AANPCB Family Nurse Practitioner (FNP) Exam — All Questions

A 67-year-old man asks about lung cancer screening. He smoked 1 pack per day for 25 years and quit 9 years ago. He has no symptoms and would accept surgery if cancer were found. Which screening plan matches the current USPSTF recommendation?

• a.No screening, because he has already quit smoking
• b.A single low-dose CT now, then stop if it is negative
• c.Annual posteroanterior chest radiograph
• d.Annual low-dose CT of the chest✓

The 2021 USPSTF recommendation (grade B) covers adults 50 to 80 years old with at least a 20 pack-year history who currently smoke or quit within the past 15 years; he has 25 pack-years and quit 9 years ago, so annual low-dose CT applies. Chest radiography is not the recommended screening test. Quitting does not end eligibility until 15 years have passed, and the recommendation is for yearly screening, not a single scan.

A 70-year-old man who smoked for 12 years in his twenties and thirties comes for a wellness visit. He has never had imaging of his abdomen. Which screening test does the USPSTF recommend for him?

• a.Yearly abdominal ultrasound until age 75
• b.A one-time abdominal aortic ultrasound✓
• c.No aortic screening, since he quit decades ago
• d.CT angiography of the abdomen and pelvis

The USPSTF (2019, grade B) recommends one-time ultrasonography screening for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked; any smoking history qualifies, however remote. Screening is a single study, not an annual one, and CT angiography is not the screening modality.

A 46-year-old woman with no personal or family history of colorectal cancer or polyps has never been screened. She has no GI symptoms. What should the nurse practitioner advise?

• a.Start colorectal cancer screening now✓
• b.Screen only if a first-degree relative is diagnosed
• c.Wait until she turns 50 to begin screening
• d.Screen only if she develops rectal bleeding

The 2021 USPSTF recommendation added adults aged 45 to 49 (grade B) to the grade A recommendation for ages 50 to 75, so an average-risk 46-year-old should begin screening now. Waiting until 50 reflects the older recommendation. Screening is by definition for people without symptoms, and average-risk adults are screened without any family history.

A 41-year-old woman at average risk for breast cancer asks when she should start screening mammography. According to the 2024 USPSTF recommendation, what should she be told?

• a.Mammography every year starting at 45
• b.Wait until age 50 to begin mammography
• c.Screening mammography every 2 years, starting now✓
• d.Annual breast MRI instead of mammography

In April 2024 the USPSTF lowered the start age and now recommends biennial screening mammography for women aged 40 to 74 (grade B). Starting at 50 was the previous recommendation. MRI is not a routine screening test for average-risk women, and the USPSTF interval is every 2 years rather than yearly.

A 19-year-old sexually active woman asks for a Pap test at her first visit. She has no symptoms. Which screening plan follows current USPSTF recommendations?

• a.Perform cervical cytology now because she is sexually active
• b.Skip STI testing and cytology because she has no symptoms
• c.Perform cytology with HPV cotesting at this visit
• d.Chlamydia and gonorrhea testing; cytology at age 21✓

The USPSTF recommends against cervical cancer screening before age 21 (grade D), regardless of sexual activity. It also recommends chlamydia and gonorrhea screening for all sexually active women aged 24 or younger (grade B), and screening by definition is for people without symptoms. HPV cotesting is not used in women under 30.

A 38-year-old man with a BMI of 28 kg/m2 and no symptoms of diabetes asks whether he needs any blood sugar testing. What does the USPSTF recommend?

• a.Screen for prediabetes and diabetes now✓
• b.Begin screening at age 45
• c.Screen only if polyuria or polydipsia develops
• d.Screen only once his BMI reaches 30 or higher

The 2021 USPSTF recommendation (grade B) is to screen adults aged 35 to 70 who have overweight or obesity, with overweight defined as BMI 25 or higher; the starting age was lowered from 40 to 35. A BMI of 28 already qualifies. Testing someone with polyuria or polydipsia is diagnostic evaluation, not screening.

A 66-year-old woman has never had a bone density test. She has no history of fracture. Which screening approach does the USPSTF recommend?

