ANCC Practice Questions
Adult-Gerontology Primary Care Nurse
Practitioner Review
I. Hematology
Iron Deficiency Anemia: Early Stages
In the early stages of iron deficiency anemia, blood studies typically reveal a normochromic
normocytic presentation.
o (a) macrocytic normochromic: Characterizes other types of anemia.
o (b) microcytic hypochromic: A later finding in iron deficiency anemia.
o (c) normochromic normocytic: Correct. Indicates normal-sized and normal-colored red
blood cells, which can be present in early deficiency before changes in size and color
occur.
o (d) pancytopenic hypocytic: Indicates a deficiency in all blood cell types.
II. Dermatology
Eczema Risk Factors in Adolescents
A 14-year-old male with a family history of eczema and a personal history of allergic rhinitis is
at increased risk for developing eczema. The third significant risk factor in this patient's history
is:
o (a) asthma: Correct. Asthma is a key component of the atopic triad,
which includes eczema, allergic rhinitis, and asthma.
o (b) bee allergy: While an allergy, it's not a primary risk factor for
eczema development.
o (c) otitis media: A common childhood infection, but not directly
linked as a major risk factor for eczema.
o (d) psoriasis: A distinct inflammatory skin condition.
(
,III. Neurology
Assessing Ankle Clonus
To assess for ankle clonus in a patient with hyperactive reflexes of the lower extremities, the
adult-gerontology primary care nurse practitioner performs the following action:
o (a) firmly applying a low-pitched tuning fork to the lateral malleolus: This assesses
vibratory sensation.
o (b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon
with the percussion hammer: This elicits the Achilles reflex.
o (c) sharply dorsiflexing the foot and maintaining this position while supporting the
knee: Correct. This maneuver stretches the gastrocnemius muscle and can elicit clonus
(rhythmic involuntary dorsiflexion and plantarflexion of the foot).
o (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the
sharp end of the percussion hammer: This elicits the Babinski reflex.
IV. Geriatrics & Gynecology
Prioritizing Physical Examination Findings in Older Women
During a yearly evaluation of a 70-year-old female patient, the physical examination finding that
warrants the highest priority for immediate treatment is:
o (a) Atrophy of vaginal rugae: A normal age-related change due to decreased estrogen.
o (b) Cystocele present: A common finding in older women, but not typically requiring
immediate treatment unless symptomatic or severe.
o (c) Palpable ovary: Correct. A palpable ovary in a postmenopausal woman is abnormal
and requires immediate investigation to rule out malignancy.
o (d) Pessary in place: Indicates management of pelvic organ prolapse and is not an acute
concern.
V. Health Promotion & Patient Education
Health Belief Model: Perceived Severity
A 16-year-old male patient who just received his driver's license states he doesn't need to wear a
seat belt because nothing will happen to him in a car collision. According to the Health Belief
Model, this patient lacks the chief component of:
(
, o (a) Enabling factors: Resources or skills needed to adopt a behavior.
o (b) Motivation: The general desire to take action.
o (c) Perceived role conflict: Stress arising from competing social roles.
o (d) Perceived severity: Correct. The individual's belief about the seriousness of a
condition and its potential consequences.
VI. Epidemiology & Public Health
Documenting Epidemiological Factors for Biological Exposure
When treating patients for biological exposure, the adult-gerontology primary care nurse
practitioner documents the following epidemiological factors for each exposure:
o (a) Comorbidities and length of exposure: Important for individual patient management
but not primary epidemiological factors.
o (b) Location and event intensity: Relevant to the context of the exposure but not the
core epidemiological determinants of disease spread.
o (c) Mode of transmission and incubation: Correct. These are fundamental
epidemiological factors that describe how the infectious agent spreads and the time
between exposure and symptom onset.
o (d) Premorbid conditions and surveillance rates: Surveillance rates are population-
level data, and premorbid conditions relate to individual susceptibility.
VII. Research & Evidence-Based Practice
Disseminating Research Findings
When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary
care nurse practitioner:
o (a) concludes that the study proves the hypothesis: Research studies support or fail to
support hypotheses; they rarely "prove" them definitively.
o (b) excludes the discussion section, because the conclusion contains this information:
The discussion section is crucial for interpreting results, limitations, and implications.
o (c) recommends incorporating the results directly into clinical practice:
Recommendations for practice change require careful consideration of the study's strength
and context.
o (d) uses the methodology section to support the validity of the study: Correct. A well-
described and rigorous methodology enhances the credibility and validity of the research
findings.
