ANCC AGPCNP UPDATED ACTUAL
Exam Questions and CORECT Answers
An 18-year-old female patient is being followed up for acne by the nurse practitioner. During the
facial exam, papules and pustules are noted mostly on the forehead and the chin areas. The
patient has been using over-the-counter topical antibiotic gels and medicated soap daily for 6
months without much improvement. The nurse practitioner will recommend:
a. Isotretinoin (Accutane)
b. Tetracycline (Sumycin)
c. Clindamycin topical solution (Cleocin- T)
d. Minoxidil (Rogaine) - CORRECT ANSWER b. Tetracycline (Sumycin)
First-line treatment for acne vulgaris includes over-the-counter medicated soap and water with
topical antibiotic gels. The next step in treatment would be the initiation of oral tetracycline.
A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is
currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime
symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week.
The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner
upgrades the patient to the next stage of treatment, which includes:
a. Budesonide with formoterol
b. Budesonide with montelukast
c. Cromolyn or nedocromil
d. Fluticasone with salmeterol - CORRECT ANSWER a. Budesonide with formoterol.
The patient has moved from step 2 to step 3 on the asthma classification scale. Therefore, a low-
dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with
formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient
is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been
discontinued in the United States.
,Which of the following drugs can increase the risk of bleeding in patients who are receiving
anticoagulation therapy with warfarin sodium (Coumadin)?
a. Trimethoprim-sulfamethoxazole (Bactrim DS)
b. Carafate (Sucralfate)
c. Losartan (Cozaar)
d. Furosemide (Lasix) - CORRECT ANSWER a. Trimethoprim-sulfamethoxazole (Bactrim
DS).
Warfarin sodium (Coumadin) interacts with Bactrim and will increase the risk of bleeding;
therefore, concurrent use is contraindicated.
A 22-year-old woman is going on a 5-day cruise for her honeymoon. She reports a history of
severe motion sickness. Which of the following medicines can be prescribed for motion
sickness?
a. Dimenhydrinate (Dramamine)
b. Metoclopramide (Reglan)
c. Ondansetron (Zofran)
d. Scopolamine patch (Transderm Scop) - CORRECT ANSWER d. Scopolamine patch
(Transderm Scop)
Scopolamine patch (Transderm Scop) is a prescription medicine that is used for motion/sea
sickness. It is a small, circular patch that is placed behind the ear and is effective for 3 days.
Advise the patient to apply it 4 hours before the trip to be effective. Because the question is
asking about a "prescribed" medication, an over-the-counter (OTC) medicine, such as
Dramamine, is an incorrect response. Zofran is indicated for cancer-related nausea and vomiting
(chemotherapy, radiation, surgery).
The nurse practitioner is completing a health assessment on a 15-year-old female patient who is
in the office for her annual physical. The patient reports feelings of hopelessness and sadness for
several months, no history of suicidal ideations, and a struggle with anorexia. The patient scores
,an 11 on Beck's Depression Inventory. Which antidepressant will the nurse practitioner
prescribe?
a. Sertraline (Zoloft)
b. Lithium carbonate (Eskalith)
c. Bupropion (Wellbutrin)
d. Escitalopram (Lexapro) - CORRECT ANSWER d. Escitalopram [Lexapro]
Escitalopram is a safe antidepressant for an adolescent who has severe depression and no history
of suicidal ideations. Sertraline is not a safe option for patients younger than 24 years of age
because of increased risk of suicidal ideation. Bupropion is an atypical antidepressant and is not
a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium
is indicated for patients with bipolar disorder.
Which initial treatment will the nurse practitioner prescribe to a 23-year-old female allergic to
sulfa drugs who is diagnosed with acute cystitis?
a. Cephalexin (Keflex) 500 mg BID × 5 days
b. Ciprofloxacin (Cipro) 250 mg BID × 3 days
c. Nitrofurantoin (Macrobid) 100 mg BID × 5 days
d. Amoxicillin 500 mg BID × 5 days - CORRECT ANSWER c. Nitrofurantoin (Macrobid)
100 mg BID × 5 days
Nitrofurantoin can be safely administered to a patient with a sulfa allergy to treat acute cystitis
and is the first line of treatment. Cephalexin and amoxicillin are beta-lactam antibiotics that can
be prescribed for a patient who has an allergy to sulfa and nitrofurantoin. A fluoroquinolone,
such as ciprofloxacin, is recommended for a patient who is allergic to sulfa and beta-lactam
drugs or has a sulfa allergy and a known resistance to beta-lactam antibiotics.
A 68-year-old patient recently prescribed caridopa-levodopa (Sinemet) tells the nurse
practitioner that he has been bloated and experiencing difficulty with bowel movements. Which
medication will the nurse practitioner consider incorporating into the treatment plan?
