Study with our free AANP Practice Questions, Qbank Test 1. The questions include answers and detailed rationales. Topics focus on diagnosis, diagnostic tests, critical thinking, priorities of care, safe and effective care, treatments, and AANP clinical management. Achieve your highest score on the AANP Exam!
AANP Question 1: A 58-year-old male patient presents with severe chest pain, diaphoresis, and shortness of breath. His past medical history includes hypertension and hyperlipidemia. He is currently experiencing chest discomfort that has been ongoing for the past 30 minutes. His vital signs show elevated blood pressure and heart rate. An ECG reveals ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial intervention for this patient?
A) Administer fibrinolytic therapy
B) Initiate dual antiplatelet therapy with aspirin and clopidogrel
C) Perform coronary angiography with percutaneous coronary intervention (PCI)
D) Administer a beta-blocker to control heart rate
E) Discharge the patient with instructions for outpatient follow-up
Rationale: This patient presents with classic signs and ECG changes indicative of an ST-segment elevation myocardial infarction (STEMI). The most appropriate initial intervention is to perform coronary angiography with PCI to restore blood flow to the occluded coronary artery, as it is the standard of care for managing STEMI.
AANP Question 2: A 64-year-old female patient with a history of type 2 diabetes mellitus, hypertension, and smoking presents to the clinic with fatigue and intermittent chest discomfort for the past week. The pain is described as a dull ache in the chest, which sometimes radiates to the jaw. Physical examination and ECG are unremarkable. What additional diagnostic test should be ordered to evaluate this patient’s symptoms?
A) Exercise stress test
B) Cardiac CT angiography
C) Troponin level measurement
D) Coronary artery calcium score
E) Carotid ultrasound
Rationale: This patient’s risk factors and atypical chest pain symptoms warrant further evaluation for coronary artery disease. An exercise stress test is a suitable initial diagnostic test to assess for inducible myocardial ischemia in patients with suspected stable angina or atypical chest pain.
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AANP Question 3: A 70-year-old male patient presents with crushing chest pain, nausea, and diaphoresis. His past medical history includes coronary artery disease, chronic kidney disease, and a recent hip replacement surgery. On examination, he is hypotensive with muffled heart sounds and jugular venous distention. An ECG shows electrical alternans. What is the most likely diagnosis?
A) NSTEMI (Non-ST-segment elevation myocardial infarction)
B) Aortic dissection
C) Congestive heart failure exacerbation
D) Pulmonary embolism
E) Pericarditis
Rationale: This patient’s presentation is highly suggestive of aortic dissection, characterized by severe chest pain, hypotension, muffled heart sounds, and jugular venous distention. The ECG findings of electrical alternans can be seen in pericardial effusion due to hemodynamic compromise from aortic dissection. It is crucial to consider this life-threatening condition in the differential diagnosis and initiate appropriate management promptly.
AANP Question 4: A 55-year-old female patient presents to the clinic for a routine check-up. She has a family history of cardiovascular disease, and her past medical history includes hypertension and hyperlipidemia. Her blood pressure is well-controlled on medication, and she reports adherence to a statin for cholesterol management. She is a non-smoker, exercises regularly, and follows a heart-healthy diet. Which additional cardiovascular risk factor assessment should the APRN prioritize in this patient?
A) Fasting blood glucose
B) Serum creatinine
C) Bone mineral density (BMD)
D) Thyroid-stimulating hormone (TSH)
E) Hemoglobin A1c
Rationale: Given this patient’s risk factors and family history, it is important to assess her risk for diabetes, as it is a significant cardiovascular risk factor. Fasting blood glucose is a key parameter to evaluate her glycemic control and risk for future cardiovascular events.
AANP Question 5: A 65-year-old male patient with a history of stable angina presents to the emergency department with chest pain at rest. He reports that the pain has been more frequent and severe over the past few weeks, occurring with progressively less exertion and lasting longer. He is currently taking aspirin, a beta-blocker, and a statin. On examination, he appears anxious, and his ECG shows ST-segment depression. What is the most appropriate immediate intervention for this patient?
