20 free AANPCB FNP practice questions

Correct answer: B · Collect standardized rating scales from a parent and from his teacher

The AAP's 2019 ADHD guideline asks the clinician to confirm that DSM-5 criteria are met, including symptoms and impairment in more than one major setting, with information gathered mainly from parents or guardians, teachers, and other school staff. CDC's summary of that guideline adds the use of rating scales to document symptoms. Validated rating scales from a parent and from his teacher do both. A stimulant trial does not establish the diagnosis: treatment follows a diagnosis rather than replacing it, and a response is not specific to ADHD. An EEG and brain imaging are not part of a routine ADHD evaluation when there are no other neurologic findings. The mother's interview alone leaves out the school setting, where most of the reported problems occur.

Look for this next time: An ADHD diagnosis needs symptoms and impairment documented in two or more settings, usually with parent and teacher rating scales.

Correct answer: D · Give a validated autism-specific screen, such as the M-CHAT-R/F

The AAP's 2020 clinical report on autism spectrum disorder recommends developmental surveillance at every visit plus standardized autism-specific screening at 18 and 24 months, with general developmental screening at 9, 18, and 30 months. The M-CHAT-R/F is the most studied autism screen for primary care, so this visit calls for it, along with the general developmental screen that is also due. A lack of parental concern does not replace screening: early signs can be subtle, and screening exists to find children whose parents have not noticed a problem. Waiting until age 3 delays referral and early intervention. Genetic testing may follow a diagnosis, but it does not take the place of screening.

Look for this next time: Screen every child for autism with a validated tool at 18 and 24 months, even when parents report no concerns.

Correct answer: B · Lachman test

A noncontact pivoting injury with a pop, inability to continue, and swelling within hours suggests an anterior cruciate ligament tear with hemarthrosis. AAFP reviews describe the Lachman test as the most accurate and most sensitive bedside test for an ACL tear, and it is easier than the pivot shift to perform on an acutely swollen, guarded knee. The McMurray test assesses the menisci, which are often injured at the same time, but it does not test ACL stability. Valgus stress at 30 degrees tests the medial collateral ligament. The patellar apprehension test looks for patellar instability after a dislocation. The examination findings then guide imaging and orthopedic referral.

Look for this next time: For a suspected ACL tear after a pivoting injury with rapid swelling, the Lachman test is the most sensitive bedside maneuver.

Correct answer: A · Serum ferritin

Microcytic anemia with heavy menstrual bleeding points first to iron deficiency. Serum ferritin is the most useful single test, and the AGA's 2020 guideline on iron deficiency anemia recommends a ferritin cutoff of 45 ng/mL rather than 15 ng/mL in people with anemia, because the higher cutoff detects far more true iron deficiency. Ferritin is less reliable when inflammation or chronic kidney disease is present, and she has neither. Vitamin B12 and folate deficiencies cause macrocytic, not microcytic, anemia. Hemoglobin electrophoresis helps evaluate thalassemia trait when iron studies are normal, so it is not the first test here. Bone marrow examination is invasive and is not needed to diagnose iron deficiency.

Look for this next time: In microcytic anemia, check serum ferritin first; the AGA uses 45 ng/mL as the cutoff when anemia is present.

Correct answer: B · Confirm with home or ambulatory blood pressure monitoring

The USPSTF's 2021 recommendation on screening for hypertension in adults (grade A) uses office measurement for screening and calls for blood pressure measurements outside the clinical setting to confirm the diagnosis before treatment starts. Ambulatory or home monitoring identifies white-coat hypertension and gives a more reliable average than one office reading. Starting a drug on a single elevated reading skips that confirmation, and a 1-year recheck is far too long for a newly elevated value. An echocardiogram is not a routine step in confirming hypertension. A 2-year interval treats 146/92 mm Hg as normal, which it is not.

Look for this next time: Confirm an elevated office blood pressure with home or ambulatory readings before diagnosing hypertension and starting treatment.

