AANPCB FNP Exam Questions

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81.

While conducting a well-child check-up for a two-year-old, you note the presence of three superficial pustular vesicles on her neck. Which medication will you plan to prescribe as treatment?

  • Topical mupirocin

  • Oral erythromycin

  • Oral penicillin

  • Topical neomycin

Correct answer: Topical mupirocin

Topical antimicrobial therapy is adequate for nonbullous impetigo with a single lesion or small area of involvement. First-line therapy for a mild infection is mupirocin (Bactroban, Centany) as the preferred agent. Retapamulin (Altabax) is another antibacterial that is sometimes used during initial treatment of lesions.

Mupirocin use is associated with higher cure rates compared with oral erythromycin; however, both are noted to be superior to penicillin. Bacitracin and neomycin are less effective topical treatments; use of these products is not recommended for the treatment of impetigo.

82.

Following the review of patient education materials with a patient diagnosed with celiac disease, which statement made by the patient indicates the need for further education?

  • "I need to avoid all dairy products for the rest of my life."

  • "Foods I will not be able to eat include crackers, bagels, and pasta."

  • "I can include corn and any type of plain rice in my diet."

  • "I can have a glass of wine with my evening meal."

Correct answer: "I need to avoid all dairy products for the rest of my life."

While some people with celiac disease need to avoid cow's milk and milk products when they first begin treatment (temporarily), most can slowly add dairy foods, except processed cheese, back into their diet as the intestine heals (when intestinal symptoms resolve). It is important to reintroduce dairy products slowly, gauging symptom response. 

The person with celiac disease must avoid all foods that contain gluten; a gluten-free diet is essential. This includes foods made with wheat, barley, rye, or triticale, such as bread, crackers, bagels, and pasta. Grains that do not contain gluten include corn and any type of plain rice. Distilled alcoholic beverages such as wine are gluten-free because distillation effectively removes gluten.

83.

Which assessment findings would MOST LIKELY indicate a urinary tract infection (UTI) in your elderly female patient?

  • Change in mental status and muscle weakness

  • Dysuria, urinary frequency

  • Hematuria, pyuria and new-onset urinary incontinence

  • Pyrexia, bacteriuria, and muscle weakness 

Correct answer: Change in mental status and muscle weakness

The elderly often present with "atypical" symptoms of UTI, such as confusion (or dementia), anorexia, muscle weakness, and/or new-onset incontinence.

The more typical urinary symptoms, such as dysuria, hematuria, and frequency, are often absent. The elderly patient may have a delay in developing a fever (pyrexia), may not have an elevation in temperature, may have an elevation of less than 2 degrees Fahrenheit above their baseline, or may be hypothermic.

An elevated bacteria count and the presence of pus in the urine (pyuria) without other signs and symptoms indicate asymptomatic bacteriuria rather than a UTI.

84.

A group of Family Nurse Practitioner (FNP) students is practicing performing the visual exam, including the fundoscopic exam. Which of the following findings is most likely to be considered a normal finding of the fundoscopic exam?

  • The optic disc is well-circumscribed and lighter in color than the rest of the retina.

  • The retinal arteries and veins show evidence of nicking.

  • The retinal veins are smaller than the arteries.

  • The retinal arteries are darker in color than the veins. 

Correct answer: The optic disc is well-circumscribed and lighter in color than the rest of the retina.

While the FNP may not often be called upon to complete a full fundoscopic exam, they should be familiar with normal fundoscopic findings and also be able to recognize abnormal changes to the retina. The retinal veins are larger than the arteries and appear darker in color than the arteries. The optic disc should be lighter in color than the rest of the retina and well-circumscribed and oval in appearance, being located on the nasal side of the retina. The retinal arteries and veins appear to branch out from the center of the optic disc. The macula is located laterally to the optic disc in the center of the retina and is more heavily pigmented than the surrounding retinal tissue; it is also somewhat oval. 

Nicking of the arteries and veins is an abnormal sign caused by hypertensive retinopathy. Other abnormal fundoscopic findings include cupping of the optic disc (glaucoma), microaneurysms, cotton-wool spots (most commonly found in diabetic retinopathy), and papilledema (caused by increased intracranial pressure).

85.

Your 40-year-old female patient describes experiencing recurring headaches, characterized by moderate pressing pain, occurring bilaterally. She denies symptoms such as photophobia or nausea. Which type of medication will you plan to prescribe to prevent recurrence?

