×

Quiz Session - Attempts With Random Questions

ANCC AGPCNP-BC Exam Questions

Page 1 of 25

1.

What type of skin lesion is a mole considered?

  • Papule

  • Macule

  • Nodule

  • Vesicle

Correct answer: Papule 

A papule is a palpable solid lesion less than or equal to 0.5 cm in diameter. Moles, acne, and small cherry angiomas are examples of papules. 

Freckles, petechiae, and small birthmarks are considered macules, which are flat nonpalpable lesions less than 1 cm in diameter. A nodule is a growth of abnormal tissue or fluid inside or under the skin with a diameter greater than 0.5 cm. Vesicles are elevated, superficial skin lesions less than 1 cm in diameter and filled with fluid.

2.

Which of the following is true of disease in the elderly?

  • Older adults and the elderly are more likely to be asymptomatic or to present with subtle symptoms

  • Atypical disease presentations are less common in the elderly

  • The immune system becomes more easily stimulated by viral and bacterial infections

  • The elderly will often exhibit high fever in response to an infection

Correct answer: Older adults and the elderly are more likely to be asymptomatic or to present with subtle symptoms 

Atypical disease presentations are more common in this age group. The immune system becomes less robust as people age and is less likely to become stimulated by bacterial and viral infections. Vaccines may not be as effective in the elderly as in the young because of decreased immune response in the former (the result is lower antibody production).

Older adults and the elderly are more likely to be asymptomatic or to present with subtle symptoms. The elderly are less likely to have a high fever during an infection.

3.

A 79-year-old patient comes in for an annual physical exam. He asks the adult-gerontology nurse practitioner about health screening recommendations for colon and colorectal cancer, wanting to know if he needs a colonoscopy since it has been over ten years since his last one.

The nurse practitioner recommends:

  • Watchful waiting

  • That a fecal occult blood test be performed

  • That a sigmoidoscopy be performed

  • That a colonoscopy be performed

Correct answer: Watchful waiting 

For individuals from the ages of 50 to 75 years, the United States Preventative Services Task Force (USPSTF) recommends a high-sensitivity fecal occult blood test (FOBT) every year, or sigmoidoscopy (every five years), or colonoscopy (every 10 years). From ages 76 to 85, screening is individualized based on risk factors, life expectancy ( >10 years), and risk versus benefits. Therefore, in the 79-year-old patient without risk factors or symptoms, watchful waiting would be indicated. In the patient older than 85, routine screening is not recommended and should be stopped.

4.

What is an example of how the utilitarianism principle is applied?

  • The Women, Infants, and Children (WIC) program is only for pregnant women and children because it may cost society more if this population were harmed by inadequate food intake.

  • A homeless alcoholic man without health insurance presents to the ED with abdominal pain. The patient is triaged and treated in the same manner as the other patients who have health insurance.

  • A woman with terminal breast cancer does not want the NP to reveal her poor prognosis to her mother. Thus, the NP keeps the prognosis in confidence from the patient's mother as per the patient's request. 

  • An NP has an adult male patient with acute bronchitis who complains of acute onset of chest pain. He is diagnosed with pneumonia. The patient then goes to the ED and is diagnosed with an acute MI. The NP made an error in diagnosis and is held responsible for that in a court of law.

Correct answer: The Women, Infants, and Children (WIC) program is only for pregnant women and children because it may cost society more if this population were harmed by inadequate food intake.

Utilitarianism is an obligation to act in a way that is useful to or benefits the majority; it produces the greatest amount of good for the greatest number of people. It also means using a resource for the benefit of most. It is similar to justice but is not the same concept.

5.

Which of the following statements is accurate regarding the Weber test?

  • A result of lateralization to the "bad" or affected ear, in which sound is heard louder in that ear, is indicative of conductive hearing loss.

  • An abnormal result of this test is no lateralization.

  • This test is performed by placing a tuning fork first on the mastoid process, then at the front of the ear, and timing each area.

  • A normal finding of this test is air conduction lasts longer than bone conduction (AC > BC).

Correct answer: A result of lateralization to the "bad" or affected ear, in which sound is heard louder in that ear, is indicative of conductive hearing loss.

Weber and Rinne tests both use tuning forks to test how a patient responds to sounds and vibrations near their ears, and are tests of the acoustic nerve or CN VIII. With the Weber test, the examiner strikes the tuning fork and places in midline on the patient's forehead. The patient then notes where the sound is heard best; the left ear, right ear, or both equally. No lateralization (hearing sound equally in both ears) is a normal finding. If sound is heard louder in the affected or "bad" ear (lateralization to "bad ear"), conductive hearing loss is likely. If sound is heard louder in the ear that is normal (lateralization to "good" ear), sensorineural loss is likely. 

The Rinne test is performed by placing a tuning fork first on the mastoid process, then at the front of the ear, and timing each area. A normal finding of this test is air conduction that lasts longer than bone conduction (AC > BC). A Rinne test result of BC > AC is indicative of conductive hearing loss (i.e., ceruminosis, AOM).

