Nurse Practitioner Exam Question Bank

Based on the American Academy of Nurse Practitioners Certification Board format.

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Sample Stem:

An 8-year-old girl has had 1-day history of fever (≤ 39 °C), cough, nasal congestion, sore throat, and myalgia. It is February, and many students in her school have been ill and absent with confirmed influenza illness.

On examination, she has clear lungs, nasal congestion, and pharyngitis without exudate. She appears miserable, but her vital signs, apart from her fever of 39 °C, are normal. She is up to date on immunizations, except she has not received influenza vaccine in the current year. She has received influenza vaccines in prior years.

What is the most appropriate next step in caring for this child?

Answers

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Answer Options:

 Start oseltamivir orally immediately.
 Obtain a rapid influenza test.
 Start amantadine.
 Discuss treatment with oseltamivir with parents, explaining that it decreases duration of illness by roughly 1 day if their daughter has influenza.

Explanations

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Correct Answer:

Discuss treatment with oseltamivir with parents, explaining that it decreases duration of illness by roughly 1 day if their daughter has influenza.

Educational Objective:

Diagnose and treat possible influenza in children.

Key Point:

In healthy children who are not requiring hospitalization, influenza testing is not required to initiate treatment, and treatment is not mandatory because it will usually only reduce the duration of the normally 7-10 day long illness by 1 day if the patient likely has influenza A or B (antivirals are neither recommended nor effective against other viruses).

Explanation:

When influenza is prevalent (peak month is usually February), healthy children with influenza-like illness do not require rapid testing to make decisions about treatment. Testing should be reserved for high-risk children or children ill enough to be hospitalized.

Similarly, treatment with antiviral medications for influenza-like illness in otherwise healthy children is optional and should be discussed with parents. In patients with influenza A or B, antiviral treatment will usually decrease the 7-10 days of symptoms by 1 day at the risk of experiencing side effects from the medication (increased incidence of vomiting, diarrhea, headache, and trouble sleeping as compared to placebo; the drug also carries a warning about neuropsychiatric side effects such as hallucinations). Two meta-analyses have concluded that in those who are otherwise healthy, the benefits of treating influenza with antivirals do not outweigh its risks.

If antiviral therapy is used, then it should be started within 48 hours of symptom onset.

Vaccination is the best approach to influenza prevention and is recommended for all children older than 6 months.

Pearl: patients need to be warned that, different from antibiotics, oseltamivir does NOT shorten the time period of being contagious. The CDC guidelines recommend that patients practice droplet precaution for 7 days or 24 hours AFTER resolution of fever and respiratory symptoms – whichever takes longer.

References:

American Academy of Pediatrics. Influenza (section 3). In: Kimberlin DW, et al, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 2018:476-490.

Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2018-2019. Pediatrics. 2018;142(4):pii:e20182367.

Tamiflu Drug Description  reviewed Jan 4, 2019; accessed Feb 27, 2019.

Coenen, B; Van Puyenbroeck, K; Verhoeven, V; Vermeire, E; Coenen, S (2013). Jefferson, Tom, ed. The value of neuraminidase inhibitors for the prevention and treatment of seasonal influenza: a systematic review of systematic reviews. PLoS ONE. 8 (4): e60348.

Ebell, MH; Call, M; Shinholser, J (April 2013). Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials. Family Practice. 30 (2): 125–133.

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Nurse Practitioner Exam Review Topics

Blueprint-based Exam Simulation

AANP and ANCC publishes a content blueprint of the material that will appear on the exam.

This is how we determine which material appears in Nurse Practitioner exam simulations.

Cardiovascular16%
Pulmonary12%
Gastrointestinal/Nutritional10%
Musculoskeletal10%
Eyes, Ears, Nose, and Throat7%
Reproductive6%
Endocrine6%
Genitourinary6%
Neurologic System6%
Psychiatry/Behavioral6%
Dermatologic6%
Hematologic3%
Infectious Diseases3%
TOTAL100%

Blueprint-based Exam Simulation

AAENP and AANP publish a content blueprint of the material that will appear on the exam.

This is how we determine which material appears in AAENP board exam simulations.

Cardiovascular16%
Pulmonary12%
Gastrointestinal/Nutritional10%
Musculoskeletal10%
Eyes, Ears, Nose, and Throat7%
Reproductive6%
Endocrine6%
Genitourinary6%
Neurologic System6%
Psychiatry/Behavioral6%
Dermatologic6%
Hematologic3%
Infectious Diseases3%
TOTAL100%

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