ANCC FNP review questions with
accurate answers
43-year-old patient with past medical history of mild asthma in his
childhood presents for management of hypertension. He has heard that
some antihypertensive medications can worsen breathing in asthmatic
patients. Which of the following medications would be most likely to
cause bronchospasm in a patient with asthma?
A. Metoprolol
B. Atenolol
C. Propranolol
D. Bisoprolol correct answer Correct Answer: C. Propranolol
Propranolol is the only beta-blocker listed with is non-selective. Beta-
blockers can be cardioselective, or non- selective. Cardioselectivity
refers to the ability to affect predominantly beta 1 receptors rather
than beta 2 receptors. Beta 1 receptors are located mainly in the heart
and mediate the sympathetic nervous system's direct effects on the
heart. Beta 2 receptors are located predominantly in the peripheral
vascular system and other organs like the lungs. Although all beta-
blockers affect beta receptors, some affect subsets of receptors
differently. This has significant consequences in terms of side effects, as
beta-blockers are known to cause extra-cardiac symptoms such as
worsened bronchospasms in asthmatics. Although beta-1 selective
blockers are safer than nonselective beta blockers, and would be
preferred in patients with asthma, they should still be used with
caution in patients with asthma, particularly in those with severe
obstruction or markedly reduced pulmonary function at baseline.
,Incorrect Answers:
A. B. and D. These are all cardioselective beta-blockers.
A 10-month-old girl with no prior medical history presents to the
emergency room with signs of bronchiolitis. The patient's parents
report that she developed a cough 3 days ago, and today she developed
rhinorrhea, wheezing, and a fever of 100.4°F. Physical examination
reveals a temperature of 100.5°F, and wheezing is evident on
pulmonary exam. Physical examination also reveals right tympanic
membrane fullness, with loss of light reflex and erythema. The patient
keeps pulling on her ear. It is December, and this is the 10th patient this
month who has presented with the same symptoms. Which of the
following is the most appropriate therapy for this patient?
A. Amoxicillin with analgesics
B. Bronchodilators
C. Corticosteroids
D. Ribavirin correct answer Correct Answer: A. Amoxicillin with
analgesics
The patient's age, lower respiratory tract symptoms, and the spike in
cases seen during this time of year indicate that the patient most likely
has respiratory syncytial virus (RSV). RSV is a viral infection that attacks
the lower respiratory tract, causing bronchiolitis or pneumonia. While
RSV commonly affects young children, it can be seen in adults. While
uncomplicated RSV is treated with supportive therapy, the patient also
,has evidence of otitis media. The 2013 AAP/AAFP guideline
recommends either immediate treatment or observation (with pain
control) for children between 6 and 24 months with unilateral
nonsevere AOM and for children ≥24 months with unilateral or bilateral
nonsevere AOM. Since this child has evidence of unilateral AOM, either
observation or treatment with antibiotics are appropriate. Individually
randomized trials that used stringent diagnostic criteria demonstrated
that children under the age of two benefits from antibiotic therapy,
including those with nonsevere unilateral AOM.
Incorrect Answers:
B. Bronchodilators are not recommended for the routine treatment of
RSV bronchiolitis. While bronchodilators may provide modest short-
term improvement, they do not improve long-term outcomes and may
have adverse effects. Bronchodilators also increase the cost of care and
should only be used if a single trial leads to a prompt favorable
response.
C. Corticosteroids are not recommended for the routine treatment of
RSV bronchiolitis in infants. However, corticosteroids may be helpful in
older children and adults who have RSV-associated bronchial reactivity,
especially those who have a history of asthma that may have been
exacerbated by the recent RSV infection. Corticosteroids can potentially
decrease bronchial swelling and airway obstruction through their inh
A 12-year-old boy complains of abrupt onset of scrotal pain upon
awakening this morning. He has had nausea and vomiting for the past
hour. He is afebrile and his heart rate is 100/minute. His scrotum is red
and swollen and the right testicle is higher than the left. When you
stroke the inner thigh on the right, there is no movement of the
, testicle. Which of the following is an indicated treatment for this
condition?
A. Manual reduction
B. Antibiotics
C. Topical azole cream
D. Chemotherapy correct answer Correct Answer: A. Manual reduction
The patient, in this case, has a presentation consistent with testicular
torsion. Patients with testicular torsion are usually young men between
the ages of 10 and 20. They will complain of sudden onset of scrotal
pain, usually in the middle of the night or upon awakening. The scrotum
will be red and swollen and the affected testicle is usually positioned
higher than the unaffected testicle, often closer to the body. The
cremasteric reflex refers to elevation of the testicle when the ipsilateral
thigh is stroked. This reflex is absent in testicular torsion. Testicular
torsion is a urologic emergency. Torsion interrupts the blood supply to
the testicle and permanent damage ensues if not reduced within 6
hours. After 24 hours, the testicle will become gangrenous and must be
surgically removed. The nurse practitioner should call 911 and the
patient should undergo Doppler ultrasound in the ED. Manual
detorsion can be accomplished in the ED by the "open book"
maneuver, but a surgical reduction is necessary if a manual reduction is
unsuccessful.
