Free ANCC FNP Practice Test: 60 Questions With Answers

Answer: B. Confirm with ambulatory or home blood pressure readings

Why B is right: The USPSTF recommends screening with office blood pressure measurement, then obtaining measurements outside the clinical setting to confirm the diagnosis before starting treatment. Out-of-office readings separate sustained hypertension from an office-only elevation.

Why the other choices are wrong:

• A. Waiting a year leaves a likely diagnosis unconfirmed. The next step is confirmation now.
• C. In a nonurgent case, USPSTF guidance calls for confirmation outside the clinic before treatment starts.
• D. High blood pressure is usually silent. Having no symptoms tells you nothing about his readings.

Takeaway: New, nonurgent office elevation → confirm out of office before labeling and treating.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Source: USPSTF: Hypertension in Adults: Screening — Recommendation summary; implementation—confirm outside the clinical setting

Answer: C. It doesn’t apply to disclosures to another provider for treatment

Why C is right: HHS guidance states that the minimum necessary standard doesn’t apply to disclosures to, or requests by, a health care provider for treatment purposes. That exception exists so information can flow for patient care.

Why the other choices are wrong:

• A. The minimum necessary standard doesn’t apply to treatment disclosures between providers.
• B. A treating provider needs identifiable information. De-identification isn’t required for a treatment disclosure.
• D. HHS guidance describes treatment disclosures between providers as exempt from the standard, not prohibited.

Takeaway: Provider-to-provider disclosures for treatment are exempt from HIPAA’s minimum necessary standard.

ANCC domain: Implementation · Legal and ethical implications for healthcare

Source: HHS: HIPAA Minimum Necessary Requirement — Exceptions for treatment disclosures; workforce access policies

Answer: D. Folic acid 0.4 to 0.8 mg (400 to 800 mcg) daily

Why D is right: For persons at average risk of neural tube defects, the USPSTF recommends that those planning to or who could become pregnant take a daily supplement containing 0.4 to 0.8 mg of folic acid (grade A, August 2023).

Why the other choices are wrong:

• A. The recommendation covers people planning to or able to become pregnant, so supplementation starts before conception.
• B. That isn’t the USPSTF recommendation, which is 0.4 to 0.8 mg daily for this population.
• C. The USPSTF recommendation applies to people planning to or who could become pregnant in this average-risk population.

Takeaway: Average risk, planning pregnancy or able to become pregnant → daily folic acid 0.4–0.8 mg.

ANCC domain: Planning · Age-appropriate primary, secondary, and tertiary prevention

Source: USPSTF: Folic Acid Supplementation to Prevent Neural Tube Defects — Recommendation summary; patient population and timing

Answer: A. Biennial screening mammography, starting now

Why A is right: The USPSTF recommends biennial screening mammography for women aged 40 to 74 (grade B, April 2024). She is 42 and at average risk, so she falls inside that range today.

Why the other choices are wrong:

• B. Age 50 was the starting point in earlier USPSTF guidance. The April 2024 recommendation starts at 40.
• C. The recommendation covers average-risk women aged 40 to 74. It doesn’t depend on a relative’s diagnosis.
• D. The USPSTF recommendation is for screening mammography. A clinical breast exam doesn’t replace it.

Takeaway: Average-risk woman aged 40–74: biennial screening mammography (USPSTF, 2024).

ANCC domain: Assessment · Evidence-based health promotion and screening of the population

Source: USPSTF: Breast Cancer: Screening — Recommendation summary; population

Answer: B. Respect his decision, document it, and keep discussing options

Why B is right: AMA ethics guidance on informed consent focuses on the patient’s ability to understand relevant information and make an independent, voluntary decision, and it calls for documenting the conversation and the patient’s decision. He shows understanding, reasons from his own values, and is consistent, so this is an informed refusal.

Why the other choices are wrong:

• A. Disagreeing with a recommendation isn’t evidence of incapacity. He shows the understanding and reasoning that capacity requires.
• C. AMA guidance calls for documenting the conversation and the patient’s decision.
• D. Surrogate decisions apply when a patient lacks capacity or declines to take part in decisions. Neither is true here.

Takeaway: A capable, informed, voluntary refusal is respected and documented, and the conversation continues.

ANCC domain: Evaluation · Ethical and legal principles and issues

Source: AMA Code of Medical Ethics: Informed Consent — Opinion 2.1.1

Answer: A. She may consent to chlamydia diagnosis and treatment without a parent’s consent

Why A is right: California Family Code § 6926 allows a minor aged 12 or older to consent to medical care for the diagnosis and treatment of a sexually transmitted disease. This 16-year-old may consent to her chlamydia care. Consent authority is the question here; it is not an absolute promise that every billing or records process is confidential.

Why the other choices are wrong:

• B. California’s specific minor-consent provision applies to this STI care; a parent’s consent is not required.
• C. The statutory age threshold for this care is 12, not 18.
• D. She can be treated in your office. A referral delays care and doesn’t change the consent question.

