A 72-year-old patient with postherpetic neuralgia and NYHA Class III heart failure was started on pregabalin 75 mg twice daily two weeks ago. The patient now presents with increased shortness of breath and 2+ pitting edema in both lower extremities. What is the most appropriate intervention?

Taper the pregabalin gradually while monitoring fluid status closely.

Discontinue the pregabalin immediately to prevent sudden fluid retention.

Increase the daily furosemide dose and maintain the pregabalin.

Switch the pregabalin to gabapentin to resolve the swelling.

A 78-year-old female presents with acute dysuria and urgency without fever or flank pain. Her recent metabolic panel shows an estimated glomerular filtration rate of 26 mL/min. Which of the following is the most appropriate prescription for her uncomplicated cystitis?

Cephalexin 500 mg orally twice daily for 7 days

Nitrofurantoin 100 mg orally twice daily for 5 days

Ciprofloxacin 250 mg orally twice daily for 3 days

Amoxicillin 500 mg orally three times daily for 7 days

A 45-year-old patient completes spirometry testing for chronic cough. The nurse practitioner notes the flow-volume loop shows early termination and there are variable expiratory efforts across three trials. Post-bronchodilator results indicate a 5% decrease in FEV1. What is the most appropriate action for the nurse practitioner?

Withhold interpretation due to unacceptable technique.

Interpret the results as paradoxical bronchospasm.

Diagnose severe fixed obstructive pulmonary disease.

Diagnose early restrictive pulmonary disease pattern.

A 6-year-old child presents for a follow-up regarding post-tonsillectomy pain management. The child has a history of obstructive sleep apnea and is refusing to drink fluids due to severe throat discomfort. Which analgesic plan is most appropriate?

Advise scheduled weight-based ibuprofen every six to eight hours.

Prescribe oral codeine solution every four to six hours.

Recommend oral tramadol tablets every six to eight hours.

Suggest alternating hydrocodone and acetaminophen every four to six hours.

A 68-year-old male with heart failure with reduced ejection fraction presents with an acute, severely painful flare of osteoarthritis isolated to his left knee. He cannot bear weight.

Perform an intra-articular corticosteroid knee joint injection.

Prescribe a short course of oral dexamethasone.

Recommend scheduled oral naproxen for one week.

Initiate daily oral colchicine for flare management.

How many questions are scored on the AANP exam?

The AANP exam has 150 total questions, but only 135 are scored. The remaining 15 are unscored pretest items used to evaluate future test material.

How many questions are scored on the ANCC exam?

The ANCC exam has 175 total questions, with 150 of them scored. You will see 25 unscored pretest items mixed throughout the test.

How much time do I get for the test?

You get 3 hours to finish the AANP exam. If you take the ANCC version, you have 3.5 hours.

What types of questions are on the AANP FNP-C?

The AANP uses a traditional multiple-choice format. Every item has exactly one correct answer.

What types of questions are on the ANCC FNP-BC?

The ANCC uses mixed item types. You will see standard multiple-choice, plus alternative formats like multiple-response, drag-and-drop, and hot-spot image questions.

What is the passing score for the AANP exam?

You need a score of 500 to pass the AANP test. The scoring scale ranges from 200 to 800.

What is the passing score for the ANCC exam?

The ANCC passing score is 350. This is based on a scale that runs from 0 to 500.

How are the clinical domains weighted on the AANP exam?

The 2024 AANP blueprint divides the 135 scored items into four domains: Assess (32%), Diagnose (26.5%), Plan (26.5%), and Evaluate (15%).

How are the clinical domains weighted on the ANCC exam?

The ANCC blueprint (effective September 4, 2025) splits 150 scored items across five domains: Implementation (29%), Assessment (19%), Planning (19%), Diagnosis (17%), and Evaluation (15%).

Does one exam format include non-clinical questions?

Yes. The ANCC FNP-BC format includes questions on nursing policy, theory, and research. The AANP FNP-C format focuses purely on clinical knowledge.

Are breaks included in the exam time?

Neither testing body builds mandatory break time into your total testing window. If you need to step away, the clock keeps running. For specific policies on leaving the room, check the ANCC (FNP-BC) & AANPCB (FNP-C) official handbook.

What items can I bring into the testing room?

You cannot bring personal items, electronics, or study materials into the testing area. For a complete list of prohibited items and locker availability, consult the official AANPCB or ANCC candidate manuals.

How should I prepare for these question formats?

Work through realistic clinical scenarios. You can use our database of 3000+ practice questions to get comfortable with both single-answer and alternative item types before test day.

What is the FNP Exam Format and How Many Questions?

The AANP FNP-C exam contains 150 questions to be completed in 3 hours, using only single-answer multiple-choice items. The ANCC FNP-BC exam contains 175 questions over 3.5 hours and includes alternative item types like multiple-select and drag-and-drop.

3,000+

questions in the app

10+ yrs

exam-prep publishing

Free

on iOS & Android

Built to help you pass faster — by exam-prep publishers with 10+ years' experience

💡 Key Takeaways — the one transferable rule per question
🔍 Hint highlights — the decisive cue phrases in each stem
📖 Full rationales — why every option is right or wrong

Every FNP question is written to the current exam outline for quick learning and a clear pass strategy.

Written and reviewed by the LexPort exam-prep team, led by our Founder & Exam-Prep Lead. LexPort builds certification practice questions — this is exam-preparation material, not medical advice. Last reviewed July 2026.