Incorrect Answers:
B. Antibiotics would be appropriate for the treatment of epididymitis.C.
Topical azole creams are used to treat balanitis, which is candida
infection of the glans penis.
accurate answers
43-year-old patient with past medical history of mild asthma in his
childhood presents for management of hypertension. He has heard that
some antihypertensive medications can worsen breathing in asthmatic
patients. Which of the following medications would be most likely to
cause bronchospasm in a patient with asthma?
A. Metoprolol
B. Atenolol
C. Propranolol
D. Bisoprolol correct answer Correct Answer: C. Propranolol
Propranolol is the only beta-blocker listed with is non-selective. Beta-
blockers can be cardioselective, or non- selective. Cardioselectivity
refers to the ability to affect predominantly beta 1 receptors rather
than beta 2 receptors. Beta 1 receptors are located mainly in the heart
and mediate the sympathetic nervous system's direct effects on the
heart. Beta 2 receptors are located predominantly in the peripheral
vascular system and other organs like the lungs. Although all beta-
blockers affect beta receptors, some affect subsets of receptors
differently. This has significant consequences in terms of side effects, as
beta-blockers are known to cause extra-cardiac symptoms such as
worsened bronchospasms in asthmatics. Although beta-1 selective
blockers are safer than nonselective beta blockers, and would be
preferred in patients with asthma, they should still be used with
caution in patients with asthma, particularly in those with severe
obstruction or markedly reduced pulmonary function at baseline.
,Incorrect Answers:
A. B. and D. These are all cardioselective beta-blockers.
A 10-month-old girl with no prior medical history presents to the
emergency room with signs of bronchiolitis. The patient's parents
report that she developed a cough 3 days ago, and today she developed
rhinorrhea, wheezing, and a fever of 100.4°F. Physical examination
reveals a temperature of 100.5°F, and wheezing is evident on
pulmonary exam. Physical examination also reveals right tympanic
membrane fullness, with loss of light reflex and erythema. The patient
keeps pulling on her ear. It is December, and this is the 10th patient this
month who has presented with the same symptoms. Which of the
following is the most appropriate therapy for this patient?
A. Amoxicillin with analgesics
B. Bronchodilators
C. Corticosteroids
D. Ribavirin correct answer Correct Answer: A. Amoxicillin with
analgesics
The patient's age, lower respiratory tract symptoms, and the spike in
cases seen during this time of year indicate that the patient most likely
has respiratory syncytial virus (RSV). RSV is a viral infection that attacks
the lower respiratory tract, causing bronchiolitis or pneumonia. While
RSV commonly affects young children, it can be seen in adults. While
uncomplicated RSV is treated with supportive therapy, the patient also
,has evidence of otitis media. The 2013 AAP/AAFP guideline
recommends either immediate treatment or observation (with pain
control) for children between 6 and 24 months with unilateral
nonsevere AOM and for children ≥24 months with unilateral or bilateral
nonsevere AOM. Since this child has evidence of unilateral AOM, either
observation or treatment with antibiotics are appropriate. Individually
randomized trials that used stringent diagnostic criteria demonstrated
that children under the age of two benefits from antibiotic therapy,
including those with nonsevere unilateral AOM.
Incorrect Answers:
B. Bronchodilators are not recommended for the routine treatment of
RSV bronchiolitis. While bronchodilators may provide modest short-
term improvement, they do not improve long-term outcomes and may
have adverse effects. Bronchodilators also increase the cost of care and
should only be used if a single trial leads to a prompt favorable
response.
C. Corticosteroids are not recommended for the routine treatment of
RSV bronchiolitis in infants. However, corticosteroids may be helpful in
older children and adults who have RSV-associated bronchial reactivity,
especially those who have a history of asthma that may have been
exacerbated by the recent RSV infection. Corticosteroids can potentially
decrease bronchial swelling and airway obstruction through their inh
A 12-year-old boy complains of abrupt onset of scrotal pain upon
awakening this morning. He has had nausea and vomiting for the past
hour. He is afebrile and his heart rate is 100/minute. His scrotum is red
and swollen and the right testicle is higher than the left. When you
stroke the inner thigh on the right, there is no movement of the
, testicle. Which of the following is an indicated treatment for this
condition?
A. Manual reduction
B. Antibiotics
C. Topical azole cream
D. Chemotherapy correct answer Correct Answer: A. Manual reduction
The patient, in this case, has a presentation consistent with testicular
torsion. Patients with testicular torsion are usually young men between
the ages of 10 and 20. They will complain of sudden onset of scrotal
pain, usually in the middle of the night or upon awakening. The scrotum
will be red and swollen and the affected testicle is usually positioned
higher than the unaffected testicle, often closer to the body. The
cremasteric reflex refers to elevation of the testicle when the ipsilateral
thigh is stroked. This reflex is absent in testicular torsion. Testicular
torsion is a urologic emergency. Torsion interrupts the blood supply to
the testicle and permanent damage ensues if not reduced within 6
hours. After 24 hours, the testicle will become gangrenous and must be
surgically removed. The nurse practitioner should call 911 and the
patient should undergo Doppler ultrasound in the ED. Manual
detorsion can be accomplished in the ED by the "open book"
maneuver, but a surgical reduction is necessary if a manual reduction is
unsuccessful.
Incorrect Answers:
B. Antibiotics would be appropriate for the treatment of epididymitis.C.
Topical azole creams are used to treat balanitis, which is candida
infection of the glans penis.
