AANPCB-FNP exam questions

1. Question 1

   Single answer

   When performing an examination of a patient with varicose veins, which of the following findings would you expect to observe?

   • A

     The degree of discomfort experienced is directly related to the number and appearance of affected veins.

   • B

     Lifestyle modification has been ineffective in minimizing symptoms.

   • C

     Palpation of the affected vein causes acute pain.

   • D

     Mild edema in the ankle area seen at the end of the day

   Reveal answer

   Correct answer

   • D

     Mild edema in the ankle area seen at the end of the day

   Explanation

   Mild edema in the ankle area, particularly during warm weather and/or at the end of the day, is a common occurrence in patients with varicose veins.
   In uncomplicated varicose veins, lifestyle modification usually helps minimize the symptoms and disease progression. When palpated, the affected vein compresses easily and without pain. The degree of discomfort with varicose veins is poorly correlated with the number and appearance of the affected veins.

2. Question 2

   Single answer

   You are providing care for a patient with mild osteoarthritis (OA) of the knee. As you develop the treatment plan, you recognize which of the following medications is recommended by the American Academy of Orthopaedic Surgeons for controlling the pain associated with mild OA of the knee?

   • A

     Tramadol (Ultram, Tramal)

   • B

     Acetaminophen (Tylenol)

   • C

     Topical analgesics

   • D

     Intra-articular corticosteroid joint injections

   Reveal answer

   Correct answer

   • B

     Acetaminophen (Tylenol)

   Explanation

   First-line medication is acetaminophen (Tylenol) 325 to 1,000 mg every 4 to 6 hours (maximum 4 g/day) PRN for less severe cases of OA. Dehydration increases risk of hepatic adverse events; the patient should be advised to drink a lot of water. If there is no relief with acetaminophen, switch to a short-acting NSAID.
   Although NSAIDS also have potential anti-inflammatory activity, this mechanism of drug action is seldom needed in OA therapy because inflammation is a minor contributor to symptoms. Because of the gastropathy potential associated with long-term use of NSAIDS, a trial of acetaminophen is warranted for symptom control in less severe cases of OA, recognizing that NSAIDs are usually associated with superior analgesic effect. Opioid analgesics should be avoided if possible.
   The AAOS does not recommend for or against the use of intra-articular corticosteroid joint injections because of a lack of compelling evidence comparing the benefits with risks. Topical analgesics can be considered for superficial joints, though these will not work well for deeper joints. In addition, these agents must be used for at least 2 weeks before the full effects are realized.

3. Question 3

   Single answer

   When should an infant who is born to a mother infected with hepatitis B virus (HBV) receive the HBV vaccine?

   • A

     During the first 24 hours of life administered along with hepatitis B immune globulin (HBIG)

   • B

     During the second month of life as part of the Centers for Disease Control (CDC) recommended two-month vaccine schedule

   • C

     During the first 24 hours of life administered alone

   • D

     HBV vaccine should be administered during pregnancy to women infected with the virus to protect the developing fetus

   Reveal answer

   Correct answer

   • A

     During the first 24 hours of life administered along with hepatitis B immune globulin (HBIG)

   Explanation

   Perinatal transmission of HBV to the fetus is highly efficient and usually occurs during exposure to blood during labor and delivery. An infant born to a mother infected with HBV should receive the HBV vaccine and HBIG during the first 24 hours of life to minimize the risk of perinatal transmission and the subsequent development of chronic HBV infection.
   The Centers for Disease Control (CDC) recommends routine vaccination for all infants, delivered as a three-injection series at birth, one month, and six months of age.

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5. Question 4

   Single answer

   A 45-year-old morbidly obese male patient has been regularly seen at the primary care clinic for the last 2 years due to diabetes (DM) and hypertension (HTN). The patient is compliant with the medication treatment plan and has expressed concern in the past about his need to take medication to manage his DM and HTN, but he has never expressed concern about his weight.
   Which of the following statements by the nurse practitioner regarding weight loss is appropriate for this patient?

   • A

     "What barriers can you identify as preventing you from losing weight?"

   • B

     "How do you feel about your weight?"

   • C

     "What can I do to help you lose weight?"

   • D

     "What is your personal health goal?"

