AANP Family Nurse Practitioner Certification Exam Questions and Answers, Exams of Nursing

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AANP Family Nurse Practitioner Certification Exam

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1. 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order Ans>> Iron, TIBC
2. 3 months of synthroid, TSH increased, T4 normal, what do you do Ans>> increase medication
3. 3 ways to assess cognitive function in patient with signs/symptoms of memory loss: Ans>> MMSE
4. 4 month old with strabismus, mom is worried

2 / Ans>>: tell her it is normal

5. 4 month old wont keep anything down, what is the main thing you look at Ans>> growth chart
6. 6 month old closed anterior fontanel: Ans>> XRAY
7. 88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt: Ans>> change to NSAID, SED rate is a sign of inflammation
8. a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done: Ans>> order Ultrasound
9. If A1C > 9 on two oral meds what do you order : Ans>> If you are already on TWO oral drugs for diabetes and A1c is 9

3 / or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM Intermediate-acting- NPH (Humulin N, Novolin N) Long-acting-Levimir/Basalgar/Lantus Ultra-long-acting-Degludec (Tresiba) and glargine u-300 (Toujeo)

10. Abnormal cells on PAP, what do you do next Ans>> refer for Colposcopy
11. ACE/ARB contraindications: pregnancy Renal failure Renal Stenosis
12. Condition when ACE is contraindicated: pregnancy
13. Acne Rosacea: chronic small acne like papules/pustules around nose mouth chin TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM
14. Acne Vulgaris: common acne TREATMENT-Retin-A, acne worsens 4-6 weeks if no improvement in 8-

4 / weeks increase dose or add erythromycin, benzoyl peroxide.

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15. actinic keratoses: Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Small area- liquid nitrogen or (cryotherapy), Large area (5-FU cream)- which causes skin to ooze, crust, scab, redness EXAM
16. Acute Angle Closure Glaucoma: acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM
17. Acute Bacterial Pneumonia CXR: middle lobe. ON EXAM
18. Acute Closed Angle Glaucoma Vs Open Angle: Acute-Sudden pain, halos, cupping, dilated, cloudy , intraocular pressure, HA, refer ED
19. Open Angle Glaucoma (primary): CN 2, gradual loss peripheral vision first TX-laser trabeculoplasty Eye drops (prostaglandin analogues)-latanoprost , bimatoprost ,travoprost
20. Treatment of Initial Genital Herpes: Acyclovir 200mg 5 x day
21. Addison's disease: Addison's- deficient in cortisol (pt have low

6 / sodium, blood sugar, but Increased K.) You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM

22. ADHD: A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity.
23. Which murmurs are pathological: all diastolic murmurs
24. Murmur grading: I- barely II-audible III- clearly audible. IV- first time thrill V- Steth edge VI-entire steth. EXAM
25. Allergic Conjunctivitis: "stringy; increased tearing" Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. TX=PO antihistamines

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26. allergic rhinitis: blue pale turbinate clear drainage Tx=inhaled corticosteroids
27. Aphthous stomatitis AKA canker sores are Ans>> painful shallow ulcers heal 7-10 days TX=Magic mouthwash
28. Abd assessment on patient with ascites will be: Dull to percussion
29. Atopic Dermatitis (eczema): Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy le- sions" they become lichenified from itching. tx=First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM
30. AV nicking (Arterioles pressing on vein of the eye): HTN retinopathy
31. Basal cell cancer: Waxy, pearly, telangiectasia, ulcer center lesion -most com- mon type of skin cancer caused by UV exposure. Metastatic is rare
32. When prescribing lithium what lab do you monitor Ans>> monitor TSH, toxicity bind to TH cause hypothyroidism.
33. What are the B/P ranges

8 / Normal in elderly: Normal is <120/ Elevated Blood Pressure: A reading ranging from 120- 129/80 Stage 1 Hypertension: A reading ranging from 130 to 139/80 to 89 Stage 2 Hypertension: A reading ranging from 140 or higher/ Hypertensive Crisis (consult your doctor immediately): A reading higher than 180/ ELDERLY OVER 60 BP of 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.

