AANPCB Family Nurse Practitioner (FNP) Exam — All Questions

A 23-year-old nonpregnant woman has a positive urine NAAT for Chlamydia trachomatis. She has no drug allergies. Which regimen does CDC recommend?

• a.Doxycycline twice daily for 7 days✓
• b.Metronidazole twice daily for 7 days
• c.Single-dose oral azithromycin as preferred therapy
• d.Ceftriaxone as a single intramuscular dose

The CDC 2021 STI treatment guidelines list doxycycline 100 mg twice daily for 7 days as the recommended regimen for chlamydia in adolescents and adults; azithromycin moved to an alternative regimen because of concern about its effectiveness for rectal infection. Ceftriaxone treats gonorrhea, and metronidazole treats trichomoniasis and bacterial vaginosis.

A 17-year-old weighing 68 kg has urogenital gonorrhea on NAAT; chlamydia testing is pending. Which treatment plan follows CDC recommendations?

• a.Ceftriaxone 500 mg IM plus doxycycline✓
• b.Doxycycline for 7 days without ceftriaxone
• c.Ceftriaxone 250 mg IM once, plus azithromycin 1 g
• d.Oral cefixime alone as preferred therapy

CDC recommends a single 500 mg intramuscular dose of ceftriaxone for uncomplicated gonorrhea in persons under 150 kg, and doxycycline 100 mg twice daily for 7 days if chlamydia has not been excluded. The 250 mg dose with azithromycin was the older regimen, oral cefixime is only an alternative because it gives lower drug levels, and doxycycline alone does not treat gonorrhea.

A 27-year-old nonpregnant woman has trichomoniasis confirmed by NAAT. Which regimen does CDC recommend for her?

• a.Doxycycline twice daily for 7 days
• b.Metronidazole twice daily for 7 days✓
• c.Fluconazole as a single 150 mg oral dose
• d.A single 2 g dose of metronidazole

CDC recommends metronidazole 500 mg twice daily for 7 days for trichomoniasis in women because the multidose course was more effective than a single dose. The single 2 g dose is the recommended regimen for men. Fluconazole treats candidiasis, and doxycycline treats chlamydia.

A 25-year-old woman at 20 weeks of gestation has symptomatic bacterial vaginosis. What is the appropriate plan?

• a.Defer treatment until after delivery
• b.Treat only if culture is positive
• c.Treat her male partner instead of her
• d.Treat with a recommended BV regimen now✓

CDC recommends treating all symptomatic pregnant women with bacterial vaginosis because it is associated with preterm birth, premature rupture of membranes, and postpartum infection; the recommended nonpregnant regimens can be used in pregnancy. Treating male partners does not prevent recurrence, and BV is diagnosed by Amsel criteria or Gram stain, not by culture.

A healthy, nonpregnant 29-year-old woman has dysuria, frequency, and urgency without fever or flank pain. Local E. coli resistance to TMP-SMX is 25%. Which is an appropriate first-line antibiotic?

• a.Trimethoprim-sulfamethoxazole
• b.Ciprofloxacin
• c.Amoxicillin
• d.Nitrofurantoin✓

CDC lists nitrofurantoin, TMP-SMX (where local resistance is under 20%), and fosfomycin as first-line agents for acute uncomplicated cystitis in healthy nonpregnant premenopausal women. Local resistance of 25% rules out TMP-SMX, and fluoroquinolones such as ciprofloxacin should be reserved for when other agents are not appropriate. Amoxicillin is not a listed first-line agent.

A 9-year-old has group A strep pharyngitis confirmed by rapid test. He has no drug allergies. Which treatment is appropriate?

• a.Amoxicillin for 3 days
• b.Azithromycin for 5 days
• c.Symptomatic care only, without antibiotics
• d.Amoxicillin for 10 days✓

Amoxicillin or penicillin is first-line therapy for group A strep pharyngitis, and the recommended course for oral beta-lactams is 10 days. Macrolides are reserved for patients with penicillin allergy, and resistance to azithromycin is increasingly common. A 3-day course is too short, and confirmed strep pharyngitis should be treated.

A 24-year-old woman with confirmed group A strep pharyngitis developed hives and wheezing after taking penicillin as a child. Which antibiotic is appropriate?

