with use of SAMA Rationale: A post-bronchodilator FEV1/FVC ratio <0.70 confirms airflow limitation consistent with COPD. Large reversibility (like 50%) suggests asthma, not COPD. 4. A 63-year-old woman treated for ABRS now has a fever. Which sign indicates a serious complication?
A. Tender preauricular lymph nodes B. Foul-tasting post nasal drip C. Facial tenderness D. Eyelid erythema and edema ✅ Rationale: Eyelid erythema and edema suggest orbital cellulitis, a severe complication of sinusitis that requires urgent attention.
5. A 61-year-old with allergic rhinitis and heart disease should avoid: A. Antihistamine nasal spray B. Leukotriene modifier C. Oral decongestant ✅ D. Intranasal corticosteroid Rationale: Oral decongestants (like pseudoephedrine) may raise blood pressure and increase cardiovascular risk—unsafe for someone post-NSTEMI. 6. The preferred initial diagnostic tool for knee osteoarthritis is: A. X-ray ✅ B. MRI C. CT scan D. Arthroscopy Rationale: A plain radiograph is typically sufficient to confirm osteoarthritis and assess joint space narrowing. 7. A 67-year-old woman has a 1.5 cm thyroid nodule. What is the next best step? A. Schedule follow-up in 3 months B. Obtain TSH and thyroid ultrasound ✅ C. Schedule MRI D. Refer to oncologist Rationale: Thyroid ultrasound and TSH levels guide next steps, including potential need for biopsy. 8. When communicating decisions via a healthcare proxy, the NP knows: A. Proxy has same rights as patient to request/refuse treatment ✅ B. Only life-saving decisions need to be communicated C. Proxy can't refuse treatment needed to preserve life D. Closest relative automatically becomes the proxy Rationale: Legally appointed proxies have full authority to make medical decisions as if they were the patient.
Rationale: Glipizide, a sulfonylurea, increases insulin secretion and is a common cause of hypoglycemia. Discontinuing it is appropriate in patients with frequent episodes.
14. A 70-year-old patient presents with new-onset atrial fibrillation. Which medication should be evaluated first for stroke prevention? A. Aspirin B. Clopidogrel C. Warfarin D. Direct oral anticoagulant (DOAC) ✅ Rationale: DOACs are now first-line agents for stroke prevention in non-valvular atrial fibrillation, offering similar efficacy to warfarin with fewer monitoring requirements. 15. A 58-year-old woman on long-term proton pump inhibitor (PPI) therapy for GERD is at increased risk for: A. Hypercalcemia B. Iron overload C. Vitamin B12 deficiency ✅ D. Thyrotoxicosis Rationale: PPIs reduce stomach acid, which impairs B12 absorption over time, potentially leading to deficiency. 16. A 35-year-old female presents with signs of depression and a 15-lb weight gain. Her TSH is 12.0 mU/L. What is the most appropriate next step? A. Refer to psychiatry B. Order a brain MRI C. Start levothyroxine ✅ D. Repeat TSH in 6 months Rationale: A TSH of 12 indicates overt hypothyroidism, and initiating levothyroxine is the appropriate treatment. 17. A 47-year-old man has blood pressure readings averaging 148/94 mmHg. He has no other medical problems. What is the best initial therapy? A. Lifestyle modification only B. ACE inhibitor monotherapy ✅ C. Beta-blocker D. Statin Rationale: Stage 1 hypertension (≥130/80) with no ASCVD risk may initially be treated with lifestyle, but at ≥140/90, antihypertensive medication is warranted—ACE inhibitors are a first- line option.
18. A patient is diagnosed with shingles affecting a single dermatome. The most appropriate treatment is: A. Oral corticosteroids alone B. Antiviral therapy within 72 hours ✅ C. Antibiotics D. Observation only Rationale: Antiviral therapy (e.g., acyclovir or valacyclovir) should be started within 72 hours of symptom onset to reduce duration and severity of shingles. 19. A 60-year-old woman presents with dry mouth, dry eyes, and joint pain. Which test is most useful for diagnosis? A. ANA B. ESR C. Anti-Ro/SSA and Anti-La/SSB antibodies ✅ D. Rheumatoid factor Rationale: These autoantibodies are highly specific for Sjögren’s syndrome and support the diagnosis in a compatible clinical context. 20. A 55-year-old male complains of frequent nighttime urination. His PSA is 1.8 ng/mL, and DRE reveals a mildly enlarged, smooth prostate. The best initial management is: A. Alpha-1 blocker (e.g., tamsulosin) ✅ B. 5-alpha-reductase inhibitor C. Prostate biopsy D. TURP Rationale: Alpha blockers relieve lower urinary tract symptoms due to benign prostatic hyperplasia and are first-line treatment. 21. A 59-year-old male has elevated liver enzymes (AST > ALT), history of alcohol use, and no viral hepatitis. What is the most likely diagnosis? A. Hepatitis B infection B. Non-alcoholic fatty liver disease C. Alcoholic liver disease ✅ D. Autoimmune hepatitis Rationale: A classic finding in alcoholic liver disease is AST:ALT ratio >2:1. Viral and NAFLD typically show ALT > AST. 22. A 36-year-old woman presents with a butterfly-shaped rash on her face that worsens with sun exposure. What lab test is most appropriate first? A. RF (Rheumatoid Factor) B. ANA (Antinuclear Antibody) ✅
