20 FNP Certification Practice Questions, Answers Explained
By Roupen Odabashian, MD, FRCPC · Published · Last updated · 30 min read
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Pending clinician review
20 FNP Certification Practice Questions, Answers Explained
How should you use these FNP practice questions?
You can work through these 20 items in two ways. In timed mode, answer all of them before you check any answers, and give yourself about a minute per question. Both exams work out to roughly 72 seconds per item: the AANPCB FNP exam allows 3 hours for 150 questions[18], and the ANCC FNP exam allows 3.5 hours for 175 questions[17]. In tutor mode, read the answer and rationale right after each item, which suits the early weeks of review when you are still learning the content.
In either mode, review every miss and every lucky guess. Read why each wrong option is wrong, not only why the key is right, and write the rule you missed in one line. Each item is tagged with its body system and exam domain, so after one pass you can see where your misses cluster.
How are AANP vs ANCC FNP question styles different?
AANPCB describes its FNP exam as 150 multiple-choice questions, and ANCC’s free FNP sample questions are all single-best-answer items. ANCC’s certification handbook describes its exams as multiple-choice, but its adult-gerontology primary care sample-question page says that exam also includes multiple-response, drag-and-drop and hot-spot items (most questions are multiple choice). We found no mention of those formats in ANCC’s FNP outline or FNP samples. Questions 17 to 19 below practise them in case you meet them, so do not expect them on every exam. If you do see “Select all that apply” or an ordering item, slow down and convert the stem into a checklist or timeline before looking at options: every selected option must be correct for multiple-response items, and every step must be in correct sequence for ordering items.
The two exams also differ in length, timing and content outline. For a side-by-side comparison, see our guide on how to choose between the ANCC and AANP FNP exams.
Questions 1 to 6: cardiovascular, respiratory and endocrine
Question 1
Tags: Cardiovascular; Diagnosis & management
A 52-year-old man with no known medical history has an average office blood pressure of 152/96 mm Hg at two visits, measured with proper technique. Home readings over the past 2 weeks average 150/94 mm Hg. He is a nonsmoker and has no diabetes, chronic kidney disease or cardiovascular disease. Which is the best next step?
- A. Reassure and recheck blood pressure in one year
- B. Initiate lifestyle modifications and start antihypertensive medication
- C. Order ambulatory blood pressure monitoring and defer treatment until results return
- D. Start aspirin for primary prevention and recheck blood pressure at a later visit
Answer: B
Rationale: Properly measured office readings at two visits, confirmed by home monitoring, show stage 2 hypertension (140/90 mm Hg or higher). The 2025 AHA/ACC high blood pressure guideline, which AANP cosponsored, recommends lifestyle changes plus antihypertensive medication for stage 2 hypertension and favors starting two first-line drugs from different classes, preferably as a single-pill combination[11]. The treatment goal for most adults is below 130/80 mm Hg[11].
- A: Incorrect because sustained elevated readings make waiting a full year inappropriate.
- C: Incorrect because home readings have already confirmed the diagnosis outside the office, so more monitoring would only delay treatment[11].
- D: Incorrect because aspirin does not treat hypertension, and the USPSTF calls starting low-dose aspirin for primary prevention an individual decision only for adults 40 to 59 years with a 10-year CVD risk of 10% or higher[12].
Question 2
Tags: Cardiovascular; Prevention & screening
A 55-year-old woman with hypertension and dyslipidemia (LDL cholesterol 145 mg/dL) has no diabetes and no history of cardiovascular disease. Her estimated 10-year cardiovascular risk using the Pooled Cohort Equations is 12%. According to the USPSTF, which is the most appropriate recommendation?
- A. Do not start a statin because she has no prior events
- B. Start moderate-intensity statin therapy after discussion
- C. Start high-intensity statin therapy without shared decision-making
- D. Recommend aspirin instead of statin for primary prevention
Answer: B
Rationale: Adults 40 to 75 years old with at least one cardiovascular risk factor and an estimated 10-year risk of 10% or greater should be prescribed a statin for primary prevention after discussion, with moderate-intensity therapy being reasonable for most[1]. This patient meets age, risk-factor, and risk-threshold criteria. Shared decision-making remains important to align therapy with patient values and preferences. One harm to discuss is a small, dose-dependent rise in new diabetes diagnoses, mostly in people whose glucose is already near the diagnostic threshold[15].