• a.Cephalexin
• b.Clindamycin✓
• c.Amoxicillin-clavulanate
• d.Amoxicillin

For a patient with an immediate (type I) penicillin hypersensitivity, CDC guidance lists clindamycin, clarithromycin, or azithromycin; cephalexin and cefadroxil are options only for non-type I reactions. Amoxicillin and amoxicillin-clavulanate are penicillins and are contraindicated after hives and wheezing.

A 20-month-old has acute otitis media with moderate bulging of the right tympanic membrane. He finished a course of amoxicillin for a sinus infection 2 weeks ago. Which antibiotic is preferred?

• a.Azithromycin
• b.Prophylactic amoxicillin for the whole season
• c.Amoxicillin
• d.Amoxicillin-clavulanate✓

Amoxicillin is first-line for acute otitis media unless the child has received amoxicillin in the past 30 days, has concurrent purulent conjunctivitis, or has recurrent AOM unresponsive to amoxicillin; in those cases amoxicillin-clavulanate is recommended. Azithromycin is not a first-line alternative here, and prophylactic antibiotics are not recommended for recurrent AOM.

A 78-year-old woman with COPD has had fever, cough, and body aches for 36 hours. Influenza is circulating locally, and the rapid molecular test result will not be back until tomorrow. What should the nurse practitioner do?

• a.Wait for the influenza test result before treating
• b.Start oral oseltamivir now✓
• c.Prescribe inhaled zanamivir
• d.Give amantadine

CDC recommends antiviral treatment as soon as possible for suspected influenza in people at higher risk for complications, such as adults 65 and older and people with chronic lung disease, without waiting for laboratory confirmation. Inhaled zanamivir is contraindicated in people with underlying airway disease such as COPD, and amantadine is not recommended because of widespread resistance.

A 40-year-old man returned from hiking in Connecticut 8 days ago. He has a 9 cm expanding red rash with central clearing on his thigh, mild fatigue, and no other findings. What is the most appropriate next step?

• a.Observe, because the rash will resolve on its own
• b.Order Lyme serology and treat only if positive
• c.Start doxycycline now, before any serology✓
• d.Refer for lumbar puncture before treatment

CDC advises that patients with likely erythema migrans and possible tick exposure in an endemic area be treated promptly, whether or not serology is ordered, because antibody tests are often falsely negative in the first weeks of infection. Doxycycline, amoxicillin, and cefuroxime are the listed regimens. Untreated infection can spread, and a lumbar puncture is not needed for an isolated EM rash.

A 57-year-old man has confirmed average blood pressure of 152/98 mm Hg despite lifestyle changes. He has no compelling indication for a specific drug class. Which initial pharmacologic approach does the 2025 AHA/ACC guideline favor?

• a.A beta-blocker alone, titrated to the maximum dose
• b.One agent, adding a second after 6 months
• c.A loop diuretic alone as initial therapy
• d.A single-pill combination of two first-line agents✓

For stage 2 hypertension the 2025 AHA/ACC guideline keeps the recommendation to start two medications at once, preferably as a single-pill combination, drawn from the first-line classes: thiazide-type diuretics, long-acting dihydropyridine calcium channel blockers, and ACE inhibitors or ARBs. Beta-blockers and loop diuretics are not first-line without a compelling indication, and delaying a second agent for 6 months leaves him at high risk.

A 30-year-old woman with type 2 diabetes and newly confirmed hypertension is sexually active and not using reliable contraception. Which antihypertensive class should be avoided for her?

• a.Long-acting dihydropyridine calcium channel blockers
• b.ACE inhibitors and angiotensin receptor blockers✓
• c.Thiazide-type diuretics
• d.Centrally acting agents such as methyldopa

The ADA Standards of Care 2026 say to avoid ACE inhibitors, ARBs, mineralocorticoid receptor antagonists, direct renin inhibitors, and neprilysin inhibitors in sexually active people of childbearing potential who are not using reliable contraception, because these drugs are contraindicated in pregnancy. Dihydropyridine calcium channel blockers, thiazide-type diuretics, and methyldopa are not on that list; methyldopa is in fact a long-standing option in pregnancy.

A 72-year-old man with type 2 diabetes and heart failure with reduced ejection fraction has an A1C of 7.1% on metformin. Which change is recommended by the ADA Standards of Care?