Takeaway: California: a minor aged 12 or older may consent to STI diagnosis and treatment.

ANCC domain: Implementation · Legal and ethical implications for healthcare

Source: California Family Code § 6926 — Subsections (a)–(b)

Answer: C. On her back on a firm, flat crib mattress in the parents’ room, fitted sheet only

Why C is right: NICHD’s Safe to Sleep guidance: back to sleep for naps and at night; a firm, flat, level surface covered only by a fitted sheet; no objects or loose bedding; and the baby’s own sleep space in the parents’ room.

Why the other choices are wrong:

• A. The baby should have a separate sleep space in the parents’ room, not an adult bed.
• B. Back sleeping is recommended for every sleep, and blankets don’t belong in the sleep area.
• D. The sleep surface should be flat and level, not at an angle.

Takeaway: Back, alone in her own space, flat and firm, fitted sheet only, room-shared.

ANCC domain: Planning · Anticipatory guidance

Source: NICHD Safe to Sleep: Reduce the Risk — Back sleeping; firm flat sleep surface; separate sleep area in parent’s room

Answer: A. Report your suspicion to child protective services now

Why A is right: California Penal Code § 11166 requires a mandated reporter with reasonable suspicion of child abuse to report by telephone immediately or as soon as practicably possible, with a written follow-up report within 36 hours of receiving the information. Proof isn’t required. Investigation is the agency’s job. Reporting does not replace attending to the child’s immediate medical and safety needs.

Why the other choices are wrong:

• B. The duty to report starts with reasonable suspicion. Waiting for proof delays protection.
• C. An admission isn’t required. Reasonable suspicion triggers the report.
• D. Documenting without reporting doesn’t meet a mandated reporter’s duty.

Takeaway: Mandated reporters act on reasonable suspicion, not proof.

ANCC domain: Implementation · Regulatory guidelines (reportable diseases, abuse reporting)

Source: California Penal Code § 11166 — Subsection (a), reporting threshold and timeframes

Answer: B. One-time abdominal ultrasound for aortic aneurysm

Why B is right: The USPSTF recommends one-time AAA screening with ultrasound in men aged 65 to 75 who have ever smoked. He is 68 and has a smoking history, so he qualifies.

Why the other choices are wrong:

• A. For asymptomatic adults, the USPSTF recommends against screening ECG at low cardiovascular risk and finds insufficient evidence at intermediate or high risk. It does not establish resting ECG as the recommended screening test in this case.
• C. USPSTF lung screening applies to adults 50 to 80 with a 20 pack-year history who currently smoke or quit within the past 15 years. He quit 20 years ago, so he no longer qualifies.
• D. The USPSTF recommends against screening asymptomatic adults for carotid artery stenosis (grade D).

Takeaway: Under USPSTF criteria, read the whole smoking history: “quit more than 15 years ago” ends lung screening, but “ever smoked” still triggers AAA screening in men 65–75.

ANCC domain: Assessment · Evidence-based health promotion and screening of the population

Sources: USPSTF: Abdominal Aortic Aneurysm: Screening — Recommendation summary; USPSTF: Lung Cancer: Screening — Recommendation summary; stopping screening; USPSTF: Cardiovascular Disease Risk: Screening With Electrocardiography — Recommendation summary; USPSTF: Asymptomatic Carotid Artery Stenosis: Screening — Recommendation summary

Answer: A. Diabetes is diagnosed, since two different tests from one sample are both abnormal

Why A is right: ADA thresholds are A1C ≥6.5% and fasting plasma glucose ≥126 mg/dL. Without unequivocal hyperglycemia, diagnosis needs two abnormal results, and those can be two different tests from the same sample. Both of his values clear the threshold.

Why the other choices are wrong:

• B. A second abnormal test from the same sample already confirms the diagnosis.
• C. A1C measured by an NGSP-certified lab method is an accepted diagnostic test.
• D. His values are above the prediabetes ranges (A1C 5.7–6.4%; fasting glucose 100–125 mg/dL).

Takeaway: Two abnormal results confirm diabetes, even when they’re two different tests from one blood draw.

ANCC domain: Diagnosis · Interpreting results of diagnostic tests and procedures

Source: ADA Standards of Care in Diabetes—2026, Section 2: Diagnosis and Classification — Printed S28, Table 2.1; S30, Confirming the Diagnosis

Answer: C. Report the case to the health department as required

Why C is right: CDC’s STI guidelines state that syphilis is reportable in every state under applicable state and local requirements. Report the case as those requirements direct. HIPAA permits disclosures that are required by law.

Why the other choices are wrong:

• A. HIPAA permits disclosures required by law, so mandated reporting doesn’t depend on an authorization.
• B. Treatment doesn’t replace the reporting requirement.
• D. Syphilis is reportable in its own right.