34. How do you treat BPH and urge incontinence: anticholinergics/oxybutynin, impamine/tricyclic/antidepressant
35. Anticholinergic SE: can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit

9 / SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH

36. CAGE ACRONYM: Cut down Annoyed by criticism Guilty about drinking Eye opener drink
37. Carotid bruit: abnormal flow of blood through the carotid artery
38. Cataracts: in elderly night vision issues. Opaque EXAM
39. Causes of tachycardia: Fever Anemia Hypotension
40. CCB side effects: BLE edema Constipation Headache Irregular heart beat Dizziness Fatigue No grapefruit juice while taking diltiazem and verapamil
41. Cellulitis is: Deep dermis poor demarcated low legs DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS EXAM/ MULTIPLE QUESTIONS
42. Chlamydia treatment in pregnancy: Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x 7d. Test of cure 3 weeks after completion

10 / of treatment (PREGO). EXAM

43. Chlamydia trachomatis ABX treatment: Doxycycline (+ ceftriaxone for gonor- rhea coinfection)
44. Cholesteatoma assessment: chronic sinusitis or OM. "Cauliflower ear", foul-smell, hearing loss. Erodes bones in face affects facial CN 7 Benign- risk hearing loss refer SURGERY
45. Chronic Bronchitis Treatment: Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen
46. CN IX Glossopharyngeal: gag reflex and swallow without any difficulty EXAM
47. CN V Trigeminal exam for which eye problem: Herpes. CORNEAL ABRA- SION. EXAM

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48. CN VII Facial assesses what: BELLS PALSY EXAM
49. CN VIII Vestibulocochlear: ears EXAM
50. Coarctation of Aorta: -congenital cardiac condition characterized by a narrow- ing of the aorta bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs.
51. Common causes of GERD: risk factors: alcohol, anticholinergic, CCB (ver- apamil), BB chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline
52. Conductive Hearing loss: Lateralization to bad ear. Rinne- BC > AC Rinne (1st mastoid, 2 front of ear, time each area) Weber: Tuning fork midline. CN 8 (acoustic). EXAM
53. COPD: Gold 1-2: SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM
54. COPD Gold 1-2 that are poor controlled: LAMA or LABA. May use SABA for rescue
55. COPD Gold 3-4: LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS

12 / refer to pulm

56. SABA: Albuterol, levoalbuterol (terol)
57. LABA: Formeterol, salmeterol (Terol)
58. SAMA: Atrovent Ipatropium (tropiuM)
59. LAMA: Spiriva Tiotroium (tropium)
60. COPD long term treatment is: OXYGEN
61. Corneal abrasion assessment: Round/Irregular EXAM
62. Cranial nerves responsible for extraocular eye movements: CN III,IV, VI
63. Cushing's assessment: Central obesity, moon face, purple striae, hairy, hyper- tension, elevated plasma CORTISOL in AM. "INCREASED BS, SODIUM" Decreased K.

13 / You must draw cortisol levels in the morning.

64. CVI: Impaired venous return. Achy legs relieved by elevation, edema after pro- longed standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM
65. Dacrocystitis: lacrimal sac, rub down towards mouth. If suspect secondary infection abx. EXAM how it presents. Clinically, patients present with signs of periorbital cellulitis, including erythema, warmth, and swelling around the eye, along with tenderness and purulent discharge from the tear duct.
66. Definition of metabolic syndrome: cluster of conditions that increase risk of heart disease, stroke, diabetes.
67. Definitive diagnosis of acute bacterial prostatitis: urinalysis and culture
68. Depression med acute Anxiety/ panic med GAD med Ans>> depression SSRI panic benzo, Xanax, ativan GAD SSRI SNRI- Buspar, Effexor, Cymbalta- Taper OFF
69. Diabetic Retinopathy: Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), microaneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED
70. Test to diagnose trichomoniasis: wet prep/mount

