ANCC FNP Board Questions
Key Concepts in Advanced Practice Nursing
1. Hidradenitis Suppurativa Management
Clinical Scenario:
A middle-aged female patient presents with a recurrence of mild hidradenitis suppurativa after topical
therapies have failed.
Recommended First-Line Treatment:
The recommended first-line treatment for hidradenitis suppurativa is a 12-week course of oral
tetracycline, such as doxycycline (Sumycin).
Understanding Hidradenitis Suppurativa:
Definition: A disorder of the terminal follicular epithelium in apocrine gland-bearing skin.
Nature of the Disorder: Chronic, disabling, and progressive, often leading to complications
such as keloids, contractures, and immobility.
Key Characteristics:
o Comedone-like follicular occlusion
o Chronic and relapsing inflammation
o Mucopurulent discharge
o Progressive scarring
Associated Condition: Arthropathy may be present.
Typical Presentation: Nodules (inflamed or noninflamed), sinus tracts, abscesses, and scarring
found in:
o Axilla
o Genitofemoral area
o Perineum
o Gluteal area
o Inframammary area (in women)
Treatment Options:
Recommended treatments include:
, Antibiotics
Steroids
Retinoids
Dapsone
Anti-tumor necrosis factor (TNF) agents
Consideration for Dermatology Consultation is also important.
Step-Up Treatment:
First-Line: A 12-week course of oral tetracycline (e.g., doxycycline).
Second-Line (if no response to doxycycline): Combination of twice-daily clindamycin
(Cleocin) and rifampicin (Rifadin) for 10-12 weeks.
Third-Line (if treatment fails): Consider acitretin (Soriatane) (for males and nonfertile
females) or dapsone (Aczone), typically managed by a dermatologist.
Moderate to Severe Cases: Adalimumab (Humira) may be considered.
2. Culturally Competent Healthcare for American Indian Elders
Key Understanding:
When providing culturally competent healthcare services to an American Indian elder, the nurse
practitioner understands that the "Medicine Wheel" is traditionally used by many for the purpose of
health and healing.
The "Medicine Wheel":
Traditionally contains four directions: north, south, east, and west.
Tribal Variations: Each tribe may have different meanings for each direction.
Representations: Directions can represent seasons of the year or stages of life.
Purpose: Aimed at providing a holistic view of life.
Importance of Cultural Competence:
Understanding different cultural preferences is crucial for cultural competence in healthcare.
Respecting and incorporating traditional culture and preferences into the patient's care is
essential.
Individual preferences should be included in the interview and treatment plan.
Traditional American Indian Healthcare Values:
, Values a holistic approach integrating:
o The person
o Lifestyle
o Environment
o Family
o Religion
Illness is often perceived as a lack of harmony with the physical body, mind, spirit, and
emotions.
Patients may seek care from Western medicine for specific ailments while also consulting with
traditional healers for spiritual guidance.
Nurse Practitioner's Role:
Healthcare providers should:
Understand relevant cultural factors.
Assess each individual's healthcare literacy.
Strive to provide culturally competent care.
3. Conductive Hearing Loss
Clinical Scenario:
An older adult patient presents with the primary report of hearing loss and a sensation of fullness in
the right ear. The nurse practitioner suspects conductive hearing loss.
Possible Contributing Factor:
Cerumen impaction, commonly called earwax, can contribute to conductive hearing loss.
Understanding Cerumen:
Composition: A combination of secretions and sloughed epithelial cells.
Function: Protects the ears from infection, water, and insects.
Normal Expulsion: Usually expelled from the ear canal through natural jaw movement.
Impaction: Occurs when the self-cleaning process fails.
Mechanism of Hearing Loss: Impacted cerumen can occlude the ear canal and press against
the tympanic membrane, resulting in conductive hearing loss.
Types of Hearing Loss:
, Conductive Hearing Loss:
o Involves the transition of sound from the external and middle ear to the inner ear.
o Caused by problems in the external and middle ear that interfere with the transmission of
sound and its conversion to mechanical vibration.
o Causes:
Obstruction of the external auditory canal by cerumen, foreign bodies, debris
from otitis externa.
Large exostoses and osteomas.
Sensorineural Hearing Loss:
o Involves difficulty converting mechanical vibrations to electrical potential in the cochlea
or in auditory nerve transmission to the brain.
o Mostly caused by permanent damage in the organ of Corti.
o Causes:
Age-related hearing loss (presbycusis)
Noise trauma
Medications (ototoxic drugs)
Autoimmune diseases
Mechanical trauma
Meniere disease
Infection
Neoplasm (acoustic neuroma)
Hearing Loss in Older Adults:
Prevalence: Approximately one-third of older adults between 61 and 70 years have hearing loss.
More than 90% of adults older than 85 years have hearing loss.
Most Common Type: Age-related and sensorineural.
Screening Recommendation: All adults older than 60 years should be screened for hearing loss
at periodic health examinations.
4. Community-Acquired Pneumonia (CAP) Treatment
Clinical Scenario:
An otherwise healthy adult patient presents with a diagnosis of community-acquired pneumonia
(CAP) and no recent antibiotic therapy.
Best Option for Treatment:
High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults
without comorbidities.
