AANP Family Nurse Practitioner Exam (2024 / 2025) Questions and Answers, Exams of Nursing

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AANP Family Nurse Practitioner Exam

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1. A patient tells the nurse practitioner that she recently started taking the supplement St. John's wort after reading about its benefits online. Which of the following medications, if being actively consumed, must be immediately stopped? A. Benadryl B. Famotidine (Pepcid) C. Metformnin (Glucophage) D. Sumatriptan (Imitrex) Ans>> Sumatriptan (imitrex) Sumatriptan (Imitrex) (D) is a medication used to treat migraines and belongs to a drug class known as serotonin agonists. When used in conjunction with St. John's wort, it may increase the risk of serotonin syndrome, a potentially life-threatening condition.
2. Which of the following is not a symptom of both major

2 / depressive disorder and post-traumatic stress disorder? A. Difficulty concentrating B. Hypervigilance C. Insomnia D. Irritabilty Ans>> Hypervigilance In addition to difficulty concentrating, insomnia, and irritability, major depressive disorder (MDD) may also include symptoms of depressed mood, anhedonia, weight loss or gain, and low energy. However, hypervigilance (B) is not a symptom associ- ated with this diagnosis.

3. A patient with type 1 diabetes presents for a follow-up visit. He has been stable on his medication regimen but is worried because he is between jobs and will be without health insurance coverage for a few months. He asks if there are less expensive insulin options to get him through this time. Which of the following would be good options for this patient, given his circumstance? Incorrect A. Insulin aspart 70/ B. Insulin

3 / detemir C.

4 / Insulin isophane D. Insulin degludec Ans>>: Insulin Isophane The least expensive insulin type listed in this question is insulin isophane (C) (neutral protamine Hagedorn insulin). There are also often pharmacy-specific coupons that can be used on insulin, so helping patients apply for and navigate these pro- grams can be instrumental in managing their diabetes. Another inexpensive option is regular insulin.Insulin analogs (glargine, detemir, degludec, lispro, and aspart) are significantly more expensive than human insulin (isophane, regular). Insulins modified by manufacturers, especially when sold as brand- name medications, tend to be more expensive due to this modification. While analogs offer alternate lengths of action and convenience, there is no well-documented clinical evidence that patient outcomes are improved with differing brands. Therefore, maintaining a patient's blood glucose level through outcome-focused treatment is more valuable than a process-focused plan based on medication.

4. A 40-year-old woman with type 2 diabetes presents to the clinic with con- cerns of spiking blood sugar between lunch and dinner. She states she is on a rapid-acting insulin sliding scale and long-acting insulin. Which change should be implemented

5 / to help prevent or curb this glycemic spike? A. Add a dose of mealtime insulin aspart (Novolog) at lunch B. Add insulin detemir (Levemir) at night C. Increase her insulin glargine (Lantus) D. Prescribe a dose of neutral protamine Hagedorn insulin with dinner Ans>> Add a dose of mealtime insulin aspart (Novolog) at lunch Insulin aspart (Novolog) (A) is a rapid acting insulin that is commonly dosed with meals and as a sliding scale regimen based on a patient's glucose prior to eating (preprandial). It is the appropriate insulin to add as a mealtime dose when patients experience blood glucose spikes between meals because of its short-acting proper-

6 / ties. Peak time action of insulin aspart is 2 hours with initial effect within the first 30 minutes, making it an ideal choice to control expected postprandial glycemic spikes

5. Which of the following conditions is associated with an increased risk for conductive hearing loss? A. Acoustic neuroma B. Ménière disease C. Otitis media D. Presbycusis Ans>> Otitis media Causes of conductive hearing loss are otitis media (C), otitis externa, foreign objects in the ear canal, impacted ear wax, tumors, congenital anomalies, discontinuity of middle ear bones, cholesteatoma, and tympanic membrane rupture. Sound normally travels down the ear canal to vibrate the eardrum

7 / (tympanic membrane). The eardrum is connected to three middle ear bones (malleus, incus, and stapes), which transmit the sound into the inner ear (cochlea). The cochlea is the organ that changes sound vibrations into a nerve signal that travels to the brain. The four types of hearing loss are conductive, sensorineural, mixed, and retrocochlear. Conductive hearing loss occurs when sound cannot effectively reach the inner ear due to issue in the outer ear and middle ear.

6. A 23-year-old patient who is pregnant at 28 weeks gestation presents to the clinic for a routine prenatal checkup. Which fundal height measurement would warrant a more conclusive assessment with an ultrasound? A. 26 cm B. 29 cm C. 30 cm

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D.

31 cm Ans>> 31 cm After 20 weeks gestation, the fundal height should be measured with a measuring tape in centimeters and should match the gestational age. It can be > or < 2 centimeters and still be within normal limits. A fundal height of 26-30 cm is a normal finding in a patient who is 28 weeks gestation. A result of 31 cm (D) is larger than expected and should be further evaluated with an ultrasound.

7. A 4-year-old boy presents with ear pain and an erythematous, bulging tympanic membrane on examination. The nurse practitioner diagnoses him with acute otitis media. Which of the following are the three most common bacterial pathogens associated with acute otitis media in children? A. Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pneumoniae B. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus

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C.

Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae D. Nontypeable Haemophilus influenzae, Staphylococcus aureus, Streptococ- cus pneumoniae Ans>> Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae Acute otitis media is commonly encountered by primary care nurse practitioners. Typically, children present with otalgia and have a bulging tympanic membrane on examination. Many times, children also have a preceding viral upper respi- ratory infection, resulting in the colonization of bacteria in the middle ear and leading to a bacterial infection. Ear infections can be caused by bacterial and viral pathogens. The most common bacterial pathogens isolated from middle ear fluid are nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (C). The most common viral pathogens include respiratory syncytial virus, coronaviruses, influenza viruses, and adenoviruses. Treatment for acute otitis

10 / media should be targeted to combat the most common bacterial causes, including amoxicillin (penicillin), amoxicillin-clavulanate (penicillin and combination beta-lac- tam and beta-lactamase inhibitor), and an oral second-generation cephalosporin (e.g., cefuroxime) in the case of a child with a penicillin allergy.

8. A 6-year-old patient presents to the clinic accompanied by his mother, who reports concerns regarding her child's progressive urinary issues. The pa- tient's mother states that she and the child's father recently divorced, and the child alternates weekly between her house and his father's house. She reports he experiences episodes of urinary incontinence and holds his stomach as if he is in pain. He frequently asks to use the bathroom but is scared of urination once he is there. Which of the following is the most likely diagnosis? A. Adjustment disorder B. Constipation C. Regression

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D.

Urinary tract infection Ans>> Urinary tract infection The most likely diagnosis is a urinary tract infection (D). His clinical presentation includes abdominal pain, urinary frequency, and dysuria, which are signs of cystitis in children, which is considered a lower urinary tract infection (UTI). Pyelonephritis is a complicated form of UTI that may present with persistent fever, flank pain, or vomiting.

9. A 12-year-old girl presents to the clinic with her parent, who is concerned about the C-shaped appearance of the girl's spine. The degree of curvature in her spine is 35 degrees. Which of the following is appropriate to educate the parent? A. "Your daughter's spine has a mild curve but does not require treatment and will likely resolve on its own." B.

12 / "Your daughter's spine has a mild curve, so we will watch and wait to see if it worsens. If so, treatment will be necessary." C. "Your daughter's spine has moderate curvature, so we will need to place her in a brace as treatment." D. "Your daughter's spine has severe curvature, so we will need to refer her for surgery as soon as possible. Ans>> "Your daughter's spine has moderate curvature, so we will need to place her in a brace as treatment." Scoliosis is a complex spinal deformity defined as a curve in the spine of at least 10 degrees. A curvature of 25 to 40 degrees is considered moderate scoliosis, and most cases require bracing for correction (C). Braces are offered for treatment in patients who are skeletally immature and have curves > 30 degrees at the first visit. Bracing is considered ineffective if the curvature is > 45 degrees because the patient has reached the threshold for surgical intervention. In male patients, the brace is worn until they stop growing, and in female patients, the brace is worn more than 1.5 years postmenarch or until the patient has grown < 1 cm over the previous 6 months.

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10. An 11-year-old patient reports a severe sore throat, fever, nausea, and headache. Upon exam, the nurse practitioner sees a strawberry red pharynx with petechiae on the hard palate. The remainder of the exam is benign. What would be the best initial test to order for this patient? A. Epstein-Barr virus panel B. Nucleic acid amplification test C. Rapid antigen detection test D. Rapid plasma reagin test Ans>> Rapid antigen detection test The patient in the above scenario is exhibiting signs of an acute group A streptococ-

14 / cal pharyngitis infection. Group A Streptococcus infections are the most common cause of bacterial pharyngitis in children and adolescents. Children typically present with the abrupt onset of pharyngitis, fever, headache, abdominal pain or nausea, and vomiting. Physical exam findings include throat erythema, palatal petechiae, enlarged or erythematous tonsils, enlarged anterior cervical lymph nodes, and a scarlatiniform rash. The gold standard for testing a patient with suspected group A streptococcal pharyngitis is a rapid antigen detection test (C). These tests provide quick, highly specific results and are readily available in most care centers. Because the sensitivity of the rapid antigen detection tests is a little lower, 70-90%, if a child initially tests negative, a confirmatory throat culture should be sent as a follow-up.

11. All of the following are potential secondary causes of hyperparathyroidism except: A. Chronic kidney disease B. Neck radiation exposure C. Parathyroid adenoma

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D.

Vitamin D deficiency Ans>> Parathyroid adenoma Secondary hyperparathyroidism occurs when an issue external to the parathy- roid lowers calcium levels. This can be due to chronic kidney disease (especially end-stage kidney disease), a vitamin D deficiency, or neck radiation exposure. Primary causes of hyperparathyroidism are due to an issue with the parathyroid itself, such as a parathyroid adenoma (C).

12. A patient recently diagnosed with primary adrenal insufficiency (Addison disease) requests additional education on this condition. Which of the follow- ing teaching statements is inaccurate? A. "If a potential Addisonian crisis goes untreated, it may lead to severe hypoten- sion and organ failure" B.

16 / "It is necessary to keep your IM hydrocortisone injection with you at all times" C. "You may experience electrolyte imbalances such as hyperkalemia and hy- ponatremia" D. "Your symptoms are related to an increase in a substance called cortisol in your blood" Ans>> "Your symptoms are related to an increase in a substance called cortisol in your blood" Your symptoms are related to an increase in a substance called cortisol in your blood (D) is an inaccurate statement, as Addison disease is a condition characterized by adrenal insufficiency, meaning the body is unable to produce sufficient amounts of the hormone cortisol.

13. A 72-year-old woman presents to the clinic with jaw pain when eating for 1 day. She reports feeling tired and having some blurry vision, a new nagging headache near her left eye, and a fever. Which of the following is the best next step? A. Order inflammatory markers

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B.

Prescribe the patient sumatriptan (Imitrex) C. Refer to an ophthalmologist for a biopsy D. Refer to the ED to rule out a potential brain bleed Ans>> Refer to an ophthalmologist for a biopsy Jaw claudication, or pain in the jaw with chewing, headache, fever, and blurry vision, is suspicious for temporal arteritis. Referral to an ophthalmologist for a biopsy (C) will confirm this diagnosis.

14. A 33-year-old patient recovering from a left rotator cuff repair performed 2 weeks ago reports for a follow-up visit. Before seeing the nurse practitioner, she is told to remove her shirt and undergarments and is given a gown and

18 / a sheet for modesty. She is assured that she is seeing a female nurse practi- tioner today who is aware of her Afghani heritage, Islamic faith, and cultural values. Today, the nurse practitioner demonstrates which of the following in the care of the patient? A. Cultural competence B. Cultural ethnocentrism C. Cultural relativism D. Cultural sensitivity Ans>> Cultural competence Culture can be defined as a group phenomenon. It is expansive and inclusive of a group's customs, social institutions, and achievements. Nurse practitioners with cultural competence (A) take cultural sensitivity further by striving to learn and incorporate knowledge of diverse cultures into practice. It is viewed as a journey without any specific endpoint.

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15. A parent brings in their 6-year-old son with concerns about a pertussis ex- posure in the child's classroom. If the patient is not up to date on vaccinations, which vaccine should the nurse practitioner administer at today's visit? A. DTa P B. Td C. Tdap D. Vaccination is not necessary since he has already been exposed Ans>> DTaP The patient should receive the DTaP (A) vaccination at today's visit. Five doses of

10 / 57 pertussis-containing vaccine are recommended before a child enters school. While the DTaP vaccination is not guaranteed to prevent pertussis, it should help lessen the severity of symptoms. Postexposure prophylaxis of azithromycin is recommended in children who are in close contact with an infected person or at high risk for severe pertussis.

16. The nurse practitioner is suspicious of possible papilledema after obtain- ing a thorough history from a patient. Which statement made by the patient raises the index of suspicion for this pathology? A. "I was sitting at my desk this afternoon and suddenly developed eye pain" B. "My vision has been getting worse over the last few months but has improved with new glasses" C. "My vision suddenly became blurry, and I saw flashing lights and floaters" D. "While getting ready for work this morning, I began to

10 / 57 experience flickering vision that lasted only a few seconds" Ans>> "While getting ready for work this morning, I began to experience flickering vision that lasted only a few seconds" Papilledema is described as a sudden onset of vision changes, including blurred or double vision, flickering, and loss of vision lasting seconds at a time (D). Upon examination of the eye, the nurse practitioner may see that the margins of the disk are blurred, and the central cup cannot be visualized due to disk swelling. Headaches are also a common finding. Papilledema should be considered an emergency, as it can indicate increased intracranial pressure or a dangerously high blood pressure.

17. A 23-year-old man presents to the office with concerns of yellow/green penile discharge and pain with urination. The patient reports a poor hydration status, multiple new sexual partners over the past year, and occasional use of condoms. The vital signs are as follows: weight 180 lbs, blood pressure 120/60 mm Hg, pulse 68 bpm, and temperature 98.4°F orally. A nucleic acid amplification test is positive for gonorrhea and negative for chlamydia. What is the best treatment plan for this patient?

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A.

Ceftriaxone (Rocephin) 1 g intramuscular; retest in 3 months B. Ceftriaxone (Rocephin) 500 mg intramuscular and azithromycin (Zithromax) 1 g oral; no test of cure is indicated C. Ceftriaxone (Rocephin) 500 mg intramuscular and azithromycin (Zithromax) 1 g oral; retest in 3 months D. Ceftriaxone (Rocephin) 500 mg intramuscular; no test of cure is indicated Ans>> Ceftriaxone (Rocephin) 500 mg intramuscular; no test of cure is indicated The CDC recently updated the treatment guidelines for gonorrhea and chlamydia. For individuals weighing < 150 kg, gonorrhea infections are to be treated with a single intramuscular dose of ceftriaxone (Rocephin) 500 mg (D). For individuals weighing e 150 kg, 1 g ceftriaxone intramuscular in a single dose should be adminis- tered. A patient who is appropriately treated does not require a test of cure. Specific to chlamydia, for individuals weighing <150 kg, chlamydia (confirmed or suspected)

12 / should be treated with doxycycline 100 mg orally twice daily for 7 days

18. Which of the following headaches typically presents with bilateral pain rather than unilateral pain? A. Cluster headache B. Migraine headache C. Temporal arteritis D. Tension headache Ans>> Tension headache

13 / Headaches are one of the most commonly reported symptoms in the adult pop- ulation. It is important to know the characteristics associated with each type of headache to help correctly diagnose the condition. Tension headaches (D) are the most commonly reported headaches in adults. The usual symptoms include mildly to moderately intense head pain that is bilateral in nature. The pain is typically described as dull, pressure-like, band-like, or fullness-like. Tension headaches are not usually pulsating or throbbing in quality and do not cause associated nausea, vomiting, photophobia, or increased pain with movement. Some patients present with increased pericranial muscle tenderness, including tenderness in the myofas- cial muscles, neck muscles, and shoulders.

19. 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

14 / 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 Ans>> Without their glasses, the patient is considered legally blind Legal blindness is considered vision that is 20/200 or less (D) without corrective eyewear. This means that they can see at 20 feet what a person with 20/20 vision sees at 200 feet. Depending 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.

20. 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