AANP FNP-C Exam Flashcards

Q: How many questions are on the AANP FNP-C exam, and how much time do I get?

The exam has 150 multiple-choice questions: 135 are scored and 15 are unscored pretest items mixed in without being flagged as such. You have 3 hours to complete all 150 questions at a Prometric testing center.

Q: What score do I need to pass the AANP FNP-C exam?

AANPCB reports scores on a scaled range of 200-800, with 500 as the passing score. This is not a raw percentage-correct cutoff - it reflects a standard-setting methodology applied to the 135 scored items, so missing a specific number of questions does not map to one fixed pass/fail line.

Q: What are the current AANPCB FNP blueprint domain weights?

Per the FNP Candidate Handbook's Examination Blueprint (Appendix A), the four Domain I practice areas are Assess 32% (43 of 135 scored items), Diagnose 26.5% (36 items), Plan 26.5% (36 items), and Evaluate 15% (20 items).

Q: How does the exam distribute questions across the patient lifespan?

A second blueprint dimension, Domain II (Patient Age), spreads the same 135 scored items as Newborn 2%, Infant 3%, Toddler 4%, Child 4%, Adolescent 9%, Young Adult 22%, Middle Adult 26%, and Older Adult 30%. Prenatal care is no longer tested as its own age category - since a 2024 blueprint update, prenatal knowledge is folded into adolescent and adult population items instead.

Q: What happens if I fail the AANP FNP-C exam?

You can reapply for a re-examination as soon as you receive your official score notification by email, and current FNP candidates may test up to three (3) times per calendar year (January 1 - December 31), an increase from the prior two-attempt limit. The current candidate handbook does not list a fixed day-based waiting period, but you must submit a new re-examination application and payment, and eligibility requirements in effect at the time of reapplication will apply.

Q: Is the AANP FNP-C exam the same as the ANCC FNP-BC exam?

No. AANPCB (FNP-C) and ANCC (FNP-BC) are two separate, nationally recognized certifying bodies with different exam blueprints, item counts, and scoring models. Most employers and state boards of nursing accept either credential, so candidates often choose based on exam format preference or program guidance.

Question 1

At what age does a healthy infant typically develop a social smile?

Accepted Answer

Around 6-8 weeks (about 2 months) of age. Absence of a social smile by 2-3 months warrants developmental follow-up and vision/hearing screening.

Question 2

What two maneuvers screen a newborn for developmental dysplasia of the hip (DDH)?

Accepted Answer

The Ortolani maneuver (reduces a dislocated hip back into the acetabulum) and the Barlow maneuver (attempts to provoke dislocation of an unstable hip). A positive result warrants hip ultrasound referral before 6 months of age.

Question 3

What does the HEEADSSS interview assess in an adolescent well visit?

Accepted Answer

Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety - a structured psychosocial risk screen conducted confidentially, one-on-one with the adolescent.

Question 4

At what age should average-risk women begin biennial screening mammography?

Accepted Answer

Age 40, per the 2024 USPSTF update (grade B), continuing biennially through age 74. This lowered the prior 2016 threshold of age 50.

Question 5

At what age does USPSTF recommend starting average-risk colorectal cancer screening?

Accepted Answer

Age 45 (lowered from 50), continuing through age 75, with individualized/shared decision-making for ages 76-85.

Question 6

How is cervical cancer screening structured for ages 21-29 versus ages 30-65?

Accepted Answer

Ages 21-29: cytology (Pap) alone every 3 years. Ages 30-65: cytology plus HPV co-testing every 5 years, or cytology alone every 3 years if co-testing is unavailable.

Question 7

Who should be screened for chlamydia annually per USPSTF?

Accepted Answer

All sexually active women under age 25, and older women with risk factors such as new or multiple partners. Screening uses a urine- or swab-based NAAT.

Question 8

Which two screening tools quantify depression and anxiety severity in primary care?

Accepted Answer

PHQ-9 for depression severity and GAD-7 for anxiety severity. Both are validated, self-administered, and reused at follow-up visits to track treatment response.

Question 9

What blood pressure defines Stage 1 versus Stage 2 hypertension under the 2017 ACC/AHA guideline?

Accepted Answer

Stage 1: 130-139/80-89 mmHg. Stage 2: 140/90 mmHg or higher. Normal is under 120/80; Elevated is 120-129 systolic with diastolic under 80.