• a.Add a sulfonylurea before breakfast
• b.Add an SGLT2 inhibitor, regardless of A1C✓
• c.Add pioglitazone
• d.No change, because his A1C is near goal

The ADA recommends an SGLT2 inhibitor for adults with type 2 diabetes and heart failure, with either reduced or preserved ejection fraction, for both glycemic management and prevention of heart failure hospitalization, irrespective of A1C. An A1C near goal does not remove that indication, a sulfonylurea adds hypoglycemia risk without heart failure benefit, and thiazolidinediones cause fluid retention.

A 46-year-old man with type 2 diabetes on metformin has polyuria, polydipsia, and a 5 kg weight loss. His A1C is 11.2% and random glucose is 342 mg/dL. He is not acidotic. What should be considered now?

• a.Stopping metformin and rechecking A1C in 6 months
• b.Diet changes alone for 3 months
• c.Adding a DPP-4 inhibitor alone
• d.Starting insulin✓

The ADA recommends considering insulin, regardless of background therapy, when symptoms of hyperglycemia are present or when A1C is above 10% or glucose is 300 mg/dL or higher. He meets all of these. A DPP-4 inhibitor alone is too weak for this level of hyperglycemia, and delaying treatment for 3 to 6 months is therapeutic inertia.

A 68-year-old woman with type 2 diabetes has no known cardiovascular disease and no additional ASCVD risk factors. What does the ADA recommend for lipid management, in addition to lifestyle therapy?

• a.Fish oil supplements in place of a statin
• b.Moderate-intensity statin therapy✓
• c.No statin until her LDL exceeds 190 mg/dL
• d.Niacin as first-line therapy

The ADA recommends moderate-intensity statin therapy, in addition to lifestyle therapy, for people with diabetes aged 40 to 75 without ASCVD; high-intensity statins are for those at higher risk. Waiting for a very high LDL misses the indication created by diabetes itself, and niacin and fish oil supplements do not provide the cardiovascular benefit of statins.

A 79-year-old man on insulin checks his glucose because he feels shaky and sweaty. It is 58 mg/dL, and he is alert and able to swallow. What should he do first?

• a.Skip his next insulin dose and go to bed
• b.Eat a peanut butter sandwich and a glass of milk
• c.Take 15 g of glucose, recheck in 15 minutes✓
• d.Inject glucagon from his emergency kit

The ADA states that glucose is the preferred treatment for a conscious person with a glucose below 70 mg/dL, that most people should take about 15 g of carbohydrate, and that glucose should be rechecked 15 minutes later and treatment repeated if hypoglycemia persists. Foods high in fat or protein slow the rise in glucose, going to bed without treatment is dangerous, and glucagon is for people who cannot take oral glucose.

A 66-year-old man with COPD confirmed by spirometry has significant breathlessness (mMRC grade 2) and no exacerbations in the past year. He is on no maintenance medication. Which initial maintenance therapy does GOLD 2026 recommend?

• a.LABA plus LAMA✓
• b.As-needed short-acting bronchodilator only
• c.LABA plus inhaled corticosteroid
• d.Inhaled corticosteroid alone

He is in GOLD group B (more symptoms, no exacerbations). GOLD 2026 recommends starting a LABA plus LAMA combination for group B, provided there are no problems with availability, cost, or side effects. GOLD does not encourage LABA plus ICS in COPD, ICS alone is not a COPD maintenance therapy, and a short-acting bronchodilator alone suits only group A patients with very occasional breathlessness.

A 71-year-old woman with stable COPD has a resting PaO2 of 52 mm Hg on room air, confirmed twice 3 weeks apart. Which therapy has been shown to improve survival in this situation?

• a.Long-term oral antibiotics
• b.Oxygen only during sleep
• c.Long-term oxygen therapy✓
• d.Daily oral corticosteroids

GOLD states that long-term oxygen therapy may improve survival in patients with severe resting chronic hypoxemia (PaO2 of 55 mm Hg or less, or under 60 with cor pulmonale or polycythemia); her PaO2 of 52 qualifies. It is not prescribed routinely for moderate desaturation. Chronic oral steroids add harm without that benefit, and oxygen limited to sleep does not meet her daytime need.

A 22-year-old with mild asthma uses albuterol a few times a month and takes no controller. Which reliever strategy does GINA 2026 prefer for adults and adolescents?

• a.A daily leukotriene antagonist with albuterol
• b.Albuterol alone as needed
• c.A daily long-acting beta-agonist alone
• d.As-needed low-dose ICS-formoterol✓

GINA recommends that adults, adolescents, and children 6 to 11 not be treated with SABA alone, because every asthma patient should receive ICS-containing treatment. For adults and adolescents, Track 1 uses as-needed low-dose ICS-formoterol as the reliever, which lowers the risk of severe exacerbations compared with a SABA reliever. A LABA without ICS is unsafe in asthma, and a leukotriene antagonist is not the preferred step.