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How many questions are scored on the AANP exam?: The AANP exam has 150 total questions, but only 135 are scored. The remaining 15 are unscored pretest items used to evaluate future test material.
How many questions are scored on the ANCC exam?: The ANCC exam has 175 total questions, with 150 of them scored. You will see 25 unscored pretest items mixed throughout the test.
How much time do I get for the test?: You get 3 hours to finish the AANP exam. If you take the ANCC version, you have 3.5 hours.
What types of questions are on the AANP FNP-C?: The AANP uses a traditional multiple-choice format. Every item has exactly one correct answer.
What types of questions are on the ANCC FNP-BC?: The ANCC uses mixed item types. You will see standard multiple-choice, plus alternative formats like multiple-response, drag-and-drop, and hot-spot image questions.
What is the passing score for the AANP exam?: You need a score of 500 to pass the AANP test. The scoring scale ranges from 200 to 800.
What is the passing score for the ANCC exam?: The ANCC passing score is 350. This is based on a scale that runs from 0 to 500.
How are the clinical domains weighted on the AANP exam?: The 2024 AANP blueprint divides the 135 scored items into four domains: Assess (32%), Diagnose (26.5%), Plan (26.5%), and Evaluate (15%).
How are the clinical domains weighted on the ANCC exam?: The ANCC blueprint (effective September 4, 2025) splits 150 scored items across five domains: Implementation (29%), Assessment (19%), Planning (19%), Diagnosis (17%), and Evaluation (15%).
Does one exam format include non-clinical questions?: Yes. The ANCC FNP-BC format includes questions on nursing policy, theory, and research. The AANP FNP-C format focuses purely on clinical knowledge.
Are breaks included in the exam time?: Neither testing body builds mandatory break time into your total testing window. If you need to step away, the clock keeps running. For specific policies on leaving the room, check the ANCC (FNP-BC) & AANPCB (FNP-C) official handbook.
What items can I bring into the testing room?: You cannot bring personal items, electronics, or study materials into the testing area. For a complete list of prohibited items and locker availability, consult the official AANPCB or ANCC candidate manuals.
How should I prepare for these question formats?: Work through realistic clinical scenarios. You can use our database of 3000+ practice questions to get comfortable with both single-answer and alternative item types before test day.

What the questions actually look like

The format is one thing; the questions are another. Here are three realistic examples. The app has 3,000+, timed and scored.

Question 1

A 62-year-old male with type 2 diabetes is currently taking metformin 1000 mg twice daily. During a routine follow-up, his comprehensive metabolic panel reveals an eGFR of 38 mL/min/1.73 m2, down from 52 mL/min/1.73 m2 six months ago. Which action is most appropriate for the nurse practitioner to take?

▸ Why C is the answer

Metformin is contraindicated if the eGFR is below 30. For patients already taking metformin whose eGFR falls to 38, the standard of care is to reduce the dose by half and monitor renal function closely. Option A and Option B are incorrect because discontinuing metformin entirely is premature unless the eGFR drops below 30, and switching to a sulfonylurea or thiazolidinedione introduces unnecessary risks like hypoglycemia or fluid retention. Option D is unsafe because maintaining the maximum dose of 2000 mg daily with this level of renal impairment significantly increases the risk of lactic acidosis.

🔑 Key takeaway

Metformin doses must be reduced by half when a patient's eGFR falls between 30 and 45.

Question 2

A family nurse practitioner steps into a crowded primary care waiting room and initiates the next appointment by calling a patient's first and last name aloud. A bystander complains that this violates patient privacy. How should the nurse practitioner proceed?

▸ Why A is the answer

HIPAA privacy rules permit certain incidental disclosures of protected health information as long as the clinic has implemented reasonable safeguards to protect patient privacy. Calling a patient's first and last name in a crowded primary care waiting room is widely recognized as an acceptable incidental disclosure necessary for standard clinic operations. Option A is the correct choice because this routine practice does not violate federal privacy laws. Option B is incorrect because strict privacy rules do not prohibit this common operational necessity. Option C is incorrect because using assigned medical numbers is not legally required and can cause unnecessary confusion for patients. Option D is incorrect because requiring a signed waiver for simple waiting room announcements is an excessive administrative burden that is not mandated by any current legal or ethical compliance standards.

🔑 Key takeaway

Calling a patient's name in a waiting room is legally permitted as an incidental HIPAA disclosure.

Question 3

A parent is managing a 9-month-old infant who has had a fever of 101.0°F (38.3°C) that responds well to acetaminophen. At what point should the FNP instruct the parent to schedule a follow-up visit if the fever persists?

▸ Why A is the answer

For infants and children older than three months, a fever that persists for more than 72 hours requires clinical evaluation to rule out secondary bacterial infections or other underlying conditions. Option B is incorrect because waiting 96 hours delays necessary assessment for potential complications like otitis media, pneumonia, or urinary tract infections. Option C is incorrect because a 24-hour fever in a well-appearing 9-month-old is typically viral and does not require immediate follow-up. Option D is incorrect because 48 hours is still within the expected window for an uncomplicated viral illness.

🔑 Key takeaway

Uncomplicated fevers persisting beyond 72 hours in infants over three months require clinical evaluation for secondary infections.

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FNP · Exam Simulator

A 72-year-old patient with postherpetic neuralgia and NYHA Class III heart failure was started on pregabalin 7…

A) Discontinue the pregabalin immediately t

B) Increase the daily furosemide dose and m

C) Taper the pregabalin gradually while mon

D) Switch the pregabalin to gabapentin to r

Submit Answer

✓ CORRECT

C) Taper the pregabalin gradually while monitoring fl

💡 KEY TAKEAWAY

Gabapentinoids can cause fluid retention exacerbating heart failure but must be tapered gradually to prevent withdrawal.

WHY

Pregabalin and gabapentin can cause peripheral edema, which is particularly dangerous for patients with underlying heart failure. Because th…

Authoritative sources

AANPCB — American Academy of Nurse Practitioners Certification Board