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SARAH MICHELLE AANP BOARD EXAM NEWEST 2025
ACTUAL EXAM| COMPLETE 150 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+ (MOST RECENT!!)
Which of the following conditions is classified as sensorineural hearing
loss?
A. Presbycusis
B. Otitis media
C. Ceruminosis
D. Otitis externa – Correct Answer – A. Presbycusis
Presbycusis is a type of sensorineural hearing loss that is caused by
normal aging of the auditory system. It initially affects the ability to hear
higher-pitched sounds of speech (or high frequency). It has a gradual
onset, and over time it affects lower frequencies. An example of higher
frequency sounds is speech or speaking. A common symptom is setting
the volume of TVs or radio high and difficulty hearing in noisy
environments. A hearing aid can help. Otitis media, ceruminosis, and
otitis externa are some of the causes of conductive hearing loss.
A 40-year-old male who is building a house presents with a 2-day
history of foreign body sensation and excessive tearing of the right eye.
What type of exam is recommended initially?
A. Cardiac exam
B. Visual exam
C. Neurologic exam
pg. 1
,2|Page
D. Cerebellar exam – Correct Answer – B. Visual exam
Any patient who is complaining of new onset of eye symptoms should
have a visual exam first. Distance vision can be checked by using the
Snellen chart. Near vision is tested by asking a patient to read a
paragraph of a book or newspaper. The eye exam also includes an
inspection of the surface of the eye, pupillary reflex, and red reflex. A
fluorescein exam is performed to look for a corneal abrasion, which
appears as pooling of the dye that is visualized using a blue light in a
darkened room.
An 80-year-old female with a history of hypertension, atrial fibrillation,
and type 2 diabetes presents to the clinic with a complaint of painless
bright-red blood on the right eye that she noticed on awakening. She
denies falling, visual changes, visual loss, eye pain, headache, coryza,
and fever. The visual exam is normal, and both pupils are equal and
reactive to light and accommodation. The funduscopic exam does not
show bleeding. Which of the following conditions is most likely?
A. Hyphema
B. Subconjunctival hemorrhage
C. Ectropion
D. Blepharitis – Correct Answer – B. Subconjunctival hemorrhage
A subconjunctival hemorrhage is caused by blood that is trapped
between the sclera and conjunctiva. The patient’s history of atrial
fibrillation is highly suggestive of anticoagulation therapy, which
increases her risk of bleeding. In addition, hypertension and diabetes are
also risk factors. A hyphema is blood that is trapped in the anterior
chamber of the eye (space between the cornea and the iris); it is usually
pg. 2
,3|Page
painful. An ectropion is the eversion of the lower eyelids, which can
cause irritation but no bleeding. Blepharitis presents on the edge of an
eyelid as a painful abscess.
An elderly patient has been taking digoxin, metformin, atenolol, and
aspirin for several months. During an office visit, the patient reports dark
areas in the central vision fields. The patient's digoxin level is 1.3
ng/mL. Which of the following is the most likely cause?
A. Acute angle-closure glaucoma
B. Herpes keratitis
C. Retinal detachment
D. Age-related macular degeneration – Correct Answer - D
The patient is experiencing symptoms of macular degeneration (changes
in central vision), which can be attributed to atenolol use. The patient’s
digoxin level is within normal range (0.7 to 1.5 ng/mL). Additionally,
the patient’s vision changes are not typical of digoxin toxicity, which
include yellowish-green halos. Metformin and aspirin do not cause
macular degeneration.
While checking for the red reflex on a 3-year-old boy during a well-child
visit, the nurse practitioner notes a white reflection on the child's left
pupil. Which of the following conditions should be ruled out?
A. Unilateral strabismus
B. Unilateral cataracts
C. Retinoblastoma of the left eye
pg. 3
, 4|Page
D. Color blindness of the left eye – Correct Answer - C.
Retinoblastoma is a congenital tumor of the retina. It usually affects only
one eye (rarely both eyes are involved). During infancy, the tumor is a
small size, and it continues to grow with the child. This rare cancer is
diagnosed by noting a pupil that appears white or has white spots on it.
One or both eyes may be affected. It is often first noted in photographs,
because a white glow is present in the eye instead of the usual “red eye”
that results from the flash.
A 13-year-old girl has a throat culture that is positive for strep throat.
She reports that her younger brother was recently diagnosed with strep
throat and treated. The patient has a severe allergy to penicillin and
reports that erythromycin makes her very nauseated. Which of the
following antibiotics is the best choice?
A. Azithromycin (Zithromax)
B. Cephalexin (Keflex)
C. Cefuroxime axetil (Ceftin)
D. Levofloxacin (Levaquin) – Correct Answer – A. Azithromycin
(Zithromax).
If the patient has a severe penicillin allergy, there is a 10% chance of
cross-reactivity to cephalosporins (especially first generation). Because
the patient is a child, the levofloxacin is contraindicated. Nausea is a
common adverse reaction to erythromycin (it is not an allergic reaction).
The best option is to use azithromycin because of its minimal
gastrointestinal (GI) adverse effects. Azithromycin has fewer drug
interactions compared with other macrolides.
pg. 4
SARAH MICHELLE AANP BOARD EXAM NEWEST 2025
ACTUAL EXAM| COMPLETE 150 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+ (MOST RECENT!!)
Which of the following conditions is classified as sensorineural hearing
loss?
A. Presbycusis
B. Otitis media
C. Ceruminosis
D. Otitis externa – Correct Answer – A. Presbycusis
Presbycusis is a type of sensorineural hearing loss that is caused by
normal aging of the auditory system. It initially affects the ability to hear
higher-pitched sounds of speech (or high frequency). It has a gradual
onset, and over time it affects lower frequencies. An example of higher
frequency sounds is speech or speaking. A common symptom is setting
the volume of TVs or radio high and difficulty hearing in noisy
environments. A hearing aid can help. Otitis media, ceruminosis, and
otitis externa are some of the causes of conductive hearing loss.
A 40-year-old male who is building a house presents with a 2-day
history of foreign body sensation and excessive tearing of the right eye.
What type of exam is recommended initially?
A. Cardiac exam
B. Visual exam
C. Neurologic exam
pg. 1
,2|Page
D. Cerebellar exam – Correct Answer – B. Visual exam
Any patient who is complaining of new onset of eye symptoms should
have a visual exam first. Distance vision can be checked by using the
Snellen chart. Near vision is tested by asking a patient to read a
paragraph of a book or newspaper. The eye exam also includes an
inspection of the surface of the eye, pupillary reflex, and red reflex. A
fluorescein exam is performed to look for a corneal abrasion, which
appears as pooling of the dye that is visualized using a blue light in a
darkened room.
An 80-year-old female with a history of hypertension, atrial fibrillation,
and type 2 diabetes presents to the clinic with a complaint of painless
bright-red blood on the right eye that she noticed on awakening. She
denies falling, visual changes, visual loss, eye pain, headache, coryza,
and fever. The visual exam is normal, and both pupils are equal and
reactive to light and accommodation. The funduscopic exam does not
show bleeding. Which of the following conditions is most likely?
A. Hyphema
B. Subconjunctival hemorrhage
C. Ectropion
D. Blepharitis – Correct Answer – B. Subconjunctival hemorrhage
A subconjunctival hemorrhage is caused by blood that is trapped
between the sclera and conjunctiva. The patient’s history of atrial
fibrillation is highly suggestive of anticoagulation therapy, which
increases her risk of bleeding. In addition, hypertension and diabetes are
also risk factors. A hyphema is blood that is trapped in the anterior
chamber of the eye (space between the cornea and the iris); it is usually
pg. 2
,3|Page
painful. An ectropion is the eversion of the lower eyelids, which can
cause irritation but no bleeding. Blepharitis presents on the edge of an
eyelid as a painful abscess.
An elderly patient has been taking digoxin, metformin, atenolol, and
aspirin for several months. During an office visit, the patient reports dark
areas in the central vision fields. The patient's digoxin level is 1.3
ng/mL. Which of the following is the most likely cause?
A. Acute angle-closure glaucoma
B. Herpes keratitis
C. Retinal detachment
D. Age-related macular degeneration – Correct Answer - D
The patient is experiencing symptoms of macular degeneration (changes
in central vision), which can be attributed to atenolol use. The patient’s
digoxin level is within normal range (0.7 to 1.5 ng/mL). Additionally,
the patient’s vision changes are not typical of digoxin toxicity, which
include yellowish-green halos. Metformin and aspirin do not cause
macular degeneration.
While checking for the red reflex on a 3-year-old boy during a well-child
visit, the nurse practitioner notes a white reflection on the child's left
pupil. Which of the following conditions should be ruled out?
A. Unilateral strabismus
B. Unilateral cataracts
C. Retinoblastoma of the left eye
pg. 3
, 4|Page
D. Color blindness of the left eye – Correct Answer - C.
Retinoblastoma is a congenital tumor of the retina. It usually affects only
one eye (rarely both eyes are involved). During infancy, the tumor is a
small size, and it continues to grow with the child. This rare cancer is
diagnosed by noting a pupil that appears white or has white spots on it.
One or both eyes may be affected. It is often first noted in photographs,
because a white glow is present in the eye instead of the usual “red eye”
that results from the flash.
A 13-year-old girl has a throat culture that is positive for strep throat.
She reports that her younger brother was recently diagnosed with strep
throat and treated. The patient has a severe allergy to penicillin and
reports that erythromycin makes her very nauseated. Which of the
following antibiotics is the best choice?
A. Azithromycin (Zithromax)
B. Cephalexin (Keflex)
C. Cefuroxime axetil (Ceftin)
D. Levofloxacin (Levaquin) – Correct Answer – A. Azithromycin
(Zithromax).
If the patient has a severe penicillin allergy, there is a 10% chance of
cross-reactivity to cephalosporins (especially first generation). Because
the patient is a child, the levofloxacin is contraindicated. Nausea is a
common adverse reaction to erythromycin (it is not an allergic reaction).
The best option is to use azithromycin because of its minimal
gastrointestinal (GI) adverse effects. Azithromycin has fewer drug
interactions compared with other macrolides.
pg. 4