• a.No testing unless she has a fragility fracture
• b.Annual heel ultrasound in the office
• c.Serum calcium and vitamin D levels only
• d.Central DXA bone mineral density testing✓

The USPSTF (January 2025, grade B) recommends osteoporosis screening for all women 65 or older, with DXA bone mineral density with or without a fracture risk assessment; central DXA at the hip or spine is the most commonly used test. Waiting for a fracture is the opposite of screening, and serum calcium or vitamin D levels do not measure bone density.

A 72-year-old man with no history of injection drug use or known liver disease has never been tested for hepatitis C. Which approach follows the USPSTF recommendation?

• a.Anti-HCV antibody, then PCR if reactive✓
• b.No testing, since he reports no risk factors
• c.Liver enzymes, with HCV testing only if abnormal
• d.HCV RNA genotype testing as the first test

The USPSTF (2020, grade B) recommends hepatitis C screening for all adults aged 18 to 79 regardless of risk factors, using anti-HCV antibody testing followed by confirmatory PCR. Genotyping is not a screening test, and normal liver enzymes do not exclude chronic HCV infection.

A 16-year-old boy comes for a sports physical. He has never been tested for HIV and says he has not been sexually active. Which approach is consistent with USPSTF and CDC recommendations?

• a.Test only if he reports drug use
• b.Offer routine HIV screening at this visit✓
• c.Test only after an STI has been diagnosed
• d.Defer HIV testing until he turns 18

The USPSTF recommends HIV screening for all adolescents and adults aged 15 to 65 (grade A), and CDC recommends testing everyone aged 13 to 64 at least once as routine care using an opt-out approach. Neither limits testing to reported risk factors, and waiting until 18 or until an STI is found defeats routine screening.

A 27-year-old woman is seen for her first prenatal visit at 9 weeks of gestation. Which test does the USPSTF strongly recommend at this visit?

• a.Rh(D) blood typing and antibody screen✓
• b.Rh(D) typing only if her partner is Rh-positive
• c.Rh(D) typing only at the time of delivery
• d.Rh(D) typing deferred until 28 weeks

The USPSTF strongly recommends (grade A) Rh(D) blood typing and antibody testing for all pregnant women during their first pregnancy-related visit. A repeat antibody test at 24 to 28 weeks is a separate recommendation for unsensitized Rh(D)-negative women; it does not replace testing at the first visit, and neither recommendation depends on first knowing the partner's type.

A 24-year-old woman at 10 weeks of gestation has no urinary symptoms. How should she be screened for asymptomatic bacteriuria?

• a.No testing unless urinary symptoms develop
• b.Urine culture in the third trimester only
• c.Urine dipstick for nitrites and leukocytes
• d.Midstream clean-catch urine culture✓

The USPSTF recommends screening pregnant persons for asymptomatic bacteriuria with a midstream clean-catch urine culture at the first prenatal visit or at 12 to 16 weeks, whichever is earlier (grade B). A dipstick is not the recommended screening test, screening by definition targets people without symptoms, and deferring to the third trimester misses the recommended window.

A 22-year-old at 8 weeks of gestation has no history of sexually transmitted infection and one lifetime partner. Which statement about syphilis screening is correct?

• a.Screen only at admission for delivery
• b.Screen only if she reports a new partner
• c.Screen her at this first visit✓
• d.Screen only if a genital ulcer is seen

The USPSTF (May 2025, grade A) recommends early, universal syphilis screening in pregnancy, whether or not risk factors are present, as soon as the patient first presents for care. Screening at delivery is only for patients who were not screened earlier, and waiting for a lesion or a new partner is not universal screening.

A 14-year-old girl is seen for a well visit. She and her parent report no mood concerns. Which statement about depression screening is correct?

• a.Screen only if her school grades decline
• b.Screen only if her parent reports concerns
• c.Screen for depression today✓
• d.Screening begins at age 18

The USPSTF recommends screening adolescents aged 12 to 18 for major depressive disorder, so a routine well visit at 14 is the right time. Screening is for people without recognized symptoms, so it should not wait for a parent's report or a drop in grades.

