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AANP Exam FNP ACCURATE TESTED VERSIONS OF THE EXAM FROM 2023TO 2024 | ACCURATE AND VERIFIED ANSWERS | NEXT GEN FORMAT | GUARANTEED PASS WITH 150 + QUESTIONS
Typology: Exams
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A 50-year-old patient presents to their nurse practitioner after their yearly eye exam with the ophthalmologist. They tell the nurse practitioner that they were told their vision is 20/200 in both eyes when they are not wearing their prescribed glasses. They ask what this means. Which of the following is the most appropriate response? A. They are okay to drive short distances without their glasses on B. They can see at 200 feet what someone with 20/20 vision can see at 20 feet C. They will need surgery in the future to correct their vision D. Without their glasses, the patient is considered legally blind
on the patient's state of residence, a corrected vision to a certain degree may be required to be able to operate a motor vehicle. A 24-year-old woman presents with concerns of increased anxiety, night terrors, and feeling as if she is hyperaware of her surroundings. Based on her presenting symptoms, which of the following diagnoses is the most likely? A. Generalized anxiety disorder B. Major depressive disorder C. Post-traumatic stress disorder D. Schizophrenia
Selective serotonin reuptake inhibitors are typically the first class of medications used in the treatment of PTSD, though exceptions may occur based on individual needs and circumstances. A 6-year-old patient presents to the clinic with his parent, who reports several blister-like lesions on his child's abdomen. The child reports the lesions are pruritic and intermittently painful. Physical exam reveals large blisters filled with clear-yellow fluid. Which of the following is the most likely diagnosis? A. Bullous impetigo B. Herpes zoster C. Nonbullous impetigo D. Varicella
Increase the tretinoin dosage and follow up in 8 weeks B. Instruct him to continue the tretinoin and start him on tetracycline C. Instruct him to continue the tretinoin cream and start him on oral isotretinoin D. Instruct him to stop his tretinoin and start him on doxycycline (Vibramycin)
Health belief model C. Lewin change model D. Transition care model
Metronidazole (Flagyl) for both the patient and her partner Trichomoniasis is a genitourinary infection caused by the protozoan Trichomonas vaginalis, the most common nonviral sexually transmitted infection (STI) worldwide. Treatment involves an oral course of metronidazole (Flagyl) for both the patient and the partner (C) and can be given in a single or multidose regimen. Both symptomatic and asymptomatic patients with confirmed infection require treatment. Symptoms often include a purulent vaginal discharge with associated burning and pain. However, up to 70% of patients may be asymptomatic, thus emphasizing the importance of screening and treatment. A test of cure is not required if the CDC-recommended treatment regimen is prescribed and completed in full by the patient. The nurse practitioner is seeing an 18-year-old patient in the office who was recently diagnosed with polycystic ovary syndrome. Her parents are extremely worried about this diagnosis and ask if their daughter is at higher risk for other problems given this new diagnosis. Which of the following comorbidities is associated with polycystic ovary syndrome? A. Hyperthyroidism B. Nonalcoholic fatty liver disease C. Skin cancer D. Type 1 diabetes
Nonalcoholic fatty liver disease (B) occurs when there is an excess buildup of fatty tissue in the liver. It is common in those diagnosed with polycystic ovary syndrome (PCOS) due to the associated symptoms of obesity and hyperandrogenism. A 39-year-old woman presents to the clinic with increasing left foot pain. She reports no injury to the area but states the pain has been worsening over time. Upon physical exam, the first metatarsophalangeal joint is observed to deviate inward, causing a clear deformity of the foot. Which of the following angles observed on X-ray is regarded as the cutoff for a diagnosis of hallux valgus? A.
15° angle B. 1° angle C. 20° angle D. 5° angle
20° angle The hallux abductus angle is the angle found between the hallux and the first metatarsal. Angles 20° (C) measured on X-ray are abnormal and indicative of hallux valgus. Hallux valgus (also known as a bunion) is a common cause of foot deformities. It can be caused by arthritis, biomechanical abnormalities, neuromuscular diseases, genetic conditions, or trauma.