Question 10

At what age range and weight status does USPSTF recommend prediabetes/diabetes screening?

Accepted Answer

Adults ages 35-70 who are overweight or obese (BMI 25 or higher, or 23+ in some Asian populations). Rescreen every 3 years if the result is normal.

Question 11

What is the recommended timing and core lab panel for the first prenatal visit?

Accepted Answer

Ideally at 6-8 weeks gestation, including CBC, blood type/Rh antibody screen, rubella/varicella immunity, HIV/syphilis/hepatitis B screening, urinalysis with culture, and a Pap test if due.

Question 12

Who should receive a one-time abdominal aortic aneurysm (AAA) ultrasound screening?

Accepted Answer

Men aged 65-75 who have ever smoked. Routine screening is not recommended for women or for men who have never smoked (USPSTF).

Question 13

Which women should get a DEXA bone density scan starting at age 65?

Accepted Answer

All women age 65 and older, regardless of risk factors. Postmenopausal women under 65 are screened if their fracture risk (by FRAX) equals or exceeds that of a 65-year-old white woman.

Question 14

What criteria qualify a patient for annual low-dose CT lung cancer screening?

Accepted Answer

Ages 50-80, at least a 20 pack-year smoking history, and currently smoking or having quit within the past 15 years (USPSTF 2021 update).

Question 15

What quick bedside test screens for fall risk in an older adult?

Accepted Answer

The Timed Up and Go (TUG) test - time to rise from a chair, walk 10 feet, turn, return, and sit. A time over 12 seconds signals elevated fall risk and need for further workup.

Question 16

Which brief tool is commonly used to screen for cognitive impairment at an older adult well visit?

Accepted Answer

The Mini-Cog (3-item recall plus a clock-draw test), or the MoCA/MMSE for a more detailed evaluation. Abnormal results warrant further dementia workup rather than reassurance about normal aging.

Question 17

What are the diagnostic criteria for acute otitis media (AOM) in a child?

Accepted Answer

Moderate-to-severe bulging of the tympanic membrane, OR new-onset otorrhea not caused by otitis externa, OR mild bulging plus recent onset of ear pain or erythema (AAP criteria).

Question 18

How does the modified Centor/McIsaac score adjust its point total for patient age?

Accepted Answer

Add 1 point for ages 3-14, add 0 points for ages 15-44, and subtract 1 point for age 45 and older, on top of points for fever, tonsillar exudate, tender anterior nodes, and absent cough - higher totals raise the pretest probability of strep pharyngitis.

Question 19

Why can a Monospot (heterophile antibody) test be falsely negative early in infectious mononucleosis?

Accepted Answer

Heterophile antibodies often have not risen yet during the first week of illness; sensitivity peaks around weeks 2-5. A negative test in week 1 with a classic triad of fever, pharyngitis, and adenopathy should be repeated rather than used to rule out mono.

Question 20

What A1C, fasting glucose, and 2-hour OGTT values confirm a diabetes diagnosis?

Accepted Answer

A1C 6.5% or higher, fasting plasma glucose 126 mg/dL or higher, or 2-hour OGTT 200 mg/dL or higher - each needs confirmatory repeat testing unless the patient has clear hyperglycemia symptoms with a random glucose of 200 mg/dL or higher.

Question 21

How do impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) differ?

Accepted Answer

IFG uses a fasting glucose of 100-125 mg/dL. IGT uses a 2-hour OGTT of 140-199 mg/dL. Both define prediabetes; an A1C of 5.7-6.4% is the third prediabetes criterion.

Question 22

What clinical findings distinguish pyelonephritis from simple cystitis?

Accepted Answer

Pyelonephritis adds fever, flank pain, and systemic illness (nausea, malaise) to the dysuria and frequency seen in cystitis, and may require imaging or IV therapy if the patient appears toxic.

Question 23

What does the CURB-65 score estimate, and what are its five criteria?

Accepted Answer

Pneumonia severity and mortality risk. One point each for Confusion, Urea over 19 mg/dL (7 mmol/L), Respiratory rate 30 or higher, Blood pressure under 90/60 mmHg, and age 65 or older. A score of 2 or more suggests hospitalization.