(
, VIII. Ethics & Legal Considerations
Patient Confidentiality
A patient's adult child telephones to inquire about the patient's illness, stating the parent relies on
the child for explanations. The nurse practitioner:
o (a) asks the child to provide a copy of the patient's advance directive document:
While relevant for decision-making capacity, it doesn't override current confidentiality.
o (b) assures the child that the nurse practitioner can disclose requested information:
This would be a breach of patient confidentiality.
o (c) informs the child that he or she must come to the clinic to discuss the parent's
case: While an option, it doesn't address the core issue of confidentiality.
o (d) tells the child that the nurse practitioner can discuss the information only with
the patient: Correct. Maintaining patient confidentiality is paramount unless the patient
has provided explicit consent for disclosure.
Role in Medical Ethics Review Committee
The adult-gerontology primary care nurse practitioner appointed to a hospital's multidisciplinary
medical ethics review committee's role is to:
o (a) evaluate standards, risks, benefits, and outcomes: Correct. This committee
assesses the ethical implications of clinical decisions and policies.
o (b) identify how to anticipate and resolve similar future situations: While a potential
outcome, the primary role is evaluation.
o (c) investigate the need for disciplinary action: This is typically the role of other
committees.
o (d) obtain agreement of all parties with a chosen solution: The committee provides
recommendations, not necessarily mandates agreement.
Improving Quality of Clinical Practice
To improve the quality of clinical practice, the adult-gerontology primary care nurse
practitioner:
o (a) charges a fee for patients who arrive late to clinic appointments: This addresses
efficiency, not necessarily the quality of clinical care itself.
o (b) disseminates research study results to colleagues: Correct. Sharing evidence-based
findings promotes informed practice and quality improvement.
o (c) expresses opinions about alternative therapies with patients who consider such
treatments: While important for patient education, it doesn't directly improve overall
clinical practice.
(
Adult-Gerontology Primary Care Nurse
Practitioner Review
I. Hematology
Iron Deficiency Anemia: Early Stages
In the early stages of iron deficiency anemia, blood studies typically reveal a normochromic
normocytic presentation.
o (a) macrocytic normochromic: Characterizes other types of anemia.
o (b) microcytic hypochromic: A later finding in iron deficiency anemia.
o (c) normochromic normocytic: Correct. Indicates normal-sized and normal-colored red
blood cells, which can be present in early deficiency before changes in size and color
occur.
o (d) pancytopenic hypocytic: Indicates a deficiency in all blood cell types.
II. Dermatology
Eczema Risk Factors in Adolescents
A 14-year-old male with a family history of eczema and a personal history of allergic rhinitis is
at increased risk for developing eczema. The third significant risk factor in this patient's history
is:
o (a) asthma: Correct. Asthma is a key component of the atopic triad,
which includes eczema, allergic rhinitis, and asthma.
o (b) bee allergy: While an allergy, it's not a primary risk factor for
eczema development.
o (c) otitis media: A common childhood infection, but not directly
linked as a major risk factor for eczema.
o (d) psoriasis: A distinct inflammatory skin condition.
(
,III. Neurology
Assessing Ankle Clonus
To assess for ankle clonus in a patient with hyperactive reflexes of the lower extremities, the
adult-gerontology primary care nurse practitioner performs the following action:
o (a) firmly applying a low-pitched tuning fork to the lateral malleolus: This assesses
vibratory sensation.
o (b) flexing the leg at the knee, rotating it externally, and striking the Achilles tendon
with the percussion hammer: This elicits the Achilles reflex.
o (c) sharply dorsiflexing the foot and maintaining this position while supporting the
knee: Correct. This maneuver stretches the gastrocnemius muscle and can elicit clonus
(rhythmic involuntary dorsiflexion and plantarflexion of the foot).
o (d) stroking the lateral aspect of the sole from the heel to the ball of the foot with the
sharp end of the percussion hammer: This elicits the Babinski reflex.
