Chapter 2: What’s the Best Way to Study for Family Nurse Practitioner Certification Exams?

Once you’ve decided which FNP certification exam you’ll take, it’s time to come up with a game plan.

To become a board certified FNP on the first try, preparation is everything. You’ll need a solid understanding of all the exam preparation tools available, so that you can determine which resources and preparation techniques will be most useful.

Family Nurse Practitioner Certification Requirements

Candidates for FNP certification are already very familiar with the rigors of completing nursing coursework, studying for exams, fulfilling clinical requirements, and jumping through any hoops required to graduate and prepare for the family nurse practitioner boards.

Specific eligibility requirements to take the ANCC or AANPCB family nurse practitioner test including program nurse practitioner accreditation, degree NP accreditation, faculty supervised clinical hours (such as ANCC’s minimum of 500), and education verification document requirements can be found at:
AANPCB FNP & AGNP Certification Candidate Handbook, ANCC Certification General Testing and Renewal Handbook & ANCC Apply for Certification

Family Nurse Practitioner Certification Exam Content

Both the ANCCBC exam and the AANPCB exam are accredited by two major accreditation bodies:

  • The Accreditation Board of Specialty Nursing Certification (ABSNC)
  • The National Commission for Certifying Agencies (NCCA)

These groups use peer review to ensure that the topics and skills covered in each exam are an accurate assessment of entry-level professional competence at a level that will protect public health and safety.

Although both exams have received accreditation and cover FNP certification requirements, they differ in structure and content. Here’s a detailed look at each exam:

AANP Exam Blueprint

The American Academy of Nurse Practitioners (AANP) FNP certification exam contains 150 questions.* 15 of the questions are pretest questions which are not scored. 135 of the questions are scored questions.

You will not be able to discern which questions are pretest questions. Pretest questions are included so that the AANP can gather statistical information before they decide whether or not to include them as scored questions on future exams.*

Questions are in multiple choice format with only one answer being correct. Content is based solely on requirements for safe clinical practice and limited to knowledge that can be tested objectively.

Distribution of questions by age

As an FNP, you will encounter patients across the span of life stages. However, there are some ages that you’re likely to treat more frequently than others. The content in the test is intended to match the projected distribution of age ranges that you’ll care for as a practicing FNP.

Distribution of questions by age
  • Prenatal: 4 questions
  • Pediatric: 19 questions
  • Adolescent: 24 questions
  • Adult: 50 questions
  • Geriatric: 29 questions
  • Elderly: 9 questions

Topics and Skills Covered

The AANP test is divided into four “domains” each assessing competency of specific abilities or objectives, called “tasks.”*

AANP Content Ditribution
Domain 1: Assess

Domain 1, accounting for 36% of the test content, includes two tasks and related skill subsets. The following information is from the AANPCB’s FNP examination blueprint:

Task 0101: Obtain subjective patient information including but not limited to relevant medical history (including biopsychosocial, economic, environmental, family, military, travel, occupational, preventive components), chief complaint, history of present illness, and review of systems to determine health needs and problems by:

  • Interviewing patient/family/appropriate others.
  • Reviewing records.
  • Obtaining information regarding additional healthcare providers involved in patient care.
  • Identifying both patient-specific and population-specific health, medical, and psychosocial risk factors.

Task 0102: Obtain objective information based on patient age/developmental level, health history, and comorbidities to further define and evaluate health needs and problems by:

  • Performing physical examinations
  • Ordering/performing/supervising diagnostic tests and procedures
  • Ordering/performing/supervising screening tests
Domain 2: Diagnose

Domain 2 accounts for 24% of the AANP family nurse practitioner board exam.* Your competency in the area of diagnostics will be assessed by questions covering two tasks and related skill sets:

Task 0201: Formulate differential diagnoses by:

  • Synthesizing and analyzing subjective/objective information
  • Prioritizing potential diagnoses

Task 0202: Establish definitive diagnoses by:

  • Ordering, performing, supervising, and interpreting additional diagnostic tests
  • Performing and interpreting additional physical examinations
  • Synthesizing and analyzing additional information
Domain 3: Plan

The “Plan” domain will be covered by 23% of the AANP exam questions, and includes one task associated with 10 skill sets:*

Task 0301: Establish a safe plan of patient-centered treatment and care that is individualized, cost effective, consistent with best evidence, age appropriate, and culturally-sensitive in order to address the diagnoses by:

  • Considering co-morbidities
  • Ordering, performing, supervising, and interpreting results of further tests
  • Prescribing, ordering, and administering pharmacological therapies
  • Prescribing, ordering, and administering non-pharmacologic therapies and/or procedures
  • Providing relevant education and/or counseling
  • Providing anticipatory guidance, health promotion, and injury prevention
  • Making referrals to and engaging in consultation with other health professionals and community resources
  • Including patient/family/appropriate others as active participants
  • Providing for appropriate follow-up
  • Responding to patients in urgent and emergent situations
Domain 4: Evaluate

17% of AANP questions will measure your competency in the area of evaluation:*

Task 0401: Determine the effectiveness of the plan of treatment and care based on outcomes by:

  • Assessing patient response(s)
  • Collecting additional subjective and/or objective information as needed

Task 0402: Modify the plan of treatment and care as appropriate based on outcomes by:

  • Ordering, conducting, supervising and interpreting further tests
  • Adjusting therapies
  • Providing additional education
  • Initiating referrals and consultations
  • Coordinating follow-ups and monitoring plans of care
  • Including patient, family, and/or appropriate others as active participants
Knowledge Areas

The questions in the AANP FNP board exam will test your knowledge of the following topics:*

  • Health promotion, harm reduction, and disease prevention
  • Anatomy, physiology, and pathophysiology
  • Therapeutic communication, change management, and crisis management
  • Health history
  • Signs and symptoms
  • Physical examination
  • Healthcare economics
  • Evidence-informed practice
  • Legal and ethical issues
  • Cultural competence
  • Diagnostic and therapeutic tests and/or procedures
  • Clinical decision-making
  • Differential diagnosis
  • Pharmacological therapies
  • Non-pharmacological/ complementary/ alternative therapies
  • Biopsychosocial principles/theories
  • Patient and family education and counseling
  • Community resources
  • Principles of epidemiology, population health, and social determinants of health
  • Practice management
Procedures

You may encounter questions regarding the following common family practice procedures in the AANP FNP certification examination:*

  • Minor lesion removal
  • Incision and drainage
  • Microscopy
  • Diagnostic interp. of ECG
  • Pap tests
  • Diagnostic interp. of X-ray
  • Joint aspirations and injections
  • Cerumen removal
  • Skin biopsy
  • Pulmonary function testing & office spirometry
  • Therapeutic injections
  • Fluorescein dye
  • Wound closure
  • Long-term contraceptive management
  • Splinting
  • Long-term hormonal implantation
  • Casting
  • Foreign body removal
  • Wound management
  • Nail removal

ANCC FNP Exam Outline

The American Nurses Credentialing Center (ANCC) family nurse practitioner license exam contains a total of 175 questions. Of these, 150 questions count toward your score. The remaining 25 questions are not scored—they are “pretest questions,” which are being tested for possible inclusions in future exams. You will not be able to discern which questions are pretest questions and which are scored questions.

The exam includes four types of questions:

  • Multiple choice
  • Multiple response (more than one answer is correct)
  • Drag and drop
  • Hot spot (click a spot on an image to answer)

Note: The ANCC FNP exam was overhauled in 2019. As you research this test elsewhere, please be aware that much of the information you find online pertains to the former version of this exam. All of the information in this guide is up-to-date per 2021 exam content.

Topics and Skills Covered

Questions in the ANCC FNP test cover four categories, also referred to as content domains: Assessment, Diagnosis, Clinical Management, and Professional Role. The following information is from the ANCC Family Nurse Practitioner Board Certification Test Outline.

