NU 577 AANP Exam Pearls
AANP: Exam Pearls
Exam Format
AANP FNP exam contains very few nonclinical questions
Certification tests are designed for entry-level practice
AANP has 15 pilot questions which are not graded [there is NO WAY to identify the pilot test
questions from the graded questions]
New clinical info [treatment and/or guidelines] released in the last 10 months won’t be on the
exam
Questions will be on primary care disorders – if you are guessing, AVOID PICKING EXOTIC
DIAGNOSIS AS AN ANSWER
Labs
Normal lab results pertinent to a question WILL ONLY BE LISTED ONCE. Use your scratch
sheet of paper to jot down these values if given.
Follow the LAB NORMS GIVEN BY AANP not what you learned in NP school
Learn the significance of abnormal lab values AND type of follow -up needed [i.e. elderly
gentleman with c/o scalp tenderness + indurated temporal artery, NP suspects temporal
arteritis. Screening test is sed rate – which is expected to be MUCH HIGHER than normal
value]
Good to Know
Expect one question related to dental injury [i.e. completely avulsed permanent tooth
should be reimplanted ASAP! It can be transported to dentist in cold milk (not frozen milk)
May be a question on epidemiologic terms (i.e. sensitivity is defined as the ability of a test to
detect a person who has the disease. Specificity is defined as the ability of a test to detect a
person who is healthy or detect the person without the disease)
Learn definition of some research study designs: cohort follows a group of people who
share some common characteristics to observe the development of a disease over time –
Framingham nurses health study
Emergent conditions that will present in primary care clinics will be on the exam: navicular
fracture, MI, cauda equina syndrome, anaphylaxis, angioedema, meningococcal meningitis
Know some anatomic areas: trauma to Kiesselbach’s plexus = anterior nosebleed
Some questions ask about “gold-standard test” or the “diagnostic test for the condition”:
sickle cell anemia, G6PD anemia, and alpha/beta thalassemia = hgb electrophoresis
Disease states are usually presented in their “full-blown classic” textbook presentation:
acute mononucleosis, teen will have classic triad of sore throat, prolonged fatigue, and
enlarged cervical nodes. If patient is older with same signs/symptoms, it is still mononucleosis
reactivated type
Ethic background may provide clues to disease: alpha thal = southeast Asia / Filipinos; beta
thal = Mediterranean
NO ASYMPTOMATIC or BORDERLINE CASES OF DISEASE STATES WILL BE ON THE
EXAM: IDA in “real life” don’t present often with pica or spoon-shaped nails, on the exam they
will have these clinical findings
,NU 577 AANP Exam Pearls
Be familiar with lupus and SLE: malar rash (butterfly) = lupus. Instruct patient to avoid /
minimize sun exposure r/t photosensitivity.
Be familiar with polymyalgia rheumatica (PRM): 1 st line tx is long-term steroids. Long-term,
low-dose steroids are commonly used to control symptoms (pain, severe stiffness in shoulders
/ hip girdle). PMR patients are at HIGH RISK FOR TEMPORAL ARTERITIS.
,NU 577 AANP Exam Pearls
Gold standard exam for temporal arteritis: biopsy + refer patient to optho for management.
Learn the disorders for which maneuvers are used and what a positive report means:
o Finkelstein’s test—positive in De Quervain’s tenosynovitis
o Anterior drawer maneuver and Lachman maneuver—positive if anterior cruciate
ligament (ACL) of the knee is damaged. The knee may also be unstable.
o McMurray’s sign—positive in meniscus injuries of the knee
Conditions that NEED a radiologic test: damaged joints – order Xray 1 st (but MRI is the gold
standard)
Abnormal eye findings in DM (diabetic retinopathy) and HTN (hypertensive retinopathy)
should be MEMORIZED and learn to distinguish each one:
o Diabetic retinopathy = neovascularization, cotton wool spots, microaneurysms
o Hypertensive retinopathy = AV nicking, silver and/or copper wire arterioles
Become knowledgeable about physical exam “normal” and “abnormal” findings:
o Checking DTRs in patient w/severe sciatica or diabetic peripheral neuropathy: ankle
jerk reflex (Achilles reflex) may be absent or hypoactive. Scoring absent (0), hypoactive
(1), normal (2), hyperactive (3), and clonus (4).
ONLY A FEW QUESTIONS WILL BE ON BENIGN or PHYSIOLOGIC VARIANTS: benign S4
heart sounds may be auscultated in some elderly pt. Torus palantinus and fishtail uvula may be
seen during the oral exam in a few patients.
