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AANP Review Questions and Answers 2025 (Verified Answers), Exams of Nursing

AANP Review Questions and Answers 2025 (Verified Answers)

Typology: Exams

2024/2025

Available from 07/06/2025

Prof.-Judith-Bass
Prof.-Judith-Bass šŸ‡ŗšŸ‡ø

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AANP Review Questions and Answers 2025 (Verified
Answers)
A 64 year old with HTN and DM presents with productive cough, fever, body aches. What diagnosis is
most likely?
a. Acute bronchitis
b. Chronic bronchitis
c. Pneumonia
d. Pertussis - ANSWER-c. Pneumonia
1st clue: 64 year old
2nd clue: multiple comorbidities
3rd clue: cough, fever
what was the stem of the question?
Indications for a chest xray with acute cough - ANSWER-abnormal vital signs (increased RR or HR,
temp >38c, 100.4F
rales, consolidation
> or equal 75 years of age with cough***
***Pneumonia in older patient: tachypnea, decreased O2 sat, OR change in mental status or behavior
A 75 year old patient wo smokes and has COPD presents with a worsening cough, weight loss, fatigue,
and an enlarged right supraclavicular node. Which finding is most indicative of a right lung tumor?
1. worsening cough
2. weight loss
3. fatigue
4. supraclavicular node - ANSWER-4. supraclavicular node
most important stem clue because this lymph node drains the chest and breast. It's a BIG deal!
If the stem gives a unilateral finding, look for a unilateral diagnosis
What symptoms most commonly accompany acute bronchitis?
1. Fever, runny nose
2. Cough, fever
3. Cough and URI symptoms
4. Cough, URI, and headache - ANSWER-3. Cough and URI symptoms
Remember that bronchitis is an inflammation of the bronchioles, bronchi, and trachea; usually follows
an upper respiratory infection
Starts above the shoulders and drops down into chest.
A 35 year old patient with acute bronchitis has no underlying lung disease. He asks, "How long before
my cough goes aways?" The NP responds:
1. <1 week
2. about 1 week
3. 1-3 weeks
4. >3 weeks - ANSWER-3. 1-3 weeks
The patient with bronchitis will have evidence of upper AND lower airway symptoms.
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AANP Review Questions and Answers 2025 (Verified

Answers)

A 64 year old with HTN and DM presents with productive cough, fever, body aches. What diagnosis is most likely? a. Acute bronchitis b. Chronic bronchitis c. Pneumonia d. Pertussis - ANSWER-c. Pneumonia 1st clue: 64 year old 2nd clue: multiple comorbidities 3rd clue: cough, fever what was the stem of the question? Indications for a chest xray with acute cough - ANSWER-abnormal vital signs (increased RR or HR, temp >38c, 100.4F rales, consolidation

or equal 75 years of age with cough*** ***Pneumonia in older patient: tachypnea, decreased O2 sat, OR change in mental status or behavior A 75 year old patient wo smokes and has COPD presents with a worsening cough, weight loss, fatigue, and an enlarged right supraclavicular node. Which finding is most indicative of a right lung tumor?

  1. worsening cough
  2. weight loss
  3. fatigue
  4. supraclavicular node - ANSWER-4. supraclavicular node most important stem clue because this lymph node drains the chest and breast. It's a BIG deal! If the stem gives a unilateral finding, look for a unilateral diagnosis What symptoms most commonly accompany acute bronchitis?
  5. Fever, runny nose
  6. Cough, fever
  7. Cough and URI symptoms
  8. Cough, URI, and headache - ANSWER-3. Cough and URI symptoms Remember that bronchitis is an inflammation of the bronchioles, bronchi, and trachea; usually follows an upper respiratory infection Starts above the shoulders and drops down into chest. A 35 year old patient with acute bronchitis has no underlying lung disease. He asks, "How long before my cough goes aways?" The NP responds:
  9. <1 week
  10. about 1 week
  11. 1-3 weeks
  12. 3 weeks - ANSWER-3. 1-3 weeks The patient with bronchitis will have evidence of upper AND lower airway symptoms.

COUGH, COUGH, COUGH, usually worse at night! What is the management of bronchitis? - ANSWER-Treat symptoms! Time is the only thing for bronchitis ABX usually prescribed, but usually not necessary Differential Diagnosis for Acute Bronchitis - ANSWER-PND Asthma PNA Pertussis TB Supraclavicular nodes: associated with high rates of malignancy. What organs are on the right vs left?