- A: Incorrect because the USPSTF statin recommendation is for primary prevention, so a prior event is not required[1].
- C: Incorrect because most trials used moderate-intensity statins and decisions should be individualized[1].
- D: Incorrect because statins, not aspirin, are the primary focus for lipid-related cardiovascular risk reduction[1].
Question 3
Tags: Respiratory; Chronic disease management
A 63-year-old woman with a 40 pack-year smoking history has to stop for breath when walking at her own pace on level ground (mMRC grade 2), and her COPD Assessment Test (CAT) score is 18. Post-bronchodilator FEV1/FVC is 0.62 and FEV1 is 68% of predicted. She has had no exacerbations in the past year and uses no inhalers. According to the GOLD 2026 report, which is the most appropriate initial maintenance therapy?
- A. A short-acting bronchodilator as needed only
- B. A long-acting beta2-agonist plus a long-acting muscarinic antagonist (LABA plus LAMA), preferably in one inhaler
- C. Inhaled corticosteroid monotherapy
- D. Daily low-dose oral prednisone
Answer: B
Rationale: A post-bronchodilator FEV1/FVC below 0.70 confirms COPD. With no exacerbations in the past year and a high symptom burden (mMRC grade 2 or higher and CAT 10 or higher), she is in GOLD group B, and GOLD recommends starting a LABA plus a LAMA, preferably in a single inhaler[2]. GOLD 2026 now treats even one moderate or severe exacerbation in the prior year as a marker of higher risk, and in patients with exacerbations a blood eosinophil count of 300 cells/µL or more favors adding an inhaled corticosteroid[2].
- A: Incorrect because a short-acting bronchodilator alone is rescue therapy and does not control her persistent symptoms[2].
- C: Incorrect because long-term inhaled corticosteroid monotherapy is not recommended in COPD[2].
- D: Incorrect because long-term oral corticosteroids are not recommended for stable COPD because of their adverse effects[2].
Question 4
Tags: Respiratory; Diagnosis & management
A 27-year-old woman with asthma uses only an albuterol inhaler. She has symptoms on most days of the week and wakes at night with cough and wheeze 2 to 3 times a week. Her FEV1 is 88% of predicted, and she has had no exacerbations in the past year. According to the GINA 2026 strategy, which is the preferred initial treatment?
- A. Continue as-needed albuterol only
- B. Low-dose budesonide-formoterol as daily maintenance and as-needed reliever
- C. Daily montelukast alone
- D. Scheduled albuterol four times daily
Answer: B
Rationale: GINA recommends starting low-dose ICS-formoterol as both daily maintenance and as-needed reliever (MART) when an adult has asthma symptoms most days or wakes with asthma once a week or more[20]. For safety, GINA advises against treating asthma with as-needed SABA alone[20]. The 2020 NAEPP update for ages 12 and older also lists daily and as-needed low-dose ICS-formoterol as the preferred Step 3 treatment[21], so the answer holds under both the global and the U.S. guideline.
- A: Incorrect because GINA advises against treating asthma with as-needed SABA alone[20].
- C: Incorrect because leukotriene receptor antagonists are less effective than daily ICS, especially for preventing exacerbations, and montelukast has been linked to serious mental health effects[20].
- D: Incorrect because regular SABA use is not recommended[20].
Question 5
Tags: Endocrine; Pharmacology & management
A 61-year-old man with type 2 diabetes had a myocardial infarction 2 years ago. He takes metformin 1,000 mg twice daily, and his A1C is 7.4%. His eGFR is 78 mL/min/1.73 m², and he has no heart failure. According to the ADA Standards of Care in Diabetes 2026, which addition is most appropriate?
- A. Glipizide
- B. A GLP-1 receptor agonist or SGLT2 inhibitor with proven cardiovascular benefit
- C. Saxagliptin
- D. Basal insulin glargine
Answer: B
Rationale: In adults with type 2 diabetes and established atherosclerotic cardiovascular disease, ADA recommends that the treatment plan include a GLP-1 receptor agonist and/or an SGLT2 inhibitor with demonstrated cardiovascular benefit, irrespective of A1C[22]. ADA adds that this applies with or without metformin use[22], so his prior myocardial infarction, not his A1C, drives the choice. Pick between the two classes using person-specific factors; for example, ADA recommends an SGLT2 inhibitor when heart failure is present[22].