For which asymptomatic patient does the USPSTF recommend routine screening for anxiety disorders?

• a.A 72-year-old woman who is new to the practice
• b.A 34-year-old woman who is 6 weeks postpartum✓
• c.A 68-year-old man at his routine annual visit
• d.A 79-year-old man who lives independently at home

The 2023 USPSTF recommendation (grade B) covers adults 64 or younger, including pregnant and postpartum persons. For adults 65 and older the USPSTF issued an I statement (insufficient evidence), so the three older patients are not in the recommended screening group.

When bacterial vaginosis is diagnosed with Amsel's clinical criteria, how many of the four criteria must be present?

• a.One or more
• b.All four of the criteria
• c.Three or more✓
• d.Two or more

CDC's STI treatment guidelines state that detecting at least three of the four Amsel criteria (thin homogeneous discharge, clue cells, vaginal pH above 4.5, and a positive whiff test) correlates with Gram stain diagnosis. One or two criteria are not enough, and requiring all four is stricter than the standard.

A 47-year-old woman reports numbness in her thumb, index, and middle fingers at night. The nurse practitioner has her hold both wrists fully flexed for 60 seconds, which reproduces the numbness. What is this maneuver?

• a.Finkelstein test
• b.Allen test
• c.Tinel sign
• d.Phalen test✓

Holding the wrist fully flexed for about 60 seconds to reproduce median-nerve symptoms is the Phalen test. The Tinel sign is elicited by tapping over the median nerve at the wrist. The Finkelstein test is for de Quervain tenosynovitis, and the Allen test checks radial and ulnar artery flow to the hand.

At a 5-week well visit, a baby girl born in breech presentation has a hip clunk on examination. Which test is most appropriate to evaluate for developmental dysplasia of the hip?

• a.Ultrasound of the hips✓
• b.Plain radiograph of the pelvis
• c.No imaging; recheck at 12 months
• d.MRI of both hips

Hip ultrasound is used to confirm developmental dysplasia of the hip in young infants; plain radiographs become useful in older infants and children, once the femoral head has ossified. MRI is not the first-line test, and deferring evaluation to 12 months would miss the period in which harness treatment works best.

A 4-week-old boy has forceful, nonbilious vomiting after every feeding and seems hungry right after. An olive-shaped mass is palpated in the upper abdomen. Which imaging study is usually done first?

• a.Upper endoscopy
• b.Abdominal ultrasound✓
• c.CT of the abdomen with contrast
• d.Barium enema

This picture suggests hypertrophic pyloric stenosis, and abdominal ultrasound is usually the first imaging test to measure the thickened pylorus. Endoscopy and CT are not first-line studies in an infant, and a barium enema evaluates the colon, not the gastric outlet.

At a 9-month well visit, which skill would most babies be expected to show?

• a.Sits without support✓
• b.Says two words together
• c.Kicks a ball forward
• d.Walks without holding on

CDC's milestone checklist lists sitting without support as a movement milestone most babies reach by 9 months. Walking without holding on is an 18-month milestone, and two-word phrases and kicking a ball are listed at 2 years.

At an 18-month visit, which parental report should prompt further developmental evaluation?

• a.He walks without holding on
• b.He points to show her things he likes
• c.He no longer says words he used at 15 months✓
• d.He scribbles with a crayon

Loss of skills a child once had is a red flag at any age, and CDC's checklist asks parents about it directly at every visit. Walking without holding on, scribbling, and pointing to show interest are all milestones most children reach by 18 months, so they are reassuring.

A 2-year-old has a runny nose, cough, and a mildly red throat. The parent asks for a strep test. What is the best response?

• a.Order an antistreptolysin O titer
• b.Testing is generally not done at this age✓
• c.Do a rapid strep test, then culture if negative
• d.Give penicillin to prevent rheumatic fever

CDC guidance says testing generally should not be performed in children younger than 3 years, in whom group A strep rarely causes pharyngitis and rheumatic fever is uncommon; the viral features here also argue against strep. Empiric penicillin is not indicated, and an ASO titer reflects past infection rather than acute pharyngitis.

