AANP EXAM, PRACTICE EXAM AND STUDY GUIDE NEWEST
m m m m m m m
2024 ACTUAL EXAM 220 QUESTIONS AND CORRECT DETAI
m m m m m m m m
LED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |
m m m m m m
ALREADY GRADED A+ m m
Ampatientmtellsmthemnursempractitionermthatmshe mrecentlymstartedmtakingmthemsupplementmSt.mJohn'smwor
tmaftermreadingmaboutmitsmbenefitsmonline.mWhichmofmthemfollowingmmedications,mif mbeingmactivelymconsu
med,mmustmbe mimmediatelymstopped?
A. Benadryl
B. Famotidine m(Pepcid)
C. Metformninm(Glucophage)
D. Sumatriptanm(Imitrex) m-manswer-D.mSumatriptanm(imitrex)
Sumatriptanm(Imitrex) m(D) mismammedicationmusedmtomtreatmmigrainesmandmbelongsmtomamdrugmclassmknown
m asm serotonin magonists. mWhenm usedminmconjunction mwithm St. mJohn's mwort, mitmmay mincrease mthe mrisk mofm se
rotoninmsyndrome, mampotentiallymlife-threateningmcondition.
Whichmof mthe mfollowingmismnotmamsymptommofmbothmmajormdepressive mdisordermandmpost-
traumaticmstressmdisorder?
A. Difficultymconcentrating
B. Hypervigilance
C. Insomnia
D. Irritabiltym- manswer-B.mHypervigilance
Inmadditionmtomdifficultymconcentrating,minsomnia,mandmirritability,mmajormdepressivemdisorderm(MDD)m
maymalsomincludemsymptomsmofmdepressedmmood,manhedonia,mweightmlossmormgain,mandmlowmenergy.m
However,mhypervigilance m(B) mismnotmamsymptommassociatedmwithmthismdiagnosis.
Ampatientmwithmtype m1mdiabetesmpresentsmformamfollow-
upmvisit.mHe mhasmbeenmstable monmhismmedicationmregimenmbutmismworriedmbecause mhemismbetweenmjobsm
andmwillmbe mwithoutmhealthminsurance mcoveragemformamfewmmonths.mHemasksmifmtheremaremlessmexpensiv
e minsulinmoptionsmtomgetmhimmthroughmthismtime.mWhichmof mthemfollowingmwouldmbemgoodmoptionsmformt
hismpatient,mgivenmhismcircumstance?
Incorrect
A. Insulinm aspartm 70/30
B. Insulinm detemir
,C. Insulinm isophane
D. Insulinmdegludecm - m answer-Insulinm Isophane
The mleastmexpensive minsulinmtype mlistedminmthismquestionmisminsulinmisophanem(C) m(neutralmprotamine mHa
gedornminsulin).mThere mare malsomoftenmpharmacy-
specificmcouponsmthatmcanmbe musedmonminsulin,msomhelpingmpatientsmapplymformandmnavigate mthesemprog
ramsmcanmbe minstrumentalminmmanagingmtheirmdiabetes.mAnotherminexpensivemoptionmismregularminsulin.
Insulinmanalogsm(glargine,mdetemir,mdegludec,mlispro,mandmaspart)mare msignificantlymmoremexpensivemtha
nmhumanminsulinm(isophane,mregular).mInsulinsmmodifiedmbymmanufacturers,mespeciallymwhenmsoldmasmbr
and-
name mmedications,mtendmtombemmore mexpensivemduemtomthismmodification.mWhile manalogsmoffermalterna
te mlengthsmof mactionmandmconvenience, mthere mismnomwell-
m documentedm clinicalm evidencemthatmpatientm outcomes marem improved mwithmdifferingmbrands. mTherefore
,mmaintainingmampatient'smbloodmglucose mlevelmthroughmoutcome-
focusedmtreatmentmismmore mvaluable mthanmamprocess-focusedmplanmbasedmonmmedication.
