, AANP: Exam Pearls
Exam Format
• AANP FNP exam contains very few nonclinical questions
• Certification tests are designed for entry-level practice
• AANP has 15 pilot questions which are not graded [there is NO WAY to identify the pilot test
questions from the graded questions]
• New clinical info [treatment and/or guidelines] released in the last 10 months won’t be on the
exam
• Questions will be on primary care disorders – if you are guessing, AVOID PICKING EXOTIC
DIAGNOSIS AS AN ANSWER
Labs
• Normal lab results pertinent to a question WILL ONLY BE LISTED ONCE. Use your scratch
sheet of paper to jot down these values if given.
• Follow the LAB NORMS GIVEN BY AANP not what you learned in NP school
• Learn the significance of abnormal lab values AND type of follow-up needed [i.e. elderly
gentleman with c/o scalp tenderness + indurated temporal artery, NP suspects temporal
arteritis. Screening test is sed rate – which is expected to be MUCH HIGHER than normal
value]
Good to Know
• Expect one question related to dental injury [i.e. completely avulsed permanent tooth
should be reimplanted ASAP! It can be transported to dentist in cold milk (not frozen milk)
• May be a question on epidemiologic terms (i.e. sensitivity is defined as the ability of a test to
detect a person who has the disease. Specificity is defined as the ability of a test to detect a
person who is healthy or detect the person without the disease)
• Learn definition of some research study designs: cohort follows a group of people who
share some common characteristics to observe the development of a disease over time –
Framingham nurses health study
• Emergent conditions that will present in primary care clinics will be on the exam: navicular
fracture, MI, cauda equina syndrome, anaphylaxis, angioedema, meningococcal meningitis
• Know some anatomic areas: trauma to Kiesselbach’s plexus = anterior nosebleed
• Some questions ask about “gold-standard test” or the “diagnostic test for the condition”:
sickle cell anemia, G6PD anemia, and alpha/beta thalassemia = hgb electrophoresis
• Disease states are usually presented in their “full-blown classic” textbook presentation:
acute mononucleosis, teen will have classic triad of sore throat, prolonged fatigue, and
enlarged cervical nodes. If patient is older with same signs/symptoms, it is still mononucleosis
reactivated type
• Ethic background may provide clues to disease: alpha thal = southeast Asia / Filipinos; beta
thal = Mediterranean
• NO ASYMPTOMATIC or BORDERLINE CASES OF DISEASE STATES WILL BE ON THE
EXAM: IDA in “real life” don’t present often with pica or spoon-shaped nails, on the exam they
will have these clinical findings
• Be familiar with lupus and SLE: malar rash (butterfly) = lupus. Instruct patient to avoid /
minimize sun exposure r/t photosensitivity.
• Be familiar with polymyalgia rheumatica (PRM): 1st line tx is long-term steroids. Long-term,
low-dose steroids are commonly used to control symptoms (pain, severe stiffness in shoulders
/ hip girdle). PMR patients are at HIGH RISK FOR TEMPORAL ARTERITIS.
, • Gold standard exam for temporal arteritis: biopsy + refer patient to optho for management.
• Learn the disorders for which maneuvers are used and what a positive report means:
o Finkelstein’s test—positive in De Quervain’s tenosynovitis
o Anterior drawer maneuver and Lachman maneuver—positive if anterior cruciate
ligament (ACL) of the knee is damaged. The knee may also be unstable.
o McMurray’s sign—positive in meniscus injuries of the knee
• Conditions that NEED a radiologic test: damaged joints – order Xray 1st (but MRI is the gold
standard)
• Abnormal eye findings in DM (diabetic retinopathy) and HTN (hypertensive retinopathy)
should be MEMORIZED and learn to distinguish each one:
o Diabetic retinopathy = neovascularization, cotton wool spots, microaneurysms
o Hypertensive retinopathy = AV nicking, silver and/or copper wire arterioles
• Become knowledgeable about physical exam “normal” and “abnormal” findings:
o Checking DTRs in patient w/severe sciatica or diabetic peripheral neuropathy: ankle
jerk reflex (Achilles reflex) may be absent or hypoactive. Scoring absent (0), hypoactive
(1), normal (2), hyperactive (3), and clonus (4).
• ONLY A FEW QUESTIONS WILL BE ON BENIGN or PHYSIOLOGIC VARIANTS: benign S4
heart sounds may be auscultated in some elderly pt. Torus palantinus and fishtail uvula may be
seen during the oral exam in a few patients.
• If the question is asking for the initial or screening lab test, it will probably be a “cheap” and
readily available test: CBC (complete blood count (CBC) to screen for anemia
• There are some questions on theories and conceptual models: Stages of change or
“decision” theory (Prochaska) includes concepts such as precontemplation, contemplation,
preparation, action, and maintenance.