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71. Direct Coombs test diagnoses: r/o bilirubin
72. eating, painful lump noted on the jaw that comes and go: sialolithiasis
73. Elderly woman presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next Ans>> Pelvic US
74. Emphysema assessment CXR: Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory mus- cles, pursed-lip breathing, weight loss. ON EXAM
75. Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located Ans>> Anterior septum
76. Erysipelas: Caused by Group A strep, painful, Upper dermis, clear demarcated, cheeks, shins. TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clindamycin

15 / PCN ALLERGY? Do Azithro x5d. MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.

77. Erythema migrans: LYME (stage 1 ) Target bulls-eye, usually appears in 7- 14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 days since symptoms Amoxicillin or cefuroxime axetil. Older than 7 days Doxycycline. EXAM
78. Ectopic Pregnancy: Previous ectopic pregnancy Salpingitis history of abortion Prior fallopian tube surgery Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Pelvic inflammatory disease Endometriosis cigarette smoking age older than 35 years history of infertility use of assisted reproductive technology, such as in

16 / vitro fertiliza- tion (IVF)

79. Fibromyalgia polymyalgia: Fibro- 11/18 points. Widespread pain for at least three months polymyalgia Tx prednisone 12 months. Must taper off. RISK for Temporal arteritis, DX BX, elevated ESR EXAM
80. Fifth's Disease (Erythema Infectiosum): B19: lytic infection, respiratory trans- mission Sx: flushed rash/fever in kids Px: fever, get better in a week
81. Fingernail hematoma treatment Ans>> drill hole and drain blood
82. what is the ABX treatment for staph aureus infection (skin) with pus Pus means what Ans>> MRSA- TX Bactrim or tetracyclines

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83. Fructosamine test: checks sugar for past 2-4 weeks
84. Fundal Height: 12 weeks-above symphysis pubis EXAM 16 week- between symphysis pubis and umbilicus 20 weeks-is at umbilicus 2 cm more of less from # of wk gestation is normal if more or less order US
85. Genital warts treatment: Cryotherapy Podophyllotoxin cream Imiquimod (Aldara cream)
86. GERD treatment: H2 is first line, give HS (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid)
87. German Measles (Rubella): Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots.
88. Grade 3 cells on Pap, treatment: LEEP excision
89. Grandiosity is: Exaggerated belief in or claims about one's importance or identity. Bipolar
90. Pt has a headache after trauma what could it be Ans>> SDH
91. Blowing holosystolic murmur heard best at and radiates to where

18 / Heart murmur with mid systolic heard where: Heard best at the apex. Radiation to the axilla and inferior edge of left scapula. (5th ICS MCL) Apex the lower left sternal border

92. Aortic stenosis radiates where: radiate neck, 2nd ICS right sternal border
93. Herpetic keratitis assessment: ocular herpes - blurry vision, inflammation of eye; gritty feeling, conjunctivitis, sharp pain, and photophobia- AVOID SUN REFER OPTHO Tx acyclovir
94. HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt: tell the pt. that he is qualified to be diagnosed with AIDS according to CDC
95. hordeolum Vs chalazion blepharitis: Hordeolum-painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin.

19 / Chalazion does not hurt Blepharitis always unilateral, Tx baby shampoo warm compress

96. horizontal nystagmus that stops when eye is close to midline in a college student: Ménière's disease
97. HTN Retinopathy: Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM
98. hyperparathyroidism: high calcium
99. Hyperthyroid labs Presentation Ans>> Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise)
100. Hyperthyroidism treatment: methimazole, PTU-propylthiouracil (preferred in pregnancy), Radioactive iodine, Beta blockers
101. IBS (irritable bowel syndrome): An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. Due to Small intestinal bacterial overgrowth, or SIBO
102. IBS treatment: TX fiber, avoid gas foods, antispasmodics, decrease life stress
103. Impetigo: Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters.

