ANCC FNP BOARD REVIEW PART 1- QUESTIONS AND ANSWERS
INR of 8, no significant bleeding.
INR is a good measure of the clotting status in an outpatient who takes an oral
You are managing the warfarin dose for an
anticoagulant like warfarin. When warfarin is overdosed and INR climbs, or when
older adult with a prosthetic heart valve.
warfarin is overdosed because of food or medication that produces deleterious side
Which situation listed requires that warfarin
effects, warfarin doses may be omitted or discontinued until the INR is in a more
be discontinued now?
acceptable range. Generally, one or two doses may be omitted before rechecking
INR and resuming warfarin or decreasing the dose.
5 years
The frequency for cervical screening
Women ages 21-65 who have a cervix should be screened for cervical cancer.
depends on the patient and her age. What
Screening intervals every 3 years should take place for women of who are aged 21-
is the longest recommended time interval
29 years. Women aged 30-65 should take place every 3 years if only cytology is
between cervical screens for patients who
performed (this is not preferred); or every 5 years if cytology plus HPV screening
are 21-65 years of age?
takes place.
less than 140/90.
The 2017 American Diabetes Association's target blood pressure for "most patients
A 40-year-old patient with newly
with diabetes and hypertension" is less than 140/90 mmHg. Less than 140/90 means
diagnosed Type 2 diabetes asks what his
that the systolic blood pressure should be in the 130s at the highest and the diastolic
target blood pressure should be. The most
blood pressure should be in the 80s at the highest. Lower blood pressure targets
correct response in mm Hg is
such as 130/80 mmHg may be appropriate for patients at high risk for cardiovascular
disease if they can be easily achieved (Level C).
Sucralfate and cholestyramine
Warfarin treatment is greatly influenced by The drugs listed in choice D will decrease international normalized ratio (INR) in
a patient's food and medication intake. patients who take warfarin concurrently. Sucralfate and calcium carbonate decrease
Which group listed can potentially absorption of warfarin. The drugs listed in the other choices will increase INR. Major
decrease INR (International Normalized interactions can occur with celecoxib, ketoprofen, and naproxen. These three
Ratio) in an outpatient who takes warfarin? NSAIDs are commonly taken by older adults, so this should be part of education
with a patient who takes warfarin.
, ACE inhibitors
ACE inhibitors are commonly used in patients with systolic dysfunction because they
reduce morbidity and mortality, i.e. these medications alter prognosis. They also
Which class of medication is frequently improve symptoms of fatigue, shortness of breath, and exercise intolerance. Loop
used to improve long-term outcomes in and thiazide diuretics improve symptoms, but do not alter long-term prognosis with
patients with systolic dysfunction? heart failure. Beta blockers should be used in conjunction with ACE inhibitors and
diuretics, but not as solo agents. Beta blockers can potentially worsen heart failure,
so their use in patients with heart failure should be monitored carefully. Despite this
fact, beta blockers decrease morbidity and mortality associated with heart failure.
Digital rectal exam
Which of the following results in a clinically Digital rectal exam (DRE) leads to a clinically insignificant increase of 0.26-0.4 ng/mL
INSIGNIFICANT increase in the for about 48-72 hours afterwards. Prostate biopsy increases the PSA about 8 ng/mL
prostatespecific antigen (PSA)? for up to 4 weeks following biopsy. Prostate infection and ejaculation both can
significantly increase the PSA levels in varying amounts.
presence of hepatitis B surface antigen and IgM
The earliest serologic marker that indicates acute hepatitis B infection is the
The two tests that can indicate current presence of hepatitis B surface antigen. It becomes positive about 1-10 weeks after
infection with hepatitis B are: infection, but usually before symptom onset. A positive IgM indicates current
infection. The presence of hepatitis B core antibody identifies hepatitis B infection
(present or past) with certainty. It does not indicate timing of infection.
