AANP EXAM, PRACTICE EXAM AND STUDY GUIDE NEWEST
2025 ACTUAL EXAM 220 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
A patient tells the nurse practitioner that she recently started taking the supplement St. John's wort
after reading about its benefits online. Which of the following medications, if being actively consumed,
must be immediately stopped?
A. Benadryl
B. Famotidine (Pepcid)
C. Metformnin (Glucophage)
D. Sumatriptan (Imitrex) - answer-D. Sumatriptan (imitrex)
Sumatriptan (Imitrex) (D) is a medication used to treat migraines and belongs to a drug class known as
serotonin agonists. When used in conjunction with St. John's wort, it may increase the risk of serotonin
syndrome, a potentially life-threatening condition.
Which of the following is not a symptom of both major depressive disorder and post-traumatic stress
disorder?
A. Difficulty concentrating
B. Hypervigilance
C. Insomnia
D. Irritabilty - answer-B. Hypervigilance
In addition to difficulty concentrating, insomnia, and irritability, major depressive disorder (MDD) may
also include symptoms of depressed mood, anhedonia, weight loss or gain, and low energy. However,
hypervigilance (B) is not a symptom associated with this diagnosis.
A patient with type 1 diabetes presents for a follow-up visit. He has been stable on his medication
regimen but is worried because he is between jobs and will be without health insurance coverage for a
few months. He asks if there are less expensive insulin options to get him through this time. Which of
the following would be good options for this patient, given his circumstance?
Incorrect
A. Insulin aspart 70/30
B. Insulin detemir
,C. Insulin isophane
D. Insulin degludec - answer-Insulin Isophane
The least expensive insulin type listed in this question is insulin isophane (C) (neutral protamine
Hagedorn insulin). There are also often pharmacy-specific coupons that can be used on insulin, so
helping patients apply for and navigate these programs can be instrumental in managing their diabetes.
Another inexpensive option is regular insulin.Insulin analogs (glargine, detemir, degludec, lispro, and
aspart) are significantly more expensive than human insulin (isophane, regular). Insulins modified by
manufacturers, especially when sold as brand-name medications, tend to be more expensive due to this
modification. While analogs offer alternate lengths of action and convenience, there is no well-
documented clinical evidence that patient outcomes are improved with differing brands. Therefore,
maintaining a patient's blood glucose level through outcome-focused treatment is more valuable than a
process-focused plan based on medication.
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
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 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.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?
A.Adjustment disorder
B.Constipation
C.Regression
D.Urinary tract infection - answer-D. Urinary tract infection
The most likely diagnosis is a urinary tract infection (D). His clinical presentation includes abdominal
pain, urinary frequency, and dysuria, which are signs of cystitis in children, which is considered a lower
urinary tract infection (UTI). Pyelonephritis is a complicated form of UTI that may present with
persistent fever, flank pain, or vomiting.
A 12-year-old girl presents to the clinic with her parent, who is concerned about the C-shaped
appearance of the girl's spine. The degree of curvature in her spine is 35 degrees. Which of the following
is appropriate to educate the parent?
A."Your daughter's spine has a mild curve but does not require treatment and will likely resolve on its
own."
B."Your daughter's spine has a mild curve, so we will watch and wait to see if it worsens. If so, treatment
will be necessary."
C."Your daughter's spine has moderate curvature, so we will need to place her in a brace as treatment."
D."Your daughter's spine has severe curvature, so we will need to refer her for surgery as soon as
possible. - answer-C. "Your daughter's spine has moderate curvature, so we will need to place her in a
brace as treatment."
Scoliosis is a complex spinal deformity defined as a curve in the spine of at least 10 degrees. A curvature
of 25 to 40 degrees is considered moderate scoliosis, and most cases require bracing for correction (C).
Braces are offered for treatment in patients who are skeletally immature and have curves > 30 degrees
at the first visit. Bracing is considered ineffective if the curvature is > 45 degrees because the patient has
reached the threshold for surgical intervention. In male patients, the brace is worn until they stop
growing, and in female patients, the brace is worn more than 1.5 years postmenarch or until the patient
has grown < 1 cm over the previous 6 months.
2025 ACTUAL EXAM 220 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
A patient tells the nurse practitioner that she recently started taking the supplement St. John's wort
after reading about its benefits online. Which of the following medications, if being actively consumed,
must be immediately stopped?
A. Benadryl
B. Famotidine (Pepcid)
C. Metformnin (Glucophage)
D. Sumatriptan (Imitrex) - answer-D. Sumatriptan (imitrex)
Sumatriptan (Imitrex) (D) is a medication used to treat migraines and belongs to a drug class known as
serotonin agonists. When used in conjunction with St. John's wort, it may increase the risk of serotonin
syndrome, a potentially life-threatening condition.
Which of the following is not a symptom of both major depressive disorder and post-traumatic stress
disorder?
A. Difficulty concentrating
B. Hypervigilance
C. Insomnia
D. Irritabilty - answer-B. Hypervigilance
In addition to difficulty concentrating, insomnia, and irritability, major depressive disorder (MDD) may
also include symptoms of depressed mood, anhedonia, weight loss or gain, and low energy. However,
hypervigilance (B) is not a symptom associated with this diagnosis.
A patient with type 1 diabetes presents for a follow-up visit. He has been stable on his medication
regimen but is worried because he is between jobs and will be without health insurance coverage for a
few months. He asks if there are less expensive insulin options to get him through this time. Which of
the following would be good options for this patient, given his circumstance?
Incorrect
A. Insulin aspart 70/30
B. Insulin detemir
,C. Insulin isophane
D. Insulin degludec - answer-Insulin Isophane
The least expensive insulin type listed in this question is insulin isophane (C) (neutral protamine
Hagedorn insulin). There are also often pharmacy-specific coupons that can be used on insulin, so
helping patients apply for and navigate these programs can be instrumental in managing their diabetes.
Another inexpensive option is regular insulin.Insulin analogs (glargine, detemir, degludec, lispro, and
aspart) are significantly more expensive than human insulin (isophane, regular). Insulins modified by
manufacturers, especially when sold as brand-name medications, tend to be more expensive due to this
modification. While analogs offer alternate lengths of action and convenience, there is no well-
documented clinical evidence that patient outcomes are improved with differing brands. Therefore,
maintaining a patient's blood glucose level through outcome-focused treatment is more valuable than a
process-focused plan based on medication.
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
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 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.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?
A.Adjustment disorder
B.Constipation
C.Regression
D.Urinary tract infection - answer-D. Urinary tract infection
The most likely diagnosis is a urinary tract infection (D). His clinical presentation includes abdominal
pain, urinary frequency, and dysuria, which are signs of cystitis in children, which is considered a lower
urinary tract infection (UTI). Pyelonephritis is a complicated form of UTI that may present with
persistent fever, flank pain, or vomiting.
A 12-year-old girl presents to the clinic with her parent, who is concerned about the C-shaped
appearance of the girl's spine. The degree of curvature in her spine is 35 degrees. Which of the following
is appropriate to educate the parent?
A."Your daughter's spine has a mild curve but does not require treatment and will likely resolve on its
own."
B."Your daughter's spine has a mild curve, so we will watch and wait to see if it worsens. If so, treatment
will be necessary."
C."Your daughter's spine has moderate curvature, so we will need to place her in a brace as treatment."
D."Your daughter's spine has severe curvature, so we will need to refer her for surgery as soon as
possible. - answer-C. "Your daughter's spine has moderate curvature, so we will need to place her in a
brace as treatment."
Scoliosis is a complex spinal deformity defined as a curve in the spine of at least 10 degrees. A curvature
of 25 to 40 degrees is considered moderate scoliosis, and most cases require bracing for correction (C).
Braces are offered for treatment in patients who are skeletally immature and have curves > 30 degrees
at the first visit. Bracing is considered ineffective if the curvature is > 45 degrees because the patient has
reached the threshold for surgical intervention. In male patients, the brace is worn until they stop
growing, and in female patients, the brace is worn more than 1.5 years postmenarch or until the patient
has grown < 1 cm over the previous 6 months.