20 / Severe- Keflex, dicloxacillin. PCN Allergic Azithro, clinda. If NO BULLAE- Bactroban. EXAM

104. What is intraocular pressure (IOP) and how is it measured Ans>> Fluid pressure inside the eye; measured with tonometry
105. Intussusception: telescoping obstruction of the intestines, cuts off blood sup- ply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, CURRENT JELLY STOOL, SAUSAGE LIKE MASS
106. Isolated Systolic HTN: CCB
107. JVD caused by: -tension pneumothorax -Rt. sided heart failure -cardiac tamponade -traumatic axphysia from -Increase in portal pressure(LIVER) in venous side or cor pulmonale
108. Kava Kava: anxiety and insomnia, don't mix w sedating benzos
109. Kawasaki disease: acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet.

10 / 22 This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin and gamma globulin. EXAM

110. PAD: Absence of pulse, decrease blow flowing down, PAIN Dx doppler or ABI<0.9 TX exercise by walking or antiplatelet
111. PVD: Volume, edema, discoloration, decrease blood going up
112. Koplick spots: (rubeola). Grains of salt lesions inside mouth in Measles "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM
113. Lachman's Test: pivot shift test (ACL tear)
114. Legg-Calve-Perthes Disease: Avascular necrosis of the proximal femoral head
115. Lichen planus assessment: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes-hep C, medications, contact with chemicals. EXAM
116. Triglyceride level of 1500, increased risk for: Pancreatitis
117. Low HGB, Low HCT, High MCV indicates what

10 / 22 Ans>> Macrocytic anemia, B12 Def

118. macular degeneration: loss of central vision Screening: Amsler grid
119. Mammography Screening (Average risk): Age 45 - 54 yearly mammogram -55 and older every 2 years
120. Man with BPH, prostate feels on digital exam Ans>> Enlarged, symmetrical, smooth
121. Man with HTN, CAD, present femoral pulses but absent pedal pulses: Ar- terial Insufficiency
122. McMurray's Sign (+) palpable or audible click while extending with varus stress: Meniscus tears
123. Meiniers disease SE: VERTIGO TINNITUS, HEARING LOSS. nystagmas

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124. METABOLIC SYNDROME medications: GIVE Metformin, ACE or ARB- kid- ney protective, BB- causes hypoglycemia, NO THIAZIDES, CCB (HF) NO TZD ACTOS (Pioglitazone)
125. Metformin monitoring: Monitor BUN, Creatinine Contraindicated renal and liver disease ARF creatinine up and GFR down Affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea , flatulence CT: hold 24 hr before and 48hr after
126. migraine headache: paroxysmal (sudden, periodic) attacks of mostly unilater- al headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate
127. Mitral Regurg radiates where Aortic Stenosis radiates where: Holo/pansystolic)- radiates to axilla. Mitral area 5th ICS MCL.

12 / Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2nd ICS rsb.

128. Moderate acne treatment: Without inflammation: Topical retinoid Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered) PLUS ADD Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone
129. Molluscum contagiosum treatment: Currettage, liquid nitrogen

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130. Mono: DX- heterophile antibody test return to play : 4-6 weeks when spleenomegaly resolves ON EXAM
131. Most common cause of death in children: motor vehicle
132. MR. ASS: Mitral Regurgitation Aortic Stenosis (Systolic Murmur) Only systolic murmurs will radiate to a location EXAM
133. Murmur Grade III - VI: Loud murmur easily heard
134. MVP: S2 click, followed by systolic murmur. Asymptomatic. MVP with palpita- tions is treated with BB. LATE SYSTOLIC
135. Newborn with foot turned in, what do you do Ans>> refer to orthopedist
136. NSAID contraindicated in: HF and ARF Causes increase BP Impairs renal prostaglandin and sodium retention
137. Nystagmus test: the involuntary jerking of the eyes as a person gazes to the side
138. Otitis Externa (swimmers ear): Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM
139. OME: Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT