AANP FINAL
REAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALES TESTED AND
APPROVED!!!
A 40-year-old woman with type 2 diabetes presents to the clinic with concerns of spiking
blood sugar between lunch and dinner. She states she is on a rapid-acting insulin sliding scale
and long-acting insulin. Which change should be implemented to help prevent or curb this
glycemic spike?
A.
Add a dose of mealtime insulin aspart (Novolog) at lunch
B.
Add insulin detemir (Levemir) at night
C.
Increase her insulin glargine (Lantus)
D.
Prescribe a dose of neutral protamine Hagedorn insulin with dinner -- ANSWER--A. Add a
dose of mealtime insulin aspart (Novolog) at lunch
Page 1 of 84
,Insulin aspart (Novolog) (A) is a rapid acting insulin that is commonly dosed with meals and
as a sliding scale regimen based on a patient's glucose prior to eating (preprandial). It is the
appropriate insulin to add as a mealtime dose when patients experience blood glucose spikes
between meals because of its short-acting properties. Peak time action of insulin aspart is 2
hours with initial effect within the first 30 minutes, making it an ideal choice to control
expected postprandial glycemic spikes
Which of the following conditions is associated with an increased risk for conductive hearing
loss?
A.
Acoustic neuroma
B.
Ménière disease
C.
Otitis media
D.
Presbycusis -- ANSWER--C. Otitis media
Causes of conductive hearing loss are otitis media (C), otitis externa, foreign objects in the
ear canal, impacted ear wax, tumors, congenital anomalies, discontinuity of middle ear bones,
cholesteatoma, and tympanic membrane rupture. Sound normally travels down the ear canal
to vibrate the eardrum (tympanic membrane). The eardrum is connected to three middle ear
Page 2 of 84
,bones (malleus, incus, and stapes), which transmit the sound into the inner ear (cochlea). The
cochlea is the organ that changes sound vibrations into a nerve signal that travels to the brain.
The four types of hearing loss are conductive, sensorineural, mixed, and retrocochlear.
Conductive hearing loss occurs when sound cannot effectively reach the inner ear due to
issue in the outer ear and middle ear.
A 23-year-old patient who is pregnant at 28 weeks gestation presents to the clinic for a
routine prenatal checkup. Which fundal height measurement would warrant a more
conclusive assessment with an ultrasound?
A. 26 cm B. 29 cm C. 30 cm D.
31 cm -- ANSWER--D. 31 cm
After 20 weeks gestation, the fundal height should be measured with a measuring tape in
centimeters and should match the gestational age. It can be > or < 2 centimeters and still be
within normal limits. A fundal height of 26-30 cm is a normal finding in a patient who is 28
weeks gestation. A result of 31 cm (D) is larger than expected and should be further
evaluated with an ultrasound.
A 4-year-old boy presents with ear pain and an erythematous, bulging tympanic membrane
on examination. The nurse practitioner diagnoses him with acute otitis media. Which of the
following are the three most common bacterial pathogens associated with acute otitis media
in children?
A.
Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pneumoniae
B.
Page 3 of 84
, Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus
C.
Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae
D.
Nontypeable Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae --
ANSWER--C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus
pneumoniae
Acute otitis media is commonly encountered by primary care nurse practitioners. Typically,
children present with otalgia and have a bulging tympanic membrane on examination. Many
times, children also have a preceding viral upper respiratory infection, resulting in the
colonization of bacteria in the middle ear and leading to a bacterial infection. Ear infections
can be caused by bacterial and viral pathogens. The most common bacterial pathogens
isolated from middle ear fluid are nontypeable Haemophilus influenzae, Moraxella
catarrhalis, and Streptococcus pneumoniae (C). The most common viral pathogens include
respiratory syncytial virus, coronaviruses, influenza viruses, and adenoviruses. Treatment for
acute otitis media should be targeted to combat the most common bacterial causes, including
amoxicillin (penicillin), amoxicillin-clavulanate (penicillin and combination beta-lactam and
beta-lactamase inhibitor), and an oral second-generation cephalosporin (e.g., cefuroxime) in
the case of a child with a penicillin allergy.
A 6-year-old patient presents to the clinic accompanied by his mother, who reports concerns
regarding her child's progressive urinary issues. The patient's mother states that she and the
child's father recently divorced, and the child alternates weekly between her house and his
father's house. She reports he experiences episodes of urinary incontinence and holds his
stomach as if he is in pain. He frequently asks to use the bathroom but is scared of urination
once he is there. Which of the following is the most likely diagnosis?