An adult patient with a medical history of hypertension, hyperlipidemia, and mitral valve prolapse is due for a dental procedure. Which of the following orders should be initiated by the nurse practitioner? A. Amoxicillin (Amoxil) 1 hour before the procedure B. Amoxicillin (Amoxil) 24 hours before the procedure C. Amoxicillin-clavulanate (Augmentin) 1 hour before and for 2 days after the procedure D. This patient does not require endocarditis prophylaxis - ANSWER D. This patient does not require endocarditis prophylaxis Patients with mitral valve prolapse do not need prophylactic treatment for infective endocarditis (D). While this was previously a standard practice, it is no longer indicated as the risk of antibiotic-associated adverse effects exceeds any perceived benefit from prophylactic antibiotic therapy. Patients who should receive prophylactic antibiotics prior to dental procedures include those with a history of infective endocarditis, those with a prosthetic valve, and transplant patients with a valvulopathy. For those patients, it is appropriate to administer amoxicillin (Amoxil) approximately 1 hour before the procedure. A 71-year-old man with a history of Parkinson disease presents to the clinic with worsening bradykinesia throughout the day despite continued treatment with carbidopa-levodopa (Sinemet). What education should be provided to the patient today regarding his treatment plan? A.
"Due to worsening symptoms, the most appropriate plan is to double the dose of your medication, as it is very normal to need dose changes as your disease progresses" B. "It appears you have built up a tolerance to this medication, which is common with extended use, so we will discontinue this and change your medication to selegiline" C. "Since you are no longer finding relief of symptoms with carbidopa-levodopa (Sinemet), we will add a dopamine agonist such as pramipexole (Mirapex) to help, as these two medications work well when taken together" D. "Unfortunately, this is due to the changes and progression of Parkinson disease, not because the - ANSWER D. "Unfortunately, this is due to the changes and progression of Parkinson disease, not because the medication itself is not effective, so we will try changing the brand, dose, and administration time of the medication to see if this helps before discussing alternative medications" Although carbidopa-levodopa (Sinemet) is the gold standard for treatment of Parkinson disease, the effects can wear off over time. This is a known phenomenon and is not fully understood. Changing the brand, dosing, and timing of the medication (D) is one way to attempt to combat the wearing-off effect and provide longer-term coverage for Parkinson disease patients. Additionally, carbidopa-levodopa is not a first-line or initial treatment option and is reserved for severe cases or as a final treatment for patients in which other medications have failed, generated resistance over time, or have lessened effect or loss of control of symptoms over time. A 44-year-old man who is a construction worker stepped on a nail that went through his boot and into his foot this morning. He removed the nail and is not actively bleeding. He and his coworker who drove him to the clinic report that the nail was fresh from a new box. He had a tetanus booster 6 years ago and is up to date with all other health maintenance. Which of the following is the most appropriate plan of care for this patient?
Educate the patient that he does not need a TDaP booster because the nail was not rusty and it has not been 10 years since his last booster B. Order a TD only booster because the nail was not rusty C. Order a TDaP booster because it has been 6 years since his last one D. Refer him to the emergency department for an immunoglobulin because it has been more than 5 years since his last TDaP - ANSWER C. Order a TDaP booster because it has been 6 years since his last one The Centers for Disease Control and Prevention (CDC) recommends a TDaP booster every 5 years (C) in those over 7 years old who have come into contact with a potentially contaminated object, even a clean nail. Any puncture wound is still a risk for Clostridium tetani, even if the object was not rusty. In the absence of injury, it is recommended that adults receive a tetanus booster every 10 years. Which test is the most specific for diagnosing an acute gout flare? A. Serum uric acid levels B. Synovial fluid aspiration
Ultrasound D. X-ray - ANSWER B. Synovial fluid aspiration There are many diagnostic testing modalities that can be suggestive of an acute gout flare. However, the most specific test for diagnosis is synovial fluid aspiration (B). A 17-year-old athlete presents to the clinic for her annual sports physical examination. She reports fluctuations in her heart rate that she has noted on her fitness tracker. She reports no symptoms. You order an ECG due to a significant family history of cardiovascular disease. While connected to the ECG, you note the R-R interval is reduced when the patient breathes in and is prolonged when she breathes out. Which of the following is the most likely diagnosis for this patient? A. Pulsus paradoxus B. Pulmonary flow murmur C. Respiratory sinus arrhythmia D. Sinus bradycardia - ANSWER C.