If the question is asking for the initial or screening lab test, it will probably be a “cheap” and
readily available test: CBC (complete blood count (CBC) to screen for anemia
There are some questions on theories and conceptual models: Stages of change or
“decision” theory (Prochaska) includes concepts such as precontemplation, contemplation,
preparation, action, and maintenance.
Other health theorists who have been included on the exams in the past are (not inclusive):
o Alfred Bandura (self-efficacy), Erik Erikson, Sigmund Freud, Elisabeth Kübler-Ross
(grieving), and others
o If a small child expresses a desire to marry a parent of the opposite sex: the child is
in the oedipal stage (Freud). Child’s age is about 5 to 6 years (preschool to
kindergarten).
o Starting at the age of about 11 years, most children can understand abstract
concepts (early abstract thinking) and are better at logical thinking.
o When performing the Mini-Mental State Exam, when the NP is asking about
“proverbs,” the nurse is assessing the patient’s ability to understand abstract concepts.
Keep these good communication rules in mind: Ask open-ended questions, do not reassure
patients, avoid angering the patient, and respect the patient’s culture.
There may be two to three questions relating to abuse: child abuse, domestic abuse, elderly
abuse
Antibiotics & Medications
Know the difference between 1st and 2 nd line abx: AOM in 7 yr old treated with amoxicillin
returns in 48hr without improvement (continued ear pain, bulging TM). Next step is to d/c
amox and start child on 2nd line abx Augmentin BID x10 days
Be familiar with alternative abx for PCN-allergic patients: If patient has gram+ infection,
prescribe macrolides, clinda, quinolones = levo or moxi
Patient responds well to macrolides but thinks they’re allergic to erythromycin (nausea,
GI upset): inform patient she had an adverse rx, not a true allergic (hives/angioedema): switch
pt from erythromycin to azithromycin (z-pack)
, NU 577 AANP Exam Pearls
Fails to respond to initial medication: add another medication per treatment guidelines (i.e.
COPD pt prescribed Atrovent for dyspnea. On follow-up, patient complains symptoms are not
relieved. Next step is to prescribe albuterol (Ventolin) or combo inhaler)
Commonly used drugs with rare (potentially fatal) adverse effects: ACE-I = angioedema.
Common side effect of ACEIs = dry cough (up to 10%)
AANP: Exam Pearls
Exam Format
AANP FNP exam contains very few nonclinical questions
Certification tests are designed for entry-level practice
AANP has 15 pilot questions which are not graded [there is NO WAY to identify the pilot test
questions from the graded questions]
New clinical info [treatment and/or guidelines] released in the last 10 months won’t be on the
exam
Questions will be on primary care disorders – if you are guessing, AVOID PICKING EXOTIC
DIAGNOSIS AS AN ANSWER
Labs
Normal lab results pertinent to a question WILL ONLY BE LISTED ONCE. Use your scratch
sheet of paper to jot down these values if given.
Follow the LAB NORMS GIVEN BY AANP not what you learned in NP school
Learn the significance of abnormal lab values AND type of follow -up needed [i.e. elderly
gentleman with c/o scalp tenderness + indurated temporal artery, NP suspects temporal
arteritis. Screening test is sed rate – which is expected to be MUCH HIGHER than normal
value]
Good to Know
Expect one question related to dental injury [i.e. completely avulsed permanent tooth
should be reimplanted ASAP! It can be transported to dentist in cold milk (not frozen milk)
May be a question on epidemiologic terms (i.e. sensitivity is defined as the ability of a test to
detect a person who has the disease. Specificity is defined as the ability of a test to detect a
person who is healthy or detect the person without the disease)
Learn definition of some research study designs: cohort follows a group of people who
share some common characteristics to observe the development of a disease over time –
Framingham nurses health study
Emergent conditions that will present in primary care clinics will be on the exam: navicular
fracture, MI, cauda equina syndrome, anaphylaxis, angioedema, meningococcal meningitis
Know some anatomic areas: trauma to Kiesselbach’s plexus = anterior nosebleed
Some questions ask about “gold-standard test” or the “diagnostic test for the condition”:
sickle cell anemia, G6PD anemia, and alpha/beta thalassemia = hgb electrophoresis
Disease states are usually presented in their “full-blown classic” textbook presentation:
acute mononucleosis, teen will have classic triad of sore throat, prolonged fatigue, and
enlarged cervical nodes. If patient is older with same signs/symptoms, it is still mononucleosis
reactivated type
Ethic background may provide clues to disease: alpha thal = southeast Asia / Filipinos; beta
thal = Mediterranean
NO ASYMPTOMATIC or BORDERLINE CASES OF DISEASE STATES WILL BE ON THE
EXAM: IDA in “real life” don’t present often with pica or spoon-shaped nails, on the exam they
will have these clinical findings
,NU 577 AANP Exam Pearls
Be familiar with lupus and SLE: malar rash (butterfly) = lupus. Instruct patient to avoid /
minimize sun exposure r/t photosensitivity.