- A: Incorrect because sulfonylureas are cardiovascular neutral and carry a risk of hypoglycemia and weight gain[22].
- C: Incorrect because DPP-4 inhibitors are cardiovascular neutral, and saxagliptin carries a potential heart failure risk[22].
- D: Incorrect because ADA prefers GLP-1-based therapy over insulin for add-on therapy when there is no severe hyperglycemia[22].
Question 6
Tags: Endocrine; Pharmacology & management
A 72-year-old woman with stable coronary artery disease reports fatigue and constipation. Her TSH is 14.8 mIU/L on two measurements, and her free T4 is low. She weighs 70 kg. Which plan is most appropriate?
- A. Start levothyroxine 112 mcg daily, about 1.6 mcg/kg
- B. Start levothyroxine 25 mcg daily and titrate slowly using TSH
- C. Start liothyronine (T3) alone for faster symptom relief
- D. Recheck TSH in 12 months before starting any treatment
Answer: B
Rationale: A high TSH with a low free T4 is overt primary hypothyroidism, and levothyroxine remains the standard of care[23]. The ATA guideline says patients with known coronary artery disease should always start on a low dose of 12.5 to 25 mcg daily, with gradual increases guided by symptoms and TSH[23]. Adjust in steps of 12.5 to 25 mcg and recheck TSH 4 to 6 weeks after each change[23]. Teach her to take it consistently 60 minutes before breakfast or at bedtime[23].
- A: Incorrect because patients with known coronary artery disease should start low rather than at a full weight-based dose[23].
- C: Incorrect because levothyroxine is the standard of care, and the ATA found no consistent evidence that other preparations work better[23].
- D: Incorrect because she has symptomatic overt hypothyroidism, which should be treated now rather than watched for a year[23].
Questions 7 to 12: renal, GI, women’s and men’s health, and skin
Question 7
Tags: Renal & genitourinary; Chronic disease management
A 54-year-old man with hypertension and no diabetes has an eGFR of 52 mL/min/1.73 m² on two tests 4 months apart. His urine albumin-to-creatinine ratio is 480 mg/g on repeat testing. His blood pressure is 146/90 mm Hg, and he takes no medications. Which blood pressure medication is most appropriate to start?
- A. Amlodipine
- B. Lisinopril, titrated to the highest approved dose he tolerates
- C. Lisinopril plus losartan
- D. No medication until his eGFR falls below 30
Answer: B
Rationale: An eGFR of 52 for more than 3 months with an albumin-to-creatinine ratio above 300 mg/g is CKD category G3a with severely increased albuminuria (A3)[24]. For CKD with A3 albuminuria and no diabetes, KDIGO recommends starting an ACE inhibitor or ARB, given at the highest approved dose that is tolerated[24]. Check blood pressure, creatinine and potassium within 2 to 4 weeks of starting or raising the dose[24]. KDIGO also recommends an SGLT2 inhibitor for adults with an eGFR of 20 or higher and an albumin-to-creatinine ratio of 200 mg/g or higher[24].
- A: Incorrect because KDIGO specifically recommends an ACE inhibitor or ARB for CKD with severely increased albuminuria[24].
- C: Incorrect because KDIGO recommends avoiding any combination of ACE inhibitor, ARB and direct renin inhibitor[24].
- D: Incorrect because the recommendation applies across eGFR categories G1 to G4, so treatment should start now[24].
Question 8
Tags: Gastrointestinal & liver; Prevention & vaccination
A 36-year-old man with chronic hepatitis C infection is seen in primary care. He has not received hepatitis A or B vaccines. Which immunization strategy best aligns with current recommendations?
- A. No hepatitis vaccination is indicated for chronic hepatitis C infection
- B. Recommend hepatitis B vaccination only
- C. Recommend both hepatitis A and hepatitis B vaccination
- D. Recommend hepatitis A vaccination only
Answer: C
Rationale: Hepatitis A and B vaccines are recommended for persons with chronic liver disease, including those with hepatitis C infection, who have not had hepatitis A or hepatitis B[3]. Vaccinating against both infections reduces the risk of additional hepatic injury. NPs should review immunization needs in patients with chronic liver disease as part of routine primary care.
- A: Incorrect because vaccination is recommended for persons with chronic liver disease including hepatitis C[3].