An 18-month-old has fever and ear tugging. Which otoscopic finding establishes the diagnosis of acute otitis media?

• a.Moderate bulging of the tympanic membrane✓
• b.A red eardrum in a crying child, without effusion
• c.Mild redness of the eardrum with normal mobility
• d.A retracted eardrum with clear fluid behind it

Acute otitis media is diagnosed by moderate or severe bulging of the tympanic membrane, new otorrhea not due to otitis externa, or mild bulging with recent ear pain or intense erythema. It should not be diagnosed without middle ear effusion, so a red drum in a crying child or one with normal mobility does not qualify, and a retracted drum with clear fluid describes effusion without acute inflammation.

A 44-year-old man has had a productive cough for 10 days. Temperature is 37.2 C (99 F), heart rate 84, respiratory rate 16, and lung exam is clear. What is the most appropriate evaluation?

• a.Sputum Gram stain and culture
• b.Complete blood count with differential
• c.No chest radiograph is needed✓
• d.Chest radiograph because the cough has lasted over a week

In otherwise healthy adults with acute cough, pneumonia is uncommon in the absence of abnormal vital signs (heart rate 100 or more, respiratory rate 24 or more, temperature 38 C or more) or focal lung findings. His vitals and exam are normal, so imaging is not needed, and cough duration alone is not an indication. Sputum culture and a CBC do not change management of acute bronchitis.

A 10-month-old girl has a fever of 39.2 C (102.6 F) with no source on examination, and a urinary tract infection is suspected. How should urine be obtained for culture?

• a.As a clean-catch midstream sample
• b.By urethral catheterization✓
• c.From the diaper, for a dipstick only
• d.With an adhesive collection bag

For children 2 to 24 months old, diagnosing UTI requires a urinalysis suggesting infection plus at least 50,000 CFU/mL of a single uropathogen in urine obtained by catheterization or suprapubic aspiration, not urine collected in a bag. An infant this age cannot give a midstream sample, and a dipstick alone cannot confirm or exclude infection.

A 55-year-old man with type 2 diabetes comes for his annual comprehensive foot examination. Which neurologic assessment meets the ADA Standards of Care?

• a.Monofilament plus one other sensory test✓
• b.Nerve conduction studies for all patients yearly
• c.Monofilament testing alone, repeated every 5 years
• d.Ankle reflexes only, if he reports numbness

The ADA Standards of Care 2026 call for an annual comprehensive foot examination that includes 10-g monofilament testing (or the Ipswich touch test) plus at least one other assessment: pinprick, temperature, or vibration. The exam is annual and done for everyone, not only when symptoms appear, and nerve conduction studies are not routine screening.

A 52-year-old woman has just been diagnosed with type 2 diabetes. When should she have her first dilated, comprehensive eye examination?

• a.At the time of diagnosis✓
• b.Once her A1C reaches goal
• c.Only if her vision changes
• d.5 years after diagnosis

The ADA recommends that people with type 2 diabetes have an initial dilated and comprehensive eye examination at the time of diagnosis, because retinopathy may already be present. The 5-year delay applies to adults with type 1 diabetes. Waiting for visual symptoms or glycemic control would delay detection.

A 68-year-old man without known hypertension has office readings of 138/86 mm Hg at two visits. What should the nurse practitioner do before starting treatment?

• a.Confirm with home or ambulatory readings✓
• b.Recheck office blood pressure in 5 years
• c.Start an ACE inhibitor at this visit
• d.Order renal artery duplex ultrasound

The USPSTF (2021, grade A) recommends screening with office measurement and obtaining blood pressure measurements outside the clinical setting, such as home or ambulatory monitoring, to confirm the diagnosis before starting treatment. Starting a drug skips confirmation, a 5-year recheck ignores elevated readings, and renal artery imaging is not part of routine evaluation.

A 62-year-old woman who smokes has chronic cough and exertional dyspnea. Which finding is required to establish a diagnosis of COPD?

