ANCC FNP Board Exam Questions and
Answers
1. A middle-age female patient presents to the clinic with a
recurrence of mild hidradenitis suppurativa after topical therapies
failed. Which first-line treatment is recommended?
Answer Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for hidradenitis
suppurativa.
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing
skin. It is a chronic, disabling disorder that progresses, often causing keloids, contractures, and
immobility. It is characterized
by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge, and
progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and
sinus tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area,
perineum, gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor
agents. A dermatology consultation should also be considered.
First-line treatment is a 12-week course of an oral tetracycline (Sumycin) such as doxycycline. For
patients who do not respond to doxycycline, the next recommended step is a combination of
,twice-daily clindamycin (Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails,
acitretin (Soriatane, for males and nonfertile females) or
dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to severe hidradenitis
suppurativa, adalimumab (Humira) may possibly be considered.
2. When providing culturally competent health care services to an
American Indian elder, the nurse practitioner understands which is
traditionally true?
Answer The "Medicine Wheel" is used by many for the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west.
Traditionally each tribe has ditterent meanings for each direction and they may represent the season
of the year or stage of life. It is aimed at providing a holistic view of life.
An understanding of ditterent cultural preferences leads to cultural competence in healthcare. Some
patients may value traditional culture and preferences as it relates to healthcare. These individual
preferences should be included in the
interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to health care integrating the
person, lifestyle, environment, family, and religion. Patients adhering to these traditional cultural
practices often feel that illness is due to a lack of harmony with the physical body, mind, spirit, and
emotions. Patients may seek care from western medicine for specific ailments while also consulting
with traditional healers for spiritual guidance.
Healthcare providers should seek to understand relevant cultural factors and assess each individual's
,healthcare literacy in order to provide culturally competent care.
3. The nurse practitioner sees an older adult patient in the clinic with
the pri- mary report of hearing loss and a sensation of fullness in the
right ear. The nurse practitioner suspects conductive hearing loss.
Which could contribute to this?
Answer Cerumen, commonly called earwax, is a combination of secretions and sloughed epithelial
cells that protects the ears from infection, water, and insects. It is normally expelled from the ear
canal through natural jaw movement. When this self-cleaning process fails, cerumen can become
impacted. Cerumen impaction occludes the ear canal and can press against the tympanic membrane,
resulting in conductive hearing loss.
Conductive hearing is the transition of sound from the external and middle ear to the inner ear.
Conductive hearing loss is caused by problems in the external and middle ear that interfere with the
transmission of sound and its conversion to mechanical vibration. Causes of conductive hearing loss
include obstruction of the external auditory canal by cerumen, foreign bodies, debris from otitis externa,
and large exocytosis and osteomas.
Sensorineural hearing loss involves diflculty converting mechanical vibrations to electrical potential
in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by permanent damage
in the organ of Corti. It can be caused by age-related hearing loss, noise trauma, medications,
autoimmune diseases, mechanical trauma, Meniere disease, infection, and neoplasm (acoustic
neuroma).
Approximately one-third of older adults between the ages of 61 and 70 years have hearing loss. More
, than 90% of adults older than 85 years of age have hearing loss. The most common type of hearing loss
is age-related and sensorineural. All adults older than 60 years of age should be screened for hearing
loss at periodic health examinations.
4. An otherwise healthy adult patient presents to the clinic with a
diagnosis of community-acquired pneumonia and no recent antibiotic
therapy. Which is the best option for treatment?
Answer Amoxicillin
High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults without
comorbidities.
Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital or long-term care facility.
Patients with suspected CAP should receive a chest X-ray for diagnosis. The Pneumonia Severity Index
should be used to assist in decisions regarding the need for hospitalization in patients with CAP.
According to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA)
2019 guidelines, the initial treatment of CAP for most patients is amoxicillin or doxycycline. Macrolides are
an option for treatment, but are no longer recommended routinely as first-line treatment, given
increased macrolide resistance. This is a change from the 2007 ATS/IDSA guidelines. Respiratory
fluoroquinolones and amoxicillin/clavulanate should be used in patients who fail first-line medications,
have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents,
or have a documented infection with highly drug-resistant pneumococci.
5. A patient presents to the clinic for conception counseling. She
Answers
1. A middle-age female patient presents to the clinic with a
recurrence of mild hidradenitis suppurativa after topical therapies
failed. Which first-line treatment is recommended?
Answer Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line treatment for hidradenitis
suppurativa.