- B: Incorrect because both hepatitis A and B vaccines are recommended in this setting[3].
- D: Incorrect because limiting to hepatitis A ignores the recommendation for hepatitis B vaccination as well[3].
Question 9
Tags: Women’s health; Contraception & pharmacology
A 27-year-old woman requests contraception. She has migraine headaches that are preceded by a visual aura. She does not smoke and her blood pressure is normal. According to the 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), which method poses an unacceptable health risk for her?
- A. Copper IUD
- B. Levonorgestrel IUD
- C. Combined oral contraceptive pill
- D. Etonogestrel implant
Answer: C
Rationale: The 2024 U.S. MEC classifies combined hormonal contraception (pill, patch or ring) as category 4, an unacceptable health risk, for people with migraine with aura, because estrogen adds to an ischemic stroke risk that is already raised in migraine with aura[14]. The copper IUD, levonorgestrel IUD, implant, injection and progestin-only pill are all category 1, with no restriction[14]. Offer an effective estrogen-free method.
- A: Incorrect because the copper IUD is category 1 for migraine with aura[14].
- B: Incorrect because the levonorgestrel IUD is category 1 for migraine with aura[14].
- D: Incorrect because the implant is category 1 for migraine with aura[14].
Question 10
Tags: Women’s health & pregnancy; Prevention & vaccination
A 26-year-old pregnant woman at her first prenatal visit has no record of hepatitis B vaccination. Her HBsAg, anti-HBs and anti-HBc tests are all negative. She has one sexual partner and no other risk factors. Which is the most appropriate plan?
- A. Start the hepatitis B vaccine series during this pregnancy
- B. Defer hepatitis B vaccination until after delivery
- C. Vaccinate only if she later reports more than one sex partner or an STI
- D. Give hepatitis B immune globulin instead of vaccine
Answer: A
Rationale: ACIP recommends hepatitis B vaccination for all adults aged 19 to 59 years, including pregnant persons, and advises providers to vaccinate pregnant persons who need it[13]. Engerix-B, Heplisav-B, Recombivax HB and Twinrix can be used during pregnancy[13]. Her negative tests show she is neither infected nor immune, so her age alone is an indication; she does not need an additional risk factor.
- B: Incorrect because pregnancy is not a reason to delay hepatitis B vaccination in a susceptible adult[13].
- C: Incorrect because the universal recommendation for adults aged 19 to 59 years replaced risk-based vaccination in this age group[13].
- D: Incorrect because hepatitis B immune globulin is used for postexposure prophylaxis, not routine prevention[3].
Question 11
Tags: Men’s health & STI; Prevention & counseling
A 30-year-old man with multiple male and female partners presents for STI screening. He asks how condom quality affects protection. Which statement about natural membrane condoms is accurate regarding STI prevention?
- A. Natural membrane condoms are recommended for HIV and STI prevention because they are stronger than latex
- B. Natural membrane condoms are not recommended for prevention of STIs and HIV
- C. Natural membrane condoms have no pores and provide complete viral barrier protection
- D. Natural membrane condoms are the preferred barrier for STI prevention in all patients
Answer: B
Rationale: Natural membrane condoms, often called natural skin or lambskin condoms, are made from lamb cecum and can have pores up to 1,500 nm in diameter. They are not recommended for prevention of STIs and HIV because organisms can pass through these pores[4]. Latex or certain synthetic condoms are preferred for STI and HIV prevention when used correctly and consistently[3].
- A: Incorrect because natural membrane condoms are not recommended for STI and HIV prevention[4].
- C: Incorrect because these condoms have pores up to 1,500 nm in diameter[4].
- D: Incorrect because they are not the preferred barrier for STI prevention[3][4].
Question 12
Tags: Dermatology; Pharmacology & management
A 19-year-old college student has had facial acne for a year, with many open and closed comedones and scattered inflammatory papules. She has no nodules or scarring and has not tried prescription treatment. Which initial regimen best follows the 2024 American Academy of Dermatology (AAD) guideline?
