NU 577:
AANP
Exam
Pearls
STUDY
GUIDE
, 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
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): 1st 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.
, 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 1st (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 2nd 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
AANP
Exam
Pearls
STUDY
GUIDE
, 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
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): 1st 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.
, 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 1st (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 2nd 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