• Other health theorists who have been included on the exams in the past are (not inclusive):
o Alfred Bandura (self-efficacy), Erik Erikson, Sigmund Freud, Elisabeth Kübler-Ross
(grieving), and others
o If a small child expresses a desire to marry a parent of the opposite sex: the child is
in the oedipal stage (Freud). Child’s age is about 5 to 6 years (preschool to
kindergarten).
o Starting at the age of about 11 years, most children can understand abstract
concepts (early abstract thinking) and are better at logical thinking.
o When performing the Mini-Mental State Exam, when the NP is asking about
“proverbs,” the nurse is assessing the patient’s ability to understand abstract concepts.
• Keep these good communication rules in mind: Ask open-ended questions, do not reassure
patients, avoid angering the patient, and respect the patient’s culture.
• There may be two to three questions relating to abuse: child abuse, domestic abuse, elderly
abuse
Antibiotics & Medications
• Know the difference between 1st and 2nd line abx: AOM in 7 yr old treated with amoxicillin
returns in 48hr without improvement (continued ear pain, bulging TM). Next step is to d/c
amox and start child on 2nd line abx Augmentin BID x10 days
• Be familiar with alternative abx for PCN-allergic patients: If patient has gram+ infection,
prescribe macrolides, clinda, quinolones = levo or moxi
• Patient responds well to macrolides but thinks they’re allergic to erythromycin (nausea,
GI upset): inform patient she had an adverse rx, not a true allergic (hives/angioedema): switch
pt from erythromycin to azithromycin (z-pack)
• Fails to respond to initial medication: add another medication per treatment guidelines (i.e.
COPD pt prescribed Atrovent for dyspnea. On follow-up, patient complains symptoms are not
relieved. Next step is to prescribe albuterol (Ventolin) or combo inhaler)
• Commonly used drugs with rare (potentially fatal) adverse effects: ACE-I = angioedema.
Common side effect of ACEIs = dry cough (up to 10%)
, • Learn the preferred and/or 1st line drug to tx some diseases: ACEI/ARB is preferred for HTN
in DM and patients with mild-mod renal disease = renal protective properties
• When meds are used in answer options, they will be listed either by name (generic and brand
name) or by drug class alone: ipratropium (Atrovent) or an anticholinergic
• Most of the drugs mentioned in the exam are the well-recognized drugs:
o Penicillin: Amoxicillin (broad-spectrum penicillin), penicillin VK
o Macrolide: Erythromycin, azithromycin (Z-Pack), or clarithromycin (Biaxin)
o Cephalosporins: First-generation (Keflex), second-generation (Cefaclor, Ceftin, Cefzil),
third generation (Rocephin, Suprax, Omnicef)
o Quinolones: Ciprofloxacin (Cipro), ofloxacin (Floxin)
o Quinolones with gram-positive coverage: Levofloxacin (Levaquin), moxifloxacin
(Avelox), gatifloxacin (Tequin)
o Sulfa: Trimethoprim-sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid)
o Tetracyclines: Tetracycline, doxycycline, minocycline (Minocin)
o Nonsteroidal anti-inflammatory drug (NSAID): Ibuprofen, naproxen (Aleve,
Anaprox)
o COX-2 inhibitor: Celecoxib (Celebrex)
• Category B drugs are ALLOWED for pregnant or lactating women: Pain relief, pick
acetaminophen (Tylenol) instead of NSAIDs such as ibuprofen (Advil) or naproxen (Aleve,
Anaprox). Avoid nitrofurantoin and sulfa drugs during the third trimester (these increase risk of
hyperbilirubinemia).
• Preferred tx for cutaneous anthrax: ciprofloxacin 500 mg orally BID for 60 days or for 8
weeks. If the patient is allergic to ciprofloxacin, use doxycycline 100 mg BID. Cutaneous
anthrax is not contagious; it comes from touching fur or animal skins that are contaminated
with anthrax spores.
Follow national treatment guidelines for certain disorders:
• Asthma: National Asthma Education and Prevention Program (NAEPP)
• COPD: Global Initiative for Chronic Obstructive Lung Disease (GOLD Guidelines)
• Diabetes: American Diabetes Association Clinical Practice Recommendations (ADA)
• Ethics: Guide to the Code of Ethics for Nurses with Interpretive Statements: Development,
Interpretation, and Application
• Healthy People: Office of Disease Promotion and Health Prevention
• Health Promotion: The Guide to Clinical Preventive Services 2014: Recommendations of the
U.S. Preventive Services Task Force (USPSTF)
• Hyperlipidemia: (ACC/AHA)
• Hypertension: (JNC 8)
• Mental Health: American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders (APA)
• Pediatrics: American Academy of Pediatrics. (AAP – Bright Futures)
• Sexually Transmitted Diseases (CDC)
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