- A. Topical clindamycin alone
- B. A topical retinoid combined with benzoyl peroxide
- C. Oral isotretinoin
- D. Oral doxycycline alone for 6 months
Answer: B
Rationale: The AAD strongly recommends benzoyl peroxide, topical retinoids and their fixed-dose combination for acne[25]. Topical retinoids are comedolytic and anti-inflammatory, which suits her mix of comedones and papules[25], and the AAD advises combining topical agents with different mechanisms of action to improve results and lower the risk of antibiotic resistance[25]. Oral isotretinoin is reserved for severe acne, acne causing scarring or psychosocial burden, or acne that fails standard therapy[25].
- A: Incorrect because the AAD does not recommend topical antibiotic monotherapy, given concern for antibiotic resistance[25].
- C: Incorrect because her acne is not severe, scarring or resistant to standard therapy[25].
- D: Incorrect because oral antibiotics should not be used alone, should be paired with benzoyl peroxide and topical therapy, and should usually be limited to 3 to 4 months[25].
Questions 13 to 16: pediatrics, geriatrics and neurology
Question 13
Tags: Pediatrics; Prevention & vaccination
A 12-year-old boy presents for a well-child visit. He is healthy and up to date on childhood vaccines but has not received HPV vaccine. Which recommendation is most appropriate?
- A. Defer HPV vaccination until adulthood
- B. Recommend routine HPV vaccination at this visit
- C. HPV vaccination is recommended only for females, not males
- D. Begin HPV vaccination only if he becomes sexually active
Answer: B
Rationale: HPV vaccination is recommended routinely for males and females aged 11 or 12 years and can be administered beginning at age 9 years[3][4]. Vaccination prior to onset of sexual activity maximizes effectiveness by providing protection before exposure. NPs should normalize and recommend HPV vaccination at routine adolescent visits in this age group.
- A: Incorrect because adolescent years are the routine target age for HPV vaccination[3][4].
- C: Incorrect because recommendations include both males and females[3][4].
- D: Incorrect because vaccination is recommended prior to sexual exposure, not delayed until after activity begins[3].
Question 14
Tags: Geriatrics; Prevention & immunization schedule
A 70-year-old woman with hypertension and osteoarthritis presents for follow-up. You want to ensure she is up to date on adult vaccinations. Which approach best reflects how clinicians should use the adult immunization schedule?
- A. Determine recommended vaccines only by age
- B. Determine recommended vaccines by age and assess need for additional recommended vaccinations by medical condition or other indication[5]
- C. Focus solely on reviewing contraindications and precautions
- D. Defer to patient preference without consulting any schedule
Answer: B
Rationale: Health care providers using the adult immunization schedule should determine recommended vaccines by age and assess need for additional vaccines by medical condition or other indication[5]. They should also review dosing, intervals, and contraindications to keep individuals up to date[5]. Combining age-based and condition-based considerations provides comprehensive preventive care.
- A: Incorrect because age alone may miss condition-based indications[5].
- C: Incorrect because contraindications are important but not the only consideration[5].
- D: Incorrect because decisions should be informed by evidence-based schedules, then aligned with patient preferences.
Question 15
Tags: Pediatrics; Diagnosis & management
An 18-month-old boy has tugged at his ears and been mildly fussy for 1 day. His temperature is 38.4°C (101.1°F). Both tympanic membranes are red and moderately bulging. He has no ear drainage, has not taken antibiotics in the past 30 days and has no drug allergies. Which is the most appropriate initial management?
- A. Observation only, with follow-up in 48 to 72 hours
- B. Amoxicillin 80 to 90 mg/kg/day in 2 divided doses for 10 days, plus pain control
- C. Azithromycin for 5 days
- D. Amoxicillin-clavulanate as first-line therapy
Answer: B
Rationale: Moderate bulging of the tympanic membrane meets the AAP definition of acute otitis media (AOM)[26]. For bilateral AOM in children 6 to 23 months old without severe signs (mild ear pain for less than 48 hours and temperature below 39°C), AAP recommends antibiotics rather than observation[26]. Amoxicillin is first line when the child has had no amoxicillin in the past 30 days, no purulent conjunctivitis and no penicillin allergy, at a high dose of 80 to 90 mg/kg/day in 2 divided doses[26]. Children younger than 2 years get a 10-day course, and pain should be treated[26].
- A: Incorrect because observation is an option at this age only for nonsevere unilateral AOM; bilateral AOM calls for antibiotics[26].
- C: Incorrect because amoxicillin, not a macrolide, is the first-line choice for this child[26].
