AANP EXAM, PRACTICE EXAM AND STUDY GUIDE NEWEST 2024 ACTUAL EXAM 500+ QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+

AANP EXAM, PRACTICE EXAM
AND STUDY GUIDE NEWEST 2024
ACTUAL EXAM 500+ QUESTIONS
AND CORRECT DETAILED
ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY
GRADED A+
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 - ANSWER-B.
Nonalcoholic fatty liver disease
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 - ANSWER-C.
>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 carbidopalevodopa (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?
A.
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
C.
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 betablockers
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
C.
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- 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
- Dihydropyridines (amlodipine-Norvasc) - potent vasodilators that have little or no
negative effect on cardiac contractility
- Non- Dihydropyridines (verapamil-Verelan), diltiazem-Cardizem) - Never give to
someone with HF
Main SE: Ankle edema and headaches
Can make GERD sx worse
papilledema on fundoscopic exam - ANSWER-EMERGENCY!
what cardio meds to avoid in pregnancy - ANSWER-ACE and ARB
STATINS
What ASCVD score do we initiate BP meds? - ANSWER-> 10%
What ASCVD score do we initiate hyperlipidemia meds? - ANSWER-> 7.5%
What is isolated systolic hypertension? and preferred med? - ANSWER-Only SBP is
high / CCB or Thiazide
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? - ANSWERS3
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-S2
What sounds are heard at the apex of the heart? - ANSWER-S1, S3, S4
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
-nifedipine
-labetalol
- methyldopa
Loops diuretics and the biggest concern with what electrolyte? - ANSWER-Furosemide
Potassium
If large doses of lasix are delivered too quickly what may happen? - ANSWEROtotoxicity and hearing damage
potassium sparing diuretic , what to educate male patients about? - ANSWERSpironolactone (Aldactone)
Gynecomastia
Digoxin (Lanoxin), what electrolyte imbalance can cause toxicity easier? what is the
antidote? - ANSWER-cardiac stimulant and diuretic
Tx for HF and also those with Afib
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
What ABX can we treat PNA? (healthy outpatient adults) - ANSWER-think MAD
Macrolides
Amoxicillin
Doxyclycline
What ABX can we treat PNA for adults with major comorbidities or who have had ABX
within 90 days? - ANSWER-Fluoroquinolone's (Levaquin) or combo Augmentin with
macrolide
CURB-65 - ANSWER-C- CONFUSION
U- UREA (BUN) >19
R- RR > 20 or > 30
B - BP < 90/60
Age 65 or older
1 pt for each criteria
2 pts may need admission
3 pts or greater = HAVE TO BE ADMITED
What lobes are affected in PNA? - ANSWER-Lower
What lobes are affected in TB? - ANSWER-Upper
What is the recommended daily folic acid supplementation during a normal pregnancy?
A.
1,000 mcg
B.
250 mcg
C.
400 mcg
D.
500 mcg - ANSWER-