IV. Geriatrics & Gynecology
Prioritizing Physical Examination Findings in Older Women
During a yearly evaluation of a 70-year-old female patient, the physical examination finding that
warrants the highest priority for immediate treatment is:
o (a) Atrophy of vaginal rugae: A normal age-related change due to decreased estrogen.
o (b) Cystocele present: A common finding in older women, but not typically requiring
immediate treatment unless symptomatic or severe.
o (c) Palpable ovary: Correct. A palpable ovary in a postmenopausal woman is abnormal
and requires immediate investigation to rule out malignancy.
o (d) Pessary in place: Indicates management of pelvic organ prolapse and is not an acute
concern.
V. Health Promotion & Patient Education
Health Belief Model: Perceived Severity
A 16-year-old male patient who just received his driver's license states he doesn't need to wear a
seat belt because nothing will happen to him in a car collision. According to the Health Belief
Model, this patient lacks the chief component of:
(
, o (a) Enabling factors: Resources or skills needed to adopt a behavior.
o (b) Motivation: The general desire to take action.
o (c) Perceived role conflict: Stress arising from competing social roles.
o (d) Perceived severity: Correct. The individual's belief about the seriousness of a
condition and its potential consequences.
VI. Epidemiology & Public Health
Documenting Epidemiological Factors for Biological Exposure
When treating patients for biological exposure, the adult-gerontology primary care nurse
practitioner documents the following epidemiological factors for each exposure:
o (a) Comorbidities and length of exposure: Important for individual patient management
but not primary epidemiological factors.
o (b) Location and event intensity: Relevant to the context of the exposure but not the
core epidemiological determinants of disease spread.
o (c) Mode of transmission and incubation: Correct. These are fundamental
epidemiological factors that describe how the infectious agent spreads and the time
between exposure and symptom onset.
o (d) Premorbid conditions and surveillance rates: Surveillance rates are population-
level data, and premorbid conditions relate to individual susceptibility.
VII. Research & Evidence-Based Practice
Disseminating Research Findings
When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary
care nurse practitioner:
o (a) concludes that the study proves the hypothesis: Research studies support or fail to
support hypotheses; they rarely "prove" them definitively.
o (b) excludes the discussion section, because the conclusion contains this information:
The discussion section is crucial for interpreting results, limitations, and implications.
o (c) recommends incorporating the results directly into clinical practice:
Recommendations for practice change require careful consideration of the study's strength
and context.
o (d) uses the methodology section to support the validity of the study: Correct. A well-
described and rigorous methodology enhances the credibility and validity of the research
findings.
(
, VIII. Ethics & Legal Considerations
Patient Confidentiality
A patient's adult child telephones to inquire about the patient's illness, stating the parent relies on
the child for explanations. The nurse practitioner:
o (a) asks the child to provide a copy of the patient's advance directive document:
While relevant for decision-making capacity, it doesn't override current confidentiality.
o (b) assures the child that the nurse practitioner can disclose requested information:
This would be a breach of patient confidentiality.
o (c) informs the child that he or she must come to the clinic to discuss the parent's
case: While an option, it doesn't address the core issue of confidentiality.
o (d) tells the child that the nurse practitioner can discuss the information only with
the patient: Correct. Maintaining patient confidentiality is paramount unless the patient
has provided explicit consent for disclosure.
Role in Medical Ethics Review Committee
The adult-gerontology primary care nurse practitioner appointed to a hospital's multidisciplinary
medical ethics review committee's role is to:
o (a) evaluate standards, risks, benefits, and outcomes: Correct. This committee
assesses the ethical implications of clinical decisions and policies.
o (b) identify how to anticipate and resolve similar future situations: While a potential
outcome, the primary role is evaluation.
o (c) investigate the need for disciplinary action: This is typically the role of other
committees.
o (d) obtain agreement of all parties with a chosen solution: The committee provides
recommendations, not necessarily mandates agreement.
Improving Quality of Clinical Practice
To improve the quality of clinical practice, the adult-gerontology primary care nurse
practitioner:
o (a) charges a fee for patients who arrive late to clinic appointments: This addresses
efficiency, not necessarily the quality of clinical care itself.
o (b) disseminates research study results to colleagues: Correct. Sharing evidence-based
findings promotes informed practice and quality improvement.
o (c) expresses opinions about alternative therapies with patients who consider such
treatments: While important for patient education, it doesn't directly improve overall
clinical practice.
(