- D: Incorrect because added beta-lactamase coverage is reserved for amoxicillin use in the past 30 days, purulent conjunctivitis or recurrent AOM unresponsive to amoxicillin[26].
Question 16
Tags: Neurology; Diagnosis & management
A 38-year-old woman woke this morning with drooping of the right side of her face. She cannot raise her right eyebrow or fully close her right eye. The rest of her neurologic exam is normal, and she has no rash, ear vesicles, hearing loss or limb weakness. Symptoms began about 12 hours ago, and her history and exam point to no other cause. Which plan is most appropriate?
- A. Oral antiviral therapy alone
- B. Oral corticosteroids started now, plus eye protection
- C. Routine laboratory tests and a brain MRI before any treatment
- D. Reassurance only, because most cases resolve on their own
Answer: B
Rationale: Acute unilateral facial weakness with no other cause found on history and exam fits Bell palsy. The AAO-HNSF guideline strongly recommends oral steroids within 72 hours of symptom onset for patients 16 years and older, and eye protection when eye closure is impaired[27]. Antiviral therapy may be added to steroids as an option but should not be given alone[27]. Reassess or refer if new neurologic findings or eye symptoms develop, or if facial recovery is incomplete 3 months after onset[27].
- A: Incorrect because the guideline advises against oral antiviral therapy alone for new-onset Bell palsy[27].
- C: Incorrect because routine laboratory testing and routine imaging are not recommended for new-onset Bell palsy[27].
- D: Incorrect because steroids within 72 hours are strongly recommended, and impaired eye closure needs eye protection[27].
Questions 17 to 20: alternate formats and professional-role items on mental health, MSK and STI care
These four items practise multiple-response and drag-and-drop ordering, which ANCC lists for some of its exams (for example adult-gerontology primary care), and professional-role content, which ANCC’s FNP test content outline includes alongside clinical content[17]. ANCC’s FNP outline and FNP sample questions do not mention the alternate formats, so treat Questions 17 to 19 as format practice, not as a preview of your exam. Select-all and ordering items require careful reading and systematic thinking.
Question 17
Format: Multiple response (Select all that apply)
Tags: Psychiatry & mental health; Prevention & screening
An FNP is updating mental health screening in a family practice that sees adults of all ages, including pregnant and postpartum patients. Which practices match the 2023 USPSTF recommendations? Select all that apply.
- A. Screen all adults for depression, including pregnant and postpartum persons and adults 65 and older
- B. Screen adults 64 and younger, including pregnant and postpartum persons, for anxiety disorders
- C. Screen adults 65 and older for anxiety disorders as a grade B recommendation
- D. Screen all adults for suicide risk as a grade B recommendation
Answers: A, B
Rationale: In June 2023 the USPSTF gave a grade B recommendation to screen all adults for depression, including pregnant and postpartum persons and older adults[28], and a grade B recommendation to screen adults 64 and younger, including pregnant and postpartum persons, for anxiety disorders[29]. It found the evidence insufficient (an I statement) for suicide risk screening in adults[28] and for anxiety screening in adults 65 and older[29]. An I statement means the evidence is too limited to weigh benefits against harms.
- A: Correct because depression screening is a grade B recommendation for all adults, including these groups[28].
- B: Correct because anxiety screening is a grade B recommendation for adults 64 and younger[29].
- C: Incorrect because the evidence for anxiety screening in adults 65 and older is insufficient (I statement)[29].
- D: Incorrect because the evidence for suicide risk screening in adults is insufficient (I statement)[28].
Question 18
Format: Multiple response (Select all that apply)
Tags: Musculoskeletal; Assessment & diagnostics
A 28-year-old man rolled his right ankle playing basketball 2 hours ago and has pain around the ankle. According to the Ottawa ankle and foot rules, which findings would indicate radiographs? Select all that apply.
- A. Bone tenderness at the posterior edge or tip of the lateral malleolus
- B. Inability to take four steps both right after the injury and in the clinic
- C. Marked swelling and bruising over the lateral ankle without bone tenderness
- D. Bone tenderness at the base of the fifth metatarsal
Answers: A, B, D
Rationale: The Ottawa rules call for ankle radiographs when there is tenderness at the posterior edge or tip of either malleolus or the patient cannot walk four steps, and for foot radiographs when there is tenderness at the navicular or the base of the fifth metatarsal or the patient cannot walk[31]. The rules were designed to rule out fractures and avoid unneeded films[31]. When the rules are negative and the patient can walk, the ACR rates radiography as usually not appropriate for patients 5 years and older[30].