Am40-year-
oldmwomanmwithmtype m2mdiabetesmpresentsmtomthe mclinicmwithmconcernsmofmspikingmbloodmsugarmbetweenmlu
nchmandmdinner.mShe mstatesmshe mismonmamrapid-actingminsulinmslidingmscale mandmlong-
actingminsulin.mWhichmchange mshouldmbe mimplementedmtomhelpmpreventmormcurbmthismglycemicmspike?
A. Addmamdose mof mmealtime minsulinmaspartm(Novolog) matmlunch
B. Addm insulinm detemirm (Levemir) m atm night
C. Increase mherminsulinmglargine m(Lantus)
D. Prescribe m am dose m of m neutralm protamine m Hagedornm insulinm withm dinnerm - m answer-
A.mAddmamdose mof mmealtime minsulinmaspartm(Novolog) matmlunch
Insulinmaspartm(Novolog)m(A) mismamrapidmactingminsulinmthatmismcommonlymdosedmwithmmealsmandmasmamsli
ding
scale mregimenmbasedmonmampatient'smglucosempriormtomeatingm(preprandial).mItmismthemappropriate minsuli
nmto
addmasmammealtime mdosemwhenmpatientsmexperiencembloodmglucosemspikesmbetweenmmealsmbecause m
ofmits
short-
actingmproperties. mPeakmtime mactionmofminsulinmaspartmism2mhoursmwithminitialmeffectmwithinmthe mfirstm30
minutes,mmakingmitmanmidealmchoice mtomcontrolmexpectedmpostprandialmglycemicmspi
kes
Whichmof mthemfollowingmconditionsmismassociatedmwithmanmincreasedmriskmformconductive mhearingmloss?mA
.Acousticmneuroma
B.Ménière mdiseas
e mC.Otitismmedia
D.Presbycusism-manswer-C.mOtitismmedia
Causesmof mconductive mhearingmlossmare motitismmediam(C),motitismexterna,mforeignmobjectsminmthe mearmcan
,al,mimpactedmearmwax,mtumors,mcongenitalmanomalies,mdiscontinuitymofmmiddle mearmbones,mcholesteato
ma,mandmtympanicmmembrane mrupture.mSoundmnormallymtravelsmdownmthe mearmcanalmtomvibrate mthemea
rdrum
, (tympanicmmembrane).mThemeardrummismconnectedmtomthree mmiddle mearmbonesm(malleus,mincus,mandmst
apes),mwhichmtransmitmthe msoundmintomtheminnermearm(cochlea).mThemcochleamismthemorganmthatmchanges
m sound m vibrations mintomamnervem signalm thatmtravelsmtomthem brain. m Themfourm typesmofm hearingmloss mare mco
nductive,msensorineural, mmixed,mandmretrocochlear.mConductivemhearingmlossmoccursmwhenmsoundmcann
otmeffectivelymreachmthe minnermearmdue mtomissue minmthe moutermearmandmmiddle mear.
Am23-year-
oldmpatientmwhomismpregnantmatm28mweeksmgestationmpresentsmtomthemclinicmformamroutine mprenatalmchec
kup.mWhichmfundalmheightmmeasurementmwouldmwarrantmammoremconclusive massessmentmwithmanmultras
ound?
A.26mcm
B.29mcm
C.30mcm
D.31mcmm-manswer-D.m31mcm
Afterm20mweeksmgestation,mthe mfundalmheightmshouldmbe mmeasuredmwithmammeasuringmtapeminmcentim
etersmandmshouldmmatchmthemgestationalmage.mItmcanmbem>morm< m2mcentimetersmandmstillmbemwithinmnor
malmlimits.mAmfundalmheightmofm26-
30mcmmismamnormalmfindingminmampatientmwhomism28mweeksmgestation.mAmresultmof m31mcm
(D) mismlargermthanmexpectedmandmshouldmbe mfurthermevaluatedmwithmanmultrasound.
Am4-year-
oldmboympresentsmwithmearmpainmandmanmerythematous,mbulgingmtympanicmmembranemonmexamination.m
The mnurse mpractitionermdiagnosesmhimmwithmacutemotitismmedia.mWhichmofmthemfollowingmaremthe mthreem
mostmcommonmbacterialmpathogensmassociatedmwithmacute motitismmediaminmchildren?