A 29-year-old at 30 weeks of gestation received Tdap during her pregnancy 2 years ago. What is the recommendation for this pregnancy?

• a.No Tdap, because she received it 2 years ago
• b.Give Tdap now✓
• c.Give Tdap after delivery instead
• d.Give Td, since Tdap was already given once

CDC recommends 1 dose of Tdap during each pregnancy, preferably early in gestational weeks 27 to 36, regardless of the interval since a previous dose; at 30 weeks she is in that window. Postpartum-only dosing misses the goal of passing maternal antibodies to the newborn, and Td does not include pertussis protection.

A 45-year-old man stepped on a rusty nail in his garden, and the wound is contaminated with soil. He completed his childhood tetanus series and his last tetanus booster was 7 years ago. What does he need?

• a.No tetanus vaccine, since his last dose was under 10 years ago
• b.A complete three-dose primary series
• c.A dose of Tdap or Td now✓
• d.Tetanus immune globulin only

For people with 3 or more prior tetanus doses, CDC advises a booster for clean, minor wounds only if more than 10 years have passed, but for all other wounds, such as a soil-contaminated puncture, if more than 5 years have passed. His last dose was 7 years ago, so he needs Tdap or Td now. The 10-year rule applies only to clean, minor wounds, and a primary series is not needed after a completed childhood series.

A 28-year-old woman plans to try to conceive in 6 months. She has no history of a neural tube defect-affected pregnancy. What does the USPSTF recommend?

• a.Folic acid starting at 12 weeks of gestation
• b.0.4 to 0.8 mg folic acid daily, starting now✓
• c.Dietary folate alone, without a supplement
• d.Folic acid only once pregnancy is confirmed

The USPSTF (grade A) recommends a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid for all persons planning to or who could become pregnant, starting at least 1 month before conception and continuing through the first 2 to 3 months of pregnancy. Starting after a positive test or at 12 weeks misses the critical early weeks, and the recommendation calls for a supplement rather than diet alone.

A 34-year-old woman at 11 weeks of gestation has chronic hypertension and had preeclampsia in her last pregnancy. What does the USPSTF recommend for preeclampsia prevention?

• a.Low-dose aspirin (81 mg/day) starting after 12 weeks✓
• b.Low-dose aspirin starting at 34 weeks
• c.Calcium supplementation instead of aspirin
• d.Blood pressure monitoring only

The USPSTF (grade B) recommends low-dose aspirin, 81 mg/day, as preventive medication after 12 weeks of gestation in persons at high risk for preeclampsia; prior preeclampsia and chronic hypertension are high-risk factors. Starting at 34 weeks is too late to provide the benefit, and blood pressure monitoring alone is screening, not prevention.

A 52-year-old man who has sex with men reports inconsistent condom use and a rectal gonorrhea infection 3 months ago. His HIV test today is negative. What should the nurse practitioner offer?

• a.HIV preexposure prophylaxis✓
• b.HIV postexposure prophylaxis for 28 days
• c.Doxycycline alone to prevent HIV
• d.Repeat HIV testing in 5 years

The USPSTF (2023, grade A) recommends that clinicians prescribe preexposure prophylaxis with effective antiretroviral therapy to people at increased risk of HIV; a recent bacterial STI and inconsistent condom use mark increased risk. Postexposure prophylaxis addresses a single recent exposure rather than ongoing risk, a 5-year retest interval is far too long for his risk, and doxycycline does not prevent HIV.

A 79-year-old community-dwelling woman has fallen twice in the past year and has slowed gait. Which intervention does the USPSTF recommend to prevent falls?

• a.Routine hip protectors
• b.Limiting how much she walks outdoors
• c.Home health aide visits alone
• d.An exercise intervention✓

The USPSTF (2024, grade B) recommends exercise interventions to prevent falls in community-dwelling adults 65 and older who are at increased risk; multifactorial interventions are offered selectively (grade C). Restricting walking reduces the strength and balance that exercise builds, and hip protectors and aide visits are not the recommended intervention.

A 34-year-old woman has a moderate ankle sprain from a soccer game and asks for something strong for the pain. She has no contraindications to NSAIDs. What does the 2022 CDC opioid prescribing guideline favor?