, a. Senna
b. Methylnaltrexone
c. Magnesium citrate
d. Polyethylene glycol - CORRECT ANSWER d. Polyethylene glycol
Levodopa, an antiparkinsonian drug, can cause constipation in an older patient. The first-line
treatment for the patient's constipation is osmotic laxatives such as polyethylene glycol. Senna is
a stimulant laxative that is a second-line treatment for constipation in an older adult.
Methylnaltrexone is a peripherally acting mu-opioid antagonist that acts on the gastrointestinal
tract to decrease opioid-induced constipation. Magnesium-based laxatives (e.g., magnesium
citrate) taken over the long term should be avoided because of the potential of toxicity.
A patient recently returned from a trip to Africa and is experiencing 10 to 12 loose stools every
day. The patient takes metformin every morning and otherwise is in good health. Which
medication will the nurse practitioner prescribe to treat the diarrhea?
a. Levofloxacin daily
b. Ofloxacin BID
c. Trimethoprim-sulfamethoxazole BID
d. Ciprofloxacin in a single dose - CORRECT ANSWER d. Ciprofloxacin in a single dose
The patient most likely has traveler's diarrhea, given the history of a recent return from another
country. The patient's treatment should be based on functional impact of symptoms and not
frequency of symptoms, which is not indicated in the question. The patient likely has moderate
acute traveler's diarrhea, which can be treated with loperamide as monotherapy or with
adjunctive antibiotic therapy. The patient is taking metformin daily for diabetes, so risk of
precipitating hypoglycemia is lower than with other oral antidiabetic agents. Because it can be
given in a single dose, ciprofloxacin would be the appropriate choice for reducing exposure and
microbiome colonization disruption. Levofloxacin and ofloxacin require one to three doses.
Trimethoprim-sulfamethoxazole is a sulfonamide and would be appropriate treatment for
cyclosporiasis but not giardiasis, which is the most common parasitic cause of traveler's diarrhea.
A patient newly diagnosed with diabetes reports severe hives and swollen lips after taking
Bactrim for a bladder infection 2 months ago. Which of the following statements is correct?
Exam Questions and CORECT Answers
An 18-year-old female patient is being followed up for acne by the nurse practitioner. During the
facial exam, papules and pustules are noted mostly on the forehead and the chin areas. The
patient has been using over-the-counter topical antibiotic gels and medicated soap daily for 6
months without much improvement. The nurse practitioner will recommend:
a. Isotretinoin (Accutane)
b. Tetracycline (Sumycin)
c. Clindamycin topical solution (Cleocin- T)
d. Minoxidil (Rogaine) - CORRECT ANSWER b. Tetracycline (Sumycin)
First-line treatment for acne vulgaris includes over-the-counter medicated soap and water with
topical antibiotic gels. The next step in treatment would be the initiation of oral tetracycline.
A young adult presents for reassessment of uncontrolled asthma symptoms. The patient is
currently taking an inhaled short-acting beta2-agonist (SABA) as needed and reports daytime
symptoms more than 3 days/week, but not daily, and nighttime awakenings 4 to 5 times/week.
The patient's forced expiratory volume (FEV1) is 80% of predicted. The nurse practitioner
upgrades the patient to the next stage of treatment, which includes:
a. Budesonide with formoterol
b. Budesonide with montelukast
c. Cromolyn or nedocromil
d. Fluticasone with salmeterol - CORRECT ANSWER a. Budesonide with formoterol.
The patient has moved from step 2 to step 3 on the asthma classification scale. Therefore, a low-
dose inhaled corticosteroid (ICS) plus long-acting beta-agonist (LABA) such as budesonide with
formoterol is an appropriate starting point. Fluticasone with salmeterol is prescribed if the patient
is at step 4; budesonide with montelukast is an alternative. Cromolyn and nedocromil have been
discontinued in the United States.
,Which of the following drugs can increase the risk of bleeding in patients who are receiving
anticoagulation therapy with warfarin sodium (Coumadin)?
a. Trimethoprim-sulfamethoxazole (Bactrim DS)
b. Carafate (Sucralfate)
c. Losartan (Cozaar)
d. Furosemide (Lasix) - CORRECT ANSWER a. Trimethoprim-sulfamethoxazole (Bactrim
DS).
Warfarin sodium (Coumadin) interacts with Bactrim and will increase the risk of bleeding;
therefore, concurrent use is contraindicated.
A 22-year-old woman is going on a 5-day cruise for her honeymoon. She reports a history of
severe motion sickness. Which of the following medicines can be prescribed for motion
sickness?
a. Dimenhydrinate (Dramamine)
b. Metoclopramide (Reglan)
c. Ondansetron (Zofran)
d. Scopolamine patch (Transderm Scop) - CORRECT ANSWER d. Scopolamine patch
(Transderm Scop)
Scopolamine patch (Transderm Scop) is a prescription medicine that is used for motion/sea
sickness. It is a small, circular patch that is placed behind the ear and is effective for 3 days.