  • Tricyclic antidepressants

  • Systemic corticosteroids

  • Neuroleptics

  • Opioids

Correct answer: Tricyclic antidepressants

The symptoms described are characteristic of tension-type headaches. Tricyclic antidepressants, such as nortriptyline and amitriptyline, are first-line medications used to prevent tension headache. Side effects of these medications may include weight gain, drowsiness, and dry mouth.

Systemic corticosteroids are effective in the treatment of severe migraine, status migrainosus, and cluster headache. 

Neuroleptics may be used as adjuncts in migraine therapy for their antiemetic effect.  

Opioids such as hydrocodone and oxycodone provide analgesia and are on occasion prescribed for migraine rescue. They are not indicated for prevention of tension-type headache, as they are sedating and potentially habituating in addition to being substances of potential abuse.

86.

The risk of which type of skin cancer does NOT increase with exposure to sunlight? 

  • Malignant melanoma 

  • Squamous cell carcinoma 

  • Basal cell carcinoma 

  • Actinic keratosis 

Correct answer: Malignant melanoma 

Malignant melanoma is a malignancy that originates from melanocytes, and the risk of this type of cancer does not increase with exposure to sunlight. Therefore, the use of sunscreen has little effect on reducing the risk of this type of skin cancer.

Sun exposure increases the risk of actinic keratosis (a precancerous skin lesion), as well as squamous cell carcinoma and basal cell carcinoma. The consistent use of high sun protection factor (SPF) sunscreen is critical and helps reduce, but not eliminate, the risk of these conditions. 

87.

You would be most likely to diagnose macular degeneration in your 75-year-old patient if she had all the following risk factors except:

  • Being of Asian descent

  • Having a history of cigarette smoking

  • Having a history of excessive sun exposure

  • Being of European descent

Correct answer: Being of Asian descent

Macular degeneration is the most common cause of newly acquired blindness or vision loss in the elderly. Loss of the central visual fields results in loss of visual acuity and contrast sensitivity. 

Risk factors include:

  • being female
  • being of European descent
  • having a history of cigarette smoking
  • having a family history of macular degeneration
  • having a history of excessive sun exposure

88.

You are examining a patient who has pain when passing stool that lasts for hours after each bowel movement. She reports seeing bright red drops of blood when wiping. Which of the following factors most increases the risk for anal fissure?

  • Recent or recurrent constipation

  • Recent or recurrent severe diarrhea

  • Recent childbirth

  • Anal intercourse or other anal insertion practices

Correct answer: Recent or recurrent constipation

A history of recent or recurrent constipation causing straining during bowel movements is the most potent risk factor for anal fissure. The primary treatment goal is to prevent constipation and, therefore, break the cycle that contributes to the condition. 

Other anal fissure risk factors include recurrent or recent severe diarrhea, recent childbirth, and anal intercourse or other anal insertion practices. 

89.

A patient with a diagnosis of gastroesophageal reflux disease (GERD) has experienced a recurrence of symptoms. Which of the following medications that the patient has recently been prescribed may have been a contributing factor?

  • Verapamil (Calan, Verelan)

  • Captopril (Capoten)

  • Losartan (Cozaar)

  • Cimetidine (Tagamet)

Correct answer: Verapamil (Calan, Verelan)

Verapamil (Calan, Verelan) is a calcium channel blocker, which can result in a decrease in lower esophageal sphincter pressure and worsen GastroEsophageal Reflux Disease (GERD). Calcium channel blockers should be discontinued if clinically possible. Other medications, including estrogen, progesterone/progestins, theophylline, iron supplements, NSAIDS, nitrates, Alpha-adrenergic receptor agonists, anticholinergics, bisphosphonates, and nicotine are other medications that can worsen GERD. 

Losartan (Cozaar) is an angiotensin receptor blocker; captopril (Capoten) is an angiotensin-converting enzyme inhibitor. Cimetidine (Tagamet) is a histamine H2-receptor antagonist, which works to suppress or neutralize gastric acid. These medications are not known to decrease lower esophageal sphincter pressure.

90.

You are reviewing the results of a urine culture that was obtained from a sexually active 19-year-old female college student who presented to the on-campus clinic with complaints consistent with urinary tract infection (UTI) 3 days ago: dysuria, urinary frequency, and lower abdominal discomfort. The patient stated at that time she practices unprotected sex. The office urinalysis at that time was positive for leukocyte esterase. The culture results are negative.