Takeaway: Report syphilis according to applicable state and local requirements; treatment doesn’t replace reporting.

ANCC domain: Implementation · Regulatory guidelines (reportable diseases, abuse reporting)

Sources: CDC Sexually Transmitted Infections Treatment Guidelines, 2021 — Reporting and Confidentiality; CDC STI Treatment Guidelines: Primary and Secondary Syphilis — Recommended regimen for adults; HHS: Summary of the HIPAA Privacy Rule — Uses and disclosures required by law; public health activities

Answer: B. Justice

Why B is right: The Belmont Report frames justice as fairness in distributing the benefits and burdens of research. Choosing participants for convenience while others receive the benefit is a justice problem.

Why the other choices are wrong:

• A. Respect for persons centers on autonomy and informed consent. The issue here is who bears the burden.
• C. Beneficence centers on minimizing harm and maximizing benefit. The core problem here is unfair selection of subjects.
• D. Fidelity isn’t one of the three Belmont principles: respect for persons, beneficence, and justice.

Takeaway: Who bears research burdens and who gets the benefits = justice.

ANCC domain: Evaluation · Ethical and legal principles and issues

Source: HHS Office for Human Research Protections: The Belmont Report — Part B.3 Justice; participant selection

Answer: A. Exercise, such as supervised gait, balance, and strength training

Why A is right: The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 or older who are at increased risk (grade B, June 2024). CDC’s STEADI also directs patients with poor gait, strength, or balance to physical therapy or an evidence-based exercise program.

Why the other choices are wrong:

• B. Restricting activity isn’t a recommended fall-prevention intervention.
• C. She’s already at increased risk. Prevention doesn’t wait for an injury.
• D. STEADI tells clinicians to identify medications that increase fall risk. Adding a sedating drug works against fall prevention.

Takeaway: Community-dwelling, 65+, increased fall risk → exercise interventions.

ANCC domain: Planning · Age-appropriate primary, secondary, and tertiary prevention

Sources: USPSTF: Falls Prevention in Community-Dwelling Older Adults: Interventions — Recommendation summary; exercise interventions; CDC STEADI: Pocket Guide for Clinicians — Pages 1–2: screen, assess, intervene; follow-up

Answer: D. That state’s nursing laws and board of nursing rules for APRNs

Why D is right: ANCC describes certification as recognition from a nongovernmental agency that validates knowledge and skills. Licensure and practice authority come from each state’s regulatory body. National certification alone does not authorize practice in the new state.

Why the other choices are wrong:

• A. Certification validates competence. It doesn’t grant authority to practice.
• B. An employer can limit duties, but it can’t expand what state law allows.
• C. Scope follows the laws of the state where she practices.

Takeaway: Certification ≠ license. State law and the board of nursing set scope.

ANCC domain: Implementation · Scope and Standards for Advanced Practice Registered Nurses

Sources: ANCC Certification Handbook, January 2026 — What Is Certification?; NCSBN: Advanced Practice Registered Nurses — APRN regulation; licensure and state implementation

Answer: A. Genetic counseling, then BRCA1/2 testing if indicated

Why A is right: The USPSTF recommends assessing women with a relevant personal or family history using a brief familial risk tool. Women with a positive result should receive genetic counseling and then genetic testing if it’s indicated after counseling.

Why the other choices are wrong:

• B. The USPSTF sequence puts genetic counseling before testing. Counseling decides whether testing is indicated and what the result would mean.
• C. A positive tool result calls for action now, not a delay.
• D. Routine mammography alone would not address this positive hereditary-risk assessment. Skipping counseling misses the recommended next step.

Takeaway: Positive familial risk tool → genetic counseling → testing if indicated.

ANCC domain: Assessment · Risk assessment

Source: USPSTF: BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing — Recommendation summary

Answer: C. Use plasma glucose, such as a fasting glucose, instead of A1C

Why C is right: ADA recommends using plasma glucose criteria when the relationship between A1C and glycemia is altered, which includes recent blood loss or transfusion.

Why the other choices are wrong:

• A. Urine glucose isn’t one of the ADA diagnostic criteria.
• B. ADA describes fructosamine as approved for monitoring glycemia, not as a diagnostic criterion.
• D. Lab certification doesn’t fix the problem. Transfused red cells change what A1C reflects.

Takeaway: Recent transfusion, blood loss, hemodialysis, and similar conditions → diagnose with plasma glucose, not A1C.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Source: ADA Standards of Care in Diabetes—2026, Section 2: Diagnosis and Classification — Printed S29, Recommendation 2.4 and Table 2.3: altered erythrocyte turnover, including transfusion

Answer: D. Correct the note to match what you did, then sign it

Why D is right: ANA’s position statement on AI says technologies that assist clinical practice are adjuncts to, not replacements for, the nurse’s knowledge and skill, and nurses remain accountable for their decisions and actions.