Key Concepts in Advanced Practice Nursing
1. Hidradenitis Suppurativa Management
Clinical Scenario:
A middle-aged female patient presents with a recurrence of mild hidradenitis suppurativa after topical
therapies have failed.
Recommended First-Line Treatment:
The recommended first-line treatment for hidradenitis suppurativa is a 12-week course of oral
tetracycline, such as doxycycline (Sumycin).
Understanding Hidradenitis Suppurativa:
Definition: A disorder of the terminal follicular epithelium in apocrine gland-bearing skin.
Nature of the Disorder: Chronic, disabling, and progressive, often leading to complications
such as keloids, contractures, and immobility.
Key Characteristics:
o Comedone-like follicular occlusion
o Chronic and relapsing inflammation
o Mucopurulent discharge
o Progressive scarring
Associated Condition: Arthropathy may be present.
Typical Presentation: Nodules (inflamed or noninflamed), sinus tracts, abscesses, and scarring
found in:
o Axilla
o Genitofemoral area
o Perineum
o Gluteal area
o Inframammary area (in women)
Treatment Options:
Recommended treatments include:
, Antibiotics
Steroids
Retinoids
Dapsone
Anti-tumor necrosis factor (TNF) agents
Consideration for Dermatology Consultation is also important.
Step-Up Treatment:
First-Line: A 12-week course of oral tetracycline (e.g., doxycycline).
Second-Line (if no response to doxycycline): Combination of twice-daily clindamycin
(Cleocin) and rifampicin (Rifadin) for 10-12 weeks.
Third-Line (if treatment fails): Consider acitretin (Soriatane) (for males and nonfertile
females) or dapsone (Aczone), typically managed by a dermatologist.
Moderate to Severe Cases: Adalimumab (Humira) may be considered.
2. Culturally Competent Healthcare for American Indian Elders
Key Understanding:
When providing culturally competent healthcare services to an American Indian elder, the nurse
practitioner understands that the "Medicine Wheel" is traditionally used by many for the purpose of
health and healing.
The "Medicine Wheel":
Traditionally contains four directions: north, south, east, and west.
Tribal Variations: Each tribe may have different meanings for each direction.
Representations: Directions can represent seasons of the year or stages of life.
Purpose: Aimed at providing a holistic view of life.
Importance of Cultural Competence:
Understanding different cultural preferences is crucial for cultural competence in healthcare.
Respecting and incorporating traditional culture and preferences into the patient's care is
essential.
Individual preferences should be included in the interview and treatment plan.
Traditional American Indian Healthcare Values:
, Values a holistic approach integrating:
o The person
o Lifestyle
o Environment
o Family
o Religion
Illness is often perceived as a lack of harmony with the physical body, mind, spirit, and
emotions.
Patients may seek care from Western medicine for specific ailments while also consulting with
traditional healers for spiritual guidance.
Nurse Practitioner's Role:
Healthcare providers should:
Understand relevant cultural factors.
Assess each individual's healthcare literacy.
Strive to provide culturally competent care.
3. Conductive Hearing Loss
Clinical Scenario:
An older adult patient presents with the primary report of hearing loss and a sensation of fullness in
the right ear. The nurse practitioner suspects conductive hearing loss.
Possible Contributing Factor:
Cerumen impaction, commonly called earwax, can contribute to conductive hearing loss.
Understanding Cerumen:
Composition: A combination of secretions and sloughed epithelial cells.
Function: Protects the ears from infection, water, and insects.
Normal Expulsion: Usually expelled from the ear canal through natural jaw movement.
Impaction: Occurs when the self-cleaning process fails.
Mechanism of Hearing Loss: Impacted cerumen can occlude the ear canal and press against
the tympanic membrane, resulting in conductive hearing loss.
Types of Hearing Loss:
, Conductive Hearing Loss:
o Involves the transition of sound from the external and middle ear to the inner ear.
o Caused by problems in the external and middle ear that interfere with the transmission of
sound and its conversion to mechanical vibration.
o Causes:
Obstruction of the external auditory canal by cerumen, foreign bodies, debris
from otitis externa.
Large exostoses and osteomas.
Sensorineural Hearing Loss:
o Involves difficulty converting mechanical vibrations to electrical potential in the cochlea
or in auditory nerve transmission to the brain.
o Mostly caused by permanent damage in the organ of Corti.
o Causes:
Age-related hearing loss (presbycusis)
Noise trauma
Medications (ototoxic drugs)
Autoimmune diseases
Mechanical trauma
Meniere disease
Infection
Neoplasm (acoustic neuroma)
Hearing Loss in Older Adults:
Prevalence: Approximately one-third of older adults between 61 and 70 years have hearing loss.
More than 90% of adults older than 85 years have hearing loss.
Most Common Type: Age-related and sensorineural.
Screening Recommendation: All adults older than 60 years should be screened for hearing loss
at periodic health examinations.
4. Community-Acquired Pneumonia (CAP) Treatment
Clinical Scenario:
An otherwise healthy adult patient presents with a diagnosis of community-acquired pneumonia
(CAP) and no recent antibiotic therapy.
Best Option for Treatment:
High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults
without comorbidities.