A.Moraxellamcatarrhalis,mStaphylococcusmaureus,mStreptococcusmpneumoniaemB.Nontypea
ble mHaemophilusminfluenzae,mMoraxellamcatarrhalis,mStaphylococcusmaureusmC.Nontypeab
le mHaemophilusminfluenzae, mMoraxellamcatarrhalis,mStreptococcusmpneumoniae
D.Nontypeable mHaemophilusminfluenzae,mStaphylococcusmaureus,mStreptococcusmpneumoniae m-manswer-
C.mNontypeable mHaemophilusminfluenzae,mMoraxellamcatarrhalis,mStreptococcusmpneumoniae
Acute motitismmediamismcommonlymencounteredmbymprimarymcare mnurse mpractitioners.mTypically,mchildren
m presentmwithmotalgiam andmhave mambulgingm tympanicm membrane monmexamination. mMany mtimes, mchildren
m alsom have mam precedingmviralm upperm respiratorym infection,mresultingm inmthemcolonization mofm bacteriam inmt
he mmiddle mearmandmleadingmtomambacterialminfection.mEarminfectionsmcanmbemcausedmbymbacterialmandmvir
almpathogens.
The mmostmcommonmbacterialmpathogensmisolatedmfrommmiddle mearmfluidmaremnontypeable mHaemophilus
m influenzae, mMoraxellam catarrhalis, mandmStreptococcus mpneumoniaem (C). mThemmostmcommonmviralm patho
gensminclude mrespiratorymsyncytialmvirus,mcoronaviruses, minfluenzamviruses,mandmadenoviruses.mTreatme
ntmformacute motitismmediamshouldmbemtargetedmtomcombatmthe mmostmcommonmbacterialmcauses,mincludin
gmamoxicillinm(penicillin),mamoxicillin-clavulanate m(penicillinmandmcombinationmbeta-lactammandmbeta-
m lactamase m inhibitor), m andm anm oralm second-
generationmcephalosporinm(e.g.,mcefuroxime) minmthe mcase mofmamchildmwithmampenicillinmallergy.
m m m m m m m
2024 ACTUAL EXAM 220 QUESTIONS AND CORRECT DETAI
m m m m m m m m
LED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |
m m m m m m
ALREADY GRADED A+ m m
Ampatientmtellsmthemnursempractitionermthatmshe mrecentlymstartedmtakingmthemsupplementmSt.mJohn'smwor
tmaftermreadingmaboutmitsmbenefitsmonline.mWhichmofmthemfollowingmmedications,mif mbeingmactivelymconsu
med,mmustmbe mimmediatelymstopped?
A. Benadryl
B. Famotidine m(Pepcid)
C. Metformninm(Glucophage)
D. Sumatriptanm(Imitrex) m-manswer-D.mSumatriptanm(imitrex)
Sumatriptanm(Imitrex) m(D) mismammedicationmusedmtomtreatmmigrainesmandmbelongsmtomamdrugmclassmknown
m asm serotonin magonists. mWhenm usedminmconjunction mwithm St. mJohn's mwort, mitmmay mincrease mthe mrisk mofm se
rotoninmsyndrome, mampotentiallymlife-threateningmcondition.
Whichmof mthe mfollowingmismnotmamsymptommofmbothmmajormdepressive mdisordermandmpost-
traumaticmstressmdisorder?
A. Difficultymconcentrating
B. Hypervigilance
C. Insomnia
D. Irritabiltym- manswer-B.mHypervigilance
Inmadditionmtomdifficultymconcentrating,minsomnia,mandmirritability,mmajormdepressivemdisorderm(MDD)m
maymalsomincludemsymptomsmofmdepressedmmood,manhedonia,mweightmlossmormgain,mandmlowmenergy.m
However,mhypervigilance m(B) mismnotmamsymptommassociatedmwithmthismdiagnosis.