27. A 65-year-old woman with osteoporosis is started on alendronate. What instruction should the NP provide? A. Take at bedtime with water B. Take after meals with milk C. Take in the morning with food D. Take with water and remain upright for 30 minutes ✅ Rationale: To prevent esophageal irritation, bisphosphonates must be taken with water and patients must stay upright for 30 minutes. 28. A 30-year-old woman with a 2-week history of low-grade fever, night sweats, and a painless enlarged cervical lymph node should be evaluated for: A. Cat-scratch disease B. Mononucleosis C. Tuberculosis D. Hodgkin lymphoma ✅ Rationale: Painless lymphadenopathy with systemic symptoms (B symptoms) such as night sweats suggest Hodgkin lymphoma. 29. A patient complains of hearing loss in one ear and ringing that began suddenly. Weber test lateralizes to the unaffected ear. Rinne test is normal. What type of hearing loss is likely? A. Conductive hearing loss B. Sensorineural hearing loss ✅ C. Presbycusis D. Otitis media Rationale: Sensorineural hearing loss results in Weber test lateralizing to the unaffected ear, with normal Rinne test (AC > BC). 30. A 55-year-old woman has a 2.5 cm non-tender breast mass. What is the most appropriate next step? A. Repeat exam in 1 month B. Diagnostic mammogram and ultrasound ✅ C. Prescribe antibiotics D. Order MRI of the breast Rationale: A new, non-tender, firm breast mass in a woman over 40 should be evaluated urgently with diagnostic imaging to rule out malignancy. In a middle-aged adult, which of the following results would not indicate a category at increased risk for diabetes mellitus?
A fasting glucose of 109 mg/dL (6.05 mmol/L) A 1-hour post-prandial glucose of 98 mg/dL (5.44 mmol/L) A hemoglobin A1C=5.9% A 2-hour post-prandial glucose of 152 mg/dL (8.44 mmol/L)
- Ans - Ans: A 1-hour post-prandial glucose of 98 mg/dL (5.44 mmol/L) A 64-year-old man presents complaining of difficulty initiating urination, a weak urine stream, and inability to completely empty the bladder. Suspecting benign prostatic hyperplasia, you prescribe tamulosin and advise the patient that this will: Decrease the size of the prostate. Relax the bladder neck muscles to ease urination. Eradicate bacteria that cause inflammation of the prostate. Reverse hormonal changes that cause prostate enlargement.
- Ans - Ans: Relax the bladder neck muscles to ease urination. Indicate whether each of the suggested long-acting reversible contraceptives (LARCs) for the following patients is (yes) or is not (no) appropriate.
- A 19-year-old woman to receive the levonorgestrel-releasing IUS (Mirena®) __
- A 30-year-old woman who smokes 1 PPD to receive the etonogestrel implant (Nexplanon®) __
1 - C 2-B 3-A
1 - C 2-A 3-B - Ans - Ans: 1-C severe dyhration (reduced BP, fontanels depressed and lethargic) 2 - A mild dehydration (normal BP, cap refill<1.5seconds, slightly dry lips and thick saliva) 3-B moderate dehydration ( slightly sunken eyes, normal BP, cap refill < 2 sec) The most appropriate next diagnostic step for Caleb is: Based on the below scenario: Caleb, a 9-month-old boy, is presented for evaluation after sudden onset of intermittent severe abdominal pain. He often draws his knees to his abdomen when he appears to be in greatest pain. The mother reports that he has had episodes of diarrhea that contain a mixture of blood and mucous. He has not vomited during this time, but also has a lack of appetite. Ultrasound of the abdomen Flat plate of the abdomen Stool culture with susceptibility testing Stool sample to check for ova and parasites - Ans - Ans: Ultrasound of the abdomen The most appropriate treatment option for Jackson is: Based on the below scenario: A mother brings in Jackson, her 4-year-old son, for evaluation after reporting that she stayed up all night with him because he was experiencing somewhat labored breathing and had a loud "barking-like"
cough. The child has a hoarse voice, is without acute respiratory distress, and a temperature of 101.6ᵒF (38.7ᵒC). Short-term systemic corticosteroid Nebulized beta2-agonist Inhaled corticosteroid Guaifenesin - Ans - Ans: Short-term systemic corticosteroid You are evaluating a 19-year-old man with acne vulgaris and determine he has approximately 20 closed comedones. The most cost-effective first-line treatment for this patient is: Oral doxycycline. Benzoyl peroxide lotion with salicylic acid facial wash. Tretinoin gel. Oral isotretinoin. - Ans - Ans: Benzoyl peroxide lotion with salicylic acid facial wash. A 19-year-old female comes to your office to discuss birth control. She has just become sexually active and wants to be responsible. She has heard a lot from her friends about "the pill" (combined oral contraception {COC}) and is asking you for advice. You tell her that:
Oral isotretinoin. Systemic antibiotics. - Ans - Ans: Topical tretinoin. According to the World Health Organization Medical Eligibility for Contraceptive Use, which of the following is a Category 4 (use represents unacceptable health risk) for the use of a combined oral contraceptive? Controlled hypertension Migraine with focal neurologic symptoms Age >35 years and smoking <10 cigarettes per day. BMI ≥30 kg/m2 - Ans - Ans: Migraine with focal neurologic symptoms Unless no other contraceptive form is acceptable, depot medroxyprogesterone acetate (DMPA; Depo-Provera®) use should be limited to ≤2 years due to the potential for: Endometrial hyperplasia. Acne. Atrophy at the injection site. Bone mineral density loss. - Ans - Ans:
Bone mineral density loss. A father presents his 3-year-old with viral gastroenteritis. He reports that she has been experiencing multiple episodes of diarrhea for the past 24 hours, with the most recent episode about 1 hour ago. Evaluation of the child suggests moderate dehydration. The NP recommends: Initiating oral rehydration therapy with oral rehydration solution. Referral for parenteral IV fluid. Offering child ginger ale in small sips. Offering child sports drink (e.g., Gatorade) diluted 1:1 with water in small sips. - Ans - Ans: Initiating oral rehydration therapy with oral rehydration solution. our patient has been on combined oral contraceptives for 4 years and is now ready to start a family. She asks how long she should wait after stopping her pills. You advise that it is safe to conceive: Immediately. After 1-2 months. After 3-4 months. After 2 normal menstrual cycles. - Ans - Ans:
6 months 18 months 36 months 4 years. - Ans - Ans: 18 months A 16-year-old young woman presents to you the day after a "condom break." She is concerned that she might become pregnant and is asking about emergency contraception. Appropriate counseling about the use of hormonal emergency contraception (EC) includes all of the following except: An established pregnancy will not be interrupted. There is about a 50% reduction in pregnancy risk with properly-timed use. There is no increased risk of birth defect if pregnancy occurs. Ulipristal (ella®) is more effective than levonorgestrel in days 3-5 following unprotected intercourse. - Ans - Ans: There is about a 50% reduction in pregnancy risk with properly-timed use. A mother brings in her 4-year-old son for a well child visit. The mother explains that he is recovering from a cold, but he is in generally good health with no complaints. Upon examination, the NP notices a reddened tympanic membrane but an absence of any bulge. The NP explains:
A follow-up visit is needed in 2 days to determine if the infection clears. Antimicrobial therapy with amoxicillin should be initiated. Antimicrobial therapy with azithromycin should be initiated. The benefits of antimicrobial therapy do not outweigh potential risks of adverse effects and resistance development. - Ans - Ans: The benefits of antimicrobial therapy do not outweigh potential risks of adverse effects and resistance development. When counseling a mother on how to assess if a newborn is nursing adequately, the NP advises that the newborn should: Be able to sleep 2-3 hours between feedings. Have at least 1-2 bowel movements per day. Have 6-8 wet diapers per day. Cease wanting to nurse after about 10 minutes of feeding. - Ans - Ans: Have 6-8 wet diapers per day. Major indications that a child could have attention-deficit/hyperactivity disorder (ADHD) include all of the following except: Does not readily respond to his/her name on a regular basis. Symptoms are present before the age of 7 years.
The mother of a 12-month-old son is expected to bring him to clinic for vaccinations later that day. She asks if she can give him some ibuprofen prior to the visit to minimize pain and fever from the vaccinations. The NP responds: Acetaminophen is preferred over ibuprofen. Ibuprofen should be administered about 1 hour prior to the visit. Half a dose can be given before the visit and half immediately following the visit. Antipyretic use is not recommended prior to vaccinations. - Ans - Ans: Antipyretic use is not recommended prior to vaccinations. When counseling parents on 'tummy time' for a newborn, the NP mentions that tummy time should be encouraged until the infant: Is able to sit solo. Can pull up to a standing position. Can roll from tummy-to-back and back-to-tummy with ease. Can crawl for at least 5 feet. - Ans - Ans: Can roll from tummy-to-back and back-to-tummy with ease. A 3-year-old girl presents with gastroenteritis and who has vomited 4 times in the past 12 hours. The child has signs of mild-to-moderate dehydration. The most appropriate treatment for this child is:
Parenteral dexamethasone (Decadron®). Oral metoclopramide (Reglan®). Oral disintegrating tablets of ondansetron (Zofran®). Rectally-administered trimethobenzamide (Tigan®). - Ans - Ans: Oral disintegrating tablets of ondansetron (Zofran®). Caleb, a 9-month-old boy, is presented for evaluation after sudden onset of intermittent severe abdominal pain. He often draws his knees to his abdomen when he appears to be in greatest pain. The mother reports that he has had episodes of diarrhea that contain a mixture of blood and mucous. He has not vomited during this time, but also has a lack of appetite. The most likely diagnosis for this child is: Pyloric stenosis. Small bowel obstruction. Giardiasis. Intussusception. - Ans - Ans: Intussusception.