Question 24

What lab pattern confirms iron deficiency anemia rather than anemia of chronic disease?

Accepted Answer

Low ferritin (most specific), low serum iron, high total iron-binding capacity (TIBC)/transferrin, elevated RDW, and microcytic (low MCV) red cells. Anemia of chronic disease typically shows low-to-normal TIBC with normal-to-high ferritin.

Question 25

How do you distinguish primary from subclinical hypothyroidism on labs?

Accepted Answer

Primary hypothyroidism: TSH high, free T4 low. Subclinical hypothyroidism: TSH high, free T4 normal. Subclinical disease is often monitored rather than immediately treated unless TSH is markedly elevated or the patient is symptomatic or pregnant.

Question 26

What distinguishes delirium from dementia at the bedside?

Accepted Answer

Delirium has an acute onset, a fluctuating course, and impaired attention, and is often reversible once an underlying cause (infection, medication, metabolic derangement) is treated. Dementia has a gradual onset, is progressive, and spares attention until late stages.

Question 27

What T-score defines osteoporosis versus osteopenia on DEXA?

Accepted Answer

Osteoporosis: T-score of -2.5 or lower. Osteopenia (low bone mass): T-score between -1.0 and -2.5. Normal: T-score of -1.0 or higher. The T-score compares the patient to a healthy young-adult reference population.

Question 28

What eGFR range defines Stage 3a versus Stage 3b chronic kidney disease?

Accepted Answer

Stage 3a: eGFR 45-59 mL/min/1.73m2. Stage 3b: eGFR 30-44. Stage 4 is 15-29, and Stage 5 (kidney failure) is under 15. Staging also requires findings to persist at least 3 months to confirm chronicity.

Question 29

What is the Beers Criteria used for in older adult care?

Accepted Answer

It identifies potentially inappropriate medications for older adults - such as benzodiazepines, first-generation antihistamines, and anticholinergics - because of increased risk for falls, sedation, and cognitive impairment.

Question 30

What vaccines are typically given at the 2, 4, and 6-month well-child visits?

Accepted Answer

DTaP, inactivated poliovirus (IPV), Hib, and pneumococcal conjugate vaccine (PCV) at each visit, plus rotavirus vaccine doses at 2 and 4 months (a 6-month dose may apply depending on the rotavirus brand used).

Question 31

What is the first-line antibiotic and dosing strategy for acute otitis media?

Accepted Answer

High-dose amoxicillin, 80-90 mg/kg/day divided twice daily, for most children. Amoxicillin-clavulanate is preferred if the child took amoxicillin in the last 30 days, has concurrent purulent conjunctivitis, or has recurrent AOM unresponsive to amoxicillin.

Question 32

How many HPV vaccine doses are needed if the series starts at age 11-12 versus at age 16?

Accepted Answer

2 doses, given 6-12 months apart, if the series starts before age 15. 3 doses (0, 1-2, and 6 months) if the series starts at age 15 or later, or in an immunocompromised patient.

Question 33

Which first-line antihypertensive classes are preferred for a Black patient without CKD?

Accepted Answer

Thiazide diuretics or calcium channel blockers (CCBs), per ACC/AHA guidance - this population shows a stronger response to these classes as monotherapy than to ACE inhibitors or ARBs.

Question 34

What is first-line pharmacotherapy for newly diagnosed type 2 diabetes, and when do you add a GLP-1 RA or SGLT2 inhibitor?

Accepted Answer

Metformin is first-line unless contraindicated (eGFR under 30, acute illness risk). Add a GLP-1 receptor agonist or SGLT2 inhibitor regardless of A1C when the patient has established ASCVD, heart failure, or CKD, per ADA Standards of Care.

Question 35

What is the first-line treatment for uncomplicated cystitis in a non-pregnant adult?

Accepted Answer

Nitrofurantoin 100 mg twice daily for 5 days, or TMP-SMX DS twice daily for 3 days where local resistance is under 20%, or a single 3 g dose of fosfomycin.

Question 36

What is the first-line treatment for confirmed strep pharyngitis?

Accepted Answer

Penicillin V or amoxicillin for 10 days. For penicillin allergy, use a first-generation cephalosporin (if the allergy is non-severe) or azithromycin/clindamycin.

Question 37

At what age range is statin therapy for primary prevention typically considered?