   Reveal answer

   Correct answer

   • B

     "How do you feel about your weight?"

   Explanation

   Nurse practitioners (NPs) who have the opportunity to provide primary care for patients who are overweight or obese should take the additional opportunity to ask the patient about their readiness to make a change at every scheduled visit. Despite experiencing health complications such as DM or HTN as a result of obesity, some patients may have never contemplated the effect their weight has on their overall health or may believe that they are incapable of losing weight. Patients who have close family members or a significant other who are also obese or overweight may be unaware of their need for weight loss or less motivated to consider weight loss due to the unspoken support for a lifestyle that promotes obesity from these close individuals.
   When asking the patient about readiness to make a change that will promote weight loss, the NP first has to consider at which stage of change-making the patient is. Patients who have never expressed interest in making changes to lose weight or who have expressed disinterest in losing weight should be considered to be in the pre-contemplation phase of change-making. It is most appropriate for the NP to ask this patient how he feels about his weight or how his weight affects him or to ask if the patient is considering losing weight. Once the patient has provided his answer, the NP should validate the patient,s response and offer help.
   Patients who have made comments suggesting they are contemplating making changes to lose weight are considered to be in the contemplation stage of change-making. The NP can ask the patient about perceived barriers that may hinder or prevent the patient from making the necessary changes. Patients who have contemplated making changes to lose weight typically progress to being prepared to make changes. Asking about the patient,s personal health goal or personal weight loss goal and then helping identify the patient,s support system and assisting in setting behavioral goals are appropriate during this preparation stage. The NP should ask patients who are already making changes that will facilitate weight loss how to assist them with their progress. Finally, patients who are in the stage of maintaining their weight loss should be asked if they are encountering anything that is hindering them from fully reaching their goal(s).
   Patients who have relapsed with weight gain should also be provided with support and reminded about what helped them to be successful in their weight loss.

6. Question 5

   Single answer

   A 45-year-old African American female presented to the family practice office for an evaluation after she noticed persistent edema of her fingers, hands, and face, and that her lower legs were edematous and pitting. She also described experiencing intense pruritus and a burning sensation in the affected areas. The patient stated she had been diagnosed with Raynaud''s approximately one year ago and that she has been taking oral nifedipine to manage Raynaud''s symptoms. Based on the information provided in the scenario, which of the following is the most likely cause of the patient''s symptoms?

   • A

     Severe adverse effects associated with the use of oral nifedipine

   • B

     Poor response of Raynaud,s phenomenon to medication treatment with marked worsening of Raynaud,s

   • C

     Systemic sclerosis

   • D

     Systemic lupus erythematous

   Reveal answer

   Correct answer

   • C

     Systemic sclerosis

   Explanation

   Systemic Sclerosis (SSc), also referred to as scleroderma (which is a more specific term for the skin lesions that may be experienced by some individuals), is an autoimmune inflammatory disorder with a high association with Raynaud,s Phenomenon (RP). The earliest symptoms of SSc are vague and nonspecific, including fatigue, musculoskeletal stiffness and/or pain, and feelings of illness. Patients may also complain of experiencing dysphagia, heartburn, and gastroesophageal reflux in conjunction with RP, with this constellation of symptoms often preceding a diagnosis of SSc by several years. It is common for patients to be diagnosed with RP, and then within a short time frame (one to two years) to return with symptoms of soft tissue edema (hands, fingers, face, lower extremities), severe pruritus, and a burning sensation to the affected areas, and pitting edema of the lower extremities. The skin may become hyperpigmented or develop areas of hypopigmentation similar to that seen in vitiligo, especially noted along the scalp, the back of the hands, the chest, and the back. Musculoskeletal symptoms tend to gradually worsen with the patient noticing weakening of the muscles and a decrease in joint mobility. After the edematous/inflammatory phase of SSc has subsided, the fibrotic phase begins, with fibrosis first affecting the skin and then progressing to the subcutaneous fat, fascia, muscle, and other soft tissue structures.
   SSc is divided into four subtypes: limited cutaneous SSc, diffuse cutaneous SSc, systemic sclerosis sine scleroderma, and morphea. Choctaw Native Americans and African Americans have higher rates of systemic SSC, while European Americans have higher rates of localized variants of the disease.

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