• a.An NSAID with nonpharmacologic measures✓
• b.Immediate-release opioid for 14 days
• c.An extended-release opioid for 2 weeks
• d.Tramadol as first-line therapy

The 2022 CDC guideline states that nonopioid therapies are at least as effective as opioids for many common types of acute pain; for musculoskeletal injuries such as sprains, no opioid provided better benefit than NSAIDs, and opioids caused the most harm. If opioids are ever needed for acute pain, the guideline calls for immediate-release formulations at the lowest dose for no longer than the expected duration of severe pain, never extended-release drugs.

A 31-year-old man has opioid use disorder and asks to be 'detoxed' over a week so he can stop all medication. What does the 2022 CDC guideline recommend?

• a.Discharge him from the practice
• b.Offer medication for opioid use disorder✓
• c.Supervised withdrawal alone over 7 days
• d.Prescribe a benzodiazepine taper for withdrawal

The CDC guideline recommends offering or arranging evidence-based medication treatment, such as buprenorphine or methadone, for opioid use disorder, and states that detoxification alone without medication is not recommended because it increases the risk of resumed use, overdose, and overdose death. Discharging him abandons care, and benzodiazepines with opioids increase overdose risk.

A 73-year-old man with type 2 diabetes has burning pain in both feet from diabetic peripheral neuropathy that disrupts his sleep. Which initial medication class does the ADA recommend?

• a.High-dose oral vitamin B12 as primary therapy
• b.Tramadol as the preferred first-line agent
• c.A gabapentinoid, SNRI, tricyclic, or sodium-channel blocker✓
• d.A long-acting opioid at bedtime

The ADA Standards of Care 2026 recommend gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers as initial pharmacologic treatment for neuropathic pain in diabetes, and state that opioids, including tramadol and tapentadol, should not be used for it. Vitamin B12 is replaced when deficient but is not a treatment for neuropathic pain.

A 68-year-old woman starting levothyroxine also takes calcium carbonate and an iron supplement. Which instruction is correct?

• a.Take it with the iron to improve absorption
• b.Take it with breakfast along with the calcium
• c.Empty stomach; 4 hours apart from calcium and iron✓
• d.Take it at any time of day

Levothyroxine is usually taken once daily on an empty stomach, 30 minutes to 1 hour before breakfast, and calcium carbonate or ferrous sulfate should be taken at least 4 hours before or after it because they reduce absorption. Taking it with food, calcium, or iron, or at unplanned times around meals and supplements, lowers and destabilizes the amount absorbed.

An 82-year-old man with limited health literacy is starting a new inhaler. How should the nurse practitioner confirm that he understands how to use it?

• a.Give him the package insert to read at home
• b.Have him demonstrate it and explain it back✓
• c.Let the pharmacist check his understanding
• d.Ask him, 'Do you understand?'

The teach-back or 'show me' method confirms comprehension by having the patient explain or demonstrate the plan in his own words. Asking 'Do you understand?' is discouraged because most patients automatically say yes, a package insert does not check understanding, and the clinician teaching the skill should confirm it.

A 3-year-old has a runny nose and cough from a cold. The parent asks which over-the-counter cough and cold medicine to use. What is the best advice?

• a.An antibiotic to prevent a sinus infection
• b.A cough suppressant every 4 hours
• c.Avoid OTC cough and cold medicines at this age✓
• d.A decongestant-antihistamine at bedtime

CDC notes that over-the-counter cough and cold medicines have potential for harm and no proven benefit in children younger than 6 years, and that antibiotics should not be prescribed for the common cold. Management focuses on symptom relief such as fluids, rest, and nasal saline.

A 24-year-old pregnant woman has a history of depression and current depressive symptoms that do not meet diagnostic criteria. What does the USPSTF recommend to prevent perinatal depression?

• a.Refer her for counseling such as CBT or IPT✓
• b.Screen again only after delivery
• c.Start an antidepressant now
• d.Recommend exercise as the only intervention

The USPSTF (grade B) recommends providing or referring pregnant and postpartum persons at increased risk of perinatal depression to counseling interventions; the studied interventions were mainly cognitive behavioral therapy and interpersonal therapy. A history of depression and subthreshold symptoms are risk factors. Evidence for pharmacotherapy and physical activity as prevention was limited or mixed, and waiting until after delivery forgoes prevention.