A) Initiate oxygen therapy
B) Administer sublingual nitroglycerin
C) Perform immediate cardiac catheterization
D) Increase the beta-blocker dose
E) Order a stress echocardiogram
Rationale: This patient’s presentation is consistent with unstable angina, and the most appropriate immediate intervention is to administer sublingual nitroglycerin to relieve chest pain and reduce myocardial oxygen demand. This should be followed by further evaluation and management as needed.
AANP Question 6: A 45-year-old male patient presents with dyspnea on exertion and lower extremity edema. He has a history of untreated hypertension and has been experiencing increased fatigue and difficulty sleeping due to shortness of breath. On examination, you note elevated jugular venous pressure, hepatomegaly, and pitting edema in the ankles. An echocardiogram reveals impaired left ventricular systolic function with an ejection fraction of 25%. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Hypertrophic cardiomyopathy
C) Congestive heart failure
D) Aortic stenosis
E) Pericardial effusion
Rationale: This patient’s clinical findings, including dyspnea, edema, elevated jugular venous pressure, and impaired left ventricular systolic function on echocardiogram, are consistent with congestive heart failure (CHF). CHF is a common complication of untreated hypertension and can lead to symptoms of fluid retention and reduced cardiac output.
AANP Question 7: 60-year-old male patient presents to the clinic with complaints of intermittent chest pain that occurs during exertion and is relieved by rest. He also experiences shortness of breath on climbing stairs. His past medical history includes hypertension and hyperlipidemia, for which he is currently on medication. Physical examination reveals a harsh systolic ejection murmur heard best at the right upper sternal border. Which condition is most likely responsible for this patient’s symptoms?
A) Atrial fibrillation
B) Mitral valve stenosis
C) Coronary artery disease (CAD)
D) Hypertrophic cardiomyopathy
E) Aortic valve stenosis
Rationale: This patient’s symptoms of angina, exertional dyspnea, and a harsh systolic ejection murmur are characteristic of aortic valve stenosis. The murmur is due to the narrowing of the aortic valve, which leads to increased resistance to left ventricular ejection and decreased cardiac output.
AANP Question 8: A 45-year-old female patient presents to the emergency department with sudden-onset chest pain that radiates to her back. She describes the pain as “tearing” in nature. She has a history of hypertension and atherosclerosis. On examination, her blood pressure is significantly higher in her right arm compared to her left arm. Which condition is the most likely cause of her symptoms?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
E) Esophageal spasm
Rationale: This patient’s presentation with sudden-onset chest pain radiating to the back, a history of hypertension, and a significant difference in blood pressure between her arms is highly suggestive of aortic dissection. Aortic dissection is a life-threatening condition that requires immediate attention and management.
AANP Question 9: A 55-year-old male patient presents to the clinic with a history of smoking, elevated cholesterol levels, and a sedentary lifestyle. He is concerned about his risk of cardiovascular disease (CVD) and asks about preventive measures. Which of the following lifestyle modifications should be recommended as the most effective primary prevention strategy for reducing CVD risk?
A) Aspirin therapy
B) Regular exercise
C) Statin medication
D) Angiotensin-converting enzyme (ACE) inhibitor
E) Antiplatelet therapy
Rationale: For primary prevention of cardiovascular disease (CVD), lifestyle modifications are the cornerstone of management. Regular exercise is a key component as it helps reduce several risk factors, including hypertension, obesity, and hyperlipidemia, which can significantly lower the risk of CVD. While other interventions like aspirin therapy and statin medication may be considered for certain individuals, they are typically secondary prevention strategies for those with established CVD or high-risk profiles.
AANP Question 10: A 50-year-old male patient presents to the clinic with complaints of intermittent palpitations, dizziness, and episodes of feeling like his heart is racing. He denies chest pain or shortness of breath. His medical history is unremarkable, and he is not taking any medications. On physical examination, you note an irregular pulse, and an ECG reveals an irregularly irregular rhythm with no discernible P waves. What is the most likely diagnosis?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Supraventricular tachycardia
D) Atrial flutter
E) Bradycardia
Rationale: The symptoms of palpitations, dizziness, and an irregularly irregular rhythm on ECG are indicative of atrial fibrillation (AF). AF is the most common sustained cardiac arrhythmia and is characterized by irregular and often rapid atrial electrical activity without discernible P waves.