  • ANSWER-RT: Lungs, mediastinum, esophagus LT: Abdominal malignancy: stomach GB liver pancreas ovaries prostate Pneumonia Vaccine Who? Who else? When is it given again? - ANSWER-Who-Prevention: Pneumococcal polysaccharide vaccination (PPSV) given once in a lifetime to immunocompetent adults > or equal 65 years Who else-Adults 19-64 with --chronic CV, lung, liver disease --smokers, DM, ETOH, or asplenic --chronic care facilities --immunocompromising conditions When again-one time 5 years after for CRF, nephrotic syndrome, asplenia, sickle cell, immunocompromising conditions A 52 year old feale was recently diagnosed with RA. She is being treated with a DMARD. Should she receive PPSV? If so, should she receive another one, and if so when?
  1. Yes, in 5 years
  2. No, another is not needed
  3. Yes, at 65 years old
  4. Yes, at age 60 years - ANSWER-Yes, in 5 years What are some presentation symptoms for pneumonia? What is the classical presentation? - ANSWER-Cough (>90%) Sputum production, purulent Fever, malaise, fatigue SOB Chest pain >50%, especially with inspiration, or between shoulder blades (classical presentation) Increased RR and HR What are the common pathogens for CAP? - ANSWER-S. pneumoniae - rust colored sputum. Most common cause of death from PNA - Bad for business! or atypical organisms: M. pneumoniae - mycoplasma pneu. aka "Walking PNA" Chlamydophila pneumoniae What is the tx for CAP? - ANSWER-1st line - Macrolide (azithromycin or clarithromycin) or Doxy these ABX treat atypicals If a patient with PNA has comorbidities or have had an ABX in the past days, what do you suspect the PNA is? - ANSWER-Drug Resistant Strep Pneumo - DRSP

If both are choices are present (PFT and Spirometry), choose PFT. Otherwise spirometry. What is the diagnostic criteria for COPD? - ANSWER-Airflow obstruction <70% (FEV1/FVC ratio) What are some meds for COPD? - ANSWER-Beta agonist - SABA (about 4 hrs duration) & LABA (12 hrs duration) BRONCHODILATION Anticholinergics - ipratropium. works great in combo with beta agonists PREVENT BRONCHOCONSTRICTION Theophylline - resp stimulant. causes nervousness, like caffiene, xanthines, need theo levels. watch out for TOXIC effects (drug-drug). metabolized in liver. if pt develops lower resp infections, erythro and clarithro metabolized in liver and can cause theo levels to rise. Inhaled/systemic corticosteroids - addresses inflammatory component Strategy for prescribing meds for COPD - ANSWER-Bronchodilators and anticholinergics: improve lung function, decrease dyspnea and exacerbations Steroids: decrease exacerbations, modestly slow progression of symptoms. A patient who has COPD is using an albuterol inhaler multiple times daily. What med is unsafe in combination with inhaled albuterol?

  1. Salmeterol
  2. Ipratropium bromide
  3. Formoterol
  4. Nebulized levalbuterol - ANSWER-4. Nebulized levalbuterol (Xopenex) Levalbuterol is also a SABA. Too much SABA can cause death and is BAD for business! **It is never safe to give 2 of the same drug class to the same patient at the same time!!! The most common reason for a COPD exacerbation is:
  5. a respiratory infection
  6. stopping respiratory medications
  7. heart failure
  8. pulmonary embolism - ANSWER-1. a respiratory infection Respiratory infection (80%) Environmental pollution Others (MI, PE, HF) What meds are for management of acute exacerbations of COPD? - ANSWER-SABA Glucocortocoids ABX depends on etiology Health promotion of COPD - ANSWER-Smoking cessation Regular exercise PPSV immunization Influenza immunization Education on SABA, LABA, etc. Asthma triad - ANSWER-Wheeze Cough

SOB or chest tightness What is asthma? - ANSWER-A chronic, reversible (as opposed to COPD: irreversible), airway obstruction, inflammation and airway hyper-responsiveness. Triggers for asthma - ANSWER-Exercise Cold air Exposure to irritants, dust, molds, furry animals, etc Infection What choice below characterizes exercise induced asthma?