Ampatientmwithmtype m1mdiabetesmpresentsmformamfollow-
upmvisit.mHe mhasmbeenmstable monmhismmedicationmregimenmbutmismworriedmbecause mhemismbetweenmjobsm
andmwillmbe mwithoutmhealthminsurance mcoveragemformamfewmmonths.mHemasksmifmtheremaremlessmexpensiv
e minsulinmoptionsmtomgetmhimmthroughmthismtime.mWhichmof mthemfollowingmwouldmbemgoodmoptionsmformt
hismpatient,mgivenmhismcircumstance?
Incorrect
A. Insulinm aspartm 70/30
B. Insulinm detemir
,C. Insulinm isophane
D. Insulinmdegludecm - m answer-Insulinm Isophane
The mleastmexpensive minsulinmtype mlistedminmthismquestionmisminsulinmisophanem(C) m(neutralmprotamine mHa
gedornminsulin).mThere mare malsomoftenmpharmacy-
specificmcouponsmthatmcanmbe musedmonminsulin,msomhelpingmpatientsmapplymformandmnavigate mthesemprog
ramsmcanmbe minstrumentalminmmanagingmtheirmdiabetes.mAnotherminexpensivemoptionmismregularminsulin.
Insulinmanalogsm(glargine,mdetemir,mdegludec,mlispro,mandmaspart)mare msignificantlymmoremexpensivemtha
nmhumanminsulinm(isophane,mregular).mInsulinsmmodifiedmbymmanufacturers,mespeciallymwhenmsoldmasmbr
and-
name mmedications,mtendmtombemmore mexpensivemduemtomthismmodification.mWhile manalogsmoffermalterna
te mlengthsmof mactionmandmconvenience, mthere mismnomwell-
m documentedm clinicalm evidencemthatmpatientm outcomes marem improved mwithmdifferingmbrands. mTherefore
,mmaintainingmampatient'smbloodmglucose mlevelmthroughmoutcome-
focusedmtreatmentmismmore mvaluable mthanmamprocess-focusedmplanmbasedmonmmedication.
Am40-year-
oldmwomanmwithmtype m2mdiabetesmpresentsmtomthe mclinicmwithmconcernsmofmspikingmbloodmsugarmbetweenmlu
nchmandmdinner.mShe mstatesmshe mismonmamrapid-actingminsulinmslidingmscale mandmlong-
actingminsulin.mWhichmchange mshouldmbe mimplementedmtomhelpmpreventmormcurbmthismglycemicmspike?
A. Addmamdose mof mmealtime minsulinmaspartm(Novolog) matmlunch
B. Addm insulinm detemirm (Levemir) m atm night
C. Increase mherminsulinmglargine m(Lantus)
D. Prescribe m am dose m of m neutralm protamine m Hagedornm insulinm withm dinnerm - m answer-
A.mAddmamdose mof mmealtime minsulinmaspartm(Novolog) matmlunch
Insulinmaspartm(Novolog)m(A) mismamrapidmactingminsulinmthatmismcommonlymdosedmwithmmealsmandmasmamsli
ding
scale mregimenmbasedmonmampatient'smglucosempriormtomeatingm(preprandial).mItmismthemappropriate minsuli
nmto
addmasmammealtime mdosemwhenmpatientsmexperiencembloodmglucosemspikesmbetweenmmealsmbecause m
ofmits
short-
actingmproperties. mPeakmtime mactionmofminsulinmaspartmism2mhoursmwithminitialmeffectmwithinmthe mfirstm30
minutes,mmakingmitmanmidealmchoice mtomcontrolmexpectedmpostprandialmglycemicmspi
kes
Whichmof mthemfollowingmconditionsmismassociatedmwithmanmincreasedmriskmformconductive mhearingmloss?mA
.Acousticmneuroma
B.Ménière mdiseas
e mC.Otitismmedia
D.Presbycusism-manswer-C.mOtitismmedia
Causesmof mconductive mhearingmlossmare motitismmediam(C),motitismexterna,mforeignmobjectsminmthe mearmcan
,al,mimpactedmearmwax,mtumors,mcongenitalmanomalies,mdiscontinuitymofmmiddle mearmbones,mcholesteato
ma,mandmtympanicmmembrane mrupture.mSoundmnormallymtravelsmdownmthe mearmcanalmtomvibrate mthemea
rdrum
, (tympanicmmembrane).mThemeardrummismconnectedmtomthree mmiddle mearmbonesm(malleus,mincus,mandmst
apes),mwhichmtransmitmthe msoundmintomtheminnermearm(cochlea).mThemcochleamismthemorganmthatmchanges
m sound m vibrations mintomamnervem signalm thatmtravelsmtomthem brain. m Themfourm typesmofm hearingmloss mare mco
nductive,msensorineural, mmixed,mandmretrocochlear.mConductivemhearingmlossmoccursmwhenmsoundmcann
otmeffectivelymreachmthe minnermearmdue mtomissue minmthe moutermearmandmmiddle mear.
