ANCC Family Nurse Practitioner (FNP) Exam Questions and Answers, Exams of Nursing

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ANCC Family Nurse Practitioner – ANCC

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A 15-year-old female who is 10 weeks pregnant presents with complaints of vaginal bleeding, abdominal pain, vomiting, and muscle spasms for the last 4 hours. Her BP is 165/110. She is febrile, has cold extremities, and is trembling. Abdominal ultrasound confirms a miscarriage with no retained products of conception. Withdrawal from which of the following substances could lead to miscarriage in this female? A. Codeine B. Cannabis C. Cocaine D. NicotineCorrect Answer: A. Codeine Miscarriage is a complication of opioid withdrawal in the female. During pregnancy, opioid withdrawal, even when treated, can increase the risk of miscarriage and premature birth. In addition, there is a very high rate of relapse after detoxification, and the risk of cycling between intoxication and withdrawal can be even more dangerous to the fetus. Methadone maintenance has generally been accepted as the standard approach to the pregnant woman. Buprenorphine maintenance is also increasingly being used in pregnant opioid- dependent women. Coordinated care between the substance abuse treatment provider and the obstetrical team

is of utmost importance. Other complications of IV use of opioids include endocarditis, HIV, HBV/HCV, cellulitis, abscesses, septic arthritis, osteomyelitis, pneumonia, insomnia, myalgias, runny nose, meningitis, pulmonary emboli, and nephrotic syndrome. InCorrect Answers: B. Cannabis use during pregnancy may lead to fetal growth retardation and cognitive and behavioral impairments with psychiatric symptoms in the child. However, withdrawal symptoms in this female indicate opioid abuse. C. Cocaine can lead to fetal hypoxia and placental abruption, but withdrawal symptoms in this female are suggestive of opioid withdrawal. D. These symptoms are not suggestive of nicotine withdrawal. A 54-year-old male arrives at the office for a wellness check. He is on an MAOI medication. Which of the following foods does NOT have to be avoided by this patient taking an MAOI? A. Pickled herring B. Smoked salmon C. Chianti wine D. Lima beansCorrect Answer: D. Lima beans Lima beans are a safe food to eat while taking MAOI medications.InCorrect Answers: C

D. Leukocytes and epithelial cellsCorrect Answer: C. Clue cells Clue cells would be found in the wet mount of a person diagnosed with BV. InCorrect Answers: A. This would not be found in a BV diagnosis.B. The Tzanck cell is associated with varicella not BV. D. This would not be found in a BV diagnosis. To make a diagnosis of allergic rhinitis in the primary care office setting, the nurse practitioner would consider performing: A. A nasal smear B. A total serum IgE C. Skin tests D. RASTCorrect Answer: A. A nasal smear A nasal smear is a simple test and nurse practitioners may obtain. InCorrect Answers: B. Many clients who have uncomplicated allergic rhinitis have a normal serum IgE. C. Skin testing should be performed by trained providers only.D. RASTs cost more and have a lower sensitivity. Vital Concepts: A nasal smear is a simple test and nurse practitioners may obtain to make a diagnosis of allergic rhinitis in the primary care office setting.

While providing care to children in Bangladesh you notice that many of the children present with the same complaint. On further discussion, you learn that they eat a diet of grains, dairy and occasional meat with no fruits and vegetables. What is the most likely chief complaint? A. Night blindness B. Diarrhea, dermatitis, and dementia C. Megaloblastic anemia D. Irritability, bleeding gums, and periosteal hemorrhageCorrect Answer: D. Irritability, bleeding gums, and periosteal hemorrhage Infantile scurvy presents with irritability, bone tenderness, bone swelling, and pseudoparalysis of the legs.Scurvy may occur in infants who are fed unsupplemented cow's milk in the first year of life or if the diet islacking fruits and vegetables. In older individuals, scurvy presents with osmotic diarrhea, bleeding gums,perifollicular hemorrhage, arthropathy, and painful bones. Although scurvy is rare in children, it is still reported in children who ingest only well-cooked foods and few fruits or vegetables. Dietary sources of vitamin C include papaya, citrus fruits, cantaloupe, strawberries, tomatoes, cabbage, and potatoes. InCorrect Answers: A. A diet consisting of grains, dairy and occasional meat is lacking in vitamin C and could lead to scurvy, which typically presents with irritability and bleeding gums. Night blindness is a symptom of vitamin A deficiency. Vitamin A deficiency is the leading cause

culture will provide definitive diagnosis and will indicate which antibiotic(s) will cure the infection. InCorrect Answers: A. Creatinine is a product of muscle metabolism and is an indirect measurement of glomerular filtration rate. It is NOT a test for infection. B. The 24-hour urine for microalbumin is a test used to measure albumin in the urine. It is used to screen for early renal disease in diabetics, but is NOT a test for infection. D. An IVP is used to radiologically visualize the kidneys, ureters and urethra. It is not the test of choice for infection. Which of the following RBC indices and laboratory markers are consistent with the diagnosis of iron-deficiency anemia? A. Low MCV, low RDW, low reticulocyte count, low iron, low TIBC, low ferritin, low transferrin B. Low MCV, elevated RDW, elevated reticulocyte count, low iron, low TIBC, low ferritin, low transferrin C. Low MCV, elevated RDW, low reticulocyte count, low iron, elevated TIBC, low ferritin, high transferrin D. Elevated MCV, low RDW, elevated reticulocyte count, low iron, elevated TIBC, low ferritin, low transferrinCorrect Answer: Low

MCV, elevated RDW, low reticulocyte count, low iron, elevated TIBC, low ferritin, C. high transferrin Iron-deficiency anemia is the most common cause of anemia in children ages 9 to 24 months. It is a microcytic (low MCV, defined as a mean corpuscular volume of <80 μm3 [80 fL]) and hypochromic anemia. It is associated with an elevated RDW, reflecting a wide distribution of RBC sizes (note that RDW is often normal in anemia of chronic disease) and a low reticulocyte count (reflecting a lack of production of new RBCs). Fe studies demonstrate low iron, high TIBC (referring to the ability of unsaturated transferrin to bind iron, which will increase during iron deficiency because more receptors are available), low ferritin (lower iron in the body means that less is stored), and high transferrin (a major transporter of iron, of which the liver increases production in iron deficiency). Risk factors for iron-deficiency anemia include high milk intake, prematurity, blood loss, vegetarian diet, and elevated serum lead. Fe-deficiency anemia and even Fe-deficiency without anemia has adverse effects on attention span, behavior, and school performance. Treatment involves correction of the underlying etiology when possible (e.g. decreased milk intake) and supplemental iron therapy. InCorrect Answers: A. Low RDW, low TIBC, and low transferrin are not consistent with iron-deficiency anemia.B. Elevated reticulocyte count, low TIBC, and low transferrin are not consistent with iron-deficiency anemia. D. Elevated MCV is not consistent with iron-deficiency anemia.

perform a lateral soft tissue neck XR, but in this case, do not waste the time doing so. InCorrect Answers: (A) This patient is actively having respiratory distress that requires immediate care. (C) This patient is actively having respiratory distress that requires immediate care. (D) This patient is actively having respiratory distress that requires immediate care. Vital Concepts: This patient has a "hot potato" muffled voice consistent with epiglottitis or another acute upper-airway obstruction. The rapid- onset sore throat, fever, and drooling all support the diagnosis of possible epiglottitis. Peritonsillar abscesses can also cause these symptoms and should be on your differential as well. The patient needs to be sent to the ER immediately to stabilize her airway if necessary with intubation. An otherwise healthy 35-year-old female presents with a persistent annoying cough of two weeks' duration. She states that she initially had a temperature of about 99 degrees Fahrenheit with a runny nose. At that time, her cough was mild, but now she states that she has been experiencing paroxysm of coughing frequently without any apparent reason. On several occasions, she has vomited afterwards. Today, she is afebrile and her lungs are clear. Which of the following is most likely to be true in this case? A. Td should be given B. CT chest is indicated

C. Contact precautions should include respiratory droplet precautions D. Levofloxacin is indicated as first-line therapy for this patientCorrect Answer: C. Contact precautions should include respiratory droplet precautions The patient in this case has a presentation that is typical of pertussis, or whooping cough. This disease is caused by the gram negative bacteria Bordetella pertussis. Pertussis is a coughing illness of at least 2 weeks' duration with one of the following findings:

• Inspiratory whooping or post-tussive vomiting without apparent cause • Paroxysmal coughingThere are three stages of pertussis:• Catarrhal stage: low-grade fever, rhinorrhea, mild cough
• Paroxysmal stage: Severe cough with inspiratory "whooping" sound and post-tussive vomiting in some cases
• Convalescent stage: cough becomes less frequent and resolves Laboratory investigations include use of a nasopharyngeal swab for culture and polymerase chain reaction; pertussis antibodies by enzyme-linked immunosorbent assay (ELISA); and CBC (increased WBC count with lymphocytosis up to 80%). Chest radiographs are normally negative, unless a secondary bacterial infection is present. First-line treatment is a macrolide antibiotic. Chemoprophylaxis is recommended for close contacts, with respiratory droplet precautions. Antitussives, mucolytics, hydration, and rest are recommended. Patients who require a booster vaccination against pertussis should receive the Tdap instead of Td.

one day she figured out that what she needed was a change in her medication dose. She halved the medication, and she felt so good that she halved it again the following day. "I feel superfidiciously great!" she crows. Her husband relates that she went shopping again this morning and picked up 2 bottles of expensive perfume, 1 bottle of $400 cologne, and an armload of designer clothes. Which of the following is a medication she was likely on? A. Fluoxetine (Prozac) B. Valproate sodium (Depacon) C. Bupropion (Wellbutrin) D. Mirtazapine (Remeron)Correct Answer: B. Valproate sodium (Depacon) Both lithium and valproate sodium are treatments for bipolar disease, and a reduction in her dosage is likely what brought her into a manic state. None of the other medications listed is the first- line treatment for bipolar disease. If she had doubled a dose of medication instead of reducing it, fluoxetine would be the likely culprit to induce mania. InCorrect Answers: (A), (C), (D) None of the other medications listed is the first-line treatment for bipolar disease. All of the following are responsible for bacterial AOM in children EXCEPT?

A. Streptococcus pneumoniae B. Staphylococcus aureus C. Moraxella catarrhalis D. Haemophilus influenzaeCorrect Answer: B. Staphylococcus aureus The three most common pathogens in AOM: Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae. Amoxicillin or Amoxicillin-clavulanate arethe first-line treatment for AOM. S. aureus is rarely a causative agent in AOM. InCorrect Answers: (A), (C), (D) are correct organisms responsible for AOM. The NP knows that the appropriate test to screen for color blindness in an 8 year old is the: A. Cover/uncover test B. Red reflex exam C. Ishihara chart D. Snellen chartCorrect Answer: C. Ishihara chart The Ishihara chart is the appropriate test to use for screening for color blindness. InCorrect Answers: A. The cover/uncover test is a test for ocular deviation to test for strabismus.

neuron impairment of Bell's palsy must be distinguished from upper motor neuron dysfunction. The dorsal aspect of the facial motor nucleus receives input from bilateral cortex, while neurons in the ventral aspect of the nucleus receive primarily contralateral cortical input. The result is that the muscles of the upper face are under bilateral cortical control, while the lower facial musculature is under contralateral cortical control. The clinical consequence is that unilateral cortical lesions may spare facial emotional responses and reflexes due to their bilateral cortical control. The more distal lower motor lesions would impair facial nerve function more broadly, voluntary movements, emotional responses, and reflexes equally. A branch of the facial nerve, the chorda typmpani, carries efferents to the sublingual and submandibular glands, to control salivation. It also contains taste fibers from the anterior two-thirds of the tongue. Decreased taste sensation in the setting of Bell's palsy suggests involvement of the chorda tympani. InCorrect Answers: A. The facial nerve exits the skull at the stylomastoid foramen, where the nerve branches to innervate the f The NP suspects that the patient has a Helicobacter pylori infection of the stomach that the NP would like to treat. The patient is already undergoing an upper endoscopy to evaluate persistent GI symptoms. The definitive test for diagnosis of H. pylori is: A. A tissue biopsy from the endoscopy

B. An H. pylori titer C. An upper GI series D. A urea breath testCorrect Answer: A. A tissue biopsy from the endoscopy A definitive diagnosis of H. pylori infection is best done through a tissue biopsy from an endoscopy. InCorrect Answers: B. An H. pylori titer only determines if the patient has been exposed to H. pylori during his lifetime. Therefore, the patient may or may not have an active infection. C. Although a clinician might suspect an infection, the upper GI series is an X-ray that will not definitively diagnose H. pylori infection. D. A urea breath test or stool antigen are good non-invasive test that help to diagnose H. pylori infection. However, in patients already undergoing endoscopy, the tissue biopsy continues to be the gold standard for diagnosis of H. pylori infection. In patients not undergoing endoscopy, either a urea breath test or stool antigen would be appropriate. A 32-year-old male presents with about 1 month of cough, intermittent chills, subjective fevers, myalgias, and anorexia. He says he thought he had just caught a cold, but he "just can't shake it." He reports no other past medical history and only takes OTC pain relievers occasionally for the symptoms. He smokes a few cigarettes a week in social settings. He denies GI and urinary symptoms. He denies recent travel or camping and has had no known sick contacts.

asymmetrical. Following a thorough neurological exam, the NP determines that the patient has paralysis of cranial nerve VII and makes the determination that the patient likely has Bell's Palsy. Laboratory testing in patient's with Bell's Palsy, (when indicated) includes which of the following? A. Lyme disease antibody titer and/or blood glucose B. CBC C. CT scan of the head and neck D. BUN and creatinineCorrect Answer: A. Lyme disease antibody titer and/or blood glucose Bell's Palsy is a peripheral palsy of the facial nerve which causes muscle weakness on one side of the patient's face. If the NP does not suspect other brain dysfunction, the Lyme disease antibody titer is the most appropriate test to order if there is an appropriate history, as Bell's Palsy may be a complication of Lyme disease. In addition, there is an association between Bell's Palsy and Diabetes and a blood glucose is warranted if the patient has the appropriate risk factors. Another possible etiology is herpes simplex virus type I. Most cases of Bell's Palsy will resolve spontaneously without treatment (70-80 %), though therapy with Acyclovir and steroids has the potential to shorten the duration of the disease. InCorrect Answers: B. Although the NP is likely to order a CBC, this is not the most appropriate next diagnostic test. C. If the NP does not suspect other neurological problems, a CT scan of the head and neck is unlikely to provide diagnostic information.

D. The BUN and creatinine are unlikely to provide valuable diagnostic information. A 32-year-old male presents with a productive cough. He states that this cough started 2 weeks ago and has gotten progressively worse. He denies any fevers, changes in weight, or hemoptysis. His sputum is green in color, and he also complains of a runny nose and muscle soreness. Scattered wheezes are auscultated on physical exam. Which of the following statements are correct regarding his diagnosis? A. Order chest X-ray to rule out pneumonia. B. Order chest X-ray to diagnose bronchitis. C. Order chest X-ray to rule out tuberculosis. D. No radiologic imaging should be performed.Correct Answer: D. No radiologic imaging should be performed. This patient has acute bronchitis. Acute bronchitis has no clear- cut definition for the duration of symptoms, but the general acceptance is cough for <3 weeks. A productive cough is the predominant symptom. Fever and other systemic symptoms are usually absent. Muscle pains, pleuritic chest pain, fatigue, headache, and runny nose can be present. Care for acute bronchitis is primarily supportive, as therapy is generally focused on alleviation of symptoms. Among otherwise healthy individuals, antibiotics have not demonstrated any consistent benefit in acute bronchitis because the etiology is most likely viral in nature. Chest radiography should be performed in patients whose physical examination findings suggest pneumonia. Elderly patients may have no signs of pneumonia; therefore, chest radiography may be