Based on the patient's symptoms, the office urinalysis, and the urine culture results, you know:

  • The patient may have sterile pyuria.

  • The patient does not have a UTI.

  • The patient may have a vaginal yeast infection that is causing UTI symptoms.

  • The office urinalysis may have been incorrect.

Correct answer: The patient may have sterile pyuria.

Patients who are experiencing UTI-like symptoms and have an office urinalysis that is positive for leukocyte esterase and a negative urine culture may be experiencing what is referred to as sterile pyuria. The lack of possible pathogens on urine culture does not guarantee the patient does not have a UTI because organisms such as chlamydia or other non-gonococcal causes will not grow in the standard laboratory media utilized for diagnosing UTI.

Based on the patient's demographic and her history of unprotected sexual intercourse, the nurse practitioner should consider UTI with chlamydia or other Sexually Transmitted Infection (STI). 

91.

When performing a follow-up examination for a patient receiving acyclovir (Zovirax) for the suppression of frequently recurring outbreaks of genital herpes, which of the following assessment findings would you anticipate?

  • The incidence of recurrence has decreased 70% to 80%.

  • Virologic and serologic testing indicate that the patient is cured.

  • When recurrences occur, they are always symptomatic.

  • The incidence of recurrence has decreased 30% to 50%.

Correct answer: The incidence of recurrence has decreased 70% to 80%.

Suppressive therapy reduces the frequency of genital herpes recurrences by 70% to 80% in those who have frequent recurrences. Treatment is also effective in those who have less frequent recurrences.

Although there is no curative treatment for herpes, antiviral therapy for recurrent outbreaks can be given to reduce the frequency of recurrences or episodically to shorten the duration of lesions. Recurrent outbreaks are often asymptomatic with or without suppressive therapy.

92.

You are performing a diagnostic workup for a patient with symptoms consistent with acute kidney injury (AKI), typically associated with prerenal azotemia. You recognize all the following conditions may contribute to the development of prerenal azotemia except:

  • Urinary tract obstruction

  • Heart failure

  • Burns

  • Dehydration

Correct answer: Urinary tract obstruction

Prerenal azotemia is an abnormally high level of nitrogen waste products in the blood. It is the most common form of AKI in hospitalized patients. It can be caused by any condition that reduces blood flow to the kidneys or by hypoperfusion. An obstruction to urine flow, such as a urinary tract obstruction, causes postrenal azotemia rather than prerenal azotemia.

Heart failure, burns, and dehydration are causes of hypoperfusion, which may lead to prerenal azotemia.

93.

You are providing follow-up care for a patient who has been diagnosed with chronic hepatitis C infection. Which of the following laboratory or imaging studies should be periodically monitored to assess for hepatic tumors?

  • Alpha-fetoprotein

  • Anti-HCV (hepatitis C virus) levels

  • Magnetic resonance imaging (MRI)

  • Complete blood count (CBC) with differential

Correct answer: Alpha-fetoprotein

Individuals with chronic hepatitis B or C (HBV or HCV) are at high risk of developing hepatoma or hepatocellular carcinoma (HCC). Alpha-fetoprotein levels should be periodically monitored, and should an increased level be noted, carcinoma should be suspected. Surveillance should be performed for any adult with evidence of cirrhosis due to any etiology, as this can improve survival and early detection of HCC. 

Abdominal ultrasound or computed tomography (CT), not MRI, should follow testing of alpha-fetoprotein level. Anti-HCV level is used to establish a diagnosis of HCV, not to evaluate the development of further disease. Complete Blood Count (CBC) with differential would be utilized in assessing the extent of disease after diagnosis, as leukopenia with leukocytosis is typically found in individuals infected with the hepatitis virus.

94.

An 88-year-old male who was treated one week ago for cerumen impaction in the clinic by use of manual cerumen removal has been brought back to the clinic by his spouse for further evaluation. She states her husband has been complaining of severe ear pain and a feeling of fullness to the treated ear for the last 48 hours and is now experiencing foul-smelling drainage from the ear.

The nurse practitioner diagnoses acute otitis externa (AOE) and can plan to treat the patient with all the following agents except:

  • Tolnaftate drops

  • Hydrocortisone-neomycin sulfate-polymyxin B sulfate solution

  • Tobramycin and dexamethasone emulsion

  • Acetic acid drops

Correct answer: Tolnaftate drops

Acute otitis externa as well as pain or injury to the skin of the ear canal with hemorrhage may result from manual removal of impacted cerumen. In cases when excoriation results from removal of impacted cerumen or in patients who are immunocompromised, prophylactic antibiotics or acidic solutions that alter the pH of the external ear canal should be prescribed after completing the procedure. 

