Ancc fnp review
Ancc fnp review questions solved 100% correct
answers
Special considerations for thiazides - answer-chlorthalidone is preferred on the basis of
prolonged half-life and proven trial reduction of cvd.
Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.
Use with caution in patients with history of acute gout unless patient is on uric acid-lowering
therapy.
Special considerations for ace inhibitors - answer-do not use in combination with arbs or direct
renin inhibitor.
There is an increased risk of hyperkalemia, especially in patients with ckd or in those on k+
supplements or k+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis.
Do not use if patient has history of angioedema with ace inhibitors.
Ace inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin production.
Avoid in pregnant females or females of reproductive age without adequate contraception
Special considerations for angiotensin receptor blockers - answer-do not use in combination with
ace inhibitors or direct renin inhibitor.
There is an increased risk of hyperkalemia in ckd or in those on k+ supplements or k+-sparing
drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis.
Do not use if patient has history of angioedema with arbs. Patients with a history of angioedema
with an ace inhibitor can receive an arb beginning 6 weeks after ace inhibitor is discontinued.
Avoid in pregnant females or females of reproductive age without adequate contraception.
Lower risk of cough than ace-is.
,Ancc fnp review
Special considerations for calcium channel blockers - answer-associated with dose-related pedal
edema, which is more common in females than men.
When should you refer to a nephrologist or cardiologist in a hypertensive patient? - answer--signs
of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications
Generally, failure to achieve blood pressure goal in patients who are adhering to full doses of an
appropriate three to four drug regimen that includes a diuretic may warrant referral to a
nephrologist or cardiologist
Before referring, clinicians should first review other causes of inadequate hypertension control
such as:
-improper blood pressure measurement
-white coat hypertension
-excess sodium intake
-medication issues (e.g., nonsteroidal anti-inflammatory drugs (nsaids), illicit drugs,
sympathomimetics, oral contraceptives)
-excess alcohol intake
-underlying identifiable causes of hypertension (secondary hypertension)
A researcher is studying potential risk factors for obesity. She sends a questionnaire to 5000
patients who meet the cdc criteria for obesity that asks them about sedentary lifestyle factors,
consumption of processed food, and family history of obesity. The researcher sends the same
questionnaire to 5000 patients who are not obese. Which of the following best describes the
design of the study?
A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
d. Case-control study - answer-correct answer: d. Case-control study
This is a retrospective case-control study. In this observational study design, subjects are selected
based on an outcome, and their prior exposures are assessed and compared to subjects who do
not have the particular outcome. The result of the study is expressed as an odds ratio: or = (#
exposed with disease / # exposed without disease) / (# not exposed with disease / # not exposed
without disease). A retrospective case-control study does not prove causation but demonstrates an
association.
Incorrect
Answers:
A. A cross-sectional study is used to assess disease status and risk factors at 1 point in time.
,Ancc fnp review
B. A randomized controlled trial refers to a study where a group is given a treatment and
outcomes are compared against a control group given a placebo or treated with the standard of
care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital concepts:
In an observational study design, subjects are selected based on an outcome, and their prior
exposures are assessed and compared to subjects who do not have a particular outcome. The
result of the study is expressed as an odds ratio: or = (# exposed with disease / # exposed without
disease) / (# not exposed with disease / # not exposed without disease). A retrospective case-
control study does not prove causation but demonstrates an association.
A 49-year-old female presents to the office with a history of breast cancer who is having frequent
hot flashes who already tried first-line lifestyle changes without improvement? What is the best
treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - answer-correct answer: c. Citalopram
Selective serotonin reuptake inhibitors (ssri)s are the most effective pharmacologic choice for the
vasomotor symptoms of menopause. Citalopram is an ssri that has good evidence of efficacy
against these symptoms and is typically well-tolerated.
Incorrect answers:
A. Women with a history of breast cancer are not candidates for hormone replacement therapy.
B. "bioidentical hormones" are compounded mixtures of multiple hormones. There is no
evidence to support their use at this time, and again, hormone treatment would be contraindicated
in a patient with a history of breast cancer.
D. Black cohosh is an herbal remedy marketed for use with hot flashes. However, it has not been
demonstrated to be more effective than a placebo for this use. In addition, it has been posited to
have a possible estrogenic effect on breast tissue, which should be avoided in patients with a
history of breast cancer.
Vital concepts:
Selective serotonin reuptake inhibitors (ssri)s are the most effective pharmacologic choice for the
vasomotor symptoms of menopause. Citalopram is an ssri that has good evidence of efficacy
against these symptoms and is typically well-tolerated.
A 20-year-old presents to the office for a wellness check. What is the prevalence of bulimia
nervosa in female college students?