Why the other choices are wrong:

• A. Validation of a tool doesn’t shift accountability for the record to the software.
• B. Signing a note you know is inaccurate puts a false exam in the record, even briefly.
• C. You’re responsible for your documentation. The vendor doesn’t know what happened in the visit.

Takeaway: AI drafts; you verify. You’re accountable for everything you sign.

ANCC domain: Implementation · Responsible and ethical use of information technology

Source: ANA: The Ethical Use of Artificial Intelligence in Nursing Practice — Position statement, pages 1–2

Answer: B. Start a regimen that contains an inhaled corticosteroid

Why B is right: GINA recommends against treating asthma with as-needed short-acting beta agonist (SABA) alone. SABA-only treatment is linked to more exacerbations, worse lung function, and a higher risk of asthma death. For symptoms most days with night waking about once a week, GINA 2026’s preferred initial Track 1 regimen is low-dose inhaled corticosteroid–formoterol maintenance-and-reliever therapy (MART), not an as-needed-only regimen.

Why the other choices are wrong:

• A. A burst doesn’t change the underlying SABA-only regimen.
• C. Relying on SABA alone is exactly what GINA advises against.
• D. Her regimen still wouldn’t contain an inhaled corticosteroid, which is the problem GINA addresses.

Takeaway: Adults and adolescents with asthma need an inhaled corticosteroid–containing regimen, not SABA-only treatment.

ANCC domain: Planning · Evidence-based clinical guidelines and standards of care

Source: GINA 2026 Summary Guide for Asthma Management and Prevention — SABA-only safety discussion; Table 3, page 22: initial treatment for adults/adolescents

Answer: B. About 4 weeks after treatment, and retest at 3 months

Why B is right: CDC recommends a test of cure by NAAT about 4 weeks after treatment in pregnancy, plus retesting at 3 months because reinfection is common.

Why the other choices are wrong:

• A. Waiting until delivery misses the recommended test of cure and retest.
• C. Pregnancy is an indication for a test of cure under CDC guidance.
• D. Testing too soon can detect nonviable organisms and give a false-positive result.

Takeaway: Chlamydia in pregnancy: test of cure about 4 weeks after treatment, and retest at 3 months.

ANCC domain: Evaluation · Pharmacotherapeutic intervention and treatment outcomes

Source: CDC STI Treatment Guidelines: Chlamydial Infections — Pregnancy; recommended regimen; follow-up

Answer: D. Don’t open her record; you have no role in her care

Why D is right: Under HIPAA’s minimum necessary standard, a covered entity’s policies must limit workforce access to protected health information to the people who need it to do their jobs. Curiosity isn’t a job function.

Why the other choices are wrong:

• A. A family member’s verbal okay doesn’t create a job-related need to access the record.
• B. Viewing without a job-related need is the problem, whether or not you share it.
• C. System access isn’t the same as a need to know.

Takeaway: Technical access isn’t permission. Open records only for your job.

ANCC domain: Implementation · Responsible and ethical use of information technology

Source: HHS: HIPAA Minimum Necessary Requirement — Exceptions for treatment disclosures; workforce access policies

Answer: B. Chlamydia and gonorrhea NAAT

Why B is right: The USPSTF recommends screening for chlamydia and gonorrhea in all sexually active women 24 years or younger. Her age and sexual activity place her in that group, whether or not she has symptoms.

Why the other choices are wrong:

• A. The USPSTF recommends against routine herpes serologic screening in asymptomatic adolescents and adults (grade D).
• C. USPSTF cervical cancer screening begins at age 21.
• D. A urinalysis doesn’t screen for chlamydia or gonorrhea.

Takeaway: Sexually active and 24 or younger → screen for chlamydia and gonorrhea, even without symptoms.

ANCC domain: Assessment · Risk assessment

Sources: USPSTF: Chlamydia and Gonorrhea: Screening — Recommendation summary; screening tests; USPSTF: Genital Herpes Infection: Serologic Screening — Recommendation summary; USPSTF: Cervical Cancer: Screening — Recommendation summary: women younger than 21

Answer: D. Send a backup throat culture

Why D is right: CDC guidance says a negative RADT in children older than 3 should be followed by a throat culture, because antigen tests miss some infections. Treating confirmed strep in children lowers the risk of acute rheumatic fever.

Why the other choices are wrong:

• A. A negative antigen test isn’t enough in this age group. It needs a backup culture.
• B. Clinical features alone don’t distinguish strep from viral pharyngitis. Treatment follows a positive test.
• C. A CBC doesn’t diagnose group A strep. The backup test is a throat culture.

Takeaway: Child over 3 with a negative RADT → backup throat culture.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Sources: CDC: Clinical Guidance for Group A Streptococcal Pharyngitis — Negative RADT; children older than 3 versus other ages; treatment; CDC: Outpatient Clinical Care for Pediatric Populations — Treatment recommendations table: Pharyngitis

Answer: A. HLA-B*1502 genotyping

Why A is right: The carbamazepine boxed warning says patients with ancestry in genetically at-risk populations should be screened for HLA-B*1502 before starting treatment. The allele is strongly associated with Stevens-Johnson syndrome and toxic epidermal necrolysis in patients of Chinese ancestry.