AOE, which results from manual removal of impacted cerumen, can be treated with:

  • hydrocortisone-neomycin sulfate-polymyxin B sulfate solution
  • tobramycin and dexamethasone emulsion
  • a mixture of white vinegar and rubbing alcohol applied in the ear every day for two to three days
  • acetic acid drops
  • chloramphenicol drops
  • Domeboro solution
  • Gentian violet
  • Mercurochrome
  • Cresylate
  • gentamycin drops
  • quinolones

Tolnaftate drops are used to treat infections caused by fungal organisms and can be instilled in the ear, but in this scenario, it is more likely the patient's acute otitis externa is due to a bacterial component, not a fungal component.

95.

A patient who was diagnosed with Iron-Deficiency Anemia (IDA) returned to the clinic to discuss with the Nurse Practitioner (NP) when she would need to return for lab work to evaluate the effectiveness of the iron replacement therapy protocol that was prescribed for her. Which of the following statements most accurately identifies at what point specific lab work should be completed after starting iron replacement therapy to evaluate for resolution of IDA?

  • The patient should return four months after starting iron replacement to have her ferritin level checked.

  • The patient should return two months after starting iron replacement to have her ferritin level and hemoglobin level checked.

  • The patient should return three months after starting iron replacement to have her hemoglobin level checked.

  • The patient should return one month after starting iron replacement to have her reticulocyte level and ferritin level checked.

Correct answer: The patient should return four months after starting iron replacement to have her ferritin level checked.

Once a patient who is Iron-Deficient Anemic (IDA) has begun iron replacement therapy, the bone marrow begins to quickly respond (within days) to the iron supplementation by incorporating it into newly-produced, immature Red Blood Cells (RBCs) called reticulocytes and releasing them into the blood. If the iron dose is sufficient and iron deficiency is the actual cause of the anemia, the reticulocyte count should reflect a significant increase in circulating reticulocytes (reticulocytosis) within two weeks of initiating iron replacement therapy. Other markers which reflect anemia such as the hemoglobin level take a few weeks longer to show improvement after beginning iron replacement. On average, the hemoglobin increases at a rate of 2 g/dL every three weeks in response to oral iron therapy, requiring approximately two months to return to a normal level. The patient should return to have the hemoglobin level rechecked six to eight weeks after starting iron therapy. The final marker used to evaluate improvement in anemia is the ferritin level. The ferritin level can either be checked two months after the hemoglobin has returned to normal or four months after starting iron therapy. Ferritin reflects iron that is stored in the liver. 

96.

You are planning care for an elderly patient who reports experiencing a painful rash in a band on one side of the torso. The rash began with blisters, which have since scabbed over. Your plan of care will include interventions related to which disorder?

  • Shingles 

  • Severe atopic dermatitis

  • Scabies 

  • Psoriasis Vulgaris outbreak

Correct answer: Shingles 

The rash described is typical of shingles, or Herpes Zoster infection, a reactivation of the chickenpox virus. Anyone who has a history of chickenpox may develop shingles, but the risk increases with advancing age. It is most common in those 50 and older, and can also be seen in patients with immunocompromise (cancer, HIV, immosuppressant medications) and those with an underlying health issue. When seen in younger adults, immunocompromise should be ruled out. 

The signs described are not consistent with severe atopic dermatitis, scabies, or a Psoriasis Vulgaris outbreak.

97.

When evaluating an older adult for medication side effects, you recognize all the following as possible adverse effects of anticholinergic agents in the elderly except:

  • Tremor

  • Confusion

  • Urinary retention

  • Constipation

Correct answer: Tremor

Anticholinergic medications such as benztropine (Cogentin) are used to prevent or treat tremor in the presence of Parkinson's disease or secondary to the side effects of antipsychotics.

Confusion, urinary retention, and constipation, along with dry mouth, are common adverse effects related to the use of anticholinergics in older adults.

98.