Accepted Answer

Ages 40-75 with one or more cardiovascular risk factors (dyslipidemia, diabetes, hypertension, smoking) and an estimated 10-year ASCVD risk of about 7.5-10% or higher, using shared decision-making.

Question 38

Which antihypertensives are safe versus contraindicated in pregnancy?

Accepted Answer

Safe: labetalol, nifedipine, and methyldopa. Contraindicated: ACE inhibitors, ARBs, and direct renin inhibitors, due to fetal renal toxicity and teratogenicity risk.

Question 39

Who should receive the recombinant zoster (shingles) vaccine, and how many doses?

Accepted Answer

All adults age 50 and older (and immunocompromised adults 19 and older), given as 2 doses spaced 2-6 months apart, regardless of prior shingles history or earlier Zostavax vaccination.

Question 40

What is the current ACIP pneumococcal vaccine recommendation for adults, updated October 2024?

Accepted Answer

A single dose of a pneumococcal conjugate vaccine (PCV15, PCV20, or PCV21) for all adults age 50 and older who are unvaccinated or have unknown vaccination history - replacing the prior age-65 threshold. If PCV15 is used, follow it with PPSV23 at least 1 year later (or 8 weeks later if immunocompromised).

Question 41

Why is initial levothyroxine dosing lower in an older adult than in a younger adult?

Accepted Answer

Older adults, especially those with cardiac disease, start at a lower dose (about 25-50 mcg/day) and are titrated slowly with TSH rechecks every 6-8 weeks, to avoid precipitating angina or arrhythmia from rapid thyroid hormone correction.

Question 42

At what T-score or fracture-risk threshold should pharmacologic osteoporosis treatment begin?

Accepted Answer

A T-score of -2.5 or lower at the hip or spine, a history of hip or vertebral fragility fracture, or osteopenia combined with a FRAX 10-year risk of 3% or higher for hip fracture (or 20% or higher for major osteoporotic fracture).

Question 43

What follow-up action is triggered by growth faltering (crossing down 2 or more percentile lines) on a growth chart?

Accepted Answer

Referral to a pediatric subspecialist (GI, endocrinology, or a feeding team) for further workup, along with a focused dietary/feeding history and screening labs - growth faltering should not simply be reassured away.

Question 44

When should you reassess an adolescent started on an antibiotic for bacterial pharyngitis or sinusitis if symptoms are not improving?

Accepted Answer

At 48-72 hours. Lack of improvement by then should prompt reassessment of the diagnosis and adherence, and consideration of a broader-spectrum or alternate agent.

Question 45

How soon should you recheck blood pressure after starting or adjusting an antihypertensive?

Accepted Answer

In 2-4 weeks. Faster follow-up, within days, is needed for hypertensive urgency/emergency or when starting a drug with meaningful early risk, such as an ACE inhibitor in a patient with borderline renal function.

Question 46

How often should A1C be checked in a patient with uncontrolled versus stable, at-goal diabetes?

Accepted Answer

Every 3 months if uncontrolled or therapy was just changed; every 6 months if the patient is stable and consistently at goal.

Question 47

When should a lipid panel be rechecked after starting or increasing a statin dose?

Accepted Answer

In 4-12 weeks, to assess response and tolerability, then periodically (for example, annually) once the patient is stable at goal.

Question 48

How long should you wait before judging an antidepressant trial ineffective?

Accepted Answer

4-6 weeks at an adequate dose. Partial response at 2-4 weeks supports staying the course, while no response by 6-8 weeks warrants a dose increase or a medication change.

Question 49

What does persistent proteinuria on follow-up urinalysis prompt in a patient with diabetes or hypertension?

Accepted Answer

Referral to nephrology, along with confirming the finding using a urine albumin-to-creatinine ratio and reviewing/optimizing ACE inhibitor or ARB dosing, since persistent proteinuria signals kidney damage and higher cardiovascular risk.

Question 50

An older adult reports a new fall and gait decline since the last visit - what is the appropriate next step?

Accepted Answer

Perform a fall risk assessment such as the Timed Up and Go test, review medications for fall-risk contributors (sedatives, orthostatic agents), check orthostatic vital signs, and consider physical therapy or a home safety evaluation rather than dismissing it as normal aging.

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