A. 1%
B.2%
C. 4%
D. 5% - answer-correct answer: d. 5%
, Ancc fnp review
Bulimia nervosa occurs in approximately 5% of female college students, who are 10x more likely
than male college students to develop this disorder. The prevalence of anorexia nervosa is 1.5%
in teenage girls overall.
Incorrect answers:
(a), (b), (c) are the not correct prevalence.
A 16-year-old male presents because he is concerned about acne. He first began to notice
worsening acne 6 months ago and began using over-the-counter benzoyl peroxide and, after 3
months, saw his primary care physician who prescribed tretinoin and oral tetracycline. He states
that he has been using both medications for the last 3 months but there is no improvement in
acne. He also states he has noticed he is very quick to anger and moody over the last few months
and wonders whether that is a side effect of the acne medications. He is a football player for his
high school and has been participating in extra practices to "bulk up" in the hopes of achieving a
college scholarship. Upon closer inspection, he has gained 30 pounds in the last 3 months but
does not appear overweight, rather has increased muscle mass. He states that a friend on the
football team has been giving him pills to help his performance. Which of the following is most
likely to be identified?
A. Increased serum luteinizing hormone levels
B. Decreased prothrombin time
C. Lowered thyroxine binding globulin (tbg) levels
D. Increased serum hdl cholesterol - answer-correct answer: c. Lowered thyroxine binding
globulin (tbg) levels
Anabolic steroids can lower thyroxine-binding globulin (tbg) levels which, in turn, can decrease
total t4 levels, although free t4 remains the same.
Incorrect answers:
A. This patient has multiple features that are consistent with anabolic steroid use, including acne,
a rapid increase in weight and muscle mass, and mood swings. In men steroid use decreases
serum luteinizing hormone and follicle-stimulating hormone levels, which leads to decreased
endogenous testosterone production, decreased spermatogenesis, and testicular atrophy. There is
also an increased estrogen production due to the aromatization of circulating testosterone which
can lead to gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a suppression of
clotting factors ii, v, vii, and x.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased serum hdl
cholesterol, increased serum ldl cholesterol, increased total cholesterol, and increased blood
pressure. These effects appear to be reversible when anabolic steroid use is discontinued. The
risk of sudden death from cardiovascular causes can occur in an athlete abusing anabolic steroids
even when there is no evidence of atherosclerosis. This is due to an increased risk of thrombus
formation while using anabolic steroids.
Ancc fnp review questions solved 100% correct
answers
Special considerations for thiazides - answer-chlorthalidone is preferred on the basis of
prolonged half-life and proven trial reduction of cvd.
Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.
Use with caution in patients with history of acute gout unless patient is on uric acid-lowering
therapy.
Special considerations for ace inhibitors - answer-do not use in combination with arbs or direct
renin inhibitor.
There is an increased risk of hyperkalemia, especially in patients with ckd or in those on k+
supplements or k+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis.
Do not use if patient has history of angioedema with ace inhibitors.
Ace inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin production.
Avoid in pregnant females or females of reproductive age without adequate contraception
Special considerations for angiotensin receptor blockers - answer-do not use in combination with
ace inhibitors or direct renin inhibitor.
There is an increased risk of hyperkalemia in ckd or in those on k+ supplements or k+-sparing
drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis.
Do not use if patient has history of angioedema with arbs. Patients with a history of angioedema
with an ace inhibitor can receive an arb beginning 6 weeks after ace inhibitor is discontinued.
Avoid in pregnant females or females of reproductive age without adequate contraception.
Lower risk of cough than ace-is.
,Ancc fnp review
Special considerations for calcium channel blockers - answer-associated with dose-related pedal
edema, which is more common in females than men.
When should you refer to a nephrologist or cardiologist in a hypertensive patient? - answer--signs
of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications
Generally, failure to achieve blood pressure goal in patients who are adhering to full doses of an
appropriate three to four drug regimen that includes a diuretic may warrant referral to a
nephrologist or cardiologist
Before referring, clinicians should first review other causes of inadequate hypertension control
such as:
-improper blood pressure measurement
-white coat hypertension
-excess sodium intake
-medication issues (e.g., nonsteroidal anti-inflammatory drugs (nsaids), illicit drugs,
sympathomimetics, oral contraceptives)
-excess alcohol intake
-underlying identifiable causes of hypertension (secondary hypertension)
A researcher is studying potential risk factors for obesity. She sends a questionnaire to 5000
patients who meet the cdc criteria for obesity that asks them about sedentary lifestyle factors,
consumption of processed food, and family history of obesity. The researcher sends the same
questionnaire to 5000 patients who are not obese. Which of the following best describes the
design of the study?