- A: Correct because tenderness at the posterior edge or tip of either malleolus meets the ankle rule[31].
- B: Correct because inability to walk four steps meets the rule[31].
- C: Incorrect because swelling and bruising are not criteria; the rules rely on bone tenderness and the ability to bear weight[31].
- D: Correct because tenderness at the base of the fifth metatarsal meets the foot rule[31].
Question 19
Format: Drag and drop ordering (Place in correct order)
Tags: Professional role; Quality improvement & education
A family nurse practitioner leads an in-service for clinic staff on using current STI guidelines in practice. Place the following steps in the most logical order to implement guideline-based STI care in the clinic.
- A. Review current CDC STI treatment guidelines to identify recommended screening and treatment practices
- B. Educate staff on key recommendations and how to access the guideline tools
- C. Assess current clinic practices and compare them with guideline recommendations
- D. Develop and implement workflow changes (such as standing orders) to close identified gaps
Correct order: A, C, B, D
- Step A first: establishes knowledge of current guidelines[8].
- Step C second: identifies gaps between current practice and recommendations.
- Step B third: prepares staff to apply the guidelines in daily work.
- Step D last: operationalizes changes to close the gaps.
Question 20
Format: Professional role (single best answer)
Tags: Professional role; Ethics & patient education
A nurse practitioner preceptor is teaching a student about counseling patients with STIs. Which statement best reflects the role of CDC STI Treatment Guidelines in clinical decision-making?
- A. They provide current evidence-based prevention, diagnostic, and treatment recommendations that replace earlier guidance
- B. They are opinion pieces and should not be used in clinical practice
- C. They guarantee individual patient outcomes
- D. They replace the need for clinical assessment and local considerations
Answer: A
Rationale: The STI Treatment Guidelines provide current evidence-based prevention, diagnostic, and treatment recommendations that replace earlier guidance[8]. They are intended as a source of clinical guidance, but providers should still assess patients based on their clinical circumstances and local disease prevalence[8]. Guidelines support, but do not replace, individualized clinical judgment.
- B: Incorrect because they are formal evidence-based recommendations, not opinion pieces[8].
- C: Incorrect because guidelines cannot guarantee outcomes for individual patients.
- D: Incorrect because clinicians must still consider individual circumstances and local epidemiology[8].
How should you score these and find your weak systems?
Count one point for each fully correct question. For multiple-response items, give yourself credit only if you chose all correct options and no incorrect ones. Then group misses by system (for example, cardiovascular, endocrine) and by domain (assessment, prevention, management, professional role) to see patterns rather than focusing only on a raw score.
How do you turn missed questions into a study plan?
A missed question only helps if you can recall the rule it tested on exam day. For each miss, write that rule as a short question and answer, such as “Bell palsy seen within 72 hours in an adult: first treatment?” and “Oral steroids, plus eye protection if the eye will not close.” Then review those cards on a spaced schedule instead of rereading rationales.
If you study in Alma, add those rules to your notes and Alma turns them into flashcards scheduled with FSRS (see how Alma uses FSRS to schedule your flashcards). Alma Insights combines your flashcard and quiz results into a strength score for each topic and lists the weakest first (see how Alma Insights finds your weak topics), and the Study Schedule builds your plan backward from exam day, giving weaker topics more time and keeping the last days for catch-up and light review.
Whatever tool you use, start with your two weakest systems, then retest them with fresh questions from a Qbank or the official samples below.
Where can you find more free FNP practice questions?
Official organizations and commercial vendors both offer additional sample questions. ANCC posts 25 free FNP sample questions with an answer key but no explanations[16]. AANPCB offers paid practice examinations with 50 questions each, written by nurse practitioner content experts; scores are reported as percentages, and each exam can only be taken once[10]. Large commercial Qbanks for FNP certification also include free trials with limited numbers of exam-style questions and study tools[6].
Use these official and commercial samples primarily to learn the formats and depth of reasoning expected. Then use your own notes, guideline summaries, and spaced repetition to reinforce the underlying concepts until they feel routine in clinic-style scenarios.
Frequently asked questions
How many FNP practice questions should I do before my boards?