6.

A thyroid panel comes back with the following results: elevated TSH, normal free T4, and normal free T3. What is the most likely diagnosis?

  • Subclinical hypothyroidism

  • Subclinical hyperthyroidism

  • Hypothyroidism

  • Hyperthyroidism

Correct answer: Subclinical hypothyroidism

When the TSH is elevated, it is an indication that the thyroid is in a sluggish (i.e., hypothyroid) state and needs higher amounts of TSH to stimulate production of the thyroid hormones. In primary hypothyroidism, levels of both free T4 and free T3 are low. In cases of subclinical hypothyroidism, free T3 and free T4 are not affected, and their levels remain within the normal range.

7.

A lone elevation of gamma glutamyl transaminase (GGT) is a sensitive indicator of:

  • Alcoholism

  • Viral hepatitis

  • Acute pancreatitis

  • Diverticulitis

Correct answer: Alcoholism 

GGT is elevated in liver disease and biliary obstruction. A "lone" elevation (with/without ALT and AST) in the GGT is a sensitive indicator of possible alcoholism (occult alcohol abuse). ALT is more specific for the liver than AST because AST is also found in cardiac and skeletal muscle, kidneys, and lungs.

8.

All of the following are absolute contraindications for the use of oral contraceptive pills except:

  • Thrombosis related to trauma

  • Migraine with focal neurological aura

  • Smoker who is older than 35

  • Liver tumor

Correct answer: Thrombosis related to trauma 

Thrombosis related to either a known trauma or IV needle is not an absolute contraindication to the use of oral contraceptives. The mnemonic "My CUPLETS" is used to memorize absolute contraindications and is as follows:

  • My Migraines with focal neurological aura
  • C CAD or CVA
  • U Undiagnosed genital bleeding
  • P Pregnant or suspected pregnancy
  • L Liver tumor or active liver disease
  • E Estrogen-dependent tumor
  • T Thrombus or emboli
  • S Smoker aged 35 or older

9.

Which stage of Erikson's psychosocial development theory involves developing the virtues of "care" and "production"?

  • Generativity versus stagnation

  • Ego integrity versus despair

  • Intimacy versus isolation

  • Identity versus role confusion

Correct answer: Generativity versus stagnation

The task of middle age (40-65 years) is to hold a productive job; individuals in this stage may have a family and may become concerned with social causes. By overcoming this stage successfully, the individual develops a virtue of "care", which is shown by giving unconditional support to children and others in the community, society, and even the wider world. The person also shows the second virtue of "production", which revolves around altruism and having something to contribute to the greater good.

10.

Which of the following medications is allowed during the third trimester of pregnancy or for lactating women?

  • Acetaminophen (Tylenol)

  • Ibuprofen (Advil)

  • Trimethoprim-sulfamethoxazole (Bactrim)

  • Nitrofurantoin (Macrobid)

Correct answer: Acetaminophen (Tylenol) 

Category B drugs are allowed for pregnant or lactating women. For pain relief, choose Tylenol instead of NSAIDs such as ibuprofen or naproxen. Avoid nitrofurantoin and sulfa drugs (such as Bactrim) during the third trimester (these increase the risk of hyperbilirubinemia).

11.

Of the following medications, which is not considered to be ototoxic?

  • Iodinated radiocontrast

  • Aspirin

  • Vancomycin

  • High chronic doses of furosemide

Correct answer: Iodinated radiocontrast 

Ototoxic medications include:

  • Aminoglycosides (gentamicin, vancomycin)
  • Aspirin/salicylic acid
  • High chronic doses of furosemide
  • Chemotherapeutic drugs

Iodinated radiocontrast is nephrotoxic, and refers to any diagnostic test that contains dye, such as a CT scan with contrast. Contrast-induced kidney damage is a well-known complication of iodinated radiocontrast agents. It is one of the most common causes of kidney injury among hospitalized patients, occurring within 24-48 hours after receiving an IV contrast injection.

12.

Which of the following types of research article would be ranked as the lowest, or weakest, level of evidence?

  • Cohort/case-control studies

  • Systematic reviews

  • Randomized controlled trials (RCTs)

  • Experimental studies

Correct answer: Cohort/case-control studies

The levels of evidence rankings are:

  • Meta-analysis and/or systematic reviews (Cochrane/Medline/CINAHL/PubMed)
  • RCTs (used for testing and medical treatment effectiveness, subjects assigned at random to either a control or treatment group)
  • Experimental studies (control group, intervention group, randomization)
  • Cohort/case-control studies
  • Retrospective chart reviews
  • Expert/specialty society opinions

13.

Osteoarthritis that affects the distal interphalangeal (DIP) joints is known as:

  • Heberden's nodes 

  • Bouchard's nodes 

  • Morton's neuroma 

  • Sarcoidosis 

Correct answer: Heberden's nodes 

Heberden's nodes are bony nodules on the DIP joints (first finger joint from the fingertip) caused by osteoarthritis, while Bouchard's nodes are bony nodules found on the proximal interphalangeal (PIP) joints (second finger joint from the fingertip). Treatment involves analgesics and NSAIDs (PO and topical). 