ANCC Content Ditribution
Domain 1: Assessment

31 questions (21% of the ANCC FNP certification exam) are related to assessment knowledge and skills. Please note that the examples in parentheses are not all-inclusive and do not indicate importance.

Knowledge:

  • Evidence-based population health promotion and screening

Skills:

  • Comprehensive history and physical assessment
  • Focused history and physical assessment
  • Risk assessment (e.g., genetic, behavioral, lifestyle)
  • Functional assessment (e.g., cognitive, developmental, physical capacity)
Domain 2: Diagnosis

39 questions (26% of the ANCC FNP exam) will test your knowledge and skills in the area of diagnosis.

Knowledge:

  • Pathogenesis and clinical manifestations of disease states

Skills:

  • Differentiating between normal and abnormal physiologic or psychiatric changes
  • Diagnostic test selection and evaluation
Domain 3: Clinical Management

65 questions (43% of the exam) assess your competency in clinical management. Please note that the examples in parentheses are not all-inclusive and do not indicate importance.

Knowledge:

  • Pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenetics
  • Anticipatory guidance (e.g., developmental, behavioral, disease progression, crisis management, end-of-life care)
  • Age-appropriate primary, secondary, and tertiary prevention interventions

Skills:

  • Pharmacotherapeutic intervention selection (e.g., interactions, contraindications)
  • Pharmacotherapeutic intervention evaluation (e.g., monitoring, side/adverse effects, patient outcomes)
  • Non-pharmacologic intervention selection and evaluation
  • Therapeutic communication (e.g., motivational interviewing, shared decision making)
  • Culturally congruent practice
  • Resource management (e.g., accessibility, coordination, cost effectiveness)
Domain 4: Professional Role

15 questions (10% of the ANCC certification exam) relate to knowledge and skills in your professional role as an FNP. Please note that the examples in parentheses are not all-inclusive and do not indicate importance.

Knowledge:

  • Legal and ethical considerations for health care informatics and technology (e.g., confidentiality, accessibility)
  • Scope and standards for advanced practice registered nurses
  • Regulatory guidelines (e.g., reportable diseases, abuse reporting)
  • Evidence-based clinical guidelines and standards of care
  • Ethical and legal principles and issues for patients, populations, and systems (e.g., justice, consent, guardianship, bioethics)

Skills:

  • Research appraisal (e.g., design, results, clinical applicability)
Secondary Classifications

Content of the ANCC FNP certification exam will relate to the following classifications of body systems, drug agents, and age groups.

Body Systems Drug Agents Age Group
  1. Cardiovascular
  2. Endocrine
  3. Gastrointestinal
  4. Genitourinary and Renal
  5. Head, Eyes, Ears, Nose, and Throat
  6. Hematopoietic*
  7. Immune*
  8. Integumentary
  9. Musculoskeletal
  10. Neurological
  11. Psychiatric
  12. Reproductive
  13. Respiratory
  1. Analgesic
  2. Anti-Infective
  3. Cardiovascular
  4. Endocrine
  5. Eye, Ear, Nose and Skin
  6. Gastrointestinal
  7. Genitourologic
  8. Musculoskeletal
  9. Neurological
  10. Psychiatric
  11. Reproductive
  12. Respiratory
  1. Infant
  2. Preschool
  3. School-age
  4. Adolescent
  5. Young Adult**
  6. Adult
  7. Older Adult
  8. Frail Elderly

*Less emphasis to be placed on this body system relative to others.
**Including late adolescent and emancipated minors.

Preparing for the Family Nurse Practitioner Certification Exam: Study Tips, Resources, Tools, and More

Having reached this point in your nursing career, you’ve already developed effective study skills. However, you will benefit from using techniques and resources that are designed specifically for the family nurse practitioner certification exam.