Anti-inflammatory Meds
What nurses, doctors and other health care practitioners need to know about anti-inflammatory meds. Anti-inflammatory drugs, also known as nonsteroidal anti-inflammatory drugs (NSAIDs), are medications used to reduce inflammation, relieve pain, and alleviate fever. They work by inhibiting the production of certain chemicals in the body, called prostaglandins, which are involved in the inflammatory process.
NSAIDs are commonly used to manage various conditions causing inflammation and pain, such as:
Arthritis (including osteoarthritis and rheumatoid arthritis)
Muscle strains and sprains
Headaches
Menstrual cramps
Back pain
Dental pain
Fever
While NSAIDs are effective in managing pain and inflammation, they can have side effects, including stomach irritation, ulcers, and an increased risk of bleeding. Long-term use of NSAIDs might also impact kidney function and increase the risk of cardiovascular events. It’s essential to use these medications as directed by a healthcare professional and to be aware of potential side effects, especially when used for extended periods or in high doses. Individuals with certain medical conditions or those taking other medications should consult their healthcare provider before using NSAIDs.
Newer anti-inflammatory meds
Newer anti-inflammatory meds include drugs like Humira. Humira is a type of medication classified as a biologic disease-modifying antirheumatic drug (bDMARD). It belongs to a class of drugs known as tumor necrosis factor (TNF) inhibitors. The role of medications like Humira is Treatment of Autoimmune Diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, and psoriasis.
How Humira Works
This drugs work by targeting and inhibiting TNF, a protein that plays a key role in the body’s inflammatory response. By reducing TNF levels, these medications help decrease inflammation and suppress the immune system’s abnormal response seen in autoimmune conditions.
Humira Effects
The primary goal of using Humira and similar medications is to reduce symptoms associated with autoimmune diseases, such as joint pain, swelling, stiffness, and skin symptoms in conditions like psoriasis. In addition to symptom relief, this medication aims to slow down the progression of the underlying disease and help prevent joint damage or complications associated with autoimmune conditions. Humira is usually administered via subcutaneous injection and is often prescribed as a long-term therapy for managing chronic autoimmune diseases.
Side Effects of Humira
Medications like Humira can be highly effective in managing autoimmune conditions, they can also have potential side effects, including an increased risk of infections and, in some cases, a higher risk of certain cancers. Individuals prescribed these medications should be regularly monitored by healthcare professionals to manage potential risks and ensure the appropriate use of these drugs. Treatment decisions should be made in consultation with a healthcare provider based on the individual’s specific condition and medical history.
Several other medications belong to the same class as Humira (adalimumab), known as tumor necrosis factor (TNF) inhibitors. These drugs work similarly by targeting TNF, a protein involved in the inflammatory response in autoimmune diseases. Some medications similar to Humira include:
Etanercept (Enbrel)
Like Humira, Enbrel is a TNF inhibitor used to treat autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis.
Infliximab (Remicade)
Infliximab is used to treat various autoimmune conditions, including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, and ankylosing spondylitis.
Certolizumab Pegol (Cimzia)
This is another TNF inhibitor used for conditions like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and Crohn’s disease.
Golimumab (Simponi)
Golimumab is indicated for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis.
Adalimumab-atto (Amjevita), Adalimumab-adbm (Cyltezo), Adalimumab-bwwd (Hadlima), and Adalimumab-fkjp (Hulio): These are biosimilar versions of adalimumab, essentially replicating the effects of Humira with minor differences due to their manufacturing process.
These medications share a similar mechanism of action by inhibiting TNF and are used to manage various autoimmune diseases characterized by inflammation. However, while they belong to the same class of drugs, individual responses to these medications can vary, and the choice of medication often depends on factors such as the specific condition being treated, patient preferences, tolerability, and healthcare provider recommendation.