Morton's neuroma is an inflammation of the digital nerve of the foot between the third and fourth metatarsals. Sarcoidosis is an abnormal collection of inflammatory cells that form aggregates in the lungs, skin or lymph nodes.

14.

According to Kubler-Ross, which stage of dying is characterized by the dying person developing the hope that death can somehow be postponed?

  • Bargaining

  • Anger

  • Depression

  • Denial

Correct answer: Bargaining 

The third stage is bargaining. During this stage, the dying person develops hope that death can somehow be postponed and may try to barter with doctors, family, or even God or a higher power, saying, "I will do anything to stay alive..." The person may try to bargain for a cure, extra time with family, or less pain.

15.

Which of the following most accurately represents an epidemic?

  • A disease affects a higher-than-usual number of individuals in a specific time frame

  • A disease spreads across an entire continent

  • A disease is especially common in a specific region for a prolonged period

  • None of these choices illustrate an epidemic

Correct answer: A disease affects a higher-than-usual number of individuals in a specific time frame

An epidemic refers to the rapid increase of a disease in a population that involves a large number of people.

A pandemic is an epidemic that occurs over a very large area (several countries or continents). It involves a large proportion of the global population. An endemic is a disease or condition regularly found among particular people in a certain area for a prolonged period.

16.

When evaluating for color blindness, which of the following eye charts should the nurse practitioner use?

  • Ishihara chart 

  • Snellen chart

  • Tumbling E chart 

  • Landolt C chart 

Correct answer: The Ishihara chart 

The Ishihara chart is used to evaluate color blindness and can be used in patients ranging from school-aged children to adults. It displays colored numbers with different colored dots in the background. A pediatric color vision test for preschool children uses shapes instead of numbers.

The Snellen chart is the original eye chart designed in the 1860s by the Dutch eye doctor Hermann Snellen, and measures central distance vision. The first line on this chart is a giant letter E. You read the chart from top to bottom, left to right, covering one eye at a time.

The Tumbling E chart is used for children that are too small to read or adults with reading or speaking difficulties. The patient is asked to lift their hand up, down, to the left or right depending on the image orientation of the letter E they see on the chart.

The Landolt C chart uses a broken ring symbol in various orientations, and is a way to check vision for illiterate or mute patients.

17.

All of the following are benign conditions that may be seen in the elderly population except:

  • Senile actinic keratosis

  • Seborrheic keratosis

  • Senile purpura

  • Lentigines

Correct answer: Senile actinic keratosis

Actinic keratosis is secondary to sun exposure and has the potential for malignancy. It has the potential to be a precancerous lesion of squamous cell carcinoma. Older to elderly fair-skinned adults complain of numerous dry, round, and red-colored lesions with a rough texture that do not heal. Lesions are slow-growing and commonly located on sun-exposed areas (cheeks, nose, face, neck, arms, and back). 

Seborrheic keratosis are soft, wart-like skin lesions mostly seen on the back or trunk. Senile purpura are bright purple-colored patches with well-demarcated edges. They are mostly located on the dorsum of the forearms and hands and eventually resolve over several weeks. Lentigines, or "liver-spots" are tan- to brown-colored macules on the dorsum of the hands and forearms caused by sun damage. All of these conditions are benign.

18.

Which of the following professionals receives and investigates reports of elder abuse?

  • Adult protective services caseworkers

  • Social workers

  • Professional nurses

  • Any professional that is a mandatory reporter

Correct answer: Adult protective services caseworkers 

Adult protective services caseworkers are usually the "first responders" in many states to reports of elder abuse, exploitation, and/or neglect. Casework services include obtaining emergency housing, medical care, legal assistance, housing, law enforcement, and other supportive services.

19.

What is the leading cause of death for all ages and genders in the United States?

  • Heart disease

  • Cancer

  • Chronic lower respiratory diseases

  • Suicide

Correct answer: Heart disease 

Heart disease is the leading cause of death in the US, followed by cancer, then chronic lower respiratory diseases. Suicide accounts for 16.8% of adolescent deaths.

20.

What is the gold standard for diagnosing nonalcoholic fatty liver disease (NAFLD)?

  • Liver biopsy

  • Liver function tests

  • Hepatitis A, B, and C profile

  • Patient symptoms

Correct answer: Liver biopsy 

NAFLD is caused by triglyceride fat deposits in the hepatocytes of the liver. Most patients are asymptomatic, though some may have hepatomegaly. If the patient is symptomatic, complaints of fatigue and malaise with vague RUQ pain will likely be voiced. NAFLD is associated with obesity, metabolic syndrome, DM, and hyperlipidemia. Labwork will show slight elevations of ALT and AST (liver function tests). A hepatitis A, B, and C profile should be ordered to rule out hepatitis. The patient should be referred to a GI specialist for management, and a liver biopsy is considered the gold standard in diagnosing this condition.

×