Why the other choices are wrong:

• B. TPMT testing is used with other medicines. It isn’t the test named in the carbamazepine boxed warning.
• C. CYP2D6 testing is used with other medicines. It isn’t the test named in the carbamazepine boxed warning.
• D. An ECG doesn’t address the genetic risk of serious skin reactions that the boxed warning describes.

Takeaway: Carbamazepine + ancestry from at-risk populations → test for HLA-B*1502 first.

ANCC domain: Planning · Pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenetics

Source: Carbamazepine tablets prescribing information, DailyMed — Boxed warning: serious dermatologic reactions; HLA-B*1502

Answer: C. Stay with her and arrange an urgent mental health evaluation

Why C is right: NIMH’s ASQ Brief Suicide Safety Assessment guide says a “yes” to current thoughts of killing oneself means the patient requires an urgent/STAT mental health evaluation and can’t be left alone. A positive response indicates imminent risk.

Why the other choices are wrong:

• A. Resources help, but current suicidal thoughts need an urgent evaluation today.
• B. A routine referral is too slow for imminent risk.
• D. A promise doesn’t replace urgent evaluation, and she can’t be left without supervision.

Takeaway: Current suicidal thoughts → constant supervision + urgent mental health evaluation.

ANCC domain: Implementation · Non-pharmacologic intervention and treatment

Source: NIMH ASQ Toolkit: Youth Outpatient Brief Suicide Safety Assessment — Current suicidal thoughts; disposition; safety planning

Answer: B. Reteach it a different way, then ask her to teach it back again

Why B is right: AHRQ’s teach-back guidance says that when teach-back uncovers a misunderstanding, you explain again using a different approach and repeat the cycle until the patient can describe the information correctly in her own words.

Why the other choices are wrong:

• A. A yes-or-no question doesn’t check understanding. Teach-back asks her to explain.
• C. The first explanation didn’t work. AHRQ recommends a different approach.
• D. The gap is still there. A handout alone doesn’t confirm she understands.

Takeaway: If teach-back misses, reteach differently and check again.

ANCC domain: Implementation · Patient-specific education

Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 5: Use the Teach-Back Method — Tool 5 instructions

Answer: D. Continue it and keep monitoring

Why D is right: His creatinine rose 20%: (1.2 − 1.0) ÷ 1.0 × 100. KDIGO 2024 advises continuing an ACE inhibitor or ARB unless creatinine rises by more than 30% within 4 weeks of initiation or a dose increase. His potassium, blood pressure, and clinical status provide no separate reason to stop; continue treatment and monitoring.

Why the other choices are wrong:

• A. A 20% rise is below the 30% threshold for reconsidering therapy.
• B. His potassium is already 4.8 mEq/L. A supplement isn’t indicated and could raise it.
• C. A rise under 30% by itself doesn’t call for a dose reduction. KDIGO advises continuing therapy.

Takeaway: A modest creatinine rise can occur after starting an ACE inhibitor. A rise of 30% or less alone is not a reason to stop; assess potassium, blood pressure, and clinical status too.

ANCC domain: Evaluation · Pharmacotherapeutic intervention and treatment outcomes

Source: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease — Printed S212, Practice Points 3.6.2–3.6.5

Answer: C. “Within the past 12 months we worried whether our food would run out before we got money to buy more.”

Why C is right: That statement is the first of the two Hunger Vital Sign items. Patients answer “often true,” “sometimes true,” or “never true,” and “often” or “sometimes” to either item flags a risk of food insecurity.

Why the other choices are wrong:

• A. Income isn’t the same as food insecurity, and this isn’t part of the Hunger Vital Sign.
• B. This is not one of the two Hunger Vital Sign items. Meal frequency alone does not ask whether lack of money limits reliable access to food.
• D. This asks about diet quality, not whether the household can afford enough food.

Takeaway: The Hunger Vital Sign asks two “past 12 months” questions; “often” or “sometimes” true to either one is a positive screen.

ANCC domain: Assessment · Risk assessment

Source: Children’s HealthWatch: Hunger Vital Sign — What is the Hunger Vital Sign?; screening statements; required attribution

Hunger Vital Sign statement credited to Hager ER, Quigg AM, Black MM, et al. Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics. 2010;126(1):26–32. doi:10.1542/peds.2009-3146.

Answer: A. Iron-deficiency anemia with depleted iron stores

Why A is right: Her hemoglobin is low, her red cells are small, and ferritin, which reflects stored iron, is well below range. That pattern fits iron-deficiency anemia. The labs don’t prove the cause of iron loss, so the history still matters.

