AANP EXAM ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED A+ | LATEST VERSION 2024 A 4-year-old boy presents with ear pain and an erythematous, bulging ty mpanic membrane on examination. The nurse practitioner diagnoses him with acute otitis media. Which of the following are the three most common bacterial pathogens associated with acute otitis media in children? A. Moraxella catarrhalis, Staphylococcus aur eus, Streptococcus pneumoniae B. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae D. Nontypeable Haemophilus influenzae, Staphylococcu s aureus, Streptococcus pneumoniae -----CORRECT ANSWER ------------- C. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae Acute otitis media is commonly encountered by primary care nurse practitioners. Typically, children p resent with otalgia and have a bulging tympanic membrane on examination. Many times, children also have a preceding viral upper respiratory infection, resulting in the colonization of bacteria in the middle ear and leading to a bacterial infection. Ear inf ections can be caused by bacterial and viral pathogens. The most common bacterial pathogens isolated from middle ear fluid are nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (C). The most common viral pathogens incl ude respiratory syncytial virus, coronaviruses, influenza viruses, and adenoviruses. Treatment for acute otitis media should be targeted to combat the most common bacterial causes, including amoxicillin (penicillin), amoxicillin -clavulanate (penicillin and combination beta -lactam and beta -lactamase inhibitor), and an oral second -generation cephalosporin (e.g., cefuroxime) in the case of a child with a penicillin allergy. A 6-year-old patient presents to the clinic accompanied by his mother, who reports concerns regarding her child's progressive urinary issues. The patient's mother states that she and the child's father recently divorced, and the child alternates weekly between her house and his father's house. She reports he experiences episodes of urinar y incontinence and holds his stomach as if he is in pain. He frequently asks to use the bathroom but is scared of urination once he is there. Which of the following is the most likely diagnosis? A. Adjustment disorder B. Constipation C. Regression D. Urinary tract infection -----CORRECT ANSWER ------------- D. Urinary tract infection The most likely diagnosis is a urinary tract infection (D). His clinical presentation includes abdominal pain, urinary frequency, and dysuria, which are signs of cystitis i n children, which is considered a lower urinary tract infection (UTI). Pyelonephritis is a complicated form of UTI that may present with persistent fever, flank pain, or vomiting. A 12-year-old girl presents to the clinic with her parent, who is concern ed about the C -
shaped appearance of the girl's spine. The degree of curvature in her spine is 35 degrees. Which of the following is appropriate to educate the parent? A. "Your daughter's spine has a mild curve but does not require treatment and will likel y resolve on its own." B. "Your daughter's spine has a mild curve, so we will watch and wait to see if it worsens. If so, treatment will be necessary." C. "Your daughter's spine has moderate curvature, so we will need to place her in a brace as treatment ." D. "Your daughter's spine has severe curvature, so we will need to refer her for surgery as soon as possible. -----CORRECT ANSWER ------------- C. "Your daughter's spine has moderate curvature, so we will need to place her in a brace as treatment." Scoliosis is a complex spinal deformity defined as a curve in the spine of at least 10 degrees. A curvature of 25 to 40 degrees is considered moderate scoliosis, and most cases require bracing for correction (C). Braces are offered for treatment in patient s who are skeletally immature and have curves > 30 degrees at the first visit. Bracing is considered ineffective if the curvature is > 45 degrees because the patient has reached the threshold for surgical intervention. In male patients, the brace is worn u ntil they stop growing, and in female patients, the brace is worn more than 1.5 years postmenarch or until the patient has grown < 1 cm over the previous 6 months. An 11 -year-old patient reports a severe sore throat, fever, nausea, and headache. Upon exam, the nurse practitioner sees a strawberry red pharynx with petechiae on the hard palate. The remainder of the exam is benign. What would be the best initial test to order for this patient? A. Epstein -Barr virus panel B. Nucleic acid amplification test C. Rapid antigen detection test D. Rapid plasma reagin test -----CORRECT ANSWER ------------- C. Rapid antigen detection test The patient in the above scenario is exhibiting signs of an acute group A streptococcal pharyngitis infection. Group A Streptoco ccus infections are the most common cause of bacterial pharyngitis in children and adolescents. Children typically present with the abrupt onset of pharyngitis, fever, headache, abdominal pain or nausea, and vomiting. Physical exam findings include throat erythema, palatal petechiae, enlarged or erythematous tonsils, enlarged anterior cervical lymph nodes, and a scarlatiniform rash. The gold standard for testing a patient with suspected group A streptococcal pharyngitis is a rapid antigen detection test (C) . These tests provide quick, highly specific results and are readily available in most care centers. Because the sensitivity of the rapid antigen detection tests is a little lower, 70 -90%, if a child initially tests negative, a confirmatory throat culture should be sent as a follow -up. All of the following are potential secondary causes of hyperparathyroidism except: A. Chronic kidney disease B. Neck radiation exposure C. Parathyroid adenoma D. Vitamin D deficiency -----CORRECT ANSWER ------------- C. Parathyroid adenoma Secondary hyperparathyroidism occurs when an issue external to the parathyroid lowers calcium levels. This can be due to chronic kidney disease (especially end -
stage kidney diseas e), a vitamin D deficiency, or neck radiation exposure. Primary causes of hyperparathyroidism are due to an issue with the parathyroid itself, such as a parathyroid adenoma (C). A patient recently diagnosed with primary adrenal insufficiency (Addison di sease) requests additional education on this condition. Which of the following teaching statements is inaccurate? A. "If a potential Addisonian crisis goes untreated, it may lead to severe hypotension and organ failure" B. "It is necessary to keep your I M hydrocortisone injection with you at all times" C. "You may experience electrolyte imbalances such as hyperkalemia and hyponatremia" D. "Your symptoms are related to an increase in a substance called cortisol in your blood" -
----CORRECT ANSWER --------- ----D. "Your symptoms are related to an increase in a substance called cortisol in your blood" Your symptoms are related to an increase in a substance called cortisol in your blood (D) is an inaccurate statement, as Addison disease is a condition