A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
d. Case-control study - answer-correct answer: d. Case-control study
This is a retrospective case-control study. In this observational study design, subjects are selected
based on an outcome, and their prior exposures are assessed and compared to subjects who do
not have the particular outcome. The result of the study is expressed as an odds ratio: or = (#
exposed with disease / # exposed without disease) / (# not exposed with disease / # not exposed
without disease). A retrospective case-control study does not prove causation but demonstrates an
association.
Incorrect
Answers:
A. A cross-sectional study is used to assess disease status and risk factors at 1 point in time.
,Ancc fnp review
B. A randomized controlled trial refers to a study where a group is given a treatment and
outcomes are compared against a control group given a placebo or treated with the standard of
care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital concepts:
In an observational study design, subjects are selected based on an outcome, and their prior
exposures are assessed and compared to subjects who do not have a particular outcome. The
result of the study is expressed as an odds ratio: or = (# exposed with disease / # exposed without
disease) / (# not exposed with disease / # not exposed without disease). A retrospective case-
control study does not prove causation but demonstrates an association.
A 49-year-old female presents to the office with a history of breast cancer who is having frequent
hot flashes who already tried first-line lifestyle changes without improvement? What is the best
treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - answer-correct answer: c. Citalopram
Selective serotonin reuptake inhibitors (ssri)s are the most effective pharmacologic choice for the
vasomotor symptoms of menopause. Citalopram is an ssri that has good evidence of efficacy
against these symptoms and is typically well-tolerated.
Incorrect answers:
A. Women with a history of breast cancer are not candidates for hormone replacement therapy.
B. "bioidentical hormones" are compounded mixtures of multiple hormones. There is no
evidence to support their use at this time, and again, hormone treatment would be contraindicated
in a patient with a history of breast cancer.
D. Black cohosh is an herbal remedy marketed for use with hot flashes. However, it has not been
demonstrated to be more effective than a placebo for this use. In addition, it has been posited to
have a possible estrogenic effect on breast tissue, which should be avoided in patients with a
history of breast cancer.
Vital concepts:
Selective serotonin reuptake inhibitors (ssri)s are the most effective pharmacologic choice for the
vasomotor symptoms of menopause. Citalopram is an ssri that has good evidence of efficacy
against these symptoms and is typically well-tolerated.
A 20-year-old presents to the office for a wellness check. What is the prevalence of bulimia
nervosa in female college students?
A. 1%
B.2%
C. 4%
D. 5% - answer-correct answer: d. 5%
, Ancc fnp review
Bulimia nervosa occurs in approximately 5% of female college students, who are 10x more likely
than male college students to develop this disorder. The prevalence of anorexia nervosa is 1.5%
in teenage girls overall.
Incorrect answers:
(a), (b), (c) are the not correct prevalence.
A 16-year-old male presents because he is concerned about acne. He first began to notice
worsening acne 6 months ago and began using over-the-counter benzoyl peroxide and, after 3
months, saw his primary care physician who prescribed tretinoin and oral tetracycline. He states
that he has been using both medications for the last 3 months but there is no improvement in
acne. He also states he has noticed he is very quick to anger and moody over the last few months
and wonders whether that is a side effect of the acne medications. He is a football player for his
high school and has been participating in extra practices to "bulk up" in the hopes of achieving a
college scholarship. Upon closer inspection, he has gained 30 pounds in the last 3 months but
does not appear overweight, rather has increased muscle mass. He states that a friend on the
football team has been giving him pills to help his performance. Which of the following is most
likely to be identified?
A. Increased serum luteinizing hormone levels
B. Decreased prothrombin time
C. Lowered thyroxine binding globulin (tbg) levels
D. Increased serum hdl cholesterol - answer-correct answer: c. Lowered thyroxine binding
globulin (tbg) levels
Anabolic steroids can lower thyroxine-binding globulin (tbg) levels which, in turn, can decrease
total t4 levels, although free t4 remains the same.
Incorrect answers:
A. This patient has multiple features that are consistent with anabolic steroid use, including acne,
a rapid increase in weight and muscle mass, and mood swings. In men steroid use decreases
serum luteinizing hormone and follicle-stimulating hormone levels, which leads to decreased
endogenous testosterone production, decreased spermatogenesis, and testicular atrophy. There is
also an increased estrogen production due to the aromatization of circulating testosterone which
can lead to gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a suppression of
clotting factors ii, v, vii, and x.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased serum hdl
cholesterol, increased serum ldl cholesterol, increased total cholesterol, and increased blood
pressure. These effects appear to be reversible when anabolic steroid use is discontinued. The
risk of sudden death from cardiovascular causes can occur in an athlete abusing anabolic steroids
even when there is no evidence of atherosclerosis. This is due to an increased risk of thrombus
formation while using anabolic steroids.