Why the other choices are wrong:

• B. Her hemoglobin and MCV are below the reference ranges given, so the results aren’t normal.
• C. A ferritin of 8 ng/mL shows depleted iron stores.
• D. Iron overload raises ferritin. Hers is very low.

Takeaway: Low hemoglobin + low MCV + low ferritin → iron deficiency. Then find the cause.

ANCC domain: Diagnosis · Interpreting results of diagnostic tests and procedures

Source: NHLBI: Iron-Deficiency Anemia — Diagnosis: CBC, iron and ferritin studies

Answer: C. Advise against it and discuss other sleep options

Why C is right: The 2023 AGS Beers Criteria list first-generation antihistamines, including oral diphenhydramine, as medications to avoid in older adults (strong recommendation). They’re highly anticholinergic, and tolerance develops when they’re used as hypnotics.

Why the other choices are wrong:

• A. A lower dose doesn’t change the Beers recommendation to avoid the drug.
• B. Doxylamine is also a first-generation antihistamine on the same Beers list.
• D. Food doesn’t change the anticholinergic risk the Beers Criteria describe.

Takeaway: Older adult + first-generation antihistamine sleep aid → avoid (Beers).

ANCC domain: Planning · Pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenetics

Source: American Geriatrics Society 2023 Updated AGS Beers Criteria — Table 2: first-generation antihistamines, including oral diphenhydramine

Answer: B. Take it on an empty stomach before breakfast, at least 4 hours apart from calcium

Why B is right: Levothyroxine labeling says to take it on an empty stomach one-half to one hour before breakfast and at least 4 hours before or after drugs that interfere with absorption, such as calcium carbonate. The label also says to assess compliance and method of administration before increasing the dose.

Why the other choices are wrong:

• A. The labeling says to assess how she takes it before increasing the dose.
• C. Taking it with food doesn’t match the labeled instructions to take it on an empty stomach.
• D. Calcium carbonate decreases levothyroxine absorption.

Takeaway: Fix how the dose is taken before you change the dose.

ANCC domain: Implementation · Patient-specific education

Source: Levoxyl prescribing information: dosage and administration — Section 2.1, administration; interfering medicines

Answer: C. Ask about cost and help her find lower-cost options or assistance

Why C is right: AHRQ’s toolkit suggests asking directly whether patients have delayed medicine or taken less to make it last, and then helping them find financial assistance or less expensive medicines.

Why the other choices are wrong:

• A. A switch may not be clinically appropriate and skips the conversation about what she can afford.
• B. Education doesn’t solve a cost barrier.
• D. Increasing a dose doesn’t resolve an affordability barrier and may be unsafe.

Takeaway: Skipped doses? Ask about cost before assuming anything else.

ANCC domain: Implementation · Resource management

Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 19: Help Patients Pay Less for Medicine — Tool 19 instructions

Answer: B. Stop lisinopril now and switch to a pregnancy-appropriate drug

Why B is right: Lisinopril carries a boxed warning for fetal toxicity: when pregnancy is detected, discontinue it as soon as possible, because drugs acting on the renin-angiotensin system can injure the developing fetus. Her blood pressure still needs treatment, so the plan is to switch, not simply stop.

Why the other choices are wrong:

• A. The label says to stop as soon as pregnancy is detected.
• C. Losartan also acts directly on the renin-angiotensin system, the drug group the warning describes.
• D. Her blood pressure is elevated. Stopping lisinopril is necessary, but leaving her untreated isn’t the answer.

Takeaway: Pregnancy on an ACE inhibitor or ARB → stop it now and switch to a pregnancy-appropriate option.

ANCC domain: Planning · Pharmacotherapeutics, pharmacokinetics, pharmacodynamics, and pharmacogenetics

Sources: Lisinopril tablets prescribing information, DailyMed — Boxed warning: fetal toxicity; NHLBI: Treating chronic hypertension during pregnancy appears safe and effective — CHAP trial results; treatment target below 140/90

Answer: A. Formal developmental screening with a validated screening tool

Why A is right: AAP recommends developmental screening for all children at 9, 18, and 30 months, as reported by CDC. Screening is more formal than monitoring and is done even when no one has a concern.

Why the other choices are wrong:

• B. Waiting skips a recommended screening age and could delay referral.
• C. Monitoring continues at every visit, but it doesn’t replace the formal screening recommended at 30 months.
• D. AAP recommends autism-specific screening at 18 and 24 months. It doesn’t replace general developmental screening.

Takeaway: General developmental screening at 9, 18, and 30 months; autism-specific screening at 18 and 24 months.

ANCC domain: Assessment · Functional assessment

Source: CDC: Developmental Monitoring and Screening — AAP screening schedule

Answer: A. Subclinical hypothyroidism

Why A is right: Subclinical thyroid dysfunction means an abnormal TSH with normal free thyroid hormone levels. Here TSH is high and free T4 is normal, so the pattern is subclinical hypothyroidism.

