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ANCC FNP review (set of 124) questions WITH ANS 2024 LATEST VERSION
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special considerations for Thiazides - ANSWER-Chlorthalidone is preferred on the basis of prolonged half-life and proven trial reduction of CVD. Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels. Use with caution in patients with history of acute gout unless patie...

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  • April 25, 2024
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  • 2023/2024
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ANCC FNP review (set of 124) questions
WITH ANS 2024 LATEST VERSION
special considerations for Thiazides - ANSWER-Chlorthalidone is preferred on the basis
of prolonged half-life and proven trial reduction of CVD.

Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.

Use with caution in patients with history of acute gout unless patient is on uric acid-
lowering therapy.

special considerations for ACE inhibitors - ANSWER-Do not use in combination with
ARBs or direct renin inhibitor.

There is an increased risk of hyperkalemia, especially in patients with CKD or in those
on K+ supplements or K+-sparing drugs.

There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.

Do not use if patient has history of angioedema with ACE inhibitors.

ACE inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin
production.

Avoid in pregnant females or females of reproductive age without adequate
contraception

special considerations for Angiotensin receptor blockers - ANSWER-Do not use in
combination with ACE inhibitors or direct renin inhibitor.

There is an increased risk of hyperkalemia in CKD or in those on K+ supplements or
K+-sparing drugs.

There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.

Do not use if patient has history of angioedema with ARBs. Patients with a history of
angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after ACE
inhibitor is discontinued.

Avoid in pregnant females or females of reproductive age without adequate
contraception.

,Lower risk of cough than ACE-Is.

special considerations for Calcium channel blockers - ANSWER-Associated with dose-
related pedal edema, which is more common in females than men.

When should you Refer to a Nephrologist or Cardiologist in a hypertensive patient? -
ANSWER--signs of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications

Generally, failure to achieve blood pressure goal in patients who are adhering to full
doses of an appropriate three to four drug regimen that includes a diuretic may warrant
referral to a nephrologist or cardiologist

Before referring, clinicians should first review other causes of inadequate hypertension
control such as:
-Improper blood pressure measurement
-White coat hypertension
-Excess sodium intake
-Medication issues (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit drugs,
sympathomimetics, oral contraceptives)
-Excess alcohol intake
-Underlying identifiable causes of hypertension (secondary hypertension)

A researcher is studying potential risk factors for obesity. She sends a questionnaire to
5000 patients who meet the CDC criteria for obesity that asks them about sedentary
lifestyle factors, consumption of processed food, and family history of obesity. The
researcher sends the same questionnaire to 5000 patients who are not obese. Which of
the following best describes the design of the study?

A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
D. Case-control study - ANSWER-Correct Answer: D. Case-control study
This is a retrospective case-control study. In this observational study design, subjects
are selected based on an outcome, and their prior exposures are assessed and
compared to subjects who do not have the particular outcome. The result of the study is
expressed as an odds ratio: OR = (# exposed with disease / # exposed without disease)
/ (# not exposed with disease / # not exposed without disease). A retrospective case-
control study does not prove causation but demonstrates an association.
Incorrect
Answers:
A. A cross-sectional study is used to assess disease status and risk factors at 1 point in
time.

,B. A randomized controlled trial refers to a study where a group is given a treatment and
outcomes are compared against a control group given a placebo or treated with the
standard of care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital Concepts:
In an observational study design, subjects are selected based on an outcome, and their
prior exposures are assessed and compared to subjects who do not have a particular
outcome. The result of the study is expressed as an odds ratio: OR = (# exposed with
disease / # exposed without disease) / (# not exposed with disease / # not exposed
without disease). A retrospective case-control study does not prove causation but
demonstrates an association.

A 49-year-old female presents to the office with a history of breast cancer who is having
frequent hot flashes who already tried first-line lifestyle changes without improvement?
What is the best treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - ANSWER-Correct Answer: C. Citalopram
Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic
choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has
good evidence of efficacy against these symptoms and is typically well-tolerated.
Incorrect Answers:
A. Women with a history of breast cancer are not candidates for hormone replacement
therapy.
B. "Bioidentical hormones" are compounded mixtures of multiple hormones. There is no
evidence to support their use at this time, and again, hormone treatment would be
contraindicated in a patient with a history of breast cancer.
D. Black cohosh is an herbal remedy marketed for use with hot flashes. However, it has
not been demonstrated to be more effective than a placebo for this use. In addition, it
has been posited to have a possible estrogenic effect on breast tissue, which should be
avoided in patients with a history of breast cancer.
Vital Concepts:
Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic
choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has
good evidence of efficacy against these symptoms and is typically well-tolerated.

A 20-year-old presents to the office for a wellness check. What is the prevalence of
bulimia nervosa in female college students?
A. 1%
B.2%
C. 4%
D. 5% - ANSWER-Correct Answer: D. 5%
Bulimia nervosa occurs in approximately 5% of female college students, who are 10x
more likely than male college students to develop this disorder. The prevalence of
anorexia nervosa is 1.5% in teenage girls overall.

, Incorrect Answers:
(A), (B), (C) are the not correct prevalence.

A 16-year-old male presents because he is concerned about acne. He first began to
notice worsening acne 6 months ago and began using over-the-counter benzoyl
peroxide and, after 3 months, saw his primary care physician who prescribed tretinoin
and oral tetracycline. He states that he has been using both medications for the last 3
months but there is no improvement in acne. He also states he has noticed he is very
quick to anger and moody over the last few months and wonders whether that is a side
effect of the acne medications. He is a football player for his high school and has been
participating in extra practices to "bulk up" in the hopes of achieving a college
scholarship. Upon closer inspection, he has gained 30 pounds in the last 3 months but
does not appear overweight, rather has increased muscle mass. He states that a friend
on the football team has been giving him pills to help his performance. Which of the
following is most likely to be identified?

A. Increased serum luteinizing hormone levels
B. Decreased prothrombin time
C. Lowered thyroxine binding globulin (TBG) levels
D. Increased serum HDL cholesterol - ANSWER-Correct Answer: C. Lowered thyroxine
binding globulin (TBG) levels
Anabolic steroids can lower thyroxine-binding globulin (TBG) levels which, in turn, can
decrease total T4 levels, although free T4 remains the same.
Incorrect Answers:
A. This patient has multiple features that are consistent with anabolic steroid use,
including acne, a rapid increase in weight and muscle mass, and mood swings. In men
steroid use decreases serum luteinizing hormone and follicle-stimulating hormone
levels, which leads to decreased endogenous testosterone production, decreased
spermatogenesis, and testicular atrophy. There is also an increased estrogen
production due to the aromatization of circulating testosterone which can lead to
gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a suppression
of clotting factors II, V, VII, and X.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased
serum HDL cholesterol, increased serum LDL cholesterol, increased total cholesterol,
and increased blood pressure. These effects appear to be reversible when anabolic
steroid use is discontinued. The risk of sudden death from cardiovascular causes can
occur in an athlete abusing anabolic steroids even when there is no evidence of
atherosclerosis. This is due to an increased risk of thrombus formation while using
anabolic steroids.

A 45-year-old woman presents with abnormal uterine bleeding. You discuss your
recommendation for endometrial sampling to rule out endometrial hyperplasia and
carcinoma. What is the most common cause of endometrial cancer?

A. Human papilloma virus

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