Respiratory sinus arrhythmia The most likely diagnosis for this patient is respiratory sinus arrhythmia (C). Respiratory sinus arrhythmia is defined as an increase in HR with inspiration and decrease in HR with expiration, as detected on this patient's ECG. Pulsus paradoxus (A) is defined as a drop in systolic blood pressure of > 10 mm Hg with inspiration and is often seen with life-threatening pericardial disease A 16-year-old boy presents to the clinic with his parents for a follow-up on diagnostic test results that suggest a serious health condition. The nurse practitioner presents an explanation of the test results, the health condition, treatment options, and potential care plans to the patient and his parents. Which of the core concepts of patient- and family-centered care is the nurse practitioner demonstrating? A. Collaboration B. Dignity and respect C. Information sharing D. Participation - ANSWER C. Information sharing Patient- and family-centered care is an approach to health care that recognizes the importance of the patient and their family as partners in care. The four core concepts of patient- and family-
centered care are collaboration, dignity and respect, information sharing, and participation. Information sharing (C) involves providing the patient and their family with clear, accurate, and timely information about their condition, treatment options, and care plan. A 15-year-old boy is brought to the clinic by his parent for a rash. The rash started as one round lesion for 1 week but has now progressed into multiple itchy, pink, and scaly lesions all over the trunk. Which is true regarding this condition? A. A topical antihistamine and antifungal is necessary to treat this lesion B. This lesion requires a dermatology referral for more intensive treatment C. This lesion should be kept covered, as it is contagious D. This lesion/condition may take several months to resolve - ANSWER D. This lesion/condition may take several months to resolve The described dermatologic condition is consistent with pityriasis rosea. Classic pityriasis rosea begins with a herald patch on the trunk in up to 90% of cases but may not always be present. The patch may be defined as erythematous with slightly elevated scaling borders and a lighter depressed center. Progression of the rash can occur for up to 6 weeks into a generalized rash and may take on a fir-tree pattern. Therefore, the rash may take several months to resolve (D) altogether. Pruritus is present in up to 50% of cases. There are also noted prodromal constitutional symptoms, including general malaise, fatigue, nausea, headaches, and fever, in 69% of patients. The exact cause remains unclear. No treatment has proven beneficial, and symptomatic management remains the standard of care with the use of hydrocortisone cream or oral antihistamines for pruritus symptoms.
The nurse practitioner is reviewing a chest X-ray of an adult patient. Which of the following is a diagnostic feature of cardiomegaly? A. Cardiothoracic ratio > 50% B. Double density sign C. Rounded cardiac apex D. Upwardly displaced diaphragm - ANSWER A. Cardiothoracic ratio > 50% A cardiothoracic ratio > 50% (A) is a diagnostic feature of cardiomegaly. The cardiothoracic ratio remains an important diagnostic parameter when the heart is 50% larger than the inner diameter of the ribcage. Cardiomegaly is an enlarged heart with pulmonary congestion that can be caused by alcohol use, myocarditis, chemotherapy, coronary artery disease, hypertrophic obstructive cardiomyopathy, kidney disease, cocaine use, or pregnancy (with presentation in the postpartum period). It can also be idiopathic. A 55-year-old man presents to the clinic with fatigue, shortness of breath, and dizziness for 1 day. He has a history of hypertension. The patient's electrocardiogram reveals a second-degree atrioventricular block. Which of the following medications should be immediately discontinued if the patient is currently taking it? A.