  1. Symptoms worsen with viral URI
  2. Symptoms develop within 5 minutes of exercise
  3. Symptoms develop 5-15 minutes after exercising
  4. Symptoms abate within 5 minutes of stopping exercise - ANSWER-2. Symptoms develop within 5 minutes of exercising Classification of asthma severity - ANSWER-Intermittent: symptoms </= 2 days per week Persistent: mild: >/=2 days, but not daily mod: daily severe: thoughout day Stepwise approach to asthma mgmnt - ANSWER-SABA PRN (all asthma) low-dose ICS low-dose ICS + LABA OR med-dose ICS med-dose ICS + LABA high-dose ICS + LABA AND consider omalizumab for patients with allergies high-dose ICS + LABA + oral corticosteroids AND consider omalizumab for patients with allergies Frequency of albuterol use is a measure of how well asthma is controlled. What frequency of use constitutes "good control"?
  5. About once daily
  6. Less than or equal to twice weekly
  7. Less than or equal to 4 times weekly
  8. Less than or equal to 10 times monthly - ANSWER-2. Less than or equal to twice weekly Which medication(s) listed below is/are considered unsafe for use in a patient with asthma?
  9. ICS only
  10. LABA only
  11. SABA plus ICS
  12. SABA plus LABA - ANSWER-2. LABA only LABA's must have a steroid on board. If miss dose or late on LABA, can lead to bronchoconstriction and is a safety issue. Health Promotion for asthma - ANSWER-PNA Vaccine Influenza Vacc Exercise Asthma action plan
  1. Order nebulized albuterol, CBC, and oral steroids. D/C home meds until improved - ANSWER-3. Order a CXR and nebulized albuterol and levofloxacin pending CBC results. This patient is high risk for DRSP LABA is no more than BID DOXY is not best coice for DRSP D/C home meds will kill patient. Don't stop symbicort Mr. Smith has Stage III COPD. Which finding would be LEAST likely in him?
  2. Normal sed rate
  3. Increased resonance
  4. Hgb=10, HCT=29.
  5. 65% FEV1/FVC ratio - ANSWER-3. Hgb=10, HCT=29. COPD patients usually have high HCT An 82 y.o. patient is diagnosed with PNA. She takes tiotropium daily and is allergic to PCN. What is the most appropriate antibiotic for her treatment?
  6. Ciprofloxacin
  7. Amoxicillin-clavulanate
  8. Azithromycin
  9. Levofloxacin - ANSWER-4. Levofloxacin Likely to have DRSP because of comorbidities A 40 y.o. patient just had bilateral cataract surgery. Which choice below likely contributed to premature cataract formation?
  10. Albuterol use
  11. Daily oral steroid use
  12. Moxifloxacin use
  13. Nebulized bronchodilators - ANSWER-2. Daily oral steroid use Every anemia is characterized by what two things? - ANSWER-Size - cytic and Color - chromic Microcytic, normocytic, macrocytic Hypochromic, normochromic, hyperchromic - the greater the hgb content, the redder the cell On a CBC, the size of RBC's is described by the
  14. hemoglobin
  15. MCV (mean corpuscular volume)
  16. RDW (red cell distribution width)
  17. hematocrit - ANSWER-2. MCV (mean corpuscular volume) On a CBC, the hemoglobin content of RBC's is described by the
  18. MCH (mean corpuscular hemoglobin)
  19. MCV (mean corpuscular volume)
  20. RDW (red cell distribution width)
  21. MCHC - ANSWER-1. MCH (mean corpuscular hemoglobin) Define: serum iron serum ferritin reticulocyte count

peripheral smear TIBC (transferrin) - ANSWER-Serum iron - iron floating around Serum ferritin - iron in storage retic count - ability of bone marrow to produce RBC's. Reticulocyte is an immature RBC. If anemic, the retic count should go up. Peripheral smear - visual description of the RBC TIBC - total iron binding capacity. Reciprocal relationship. Capacity of RBC to bind to iron. Palm of hand is RBC, fingers are binding site. TIBC elevated in IDA (iron def anem). Iron Deficiency Anemia - ANSWER-Microcytic, hypochromic (small and pale) causes (men): occult malignancy ASA use blood loss - usually through GI tract impaired RBC production causes (female) occult malignancy menorrhagia poor iron absorption impaired RBC production A patient has HGB=9.1, HCT=27%. Which findings are consistent with iron deficiency anemia? Norms: MCV:80-100, MCH:28-

  1. MCV:72, MCH: 24
  2. MCV: 82, MCH: 28
  3. MCV: 120, MCH: 30
  4. MCV:65, MCH: 35 - ANSWER-1. MCV:72, MCH: 24 Microcytic, hypochromic Management of IDA - ANSWER-Diet rich in foods containing iron Organ meats (especially liver) Red meat Beans - especially in vegetarians Dark leafy veggies whole grains A patient with IDA is taking Fe supplements three times daily. What could be used with the supplements to enhance the absorption of iron?
  5. Food
  6. Vitamin C (250 mg)
  7. Vitamin D (1000mg)
  8. Milk - ANSWER-2. Vitamin C (250 mg) A 42 y.o. female with IDA has taken iron gluconate for 3 months and would like to stop. What lab parameter can help determine whether stopping iron is prudent at this time?
  9. Increased serum iron
  10. Inreased reticulocyte count
  11. Normal Hgb/Hct
  12. Normal serum ferritin - ANSWER-4. Normal serum ferritin Normal H/H is the first to be correct. Iron stores must be completed before stopping therapy Anemia of Chronic Disease - ANSWER-Mild to moderate normocytic, normochromic anemia associated with chronic disease (eg DM, SLE, RA, hyper/hypo thyroid) Usually find low serum iron, normal TIBC, normal to increased serum ferritin