• a.Peak flow below 80% of predicted
• b.Resting oxygen saturation below 92%
• c.Post-bronchodilator FEV1/FVC below 0.70✓
• d.Emphysema seen on a chest CT scan

GOLD 2026 states that spirometry showing a post-bronchodilator FEV1/FVC below 0.7 is mandatory to establish the diagnosis of COPD. CT findings, peak flow, and oximetry can support assessment but cannot confirm persistent airflow obstruction.

A 58-year-old man who immigrated from Vietnam 6 years ago does not know whether he was vaccinated against hepatitis B. Which screening test is recommended?

• a.Serum ALT alone
• b.Hepatitis B surface antibody alone
• c.No testing until his vaccine history is found
• d.Hepatitis B surface antigen✓

The USPSTF (2020, grade B) recommends screening adolescents and adults at increased risk, including people born in regions with HBV prevalence of 2% or more such as Asia, using hepatitis B surface antigen with confirmatory testing. Surface antibody alone shows immunity but not infection, ALT is not a screening test for HBV, and screening applies even to people who were vaccinated.

According to CDC, which tuberculin skin test result in an adult with no known risk factors for tuberculosis meets the threshold for considering latent TB treatment?

• a.15 mm of induration✓
• b.10 mm of redness
• c.12 mm of induration
• d.5 mm of induration

CDC states that people with no known risk factors may be considered for latent TB treatment if they have a positive IGRA or a skin test reaction of 15 mm or larger. Induration, not redness, is what is measured, and 5 mm or 12 mm is below the threshold for a person without risk factors.

A 44-year-old woman has fatigue, weight gain, and an elevated TSH. Which test most directly supports Hashimoto disease as the cause?

• a.Serum calcitonin
• b.24-hour urine cortisol
• c.Thyroid peroxidase antibodies✓
• d.Radioiodine uptake scan

NIDDK notes that thyroid peroxidase (TPO) antibodies are present in most people with Hashimoto disease, and detecting them along with thyroid function tests usually confirms the diagnosis. An iodine uptake scan is used to evaluate hyperthyroidism, calcitonin is a marker for medullary thyroid cancer, and urine cortisol evaluates adrenal disorders.

A 26-year-old woman has chronic diarrhea, bloating, and iron deficiency anemia that has not improved with oral iron. Which blood test is most appropriate to evaluate for celiac disease?

• a.Stool ova and parasite exam
• b.Serum amylase and lipase
• c.Lactose hydrogen breath test
• d.Tissue transglutaminase IgA✓

Tissue transglutaminase antibodies (or endomysial antibodies) are the blood tests used when celiac disease is suspected; if positive, upper endoscopy with duodenal biopsy follows. Stool ova and parasites looks for parasitic infection, lipase reflects pancreatic injury, and a hydrogen breath test is used for carbohydrate malabsorption or bacterial overgrowth.

A 15-year-old comes to a visit with her mother. How should the nurse practitioner approach the psychosocial history?

• a.Explain confidentiality limits, then see her alone✓
• b.Postpone questions about sex until she is 18
• c.Promise that nothing she says will ever be shared
• d.Take the history with her mother present

A key step in taking an adolescent history is to explain that the discussion stays between clinician and patient unless there is a threat to her or to others, and to give her private time to talk. Interviewing only with the parent present discourages disclosure, an unconditional promise cannot be kept because state law requires some reporting, and sexual history is part of routine adolescent care.

Which brief screening instrument was designed for adolescent substance use, with two or more 'yes' answers suggesting a serious problem?

• a.PHQ-9
• b.Morse Fall Scale
• c.Mini-Cog
• d.CRAFFT✓

CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is a brief screening instrument for substance use in adolescents, and two or more positive answers suggest a serious problem. The PHQ-9 measures depression, the Mini-Cog screens for cognitive impairment, and the Morse Fall Scale estimates fall risk in hospitalized patients.

A 12-year-old with asthma uses an albuterol inhaler as his only reliever. Which report from the past 4 weeks counts toward poor symptom control in GINA's assessment?