Some commercial FNP Qbanks advertise over 1,100 practice questions plus additional tools for AANP and ANCC prep[6], and one full course bundle lists about 2,000 questions and 13 hours of video[7]. Rather than chasing a number, aim for enough mixed-system practice that your miss patterns stabilize and you can clearly explain why each answer is right or wrong.
Where can I get official FNP example questions?
ANCC publishes certification materials and readiness test information for APRN exams, including eligibility criteria, study resources, and readiness tests with 60 questions delivered in 75 minutes with a feedback report[9]. ANCC also posts 25 free FNP sample questions with answers but no explanations[16]. AANPCB offers practice examinations with 50 questions designed to simulate the certification exam experience, written by nurse practitioner content experts, taken in 60-minute sessions, and scored as percentages[10]. These official sources are valuable ways to see authentic formatting and blueprint emphasis.
What is the difference between AANP and ANCC question styles?
Both exams test primary care across the lifespan. The AANPCB FNP exam has 150 multiple-choice questions (135 scored) in 3 hours[18]. The ANCC FNP exam has 175 questions (150 scored) in 3.5 hours, and its test content outline includes professional-role topics such as ethics, scope of practice and research appraisal[17]. ANCC’s sample question pages list multiple-response, drag-and-drop and hot spot items for some NP exams, such as adult-gerontology primary care[19], while its free FNP sample set uses single-best-answer items[16]. AANPCB practice exams have 50 multiple-choice questions each[10]. When you study, include both straightforward clinical vignettes and professional-role scenarios.
How can AI tools like Alma fit alongside an FNP Qbank?
Use a dedicated FNP Qbank for large numbers of vetted, exam-style questions and performance analytics[6][7]. Then use AI tools such as Alma to turn your personal notes and guidelines into custom quizzes and spaced-repetition flashcards, focused specifically on the topics you miss. For more on choosing and combining NP study tools, see our guide to the best AI study tools for nurse practitioner students.
References
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- 2026 GOLD Report and Pocket Guide - Global Initiative for Chronic Obstructive Lung Disease - GOLD
- Sexually Transmitted Infections Treatment Guidelines, 2021
- Sexually Transmitted Infections Treatment Guidelines, 2021 | MMWR
- Adult Immunization Schedule | Vaccines & Immunizations | CDC
- UWorld FNP Practice Question Bank | ANCC & AANP Exam Prep
- Family Nurse Practitioner (FNP) | Springer Publishing | Springer Publishing Company
- STI Treatment Guidelines
- https://www.nursingworld.org/globalassets/docs/ancc/certificates/2026-winter-aprn-faculty--staff-townhall.pdf
- NP Practice Exam - Prepare for Certification - Sign In Now
- 2025 High Blood Pressure Guideline (AHA/ACC/AANP and partners) | American Heart Association Professional
- Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication (2022) | US Preventive Services Task Force
- Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19 to 59 Years, United States, 2024 | MMWR
- U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 | CDC
- Cholesterol Treatment Trialists’ Collaboration. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia. Lancet Diabetes Endocrinol. 2024
- Family Nurse Practitioner Exam Sample Questions | ANCC
- Family Nurse Practitioner Certification (FNP-BC) | ANCC
- Family Nurse Practitioner Candidate Handbook (June 2026) | AANPCB
- Adult-Gerontology Primary Care NP Sample Questions | ANCC
- 2026 GINA Summary Guide | Global Initiative for Asthma
- 2020 Focused Updates to the Asthma Management Guidelines | NHLBI
- 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes 2026 | Diabetes Care
- Guidelines for the Treatment of Hypothyroidism (American Thyroid Association, 2014) | Thyroid
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease | Kidney International
- Guidelines of Care for the Management of Acne Vulgaris (American Academy of Dermatology, 2024) | JAAD
- The Diagnosis and Management of Acute Otitis Media (AAP, 2013) | Pediatrics
- Clinical Practice Guideline: Bell’s Palsy (AAO-HNSF, 2013) | Otolaryngol Head Neck Surg
- Depression and Suicide Risk in Adults: Screening (2023) | US Preventive Services Task Force
- Anxiety Disorders in Adults: Screening (2023) | US Preventive Services Task Force
- ACR Appropriateness Criteria: Acute Trauma to the Ankle (2020) | J Am Coll Radiol
- Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review (2003) | BMJ