2. ACD

  1. Thalassemia
  2. Pernicious anemia - ANSWER-4. Pernicious anemia (aka B12) A CBC on a 40 year old male patient demonstrates HCT 33, HGB 11, MCV 72, MCH 26. Norms: MCV 80-100, MCH 28-32. The NP should consider:
  3. iron supplementation
  4. serum iron and TIBC
  5. stool for occult blood
  6. B12 / folate orally - ANSWER-2. serum iron and TIBC 1st determine if IDA, then do stool after knowing IDA A patient with DM, HTN, and hyperlipidemia has these lab values, MCV 74 N, MCH 26 L, Serum FE low, TIBC normal, Ferritin normal. What kind of anemia is this?
  7. IDA
  8. ACD
  9. Thalassemia
  10. Folic acid deficiency - ANSWER-2. ACD An 83 y.o. complains that his tongue has an intermittent burning sensation. He feels tired. What should be part of the NP's diffferential?
  11. IDA
  12. Vit B12/Folate deficiency
  13. ACD
  14. Lead Toxicity - ANSWER-2. Vit B12/Folate deficiency Beefy red tongue = glossitis Any tongue complaint = Vit B12 deficiency A 74 year old male was diagnosed 4 weeks ago with IDA (H&H 10.1/29/9). He is taking 180 mg elemental iron daily. Today his HCT 33, HGB 11.1. What lab finding is expected?
  15. Reticulocytosis
  16. Leukocytosis
  17. Corrected anemia
  18. Thrombocytopenia - ANSWER-1. Reticulocytosis immature RBC should increase 5 parts of a Neuro exam - ANSWER-1. Mental status exam - Memory, LOC
  19. Cranial nerves
  20. Motor exam
  21. Reflex exam
  22. Sensory exam Headaches - ANSWER-Primary - stimulation, traction, tension, or pressure on pain sensitive structure (90%) Secondary - tumor, bleed. HA in elderly are usually secondary Red flags in Headaches - ANSWER-sudden onset in seconds or minutes - SAH First or Worst HA - hemorrhage or infection Focal neuro symptoms - Mass, AVM Fever - infection Change in personality, mental status, LOC Age <5 or > Red flags in headache exams - ANSWER-Age (>40-50)

Neck stiffness Neuro deficits Papilledema - swelling of optic disc, almost always bilateral Unilateral papilledema is a classic finding in which condition?

  1. Brain tumor
  2. Pseudotumor cerebri
  3. Glaucoma
  4. Hydrocephaly - ANSWER-2. Pseudotumor cerebri Triptans should be avoided in which patient?
  5. Female taking SNRI
  6. Male with ED
  7. Male with poorly controlled HTN
  8. Female with mentrual migraine HA - ANSWER-3. Male with poorly controlled HTN Prophylaxis can be topiramate depakote or beta blockers (propanolol) Limit use of triptans - overuse leads to rebound headaches unresponsive to triptans. What is the classical symptoms of trigeminal neuralgia? - ANSWER-Sudden severe brief unilateral facial pain patient has usually seen the dentist TX with carbamazapine (tegretol) Bells Palsy - ANSWER-Ask patient to close eyes, might not be able to completely close eyes. This is important because of lubrication of the eye. need to lube and tape shut eye. DX: diffuse facial nerve involvement with paralysis of facial muscles, onset over 1-2 days. Function returns after 3-4 months. TX is antiviral and steroids. Eye care. Psych support. Botox for facial spasm. A 60 y.o. male patient presents with drooping of is right cheek and right eyelid pain when closing his right eye. There is crusting near his right ear. What is a likely diagnosis?
  9. Bell's Palsy
  10. Stroke
  11. Temporal arteritis
  12. Herpes zoster - ANSWER-4. Herpes zoster Vertigo - ANSWER-Peripheral - most common. involves vestibular system example: BPV, Meniere's disease, acoustic neuroma, otitis media Central - involve brainstem or cerebellum - refer out! Tx: antihistamines (eg meclizine) and benzos (eg alprazolam) and time A 44 y.o. patient presents with vertigo suggestive of BPV. Which choice below suggests BPV?
  13. Vertigo episode lasts 15-20 minutes
  14. Diminished hearing
  15. Tinnitus
  16. Recurrent, brief, episodes of vertigo - ANSWER-4. Recurrent, brief, episodes of vertigo Diminished hearing is likely Meniere's disease or acoustic neuroma Tinnitus is usually a precursor to hearing loss