Meta-analysis
Observational studies are studies in which subjects are observed. No intervention
Which study listed below is considered an takes place with them. Examples of these are found in the first three choices. A meta-
experimental study? analysis takes published information from other studies and combines the
information to arrive at a conclusion. Although a meta analysis can use observational
studies, these should be reported separately.
Mitral valve prolapse
Mitral valve prolapse (MVP) is the most common adult murmur. It is best heard with
Which mitral disorder results from the diaphragm of the stethoscope over the cardiac apex. It is a result of redundancy
redundancy of the mitral valve's leaflets? of the mitral valve leaflets and subsequent degeneration of the mitral tissue. The
posterior leaflet is more commonly affected than the anterior leaflet. The valve's
annulus becomes enlarged in conjunction with elongation of the chordae tendineae.
A patient who takes HCTZ 25 mg daily has hypokalemia.
complaints of muscle cramps. He probably HCTZ is a thiazide diuretic that is potassium-wasting. Patients can become
has: hypokalemic and experience side effects of this. A common one is muscle cramps.
secondary prevention.
A mammogram in a healthy 50-year-old This is an example of secondary prevention. Secondary prevention is represented by
female patient is an example of: screenings intended to identify early course of a disease. In this example, a
mammogram is intended to identify early breast cancer.
18 months.
The age at which a child can first walk Common developmental tasks for an 18-month-old include: walking backwards,
backwards is: throwing a ball, saying 15-20 words, pointing to multiple body parts, pointing and
naming objects in a book, and stacking 3-4 blocks.
Mild flexible metatarsus usually spontaneously corrects.
Metatarsus adductus (MA) is the most common congenital foot deformity. It is not
related to clubfoot. In MA, the forefoot deviates medially, and the hindfoot remains
Which of the following is true about
in a neutral position. This is a common cause of in-toeing gait and usually
metatarsus adductus?
spontaneously corrects. This can be diagnosed on clinical presentation. An X-ray is
not necessary. Casting is usually reserved for severe MA characterized by a rigid
forefoot.
INR of 8, no significant bleeding.
INR is a good measure of the clotting status in an outpatient who takes an oral
You are managing the warfarin dose for an
anticoagulant like warfarin. When warfarin is overdosed and INR climbs, or when
older adult with a prosthetic heart valve.
warfarin is overdosed because of food or medication that produces deleterious side
Which situation listed requires that warfarin
effects, warfarin doses may be omitted or discontinued until the INR is in a more
be discontinued now?
acceptable range. Generally, one or two doses may be omitted before rechecking
INR and resuming warfarin or decreasing the dose.
5 years
The frequency for cervical screening
Women ages 21-65 who have a cervix should be screened for cervical cancer.
depends on the patient and her age. What
Screening intervals every 3 years should take place for women of who are aged 21-
is the longest recommended time interval
29 years. Women aged 30-65 should take place every 3 years if only cytology is
between cervical screens for patients who
performed (this is not preferred); or every 5 years if cytology plus HPV screening
are 21-65 years of age?
takes place.
less than 140/90.
The 2017 American Diabetes Association's target blood pressure for "most patients
A 40-year-old patient with newly
with diabetes and hypertension" is less than 140/90 mmHg. Less than 140/90 means
diagnosed Type 2 diabetes asks what his
that the systolic blood pressure should be in the 130s at the highest and the diastolic
target blood pressure should be. The most
blood pressure should be in the 80s at the highest. Lower blood pressure targets
correct response in mm Hg is
such as 130/80 mmHg may be appropriate for patients at high risk for cardiovascular
disease if they can be easily achieved (Level C).
Sucralfate and cholestyramine
Warfarin treatment is greatly influenced by The drugs listed in choice D will decrease international normalized ratio (INR) in
a patient's food and medication intake. patients who take warfarin concurrently. Sucralfate and calcium carbonate decrease
Which group listed can potentially absorption of warfarin. The drugs listed in the other choices will increase INR. Major
decrease INR (International Normalized interactions can occur with celecoxib, ketoprofen, and naproxen. These three
Ratio) in an outpatient who takes warfarin? NSAIDs are commonly taken by older adults, so this should be part of education
with a patient who takes warfarin.