Why the other choices are wrong:

• B. Overt primary hypothyroidism pairs a high TSH with a low free T4. Her free T4 is normal.
• C. Her TSH is above the reference range.
• D. Subclinical hyperthyroidism involves a low TSH. Hers is high.

Takeaway: High TSH + normal free T4 = subclinical hypothyroidism; add a low free T4 and it’s overt.

ANCC domain: Diagnosis · Interpreting results of diagnostic tests and procedures

Source: USPSTF: Thyroid Dysfunction: Screening — Clinical considerations: definitions of subclinical thyroid dysfunction

Answer: B. A serum vitamin B12 level

Why B is right: ADA’s 2026 Standards recommend considering periodic vitamin B12 assessment with long-term metformin, especially in people with anemia or peripheral neuropathy. His new symptoms make serum B12 the relevant test among these choices.

Why the other choices are wrong:

• A. Urine albumin testing evaluates kidney damage; it does not identify the metformin-associated deficiency that can contribute to neuropathy.
• C. Liver enzymes do not measure vitamin B12 status.
• D. An inflammatory marker does not evaluate the recognized metformin-associated vitamin deficiency.

Takeaway: Metformin user with neuropathy → check B12.

ANCC domain: Evaluation · Pharmacotherapeutic intervention and treatment outcomes

Source: ADA Standards of Care in Diabetes—2026, Section 3: Prevention or Delay of Diabetes and Associated Comorbidities — Printed S53, Recommendation 3.10

Answer: C. “Smoking calms you, and you’re also worried about your health.”

Why C is right: This is a double-sided reflection. It captures both sides of the patient’s ambivalence without arguing, which is a core motivational interviewing skill within OARS (open questions, affirmations, reflections, summaries).

Why the other choices are wrong:

• A. A “why” question plus advice can feel like judgment and skips reflecting what the patient said.
• B. Arguing for change tends to push an ambivalent patient to defend the other side.
• D. Reassurance dismisses the patient’s concern instead of exploring it.

Takeaway: Reflect both sides of ambivalence before offering advice.

ANCC domain: Implementation · Therapeutic communication

Source: Indian Health Service SBIRT faculty guide: motivational interviewing core skills — OARS; double-sided reflections, slide 28

Answer: D. Use the qualified video interpreter and speak directly to the patient

Why D is right: The National CLAS Standards call for ensuring the competence of individuals who provide language assistance and state that using untrained individuals or minors as interpreters should be avoided and discouraged.

Why the other choices are wrong:

• A. That doesn’t provide the language assistance she needs to understand a new diagnosis.
• B. An app isn’t a qualified interpreter, and a qualified interpreter is available.
• C. He’s a minor and untrained, which the CLAS Standards say to avoid.

Takeaway: Offer a qualified interpreter. Avoid minors and untrained individuals.

ANCC domain: Planning · Ethnically and culturally sensitive practice

Source: HHS Office of Minority Health: National CLAS Standards — Standards 5–8, particularly Standard 7

Answer: C. Discuss other options, such as annual FIT, and decide together

Why C is right: The USPSTF lists several recommended strategies, including annual FIT, and notes that they differ in frequency, preparation, and follow-up for abnormal results. It advises discussing the decision together with patients. Explain that a positive FIT requires colonoscopy; choosing stool testing is not a way to avoid colonoscopy after an abnormal result. Discuss whether he would complete that follow-up before selecting a strategy.

Why the other choices are wrong:

• A. The USPSTF recommends several screening strategies, not colonoscopy alone.
• B. The USPSTF recommends screening adults aged 45 to 75. He’s already due.
• D. He hasn’t refused screening, only one test. Other options fit his concern.

Takeaway: Declining one test isn’t declining screening. Offer the options and decide together. Positive FIT → colonoscopy.

ANCC domain: Implementation · Therapeutic communication

Source: USPSTF: Colorectal Cancer: Screening — Recommendation summary; stool-based tests and follow-up

Answer: C. Test her gait, strength, and balance, such as with a Timed Up and Go

Why C is right: In CDC’s STEADI approach, a positive fall-risk screen leads to assessment of modifiable risk factors, including gait, strength, and balance. Common tests are the Timed Up and Go, the 30-Second Chair Stand, and the 4-Stage Balance Test.

Why the other choices are wrong:

• A. Restricting activity doesn’t identify or treat the cause. STEADI moves from screening to assessment and targeted intervention.
• B. Unsteadiness plus a fall is a positive screen that calls for assessment, not reassurance.
• D. Education can help, but it doesn’t replace assessing the specific risk factors behind her unsteadiness.

Takeaway: Positive fall screen → assess gait, strength, and balance before choosing interventions.

ANCC domain: Assessment · Functional assessment

Source: CDC STEADI: Pocket Guide for Clinicians — Pages 1–2: screen, assess, intervene; follow-up

Answer: B. Diagnose clinically, without routine labs or a chest x-ray

Why B is right: CDC’s pediatric recommendations state that routine laboratory tests and radiologic studies aren’t recommended for bronchiolitis. A chest x-ray may be warranted only in atypical disease.