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in apocrine gland-bearing
skin. It is a chronic, disabling disorder that progresses, often causing keloids, contractures, and
immobility. It is characterized
by comedone-like follicular occlusion, chronic and relapsing inflammation, mucopurulent discharge, and
progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation includes nodules and
sinus tracts (inflamed or noninflamed), abscesses, and scarring found in the axilla, genitofemoral area,
perineum, gluteal area, and inframammary area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone, and anti-tumor necrosis factor
agents. A dermatology consultation should also be considered.
First-line treatment is a 12-week course of an oral tetracycline (Sumycin) such as doxycycline. For
patients who do not respond to doxycycline, the next recommended step is a combination of
,twice-daily clindamycin (Cleocin) and rifampicin (Rifadin) for 10-12 weeks. If treatment fails,
acitretin (Soriatane, for males and nonfertile females) or
dapsone (Aczone) may be considered by a dermatologist. In patients with moderate to severe hidradenitis
suppurativa, adalimumab (Humira) may possibly be considered.
2. When providing culturally competent health care services to an
American Indian elder, the nurse practitioner understands which is
traditionally true?
Answer The "Medicine Wheel" is used by many for the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions; north, south, east, and west.
Traditionally each tribe has ditterent meanings for each direction and they may represent the season
of the year or stage of life. It is aimed at providing a holistic view of life.
An understanding of ditterent cultural preferences leads to cultural competence in healthcare. Some
patients may value traditional culture and preferences as it relates to healthcare. These individual
preferences should be included in the
interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to health care integrating the
person, lifestyle, environment, family, and religion. Patients adhering to these traditional cultural
practices often feel that illness is due to a lack of harmony with the physical body, mind, spirit, and
emotions. Patients may seek care from western medicine for specific ailments while also consulting
with traditional healers for spiritual guidance.
Healthcare providers should seek to understand relevant cultural factors and assess each individual's
,healthcare literacy in order to provide culturally competent care.
3. The nurse practitioner sees an older adult patient in the clinic with
the pri- mary report of hearing loss and a sensation of fullness in the
right ear. The nurse practitioner suspects conductive hearing loss.
Which could contribute to this?
Answer Cerumen, commonly called earwax, is a combination of secretions and sloughed epithelial
cells that protects the ears from infection, water, and insects. It is normally expelled from the ear
canal through natural jaw movement. When this self-cleaning process fails, cerumen can become
impacted. Cerumen impaction occludes the ear canal and can press against the tympanic membrane,
resulting in conductive hearing loss.
Conductive hearing is the transition of sound from the external and middle ear to the inner ear.
Conductive hearing loss is caused by problems in the external and middle ear that interfere with the
transmission of sound and its conversion to mechanical vibration. Causes of conductive hearing loss
include obstruction of the external auditory canal by cerumen, foreign bodies, debris from otitis externa,
and large exocytosis and osteomas.
Sensorineural hearing loss involves diflculty converting mechanical vibrations to electrical potential
in the cochlea or in auditory nerve transmission to the brain. It is mostly caused by permanent damage
in the organ of Corti. It can be caused by age-related hearing loss, noise trauma, medications,
autoimmune diseases, mechanical trauma, Meniere disease, infection, and neoplasm (acoustic
neuroma).
Approximately one-third of older adults between the ages of 61 and 70 years have hearing loss. More
, than 90% of adults older than 85 years of age have hearing loss. The most common type of hearing loss
is age-related and sensorineural. All adults older than 60 years of age should be screened for hearing
loss at periodic health examinations.
4. An otherwise healthy adult patient presents to the clinic with a
diagnosis of community-acquired pneumonia and no recent antibiotic
therapy. Which is the best option for treatment?
Answer Amoxicillin
High-dose amoxicillin (Amoxil) or doxycycline are recommended as first-line therapy for adults without
comorbidities.
Community-acquired pneumonia (CAP) is pneumonia not acquired in a hospital or long-term care facility.
Patients with suspected CAP should receive a chest X-ray for diagnosis. The Pneumonia Severity Index
should be used to assist in decisions regarding the need for hospitalization in patients with CAP.
According to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA)
2019 guidelines, the initial treatment of CAP for most patients is amoxicillin or doxycycline. Macrolides are
an option for treatment, but are no longer recommended routinely as first-line treatment, given
increased macrolide resistance. This is a change from the 2007 ATS/IDSA guidelines. Respiratory
fluoroquinolones and amoxicillin/clavulanate should be used in patients who fail first-line medications,
have significant comorbidities, have had recent antibiotic therapy, are allergic to alternative agents,
or have a documented infection with highly drug-resistant pneumococci.
5. A patient presents to the clinic for conception counseling. She