Am23-year-
oldmpatientmwhomismpregnantmatm28mweeksmgestationmpresentsmtomthemclinicmformamroutine mprenatalmchec
kup.mWhichmfundalmheightmmeasurementmwouldmwarrantmammoremconclusive massessmentmwithmanmultras
ound?
A.26mcm
B.29mcm
C.30mcm
D.31mcmm-manswer-D.m31mcm
Afterm20mweeksmgestation,mthe mfundalmheightmshouldmbe mmeasuredmwithmammeasuringmtapeminmcentim
etersmandmshouldmmatchmthemgestationalmage.mItmcanmbem>morm< m2mcentimetersmandmstillmbemwithinmnor
malmlimits.mAmfundalmheightmofm26-
30mcmmismamnormalmfindingminmampatientmwhomism28mweeksmgestation.mAmresultmof m31mcm
(D) mismlargermthanmexpectedmandmshouldmbe mfurthermevaluatedmwithmanmultrasound.
Am4-year-
oldmboympresentsmwithmearmpainmandmanmerythematous,mbulgingmtympanicmmembranemonmexamination.m
The mnurse mpractitionermdiagnosesmhimmwithmacutemotitismmedia.mWhichmofmthemfollowingmaremthe mthreem
mostmcommonmbacterialmpathogensmassociatedmwithmacute motitismmediaminmchildren?
A.Moraxellamcatarrhalis,mStaphylococcusmaureus,mStreptococcusmpneumoniaemB.Nontypea
ble mHaemophilusminfluenzae,mMoraxellamcatarrhalis,mStaphylococcusmaureusmC.Nontypeab
le mHaemophilusminfluenzae, mMoraxellamcatarrhalis,mStreptococcusmpneumoniae
D.Nontypeable mHaemophilusminfluenzae,mStaphylococcusmaureus,mStreptococcusmpneumoniae m-manswer-
C.mNontypeable mHaemophilusminfluenzae,mMoraxellamcatarrhalis,mStreptococcusmpneumoniae
Acute motitismmediamismcommonlymencounteredmbymprimarymcare mnurse mpractitioners.mTypically,mchildren
m presentmwithmotalgiam andmhave mambulgingm tympanicm membrane monmexamination. mMany mtimes, mchildren
m alsom have mam precedingmviralm upperm respiratorym infection,mresultingm inmthemcolonization mofm bacteriam inmt
he mmiddle mearmandmleadingmtomambacterialminfection.mEarminfectionsmcanmbemcausedmbymbacterialmandmvir
almpathogens.
The mmostmcommonmbacterialmpathogensmisolatedmfrommmiddle mearmfluidmaremnontypeable mHaemophilus
m influenzae, mMoraxellam catarrhalis, mandmStreptococcus mpneumoniaem (C). mThemmostmcommonmviralm patho
gensminclude mrespiratorymsyncytialmvirus,mcoronaviruses, minfluenzamviruses,mandmadenoviruses.mTreatme
ntmformacute motitismmediamshouldmbemtargetedmtomcombatmthe mmostmcommonmbacterialmcauses,mincludin
gmamoxicillinm(penicillin),mamoxicillin-clavulanate m(penicillinmandmcombinationmbeta-lactammandmbeta-
m lactamase m inhibitor), m andm anm oralm second-
generationmcephalosporinm(e.g.,mcefuroxime) minmthe mcase mofmamchildmwithmampenicillinmallergy.
