FNP

Assessment is the foundation of family practice and the most heavily weighted clinical task on the AANPCB exam. This section covers evidence-based health promotion and screening across the lifespan, immunizations, sexual health and contraception, social determinants of health, and the comprehensive history, physical examination, and documentation that support accurate diagnosis.

Foundations of Health Promotion

Health promotion encompasses activities that enable individuals and communities to increase control over the determinants of health and improve overall well-being. The FNP serves as a primary agent in delivering preventive care across the lifespan. The World Health Organization defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease; this holistic perspective guides FNP assessment beyond the presenting complaint.

Adult Immunization Recommendations

Vaccine	Recommendation
Influenza	Annuallyforalladults ideallyinautumnbeforepeakseason Liveattenuatedintranasalvaccineis , .
	contraindicatedinimmunocompromisedpatients pregnancy andadults50andolder , ,
Tdap/Td	OnedoseofTdapinadulthood thenaTdorTdapboosterevery10years GiveTdapduringeach , .
	pregnancyat27–36weekstoprovidepassivepertussisimmunitytothenewborn
Pneumococcal	Recommended for all adults 50 and older and for adults 19–49 with risk conditions (chronic heart lung , ,
	liver orkidneydisease diabetes immunocompromise CSFleak cochlearimplant) GivePCV20or , , , , , .
	PCV21alone orPCV15followedbyPPSV23 ,
Recombinantzoster	Adults 50 and older (and immunocompromised adults 19 and older): two doses 2–6 months apart .
	Preferredoverthediscontinuedlivezostervaccinebecauseofsuperiorefficacy
HPV	Routine catch -up through age 26 for those not previously vaccinated; shared clinical decision-making
	forages27–45
HepatitisB	Alladultsthroughage59andadults60andolderwithriskfactors(adults60+withoutknownriskmay
	alsoreceiveit) Universalvaccinationsimplifiesdecisionsandincreasescoverage .

Pediatric Immunization Schedule

Vaccine	Schedule	KeyPoints
HepatitisB	Birth(within24hours) thencomplete ,	Birthdoseprotectsagainstperinataltransmission
	a 3 -dose series by 18 months
DTaP	2 4 6 and 15–18 months; booster at , , ,	Common reactions: injection-site erythema fever irritability , ,
	4–6years
IPV	2 4 6–18 months and 4–6 years , , ,	OralpoliovirusvaccineisnolongerusedintheUS becauseof . .
		vaccine-associated paralytic polio
MMR	12–15monthsand4–6years	Livevaccine:contraindicatedinpregnancyandsevere
		immunodeficiency andwithprioranaphylaxistoneomycinor ,
		gelatin
Varicella	12–15monthsand4–6years	Livevaccine;notneededwithadocumentedhistoryof
		varicella;avoidinimmunocompromise
Rotavirus	Oral:2 4 and(dependingonbrand)6 , ,	Maximumageforthefinaldoseis8months0days
	months
Hib	2 4 6 and 12–15 months , , ,	ConjugatevaccinethatdramaticallyreducedinvasiveHib
		disease
PCV	2 4 6 and 12–15 months , , ,	High -risk children may need additional pneumococcal
		polysaccharidedoses
HepatitisA	Twodosesstartingat12months	Dosesseparatedby6–18months
MenACWY	11–12years;boosterat16	High -risk patients may need extra doses or serogroup B
		vaccine

Cancer Screening Guidelines

Cancer	Who	MethodandInterval
Breast	Women40–74	Mammographyevery2years Clinicalbreastexaminationisnolongerroutinely .
		recommendedasascreeningmodality
Cervical	Ages21–65	Ages 21–29: cytology alone every 3 years beginning at 21 regardless of sexual ,
		debut Ages 30–65: cytology every 3 years high -risk HPV testing alone every 5 . ,
		years or co-testing every 5 years Stop after 65 if prior screening was adequate , .
		andnothighrisk;afterCIN2orhigher continuefor25yearsafterdiagnosis ,
Colorectal	Ages45–75(averagerisk)	Colonoscopyevery10years annualFIT annualguaiacFOBT multitargetstool , , ,
		DNA every 1–3 years CT colonography every 5 years or flexible sigmoidoscopy , ,
		every 5 years Individualize at 76–85 .
Lung	Ages50–80with≥20	Annual low-dose CT Stop once 15 years smoke-free or if a health problem .
	pack -years who smoke	substantiallylimitslifeexpectancy
	noworquitwithin15years
Prostate	Men55–69	1 Notuniversal:individualdecisionaboutperiodicPSAscreeningafterinformed discussion Notrecommendedat70andolderorwithlifeexpectancyunder10 . years