Amlodipine (Norvasc) B. Chlorthalidone (Thaliton) C. Diltiazem (Cardizem) D. Losartan (Cozaar) - ANSWER C. Diltiazem (Cardizem) Symptoms of a second-degree atrioventricular (AV) heart block include fatigue, dyspnea, chest pain, syncope, and even sudden cardiac arrest. Nondihydropyridine calcium channel blockers, such as diltiazem (C), are contraindicated in patients with second-degree AV heart blocks, as they alter the conduction through the AV node. Other medications that should be avoided in these patients include digoxin and beta-blockers An 80-year-old man presents to the clinic with his daughter, who reports that the patient has suddenly seemed more anxious and has difficulty concentrating and a new hand tremor. His medical history includes hypertension, type 1 diabetes mellitus, and benign prostatic hyperplasia. The daughter states that he went to bed his normal self last night and woke up in this state. At baseline, he is alert and oriented and has no problems with movement. Which of the following should be the initial step in the plan of care? A. Blood glucose level to assess for hypoglycemia B. CT scan to assess for possible stroke
Mini-Mental State Examination to test for dementia D. Urine dipstick to evaluate for a urinary tract infection - ANSWER A. Blood glucose level to assess for hypoglycemia When patients present with acute, vague symptoms, it is best practice to go from least to more invasive if time allows. Cost and probability of diagnosis are also a factor. This patient's history of diabetes mellitus should clue the nurse practitioner in on a potential hypoglycemic episode, and a quick finger stick to test blood glucose (A) should be the first thing done before moving on to more invasive or costly testing. Latent TB tx - ANSWER Latent tuberculosis (TB) is treated with a multiple antibiotic regimen (D) that typically involves isoniazid (INH) and rifampin (Rifadin) to prevent it from turning into active TB. In latent TB, the patient often has no symptoms and a chest X-ray with normal findings but a blood or skin test that is positive for TB. Navicular Fractures AKA - ANSWER Snuffbox Navicular fractures, also known as scaphoid fractures, often do not show up on imaging for a few weeks, so an X-ray will most likely not detect a fracture at this early stage (B). When a plain X-ray is normal, but the patient's history is consistent with a scaphoid fracture, the patient may need advanced imaging, such as computed tomography or magnetic resonance imaging. This can aid in an earlier, accurate diagnosis. Medicare A Medicare B Medicare C Medicare D - ANSWER A: Inpatient / Hospice B: Outpatient / Diagnostic
C: Advantage plans - Dental and Vision D: Drug Coverage Dialysis is fallen under which part of Medicare? A, B, C, or D? - ANSWER Part B At an annual visit, a 28-year-old woman tells the nurse practitioner that she knows smoking is bad for her and is considering quitting. What stage of readiness to change is she exhibiting? A. Action B. Contemplation C. Maintenance D. Precontemplation - ANSWER B. Contemplation In the contemplation (B) stage, the patient recognizes a problem exists and is considering a treatment or behavior change. In this stage, the patient is receptive to advice but is not yet ready for an action program. However, the nurse practitioner can help the patient to identify barriers, address concerns, and identify support systems. Macular degeneration - ANSWER causes loss of central vision and line distortion in older age. This is not reversible and has no cure, so selecting large print books is the best option for this patient.
Normal total cholesterol level - ANSWER <200 mg/dL Normal triglyceride level - ANSWER < 150 Normal HDL level - ANSWER 40- 60 Normal LDL level - ANSWER <100 mg/dL Check lipid profile every? - ANSWER 5 years, unless they have risk factors. When lipids are stabilizing check every? - ANSWER 1-3 months, then yearly after for patients being treated for HLD. Do not drink what when taking a statin? - ANSWER Grapefruit juice What med do we use when triglycerides are > 500? - ANSWER Fenofibrate or triCor Two signs of necrotizing pancreatitis? - ANSWER Cullens and Grey Turner sign ACE inhibitors - ANSWER "PRIL" Renal protective Do not give to pregnant patients! Dry, hacking cough Possible ANGIOEDEMA D/C if GFR drops > 30% or below 30 Cr increases > 30%
Thiazide diuretics - ANSWER Do not give to those with sulfa allergy or GFR < 30 H - hyperglycemia C - Crystals T - Triglycerides Also great for those with osteoporosis (stimulate osteoblasts that build bone) CCBs - ANSWER diltiazem verapamil nifedipine Are preferred in pts w/ African American descent