Finalize Your Decision: AANPCB vs ANCC

Much of this guide has focused on the differences between the AANPBC FNP exam and the ANCC FNP exam. As a review, here are the differences that may affect the studying methods and tools you utilize:

  • Question format: The ANCC exam uses multiple choice, multiple response, drag and drop, and hot spot (image-based) questions. The AANP FN
  • Content: The primary difference in content is that the AANP exam focuses only on clinical knowledge, while the ANCC exam contains 15 questions (10% of total content) relating to the FNP’s professional role.* Review exam outlines for specifics.
  • Retesting: If you fail the ANCC exam, you may retest again in 60 days. If you fail the AANP exam, you’ll need to complete 15 hours of CE before you retest.*

Bottom Line: Exam study and materials will be nearly identical for either test. For ANCC, you’ll need to spend some time studying the FNP professional role and prepare for different question formats.

Review Official Test Prep Materials

Both the AANP and the ANCC provide resources to assist you in preparing for their respective exams.*

Free resources from the ANCC
Free resources from the AANPCB

Review Current Authoritative References

One common reason for incorrect FNP test responses is that the examinee is relying on clinical experience rather than current evidence-based, nationally-recognized standards of care.

Assessments, diagnoses, and treatments you’ve witnessed may not actually be in alignment with the current guidelines. Keep in mind that very recent guideline changes will not be reflected on the exam.

Research is the basis for practice. Use the most recent evidence-based guidelines as the context for your exam responses:

†Please keep in mind that these lists are not all-inclusive.

Use Exam Review Courses, Prep Books, and Workbooks

FNP certification study resources are plentiful, including review courses, textbooks, and workbooks. The tough part is knowing which ones are accurate and effective.

If you plan on purchasing supplemental FNP exam prep materials, here are a few tips to ensure a high-quality selection:

  • Research the source of the study aid (organization, author, etc.). Was it created by a reputable entity?
  • Check reviews from multiple platforms (not just the seller’s website). Is this a popular resource? Was it effective for NPs who took the FNP exam?
  • Verify that it is up-to-date. Does the test prep book have several versions or editions? Is there information about the latest updates?

How To Use Practice Exams and Questions

Sample questions and practice tests are helpful resources to demonstrate areas where you need to knowledge-build, show you what to expect on your FNP certification exam and gauge your level of preparedness.

Do not use practice questions to prepare for the exam. Attempting to build your knowledge base by taking practice tests does not work and is often cited as the main study method by NPs who fail boards.

Chapter 3 of this guide explores the structure, complexities, and context of the FNP exam questions in greater detail. In the meantime, here’s where to find practice tests and sample questions directly from the AANP and ANCC:*

You’ll also find sample questions and practice exams included with FNP certification review courses and certification prep packages often include additional resources. Again, use discretion when selecting these resources to ensure that you have up-to-date, accurate information.

Use a Review Program

High-quality review courses give you a current, comprehensive, evidence-based foundation that enables you to perform successfully on your exam.

A poor approach to preparing for the exam and practice is to memorize information, so you know what to do but not why you are doing it. For both the exam room and as part of the larger health care system, a better approach to knowledge building is to understand concepts and apply knowledge so you know what to do and why you are doing it. The most effective online programs will focus on strategies that help you apply the information you’ve learned to the context and intent of the exam questions. The certification exam will test your knowledge of the following:

  • Why a patient is at risk for a problem.
  • How a clinical problem has developed.
  • What is the most likely clinical presentation of the condition?
  • Why a given intervention is effective.
  • How that intervention works.
  • What is the most likely clinical outcome?
  • Why this clinical problem is of significance to the overall healthcare system.

Here are a few benefits to using an FNP certification exam review program:

  • Save time by learning where to focus your studies
  • Gain an understanding of the “why” behind test questions, so you t can answer correctly
  • Review up-to-date evidence-based guidelines
  • Review skills that are commonly included in FNP exam content
  • Feel prepared and qualified for your first FNP job after earning your certification
  • Reduce performance-hindering test anxiety

Select an FNP certification review course that is well-respected and, if possible, one that includes a Pass Guarantee.

*AANP is often used as shorthand for AANPCB (the American Academy of Nurse Practitioners Certification Board).