Be familiar with polymyalgia rheumatica (PRM): 1 st line tx is long-term steroids. Long-term,
low-dose steroids are commonly used to control symptoms (pain, severe stiffness in shoulders
/ hip girdle). PMR patients are at HIGH RISK FOR TEMPORAL ARTERITIS.
,NU 577 AANP Exam Pearls
Gold standard exam for temporal arteritis: biopsy + refer patient to optho for management.
Learn the disorders for which maneuvers are used and what a positive report means:
o Finkelstein’s test—positive in De Quervain’s tenosynovitis
o Anterior drawer maneuver and Lachman maneuver—positive if anterior cruciate
ligament (ACL) of the knee is damaged. The knee may also be unstable.
o McMurray’s sign—positive in meniscus injuries of the knee
Conditions that NEED a radiologic test: damaged joints – order Xray 1 st (but MRI is the gold
standard)
Abnormal eye findings in DM (diabetic retinopathy) and HTN (hypertensive retinopathy)
should be MEMORIZED and learn to distinguish each one:
o Diabetic retinopathy = neovascularization, cotton wool spots, microaneurysms
o Hypertensive retinopathy = AV nicking, silver and/or copper wire arterioles
Become knowledgeable about physical exam “normal” and “abnormal” findings:
o Checking DTRs in patient w/severe sciatica or diabetic peripheral neuropathy: ankle
jerk reflex (Achilles reflex) may be absent or hypoactive. Scoring absent (0), hypoactive
(1), normal (2), hyperactive (3), and clonus (4).
ONLY A FEW QUESTIONS WILL BE ON BENIGN or PHYSIOLOGIC VARIANTS: benign S4
heart sounds may be auscultated in some elderly pt. Torus palantinus and fishtail uvula may be
seen during the oral exam in a few patients.
If the question is asking for the initial or screening lab test, it will probably be a “cheap” and
readily available test: CBC (complete blood count (CBC) to screen for anemia
There are some questions on theories and conceptual models: Stages of change or
“decision” theory (Prochaska) includes concepts such as precontemplation, contemplation,
preparation, action, and maintenance.
Other health theorists who have been included on the exams in the past are (not inclusive):
o Alfred Bandura (self-efficacy), Erik Erikson, Sigmund Freud, Elisabeth Kübler-Ross
(grieving), and others
o If a small child expresses a desire to marry a parent of the opposite sex: the child is
in the oedipal stage (Freud). Child’s age is about 5 to 6 years (preschool to
kindergarten).
o Starting at the age of about 11 years, most children can understand abstract
concepts (early abstract thinking) and are better at logical thinking.
o When performing the Mini-Mental State Exam, when the NP is asking about
“proverbs,” the nurse is assessing the patient’s ability to understand abstract concepts.
Keep these good communication rules in mind: Ask open-ended questions, do not reassure
patients, avoid angering the patient, and respect the patient’s culture.
There may be two to three questions relating to abuse: child abuse, domestic abuse, elderly
abuse
Antibiotics & Medications
Know the difference between 1st and 2 nd line abx: AOM in 7 yr old treated with amoxicillin
returns in 48hr without improvement (continued ear pain, bulging TM). Next step is to d/c
amox and start child on 2nd line abx Augmentin BID x10 days
Be familiar with alternative abx for PCN-allergic patients: If patient has gram+ infection,
prescribe macrolides, clinda, quinolones = levo or moxi
Patient responds well to macrolides but thinks they’re allergic to erythromycin (nausea,
GI upset): inform patient she had an adverse rx, not a true allergic (hives/angioedema): switch
pt from erythromycin to azithromycin (z-pack)
, NU 577 AANP Exam Pearls
Fails to respond to initial medication: add another medication per treatment guidelines (i.e.
COPD pt prescribed Atrovent for dyspnea. On follow-up, patient complains symptoms are not
relieved. Next step is to prescribe albuterol (Ventolin) or combo inhaler)
Commonly used drugs with rare (potentially fatal) adverse effects: ACE-I = angioedema.
Common side effect of ACEIs = dry cough (up to 10%)