During the completion of a clinical rotation experience, a Family Nurse Practitioner (FNP) student was required to participate in the evaluation of a three-year-old male patient who was suspected of having Chronic Granulomatous Disease (CGD) based on his clinical presentation. All of the following have a high association with CGD, except:

  • Bacteremia

  • Pneumonia

  • Liver abscess

  • Skin infection

Correct answer: Bacteremia

Chronic Granulomatous Disease (CGD) is an X-linked or autosomal recessive (two modes of transmission) disorder that is characterized by recurrent infections and hypergammaglobulinemia. Infections occur as a result of a defect of the phagocyte in its production of superoxide, which is necessary for microbial eradication. X-linked CGD is more common in the US and has a more severe presentation than the autosomal recessive form of the disease which is more commonly diagnosed in individuals with consanguinity. Typically, CGD symptoms appear in the first few weeks or months after birth, with infants experiencing severe bacterial or fungal infections including fungal pneumonias, liver abscess (often due to S. aureus infection), perianal abscess, skin abscess, and osteomyelitis, as well as failure to thrive. If the affected individual possesses some residual superoxide production, the diagnosis of CGD may be delayed for several years, even into the school-age years, due both to the body's ability to better fight off opportunistic infection and today's modern healthcare system. 

Liver abscess and its related complications, including portal hypertension, can result in significant morbidity and mortality, as can the surgical treatment methods that have been typically used to treat this infection. Newer methods of treating liver abscesses rely more heavily on the use of antibiotics and steroids to provide resolution of the abscess versus the traditional surgical management of liver abscess, which included percutaneous or open drainage of the abscess. Pulmonary infection with Aspergillosis species is common in patients with CGD, with some species being readily treated with the administration of antifungal agents such as itraconazole and other species being a major source of morbidity and mortality and requiring surgical resection to fully resolve. Patients with Aspergillosis infection rarely present with other signs of infection, including fever and leukocytosis. Older children and adults may be more likely to present with symptoms of "mulch pneumonitis," a diffuse pulmonary infection caused by the inhalation of fungal spores disturbed during raking, playing in leaves, or gardening. Fever, hypoxia, and diffuse pulmonary infiltrates characterize this infection, which frequently serves as the initial presenting infection in the older pediatric age group and adults affected with CGD. 

99.

You are evaluating your patient's knowledge of her medication to treat condyloma acuminatum and know that she understands the treatment when she states which of the following?

  • "Imiquimod (Aldara) stimulates my immune system to suppress the virus which causes my warts."

  • "I need to make sure to use my imiquimod (Aldara) because I am at risk for cervical and anogenital cancer because of the virus which causes my genital warts."

  • "I need to return to the office for further treatment with imiquimod (Aldara) to fully treat my genital warts."

  • "I only need to apply the imiquimod (Aldara) once to treat my genital warts."

Correct answer: "Imiquimod (Aldara) stimulates my immune system to suppress the virus which causes my warts."

Imiquimod (Aldara) is one of the several treatment options available for condyloma acuminatum (genital warts), which is caused by the Human PapillomaVirus (HPV). The HPV that causes genital warts is considered a low-risk HPV strain and does not cause malignancy. More than 90% of genital warts are caused by the HPV types 6 and 11 (largely benign strains of HPV infection). 

Imiquimod (Aldara) is an immune system modulator and stimulates the immune system to suppress HPV. It is applied by the patient at home and requires up to 16 weeks to complete treatment.

100.

The acute bronchoconstriction that contributes to airflow obstruction in asthma is due to which of the following?

  • Immunoglobulin E-dependent mediator release after exposure to an allergen

  • Cytokine imbalance

  • Bronchial hyperresponsiveness of the airway

  • Phenotypic differences that contribute to airway inflammation

Correct answer: Immunoglobulin E-dependent mediator release after exposure to an allergen

Asthma is a complex airway disorder that affects both adults and children and is considered to be the most common disease of childhood. The pathophysiology of asthma involves inflammation of the airway, airway obstruction (intermittent), and hyperresponsiveness of the bronchi. The acute bronchoconstriction that contributes to the intermittent airway obstruction of asthma is due to an immunoglobulin E-dependent mediator release, which occurs within 6 to 24 hours of exposure to an allergen.

The role of cytokine imbalance in contributing to airway inflammation as a result of allergen exposure is unclear but has contributed to the development of the "hygiene hypothesis" of asthma.

Bronchial hyperresponsiveness is one of the components of the pathophysiology of asthma and is due to stimulation of the smooth muscle of the airway by mast cells or nonmyelinated sensory neurons.

Phenotypic differences do not contribute to airway inflammation.