Correct answer: C · Increased fall risk, since 12 seconds or longer is the cutoff

This is the Timed Up and Go test as described in CDC's STEADI toolkit: stand from a chair, walk 10 feet (3 meters), turn, walk back, and sit. STEADI states that an older adult who takes 12 seconds or longer is at risk for falling, so 15 seconds is a positive result that calls for a fuller fall-risk assessment and targeted interventions, such as a medication review, a vision check, orthostatic blood pressure, and strength and balance training. The test assesses mobility, gait, and balance, not endurance. STEADI uses a single cutoff for older adults rather than one that rises with age, and a 30-second threshold would miss most at-risk patients. The NP also watches her gait during the test, because short strides, shuffling, or unsteadiness add information.

Look for this next time: On the Timed Up and Go test, 12 seconds or longer marks an older adult as at risk for falling (CDC STEADI).

Correct answer: A · He should have a one-time abdominal aortic ultrasound

The USPSTF's 2019 recommendation (grade B) is one-time ultrasonography screening for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked, commonly defined as 100 or more cigarettes in a lifetime. Quitting does not remove the indication, so his history qualifies him at age 69. Ultrasound is the screening test because it is safe, inexpensive, and accurate; CT angiography adds radiation and contrast and is used for planning repair, not screening. The recommendation is a single screen for men whose aorta is normal, not yearly imaging. For men aged 65 to 75 who never smoked, the USPSTF suggests offering screening selectively.

Look for this next time: Men aged 65 to 75 who have ever smoked should have one-time ultrasound screening for abdominal aortic aneurysm (USPSTF 2019).

Correct answer: C · Hypertrophic pyloric stenosis

Projectile, nonbilious vomiting in an infant of about 3 to 6 weeks who stays hungry after vomiting, with signs of dehydration and a palpable olive-shaped mass in the epigastrium or right upper quadrant, is the classic picture of hypertrophic pyloric stenosis. Ultrasound is the preferred confirmatory test, and treatment is fluid and electrolyte correction followed by pyloromyotomy. Reflux causes effortless spitting up in a thriving infant, not forceful vomiting with dehydration and a mass. Malrotation with volvulus is an emergency, but its hallmark is bilious vomiting. Viral gastroenteritis usually brings diarrhea and fever, not days of projectile vomiting in a hungry infant with an abdominal mass.

Look for this next time: Projectile nonbilious vomiting in a hungry 3- to 6-week-old with an epigastric olive suggests pyloric stenosis; confirm by ultrasound.

Correct answer: D · Testicular torsion

Sudden severe testicular pain with nausea and vomiting, a high-riding testis with a horizontal lie, and an absent cremasteric reflex on the affected side point to testicular torsion. AAFP guidance advises treating acute scrotal pain in boys and young men as torsion until proven otherwise, calls an absent cremasteric reflex the most accurate sign, and notes that the best chance of saving the testis is within about 6 hours of onset. That means immediate urologic or emergency evaluation without delay. Epididymitis usually develops more gradually, often with urinary symptoms, and the reflex is typically preserved. Torsion of the appendix testis causes pain localized to the upper pole. An incarcerated hernia causes a tender groin bulge rather than this picture.

Look for this next time: Acute scrotal pain with a high-riding testis and absent cremasteric reflex is testicular torsion until proven otherwise; refer immediately.

Correct answer: A · Type 2 diabetes, confirmed by the two abnormal results

The ADA's Standards of Care in Diabetes—2026 diagnose diabetes with an A1C of 6.5% or higher, a fasting plasma glucose of 126 mg/dL or higher, a 2-hour glucose of 200 mg/dL or higher during an oral glucose tolerance test, or a random glucose of 200 mg/dL or higher with classic symptoms. Without unequivocal hyperglycemia, two abnormal results are needed, and they may come from different tests done at the same time, such as A1C and fasting glucose. His A1C of 6.7% and fasting glucose of 134 mg/dL are both in the diabetes range, so no repeat visit is needed. Prediabetes means an A1C of 5.7% to 6.4% or a fasting glucose of 100 to 125 mg/dL, and symptoms are not required for a diabetes diagnosis. Impaired fasting glucose is the 100 to 125 mg/dL range, below his value. His age and obesity, with no acute illness, make type 2 the likely type.

Look for this next time: Two abnormal results from different tests on one blood draw, such as A1C and fasting glucose, confirm diabetes (ADA 2026).