respiratory sinus arrhythmia - ANSWER HR increases on inspiration and HR decreases on expiration Young and healthy athlete, no tx necessary pulsus paradoxus - ANSWER 10 point drop in SBP upon inspiration, this is serious! Emergency situation! Cardiac tamponade or status asthmaticus What heart sound is common to hear in HF patients and pregnant patients? - ANSWER S In HF patients what DM med should you avoid? - ANSWER TZDs - can cause edema In HF patients what OTC to avoid? - ANSWER NSAIDS - Increase sodium and fluid retention In HF patients what BP to avoid? - ANSWER CCB - cause edema What heart sound heard at the base of the heart? - ANSWER S What sounds are heard at the apex of the heart? - ANSWER S1, S3, S Diastolic murmurs "ARMS" - ANSWER Aortic regurgitation Mitral stenosis Systolic murmurs "MR PAYTON MANNING AS MVP" - ANSWER Mitral regurgitation Physiological murmur Aortic stenosis Mitral Valve Prolapse
Murmur radiating to the neck? - ANSWER aortic stenosis Murmur radiating to the armpit? - ANSWER Mitral regurgitation What heart condition in peds do we hear a click? - ANSWER Marfan syndrome Grade 4 murmur or higher - ANSWER Feel a palpable thrill What murmurs radiate? - ANSWER only systolic murmurs! Click sound is related to which murmur? - ANSWER Mitral valve prolapse S4 heart sound - ANSWER Uncontrolled HTN, left ventricular hypertrophy S1 heart sound is closure of what valves? - ANSWER Atrioventricular valves - Mitral and Tricupid S2 heart sound is closure of what valves? - ANSWER Semilunar valves - Aortic and Pulmonic peripheral arterial disease, ABI dx? risk factor? - ANSWER a condition characterized by narrowing of the major arteries that are responsible for supplying blood to the lower extremities. Legs are purple in lighter skin or hyperpigmentation and shiny. Intermittent claudication - pain is relieved with rest and dangling. Found ulcer on the toe. Dx with ankle-brachial index (ABI) < 0.9 Risk factor - smoking
Stage 1 HTN - ANSWER 130-139/80- 89 Stage 2 HTN - ANSWER > 140/90 What is the goal BP when treating a pt with HTN? - ANSWER < 130/80 ARBs - ANSWER All end in SARTAN Beta Blockers can mask signs of what? - ANSWER hypoglycemia BP meds preferred in pregnant women? - ANSWER NEW LITTLE MAMMA
Slowing down HR which allows ventricles to fill with blood easier Stronger contractility Increase dose slowly Hold dose if < 60 NARROW therapeutic range- Dig level > 2 can be toxic S/S of toxicity: Visual changes (green/yellow halos), Increasing fatigue, bradycardia, weakness Hypokalemia can precipitate toxicity Antidote: Digibind! An 81-year-old patient with a history of type 2 diabetes mellitus presents for follow-up of a nonhealing ulcer on his right foot. The patient reports it has worsened over the past few days. Physical exam reveals red streaking that extends from the ulcer into the ankle and lower leg. Foul-smelling, purulent drainage is present on the ulcer. Which of the following is the most appropriate treatment for this patient? A. Amoxicillin-clavulanate (Augmentin) B. Azithromycin (Zithromax) C. Cephalexin (Keflex) D. Clindamycin (Cleocin) - ANSWER D. Clindamycin (Cleocin)
The patient's clinical presentation is consistent with cellulitis. The presence of purulent drainage and red lymphangitic streaking that extends from the foot ulcer suggests a methicillin-resistant Staphylococcus aureus (MRSA) infection. This is a common pathogen of foot infections in patients with diabetes mellitus. The most appropriate treatment listed for this patient is clindamycin (D), as this effectively treats MRSA. A 49-year-old man presents to the clinic with a productive cough for over 2 weeks. He also reports fever, intermittent chest pain, loss of appetite, and fatigue. He has a history of HIV. The nurse practitioner is concerned for tuberculosis. Which of the following would confirm the suspected diagnosis? A. Chest X-ray B. Sputum culture C. Tuberculin skin test result > 10 mm D. Tuberculin skin test result > 5 mm - ANSWER B. Sputum culture The gold standard and definitive diagnosis of tuberculosis can only be established with a positive sputum culture (B). Statin drugs - ANSWER Need baseline Liver tests and baseline muscle pains
Niacin: what does it do? and what is the main SE? - ANSWER Decreases triglycerides / Increases HDL / no impact on LDL SE: facial flushing, warm fluids can exacerbate the flushing Patient is pregnant what anticoagulant to use? - ANSWER Lovenox (category B) INR of 7 and no bleeding, what would you do? - ANSWER Hold dose, then decrease dosage. Antidote for Warfarin (Coumadin) - ANSWER Vitamin K (PO or IV) What veggies have vitamin K? - ANSWER Green leafy veggies What med is preferred over aspirin if a stent has been placed? - ANSWER Plavix Albuterol (Proventil, Ventolin) - ANSWER short acting beta 2 agonist (SABA) Formoterol (Foradil) - ANSWER LABA Budesonide inhalation (Pulmicort) - ANSWER Corticosteroid - Inhaled Asthma COPD diagnosis - ANSWER FEV1/FVC < 0.7 or 70% What sound when we percuss COPD pts? - ANSWER Hyper resonance Two conditions that make up COPD? - ANSWER chronic bronchitis and emphysema S/S of PNA - ANSWER nasty cough, fever, chills, rhonchi, wheezes, increased tactile fremitus