, ACE inhibitors
ACE inhibitors are commonly used in patients with systolic dysfunction because they
reduce morbidity and mortality, i.e. these medications alter prognosis. They also
Which class of medication is frequently improve symptoms of fatigue, shortness of breath, and exercise intolerance. Loop
used to improve long-term outcomes in and thiazide diuretics improve symptoms, but do not alter long-term prognosis with
patients with systolic dysfunction? heart failure. Beta blockers should be used in conjunction with ACE inhibitors and
diuretics, but not as solo agents. Beta blockers can potentially worsen heart failure,
so their use in patients with heart failure should be monitored carefully. Despite this
fact, beta blockers decrease morbidity and mortality associated with heart failure.
Digital rectal exam
Which of the following results in a clinically Digital rectal exam (DRE) leads to a clinically insignificant increase of 0.26-0.4 ng/mL
INSIGNIFICANT increase in the for about 48-72 hours afterwards. Prostate biopsy increases the PSA about 8 ng/mL
prostatespecific antigen (PSA)? for up to 4 weeks following biopsy. Prostate infection and ejaculation both can
significantly increase the PSA levels in varying amounts.
presence of hepatitis B surface antigen and IgM
The earliest serologic marker that indicates acute hepatitis B infection is the
The two tests that can indicate current presence of hepatitis B surface antigen. It becomes positive about 1-10 weeks after
infection with hepatitis B are: infection, but usually before symptom onset. A positive IgM indicates current
infection. The presence of hepatitis B core antibody identifies hepatitis B infection
(present or past) with certainty. It does not indicate timing of infection.
Meta-analysis
Observational studies are studies in which subjects are observed. No intervention
Which study listed below is considered an takes place with them. Examples of these are found in the first three choices. A meta-
experimental study? analysis takes published information from other studies and combines the
information to arrive at a conclusion. Although a meta analysis can use observational
studies, these should be reported separately.
Mitral valve prolapse
Mitral valve prolapse (MVP) is the most common adult murmur. It is best heard with
Which mitral disorder results from the diaphragm of the stethoscope over the cardiac apex. It is a result of redundancy
redundancy of the mitral valve's leaflets? of the mitral valve leaflets and subsequent degeneration of the mitral tissue. The
posterior leaflet is more commonly affected than the anterior leaflet. The valve's
annulus becomes enlarged in conjunction with elongation of the chordae tendineae.
A patient who takes HCTZ 25 mg daily has hypokalemia.
complaints of muscle cramps. He probably HCTZ is a thiazide diuretic that is potassium-wasting. Patients can become
has: hypokalemic and experience side effects of this. A common one is muscle cramps.
secondary prevention.
A mammogram in a healthy 50-year-old This is an example of secondary prevention. Secondary prevention is represented by
female patient is an example of: screenings intended to identify early course of a disease. In this example, a
mammogram is intended to identify early breast cancer.
18 months.
The age at which a child can first walk Common developmental tasks for an 18-month-old include: walking backwards,
backwards is: throwing a ball, saying 15-20 words, pointing to multiple body parts, pointing and
naming objects in a book, and stacking 3-4 blocks.
Mild flexible metatarsus usually spontaneously corrects.
Metatarsus adductus (MA) is the most common congenital foot deformity. It is not
related to clubfoot. In MA, the forefoot deviates medially, and the hindfoot remains
Which of the following is true about
in a neutral position. This is a common cause of in-toeing gait and usually
metatarsus adductus?
spontaneously corrects. This can be diagnosed on clinical presentation. An X-ray is
not necessary. Casting is usually reserved for severe MA characterized by a rigid
forefoot.