Page 4 of 84
REAL EXAM QUESTIONS AND ANSWERS
WITH RATIONALES TESTED AND
APPROVED!!!
A 40-year-old woman with type 2 diabetes presents to the clinic with concerns of spiking
blood sugar between lunch and dinner. She states she is on a rapid-acting insulin sliding scale
and long-acting insulin. Which change should be implemented to help prevent or curb this
glycemic spike?
A.
Add a dose of mealtime insulin aspart (Novolog) at lunch
B.
Add insulin detemir (Levemir) at night
C.
Increase her insulin glargine (Lantus)
D.
Prescribe a dose of neutral protamine Hagedorn insulin with dinner -- ANSWER--A. Add a
dose of mealtime insulin aspart (Novolog) at lunch
Page 1 of 84
,Insulin aspart (Novolog) (A) is a rapid acting insulin that is commonly dosed with meals and
as a sliding scale regimen based on a patient's glucose prior to eating (preprandial). It is the
appropriate insulin to add as a mealtime dose when patients experience blood glucose spikes
between meals because of its short-acting properties. Peak time action of insulin aspart is 2
hours with initial effect within the first 30 minutes, making it an ideal choice to control
expected postprandial glycemic spikes
Which of the following conditions is associated with an increased risk for conductive hearing
loss?
A.
Acoustic neuroma
B.
Ménière disease
C.
Otitis media
D.
Presbycusis -- ANSWER--C. Otitis media
Causes of conductive hearing loss are otitis media (C), otitis externa, foreign objects in the
ear canal, impacted ear wax, tumors, congenital anomalies, discontinuity of middle ear bones,
cholesteatoma, and tympanic membrane rupture. Sound normally travels down the ear canal
to vibrate the eardrum (tympanic membrane). The eardrum is connected to three middle ear
Page 2 of 84
,bones (malleus, incus, and stapes), which transmit the sound into the inner ear (cochlea). The
cochlea is the organ that changes sound vibrations into a nerve signal that travels to the brain.
The four types of hearing loss are conductive, sensorineural, mixed, and retrocochlear.
Conductive hearing loss occurs when sound cannot effectively reach the inner ear due to
issue in the outer ear and middle ear.
A 23-year-old patient who is pregnant at 28 weeks gestation presents to the clinic for a
routine prenatal checkup. Which fundal height measurement would warrant a more
conclusive assessment with an ultrasound?
A. 26 cm B. 29 cm C. 30 cm D.
31 cm -- ANSWER--D. 31 cm
After 20 weeks gestation, the fundal height should be measured with a measuring tape in
centimeters and should match the gestational age. It can be > or < 2 centimeters and still be
within normal limits. A fundal height of 26-30 cm is a normal finding in a patient who is 28
weeks gestation. A result of 31 cm (D) is larger than expected and should be further
evaluated with an ultrasound.
A 4-year-old boy presents with ear pain and an erythematous, bulging tympanic membrane
on examination. The nurse practitioner diagnoses him with acute otitis media. Which of the
following are the three most common bacterial pathogens associated with acute otitis media
in children?
A.
Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pneumoniae
B.
Page 3 of 84
, Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus
C.
Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae
D.
Nontypeable Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae --
ANSWER--C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus
pneumoniae
Acute otitis media is commonly encountered by primary care nurse practitioners. Typically,
children present with otalgia and have a bulging tympanic membrane on examination. Many
times, children also have a preceding viral upper respiratory infection, resulting in the
colonization of bacteria in the middle ear and leading to a bacterial infection. Ear infections
can be caused by bacterial and viral pathogens. The most common bacterial pathogens
isolated from middle ear fluid are nontypeable Haemophilus influenzae, Moraxella
catarrhalis, and Streptococcus pneumoniae (C). The most common viral pathogens include
respiratory syncytial virus, coronaviruses, influenza viruses, and adenoviruses. Treatment for
acute otitis media should be targeted to combat the most common bacterial causes, including
amoxicillin (penicillin), amoxicillin-clavulanate (penicillin and combination beta-lactam and
beta-lactamase inhibitor), and an oral second-generation cephalosporin (e.g., cefuroxime) in
the case of a child with a penicillin allergy.
A 6-year-old patient presents to the clinic accompanied by his mother, who reports concerns
regarding her child's progressive urinary issues. The patient's mother states that she and the
child's father recently divorced, and the child alternates weekly between her house and his
father's house. She reports he experiences episodes of urinary incontinence and holds his
stomach as if he is in pain. He frequently asks to use the bathroom but is scared of urination
once he is there. Which of the following is the most likely diagnosis?
Page 4 of 84