Advise the patient to apply it 4 hours before the trip to be effective. Because the question is
asking about a "prescribed" medication, an over-the-counter (OTC) medicine, such as
Dramamine, is an incorrect response. Zofran is indicated for cancer-related nausea and vomiting
(chemotherapy, radiation, surgery).
The nurse practitioner is completing a health assessment on a 15-year-old female patient who is
in the office for her annual physical. The patient reports feelings of hopelessness and sadness for
several months, no history of suicidal ideations, and a struggle with anorexia. The patient scores
,an 11 on Beck's Depression Inventory. Which antidepressant will the nurse practitioner
prescribe?
a. Sertraline (Zoloft)
b. Lithium carbonate (Eskalith)
c. Bupropion (Wellbutrin)
d. Escitalopram (Lexapro) - CORRECT ANSWER d. Escitalopram [Lexapro]
Escitalopram is a safe antidepressant for an adolescent who has severe depression and no history
of suicidal ideations. Sertraline is not a safe option for patients younger than 24 years of age
because of increased risk of suicidal ideation. Bupropion is an atypical antidepressant and is not
a first-line therapy for depression. It is contraindicated in patients with anorexia nervosa. Lithium
is indicated for patients with bipolar disorder.
Which initial treatment will the nurse practitioner prescribe to a 23-year-old female allergic to
sulfa drugs who is diagnosed with acute cystitis?
a. Cephalexin (Keflex) 500 mg BID × 5 days
b. Ciprofloxacin (Cipro) 250 mg BID × 3 days
c. Nitrofurantoin (Macrobid) 100 mg BID × 5 days
d. Amoxicillin 500 mg BID × 5 days - CORRECT ANSWER c. Nitrofurantoin (Macrobid)
100 mg BID × 5 days
Nitrofurantoin can be safely administered to a patient with a sulfa allergy to treat acute cystitis
and is the first line of treatment. Cephalexin and amoxicillin are beta-lactam antibiotics that can
be prescribed for a patient who has an allergy to sulfa and nitrofurantoin. A fluoroquinolone,
such as ciprofloxacin, is recommended for a patient who is allergic to sulfa and beta-lactam
drugs or has a sulfa allergy and a known resistance to beta-lactam antibiotics.
A 68-year-old patient recently prescribed caridopa-levodopa (Sinemet) tells the nurse
practitioner that he has been bloated and experiencing difficulty with bowel movements. Which
medication will the nurse practitioner consider incorporating into the treatment plan?
, a. Senna
b. Methylnaltrexone
c. Magnesium citrate
d. Polyethylene glycol - CORRECT ANSWER d. Polyethylene glycol
Levodopa, an antiparkinsonian drug, can cause constipation in an older patient. The first-line
treatment for the patient's constipation is osmotic laxatives such as polyethylene glycol. Senna is
a stimulant laxative that is a second-line treatment for constipation in an older adult.
Methylnaltrexone is a peripherally acting mu-opioid antagonist that acts on the gastrointestinal
tract to decrease opioid-induced constipation. Magnesium-based laxatives (e.g., magnesium
citrate) taken over the long term should be avoided because of the potential of toxicity.
A patient recently returned from a trip to Africa and is experiencing 10 to 12 loose stools every
day. The patient takes metformin every morning and otherwise is in good health. Which
medication will the nurse practitioner prescribe to treat the diarrhea?
a. Levofloxacin daily
b. Ofloxacin BID
c. Trimethoprim-sulfamethoxazole BID
d. Ciprofloxacin in a single dose - CORRECT ANSWER d. Ciprofloxacin in a single dose
The patient most likely has traveler's diarrhea, given the history of a recent return from another
country. The patient's treatment should be based on functional impact of symptoms and not
frequency of symptoms, which is not indicated in the question. The patient likely has moderate
acute traveler's diarrhea, which can be treated with loperamide as monotherapy or with
adjunctive antibiotic therapy. The patient is taking metformin daily for diabetes, so risk of
precipitating hypoglycemia is lower than with other oral antidiabetic agents. Because it can be
given in a single dose, ciprofloxacin would be the appropriate choice for reducing exposure and
microbiome colonization disruption. Levofloxacin and ofloxacin require one to three doses.
Trimethoprim-sulfamethoxazole is a sulfonamide and would be appropriate treatment for
cyclosporiasis but not giardiasis, which is the most common parasitic cause of traveler's diarrhea.
A patient newly diagnosed with diabetes reports severe hives and swollen lips after taking
Bactrim for a bladder infection 2 months ago. Which of the following statements is correct?