Correct answer: B · Giant cell arteritis

A new headache after age 50 with scalp tenderness, jaw claudication, polymyalgia-type shoulder stiffness, and a markedly raised ESR is the classic picture of giant cell arteritis. The MSD Manual advises starting corticosteroids as soon as the disease is suspected, without waiting for a biopsy, because jaw claudication and visual symptoms are linked to a higher risk of permanent vision loss. The 2021 ACR/Vasculitis Foundation guideline favors temporal artery biopsy to confirm the diagnosis. Migraine rarely begins this late in life and does not raise the ESR. Trigeminal neuralgia causes brief, electric facial pain. A temporomandibular disorder can cause jaw pain, but not scalp tenderness, a new headache, and systemic inflammation.

Look for this next time: After age 50, a new headache with jaw claudication and a high ESR suggests giant cell arteritis; start steroids without delaying for biopsy.

Correct answer: D · Delirium

The Confusion Assessment Method identifies delirium when there is an acute onset or fluctuating course and inattention, plus either disorganized thinking or an altered level of consciousness. He has all of these: a change over 2 days, a waxing and waning course, inability to sustain attention, and drowsiness alternating with agitation. A new anticholinergic drug and a possible urinary infection are common precipitating causes, so the next steps are a medication review and a search for illness. Alzheimer disease begins insidiously over months to years, with attention preserved early. Depression can impair concentration but does not cause an acute, fluctuating change in alertness. Normal pressure hydrocephalus develops gradually, with gait problems and incontinence.

Look for this next time: Acute onset, fluctuating course, and inattention point to delirium; look for causes such as anticholinergic drugs and infection.

Correct answer: C · Nitrofurantoin for 5 days

This is acute uncomplicated cystitis in a healthy, nonpregnant woman. The IDSA's 2010 guideline lists nitrofurantoin for 5 days as a first-line option, along with single-dose fosfomycin and trimethoprim-sulfamethoxazole for 3 days where local resistance is low. Fluoroquinolones such as ciprofloxacin work, but the guideline reserves them for other uses because of collateral damage and resistance, and they carry serious adverse-effect warnings. Amoxicillin alone has poor efficacy for this infection. A culture is not routinely needed before treating a classic uncomplicated case, and withholding treatment prolongs symptoms. Nitrofurantoin is not appropriate if pyelonephritis is suspected, because it does not reach adequate levels in kidney tissue.

Look for this next time: For uncomplicated cystitis in a healthy nonpregnant woman, nitrofurantoin for 5 days is a first-line choice (IDSA 2010).

Correct answer: A · An ACE inhibitor or an ARB, titrated to the maximum tolerated dose

The ADA's Standards of Care in Diabetes—2026 strongly recommend an ACE inhibitor or an angiotensin receptor blocker, titrated to the maximum tolerated dose, for people with diabetes and hypertension who have severely increased albuminuria (UACR of 300 mg/g or more), to slow kidney disease progression. His UACR of 340 mg/g on repeat testing qualifies, and creatinine and potassium are checked after starting or changing the dose. Combining an ACE inhibitor with an ARB raises the risk of hyperkalemia and acute kidney injury without added kidney benefit, so dual blockade is avoided. Amlodipine and metoprolol lower blood pressure but lack the kidney-protective effect of renin-angiotensin blockade in albuminuria.

Look for this next time: In diabetes with hypertension and a UACR of 300 mg/g or more, use an ACE inhibitor or ARB at the maximum tolerated dose.

Correct answer: B · Cognitive behavioral therapy for insomnia, avoiding diphenhydramine

The American Geriatrics Society's 2023 Beers Criteria advise avoiding first-generation antihistamines, including oral diphenhydramine and hydroxyzine, in older adults (strong recommendation): they are highly anticholinergic, their clearance falls with age, and tolerance develops when they are used for sleep. Anticholinergic exposure is linked to confusion, delirium, and falls, which matters given her memory complaints and prior fall. The American College of Physicians' 2016 guideline recommends cognitive behavioral therapy for insomnia as the initial treatment of chronic insomnia in adults. Nonprescription status does not make a drug safe for her. Limiting diphenhydramine to weeknights keeps the same harms. Hydroxyzine is another first-generation antihistamine on the same Beers list.

Look for this next time: For chronic insomnia in an older adult, start with CBT for insomnia and avoid first-generation antihistamines such as diphenhydramine.

