AANP exam questions
1. Apatienttellsthenursepractitionerthatsherecentlystartedtakingthesupple
mentSt.John'swortafterreadingaboutitsbenefitsonline.Whichofthefollowing
medications,ifbeingactivelyconsumed,mustbeimmediatelystopped?
A. Benadryl
B. Famotidine(Pepcid)
C. Metformnin(Glucophage)
D. Sumatriptan(Imitrex):D.Sumatriptan(imitrex)
Sumatriptan(Imitrex)(D)isamedicationusedtotreatmigrainesandbelongstoadrugclass
nownasserotoninagonists.WhenusedinconjunctionwithSt.John'swort,itmayincrease
eriskofserotoninsyndrome,apotentiallylife-threateningcondition.
2. Whichofthefollowingisnotasymptomofbothmajordepressivedisorderandpo
st-traumaticstressdisorder?
A. Difficultyconcentrating
B. Hypervigilance
C. Insomnia
D. Irritabilty:B.Hypervigilance
Inadditiontodifficultyconcentrating,insomnia,andirritability,majordepressivedisorder(
MDD)mayalsoincludesymptomsofdepressedmood,anhedonia,weightlossorgain,and
owenergy.However,hypervigilance(B)isnotasymptomassoci-atedwiththisdiagnosis.
3. Apatientwithtype1diabetespresentsforafollow-
upvisit.Hehasbeenstableonhismedicationregimenbutisworriedbecauseheisb
etweenjobsandwillbewithouthealthinsurancecoverageforafewmonths.Heask
siftherearelessexpensiveinsulinoptionstogethimthroughthistime.Whichofthe
followingwouldbegoodoptionsforthispatient,givenhiscircumstance?Incorrec
t
A.
Insulinaspart70/30
B.
Insulindetemir
C.
1/62
, AANP exam questions
Insulinisophane
D.
Insulindegludec:InsulinIsophane
Theleastexpensiveinsulintypelistedinthisquestionisinsulinisophane(C)(neutralprota
mineHagedorninsulin).Therearealsooftenpharmacy-
specificcouponsthatcanbeusedoninsulin,sohelpingpatientsapplyforandnavigatethe
sepro-
gramscanbeinstrumentalinmanagingtheirdiabetes.Anotherinexpensiveoptionisregu
larinsulin.Insulinanalogs(glargine,detemir,degludec,lispro,andaspart)aresignificantl
ymoreexpensivethanhumaninsulin(isophane,regular).Insulinsmodifiedbymanufactu
rers,especiallywhensoldasbrand-
namemedications,tendtobemoreexpensiveduetothismodification.Whileanalogsoffe
ralternatelengthsofactionandconvenience,thereisnowell-
documentedclinicalevidencethatpatientoutcomesareimprovedwithdifferingbrands.T
herefore,maintainingapatient'sbloodglucoselevelthroughoutcome-
focusedtreatmentismorevaluablethanaprocess-focusedplanbasedonmedication.
4. A40-year-oldwomanwithtype2diabetespresentstotheclinicwithcon-
cernsofspikingbloodsugarbetweenlunchanddinner.Shestatessheisonarapid-
actinginsulinslidingscaleandlong-
actinginsulin.Whichchangeshouldbeimplementedtohelppreventorcurbthisgl
ycemicspike?
A.
Addadoseofmealtimeinsulinaspart(Novolog)atlunch
B.
Addinsulindetemir(Levemir)atnight
C.
Increaseherinsulinglargine(Lantus)
D.
PrescribeadoseofneutralprotamineHagedorninsulinwithdinner:A.Addadoseofm
ealtimeinsulinaspart(Novolog)atlunch
Insulinaspart(Novolog)(A)isarapidactinginsulinthatiscommonlydosedwithmealsanda
aslidingscaleregimenbasedonapatient'sglucosepriortoeating(preprandial).Itistheapp
opriateinsulintoaddasamealtimedosewhenpatientsexperiencebloodglucosespikesb
2/62
, AANP exam questions
weenmealsbecauseofitsshort-actingproper-
3/62
, AANP exam questions
ties.Peaktimeactionofinsulinaspartis2hourswithinitialeffectwithinthefirst30minutes,m
kingitanidealchoicetocontrolexpectedpostprandialglycemicspikes
5. Whichofthefollowingconditionsisassociatedwithanincreasedriskforcondu
ctivehearingloss?
A.
Acousticneuroma
B.
Ménièredisease
C.
Otitismedia
D.
Presbycusis:C.Otitismedia
Causesofconductivehearinglossareotitismedia(C),otitisexterna,foreignobjectsinthe
earcanal,impactedearwax,tumors,congenitalanomalies,discontinuity
ofmiddleearbones,cholesteatoma,andtympanicmembranerupture.Soundnormallytr
avelsdowntheearcanaltovibratetheeardrum(tympanicmembrane).Theeardrumiscon
nectedtothreemiddleearbones(malleus,incus,andstapes),whichtransmitthesoundint
otheinnerear(cochlea).Thecochleaistheorganthatchangessoundvibrationsintoanerv
esignalthattravelstothebrain.Thefourtypesofhearinglossareconductive,sensorineur
al,mixed,andretrocochlear.Conductivehearinglossoccurswhensoundcannoteffectiv
elyreachtheinnerearduetoissueintheouterearandmiddleear.
6. A23-year-
oldpatientwhoispregnantat28weeksgestationpresentstotheclinicforaroutinep
renatalcheckup.Whichfundalheightmeasurementwouldwarrantamoreconclusi
veassessmentwithanultrasound?
A.
26cm
B.
29 cm
C.