Cardiovascular, Metabolic, and Endocrine Screening

Screening	Recommendation
Bloodpressure	Atleastannuallyforadults Confirmelevatedreadingsonseparateoccasionsbeforediagnosing;use .
	thecorrectcuffsizewiththepatientseated feetflat andarmsupportedatheartlevel , ,
Lipids	Every4–6yearsforadults20–79atlowcardiovascularrisk;moreoftenwithriskfactorsorabnormal
	values Non-fasting panels are acceptable for screening .
Type2diabetes	Fasting glucose HbA1c or OGTT for adults 35–70 who are overweight or obese; screen earlier or , ,
	more often with family history high -risk ethnicity prior gestational diabetes or PCOS , , ,
Abdominalaorticaneurysm	One-time ultrasound for men 65–75 who have ever smoked; selective screening for men who never
	smoked
Thyroid	Notrecommendedforasymptomaticnonpregnantadults;keepalowthresholdfortestingwith
	nonspecificsymptoms
Osteoporosis	Bonemineraldensityforwomen65andolderandforpostmenopausalwomenunder65atincreased
	fracturerisk(FRAXassistsriskstratification) Evidenceforroutinescreeningofmenisinsufficient; .
	someguidelinesrecommendscreeningat70orearlierwithriskfactors

Mental Health and Behavioral Screening

Screening	RecommendationandTools
Depression	All adults using validated tools such as the PHQ-2 and PHQ-9 with systems in place for diagnosis , , ,
	treatment and follow-up ,
Anxiety	Adultsunder65usingtoolssuchastheGAD-7;evidenceisinsufficientforadults65andolder
Unhealthyalcoholuse	AUDIT-C or single-question screening; brief behavioral counseling is effective for risky drinking
Tobaccouse	Assessalladultsandcounselusingthe5A's;pharmacotherapyincludesnicotinereplacement ,
	bupropion andvarenicline ,
Intimatepartnerviolence	Womenofreproductiveage usingvalidatedtools withreferralresourcesandsafetyplanning , ,
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Pediatric Screening

Screening	TimingandMethod
Developmental	Standardizedtoolsat9 18 and30months(AgesandStagesQuestionnaire Parents'Evaluationof , , ,
	DevelopmentalStatus)
Autism Vision	M-CHAT-R/Fat18and24months;earlyidentificationenablesearlyintervention 1 Red reflex in the newborn period; instrument-based screening at 1–3 years; visual acuity testing from 3– 5years;periodicscreeningthroughadolescence

Screening	TimingandMethod
Hearing	Newborn screening before discharge (otoacoustic emissions or auditory brainstem response); school -
	agescreeningatrecommendedintervals
Lead	Ages 1 and 2 in at-risk populations; required for Medicaid -enrolled children Confirm elevated levels and .
	assesstheenvironment
Anemia	Hemoglobinatabout12months;riskassessmentguidesfurtherscreening
Dyslipidemia	Onceat9–11yearsandonceat17–21years;earlierwithafamilyhistoryofprematurecardiovascular
	diseaseordyslipidemia

Prenatal Screening

Timing	Screening
Firstprenatalvisit	CBC bloodtypeandRh antibodyscreen urinalysiswithculture rubellaimmunity syphilis hepatitisB , , , , , ,
	surfaceantigen hepatitisC HIV andchlamydia;gonorrheabasedonrisk , , ,
11–14weeks	First-trimester aneuploidy screening: nuchal translucency plus serum PAPP-A and free beta-hCG . Cell -
	freeDNAscreeningisanoptionforallpregnantpatientsregardlessofrisk
Secondtrimester	Quad screen (AFP hCG estriol inhibin A) or integrated screening combining first- and second -trimester , , ,
	markers
24–28weeks	Gestational diabetes: one-step 75 g OGTT or two-step 50 g glucose challenge followed by a 100 g ,
	OGTTifabnormal
36–37weeks	Group B streptococcus vaginal -rectal swab; a positive result calls for intrapartum antibiotic prophylaxis