Correct answer: C · Low-dose aspirin daily, started after 12 weeks of gestation

The USPSTF's 2021 recommendation (grade B) advises low-dose aspirin (81 mg daily) as preventive medication after 12 weeks of gestation for people at high risk of preeclampsia. A history of preeclampsia is a high-risk factor on its own, as are multifetal gestation, chronic hypertension, pregestational diabetes, kidney disease, and autoimmune disease. A normal blood pressure today does not remove that risk. Starting at 36 weeks is far too late, since the studies mostly began aspirin before 20 weeks. In this setting low-dose aspirin is recommended, not avoided: the USPSTF found a net benefit for people at high risk.

Look for this next time: A prior preeclampsia alone is high risk: recommend low-dose aspirin daily starting after 12 weeks of gestation (USPSTF 2021).

Correct answer: A · Ceftriaxone IM once, plus doxycycline twice daily for 7 days

CDC's 2021 STI Treatment Guidelines recommend a single IM dose of ceftriaxone, dosed by weight with the higher dose reserved for people weighing 150 kg or more, for uncomplicated urogenital gonorrhea, and doxycycline twice daily for 7 days when chlamydial infection has not been excluded. His chlamydia result is pending, so both are given now rather than delaying treatment and risking loss to follow-up. Azithromycin alone is no longer recommended for gonorrhea, and fluoroquinolones are not used because of widespread gonococcal resistance. A test of cure is not needed for urogenital infection treated this way, but CDC advises retesting 3 months after treatment because reinfection is common, along with partner evaluation and treatment.

Look for this next time: Treat urogenital gonorrhea with one IM dose of ceftriaxone, and add doxycycline for 7 days if chlamydia is not excluded.

Correct answer: C · Take it fasting, 4 hours from calcium; recheck TSH in 6–8 weeks

Taking levothyroxine with food, coffee, and calcium is a common reason for a persistently high TSH. FDA-approved levothyroxine labeling advises taking it on an empty stomach, 30 to 60 minutes before breakfast, at least 4 hours apart from drugs that interfere with absorption, such as calcium and iron, and checking TSH 6 to 8 weeks after any change in adults with primary hypothyroidism. Correcting the timing first may bring her TSH into range without a dose increase, and the 6- to 8-week recheck allows TSH to reach a new steady state. A 1-week recheck is too early to interpret, and doubling the dose before fixing absorption risks overtreatment. Liothyronine is not indicated. Calcium need not be stopped, and 12 months is too long while the dose is being adjusted.

Look for this next time: Before raising a levothyroxine dose, correct how it is taken; recheck TSH 6 to 8 weeks after any change.

Correct answer: D · Reduce or stop glipizide and aim for an A1C below 8.0%

His multiple chronic illnesses and mild cognitive impairment place him in the complex/intermediate health group in the ADA's Standards of Care in Diabetes—2026, which suggest an A1C goal below 8.0% for this group and goals that prioritize avoiding hypoglycemia. Recommendation 13.14a advises deintensifying hypoglycemia-causing medications, such as sulfonylureas or insulin, in older adults at high risk of hypoglycemia. An A1C of 6.4% with recurrent symptomatic lows means he is overtreated, and glipizide is the likely cause. Keeping both drugs ignores the hypoglycemia, and adding insulin increases the risk. A goal below 6.0% would raise his risk of hypoglycemia and its harms, such as falls, without a clear benefit for him.

Look for this next time: In older adults with complex health and hypoglycemia, deintensify sulfonylureas or insulin and relax the A1C goal, such as to below 8.0%.

Correct answer: D · Ask about suicidal thoughts, keep the dose, and follow up closely

FDA labeling for sertraline and other antidepressants carries a boxed warning that these drugs increased suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, and it directs clinicians to monitor all treated patients for clinical worsening and emerging suicidal thoughts, especially during the first few months of treatment and after dose changes. Asking her directly, and teaching her mother what to watch for, is the priority at this early visit. Antidepressant benefit builds over several weeks, so a partial response at 2 weeks is expected and is not a reason to stop or switch. Adding a second antidepressant this early adds side effects and interaction risk without evidence of benefit.

Look for this next time: Early in antidepressant treatment for adolescents, ask directly about suicidal thoughts at each visit and allow several weeks for a response.