30 cm
4/62
1. Apatienttellsthenursepractitionerthatsherecentlystartedtakingthesupple
mentSt.John'swortafterreadingaboutitsbenefitsonline.Whichofthefollowing
medications,ifbeingactivelyconsumed,mustbeimmediatelystopped?
A. Benadryl
B. Famotidine(Pepcid)
C. Metformnin(Glucophage)
D. Sumatriptan(Imitrex):D.Sumatriptan(imitrex)
Sumatriptan(Imitrex)(D)isamedicationusedtotreatmigrainesandbelongstoadrugclass
nownasserotoninagonists.WhenusedinconjunctionwithSt.John'swort,itmayincrease
eriskofserotoninsyndrome,apotentiallylife-threateningcondition.
2. Whichofthefollowingisnotasymptomofbothmajordepressivedisorderandpo
st-traumaticstressdisorder?
A. Difficultyconcentrating
B. Hypervigilance
C. Insomnia
D. Irritabilty:B.Hypervigilance
Inadditiontodifficultyconcentrating,insomnia,andirritability,majordepressivedisorder(
MDD)mayalsoincludesymptomsofdepressedmood,anhedonia,weightlossorgain,and
owenergy.However,hypervigilance(B)isnotasymptomassoci-atedwiththisdiagnosis.
3. Apatientwithtype1diabetespresentsforafollow-
upvisit.Hehasbeenstableonhismedicationregimenbutisworriedbecauseheisb
etweenjobsandwillbewithouthealthinsurancecoverageforafewmonths.Heask
siftherearelessexpensiveinsulinoptionstogethimthroughthistime.Whichofthe
followingwouldbegoodoptionsforthispatient,givenhiscircumstance?Incorrec
t
A.
Insulinaspart70/30
B.
Insulindetemir
C.
1/62
, AANP exam questions
Insulinisophane
D.
Insulindegludec:InsulinIsophane
Theleastexpensiveinsulintypelistedinthisquestionisinsulinisophane(C)(neutralprota
mineHagedorninsulin).Therearealsooftenpharmacy-
specificcouponsthatcanbeusedoninsulin,sohelpingpatientsapplyforandnavigatethe
sepro-
gramscanbeinstrumentalinmanagingtheirdiabetes.Anotherinexpensiveoptionisregu
larinsulin.Insulinanalogs(glargine,detemir,degludec,lispro,andaspart)aresignificantl
ymoreexpensivethanhumaninsulin(isophane,regular).Insulinsmodifiedbymanufactu
rers,especiallywhensoldasbrand-
namemedications,tendtobemoreexpensiveduetothismodification.Whileanalogsoffe
ralternatelengthsofactionandconvenience,thereisnowell-
documentedclinicalevidencethatpatientoutcomesareimprovedwithdifferingbrands.T
herefore,maintainingapatient'sbloodglucoselevelthroughoutcome-
focusedtreatmentismorevaluablethanaprocess-focusedplanbasedonmedication.
4. A40-year-oldwomanwithtype2diabetespresentstotheclinicwithcon-
cernsofspikingbloodsugarbetweenlunchanddinner.Shestatessheisonarapid-
actinginsulinslidingscaleandlong-
actinginsulin.Whichchangeshouldbeimplementedtohelppreventorcurbthisgl
ycemicspike?
A.
Addadoseofmealtimeinsulinaspart(Novolog)atlunch
B.
Addinsulindetemir(Levemir)atnight
C.
Increaseherinsulinglargine(Lantus)
D.
PrescribeadoseofneutralprotamineHagedorninsulinwithdinner:A.Addadoseofm
ealtimeinsulinaspart(Novolog)atlunch
Insulinaspart(Novolog)(A)isarapidactinginsulinthatiscommonlydosedwithmealsanda
aslidingscaleregimenbasedonapatient'sglucosepriortoeating(preprandial).Itistheapp
opriateinsulintoaddasamealtimedosewhenpatientsexperiencebloodglucosespikesb
2/62
, AANP exam questions
weenmealsbecauseofitsshort-actingproper-
3/62
, AANP exam questions
ties.Peaktimeactionofinsulinaspartis2hourswithinitialeffectwithinthefirst30minutes,m
kingitanidealchoicetocontrolexpectedpostprandialglycemicspikes
5. Whichofthefollowingconditionsisassociatedwithanincreasedriskforcondu
ctivehearingloss?
A.
Acousticneuroma
B.
Ménièredisease
C.
Otitismedia
D.
Presbycusis:C.Otitismedia
Causesofconductivehearinglossareotitismedia(C),otitisexterna,foreignobjectsinthe
earcanal,impactedearwax,tumors,congenitalanomalies,discontinuity
ofmiddleearbones,cholesteatoma,andtympanicmembranerupture.Soundnormallytr
avelsdowntheearcanaltovibratetheeardrum(tympanicmembrane).Theeardrumiscon
nectedtothreemiddleearbones(malleus,incus,andstapes),whichtransmitthesoundint
otheinnerear(cochlea).Thecochleaistheorganthatchangessoundvibrationsintoanerv
esignalthattravelstothebrain.Thefourtypesofhearinglossareconductive,sensorineur
al,mixed,andretrocochlear.Conductivehearinglossoccurswhensoundcannoteffectiv
elyreachtheinnerearduetoissueintheouterearandmiddleear.
6. A23-year-
oldpatientwhoispregnantat28weeksgestationpresentstotheclinicforaroutinep
renatalcheckup.Whichfundalheightmeasurementwouldwarrantamoreconclusi
veassessmentwithanultrasound?
A.
26cm
B.
29 cm
C.
30 cm
4/62