• a.Having an FEV1 of 92% of predicted
• b.Using albuterol only before soccer practice
• c.Having daytime symptoms once a week
• d.Waking once at night because of asthma✓

GINA assesses control over the past 4 weeks with four questions: daytime symptoms more than twice a week, any night waking due to asthma, SABA reliever use more than twice a week, and any activity limitation; any night waking counts. SABA taken before exercise is specifically excluded, one daytime episode a week is within the threshold, and FEV1 is a risk factor measure rather than one of the symptom-control questions.

A 74-year-old man with new orthopnea, leg swelling, and a 2 kg weight gain over 3 days is being evaluated for heart failure. After an ECG, which test is usually the best first test?

• a.Pulmonary function testing
• b.Coronary angiography
• c.Echocardiogram✓
• d.Exercise treadmill test

MedlinePlus notes that after an ECG, an echocardiogram is most often the best first test when heart failure is being evaluated, because it shows ventricular size, ejection fraction, and valve function and guides treatment. Stress testing and angiography look for ischemia, and pulmonary function tests evaluate lung disease rather than cardiac function.

A 3-week-old boy has had forceful, nonbilious vomiting after feeds for 4 days. He is eager to feed again right after vomiting, has fewer wet diapers, and has visible waves across the upper abdomen after feeding. What is the most likely diagnosis?

• a.Physiologic gastroesophageal reflux
• b.Cow's milk protein allergy
• c.Intussusception
• d.Hypertrophic pyloric stenosis✓

Pyloric stenosis typically begins around 3 weeks of age with forceful vomiting, visible peristaltic waves after feeding, hunger after vomiting, and signs of dehydration, because the thickened pylorus blocks gastric emptying. Physiologic reflux causes effortless spit-ups in a thriving infant, intussusception presents with colicky pain and bloody stools in older infants, and milk protein allergy more often causes bloody stools and eczema than projectile vomiting.

A 9-month-old has episodes of sudden, loud crying every 15 to 20 minutes, drawing his knees to his chest, with quiet periods between. He then passes a stool that looks like red currant jelly. What is the most likely diagnosis?

• a.Intussusception✓
• b.Infant colic
• c.Viral gastroenteritis
• d.Pyloric stenosis

Intermittent, colicky abdominal pain with knees drawn up, followed by a currant-jelly stool, is the classic presentation of intussusception, which most often affects children between 5 months and 3 years and is a surgical emergency. Colic does not cause bloody stools, pyloric stenosis presents with vomiting in the first weeks of life, and gastroenteritis does not produce this pattern of recurring pain with quiet intervals.

A 12-year-old boy with obesity has had a limp and aching knee pain for 3 weeks without injury. His knee exam is normal. A hip radiograph shows the femoral head displaced from the femoral neck at the growth plate. What is the diagnosis?

• a.Patellofemoral pain syndrome
• b.Slipped capital femoral epiphysis✓
• c.Developmental hip dysplasia
• d.Osgood-Schlatter disease

Slipped capital femoral epiphysis is separation of the femoral head from the femur at the upper growth plate; it is more common in children with obesity and often presents with a limp and pain referred to the knee, which is why the hip must be examined when the knee exam is normal. Osgood-Schlatter and patellofemoral pain are knee disorders with knee findings, and developmental dysplasia is a problem of the acetabulum present from infancy.

A 13-year-old soccer player has had pain for 2 months just below the kneecap that worsens with running, jumping, and climbing stairs. There is a tender, swollen bump over the tibial tubercle. The knee joint is stable without effusion. What is the most likely diagnosis?

• a.Slipped capital femoral epiphysis
• b.Septic arthritis of the knee
• c.Osgood-Schlatter disease✓
• d.Anterior cruciate ligament tear

Osgood-Schlatter disease is painful swelling of the anterior tibial tubercle from repetitive quadriceps pull during a growth spurt, common in adolescents who run and jump. An ACL tear causes instability and an effusion after injury, septic arthritis causes a hot, swollen joint with fever, and a slipped capital femoral epiphysis is a hip disorder without a tender tibial tubercle.