AANP EXAM QUESTIONS AND CORRECT ANSWERS 2023/2024 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) - CORRECT ANSWER -D. 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 conditi on. Which of the following is not a symptom of both major depressive disorder and post -
traumatic stress disorder? A. Difficulty concentrating B. Hypervigilance C. Insomnia D. Irritabilty - CORRECT ANSWER -B. 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 associated with t his diagnosis. 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 insuli n 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 70/30 B. Insulin detemir C. Insulin isophane D. Insulin degludec - CORRECT ANSWER -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 programs 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 manuf acturers, 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. A 40-year-old woman with type 2 diabetes presents to the clinic with concerns 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 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 - CORRECT ANSWER -A. 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 experi ence blood glucose spikes between meals because of its short -acting properties. 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 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 - CORRECT ANSWER -C. 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 travel s down the ear canal to vibrate the eardrum (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. 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 D. 31 cm - CORRECT ANSWER -D. 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. 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 C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae D. Nontypeable Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae - CORRECT ANSWER -C. 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 respiratory infection, resu lting 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 infl uenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (C). The most common viral pathogens include respiratory syncytial virus, coronaviruses, influenza viruses, and adenoviruses. Treatment for acute otitis media should be targeted to combat the most common bacterial causes, including amoxicillin (penicillin), amoxicillin -clavulanate (penicillin and combination beta -lactam and beta -lactamase inhibitor), and an oral second -generation cephalosporin (e.g., cefuroxime) in the case of a child with a penici llin allergy. A 6-year-old patient presents to the clinic accompanied by his mother, who reports concerns regarding her child's progressive urinary issues. The patient'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.