Why the other choices are wrong:

• A. Routine imaging isn’t recommended for typical bronchiolitis.
• C. Antibiotics don’t help bronchiolitis and shouldn’t be used.
• D. Routine laboratory tests aren’t recommended for typical bronchiolitis.

Takeaway: Typical bronchiolitis is a clinical diagnosis. Save imaging for atypical cases.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Source: CDC: Outpatient Clinical Care for Pediatric Populations — Treatment recommendations table: Bronchiolitis

Answer: D. Complete excisional biopsy of the lesion for histopathology

Why D is right: The National Cancer Institute’s melanoma guidance recommends biopsy, preferably local excision, for a suspicious lesion. A complete specimen permits histopathologic diagnosis and assessment of the lesion.

Why the other choices are wrong:

• A. Destroying the lesion leaves no tissue for diagnosis.
• B. A changing, asymmetric, multicolored lesion needs a biopsy now.
• C. A superficial specimen of only the raised portion may not permit complete assessment of invasion. It is not the same as a complete biopsy.

Takeaway: Suspected melanoma → biopsy for histopathology, not destruction or delayed observation.

ANCC domain: Implementation · Non-pharmacologic intervention and treatment

Source: National Cancer Institute: Melanoma Treatment (PDQ), Health Professional Version — Diagnosis

Answer: A. Screen for prediabetes and diabetes now, then annually

Why A is right: ADA recommends screening people prescribed second-generation antipsychotics for prediabetes and diabetes at baseline, again 12 to 16 weeks after starting, and annually after that, or sooner if clinically indicated. She’s at 13 weeks.

Why the other choices are wrong:

• B. The recommended schedule includes routine screening without symptoms.
• C. ADA’s schedule includes a repeat at 12 to 16 weeks.
• D. Weight gain isn’t the trigger for the recommended screening schedule.

Takeaway: Second-generation antipsychotics: screen glucose at baseline, 12–16 weeks, then yearly. Test sooner when clinically indicated.

ANCC domain: Evaluation · Pharmacotherapeutic intervention and treatment outcomes

Source: ADA Standards of Care in Diabetes—2026, Section 2: Diagnosis and Classification — Printed S35, Recommendation 2.16: second-generation antipsychotic monitoring

Answer: D. Use a validated eGFR equation that does not include race

Why D is right: KDIGO 2024 states that race should not be used in computing eGFR. Use a validated race-free equation. When a more accurate estimate is needed, additional assessment such as a combined creatinine–cystatin C estimate may be appropriate.

Why the other choices are wrong:

• A. The need for an additional filtration marker depends on the clinical situation, not a race category.
• B. An equation is not chosen by asking the patient to select between race-based values.
• C. Continuing to report race-based values retains the variable KDIGO says to avoid.

Takeaway: Use a race-free eGFR equation; use additional filtration markers when a more accurate estimate is needed.

ANCC domain: Planning · Ethnically and culturally sensitive practice

Source: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease — Printed S188, Practice Point 1.2.4.2; GFR estimation guidance

Answer: D. Superficial heat and staying active as tolerated

Why D is right: ACP recommends nonpharmacologic treatment first for acute low back pain, with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation. NIAMS also advises avoiding bedrest and gradually increasing activity as tolerated. If medicine is wanted, ACP recommends an NSAID or skeletal muscle relaxant.

Why the other choices are wrong:

• A. ACP puts nondrug treatment first, and names NSAIDs or muscle relaxants if medicine is wanted.
• B. Nothing in this history calls for imaging before starting ACP’s first-line plan.
• C. NIAMS advises avoiding bedrest and increasing physical activity as tolerated, rather than resting until all pain has resolved.

Takeaway: Acute low back pain without red flags: heat, stay active, and nondrug care first.

ANCC domain: Implementation · Non-pharmacologic intervention and treatment

Sources: ACP: Guideline for treating nonradicular low back pain — Recommendation summary for acute/subacute pain; NIAMS: Back Pain—Diagnosis, Treatment, and Steps to Take — Imaging and Blood Tests; Other Treatments

Answer: C. Acute otitis media should not be diagnosed, because there’s no middle ear effusion

Why C is right: CDC’s pediatric recommendations state that AOM should not be diagnosed in children without middle ear effusion, based on pneumatic otoscopy and/or tympanometry.

Why the other choices are wrong:

• A. There’s no AOM diagnosis to treat, and CDC notes that some mild cases in children 6 to 23 months may be managed with watchful waiting.
• B. Ear tugging is a symptom. It can support a diagnosis only when the exam findings are also present.
• D. Mild redness alone doesn’t meet the diagnostic criteria, and there’s no effusion here.

Takeaway: No middle ear effusion, no AOM diagnosis.

ANCC domain: Assessment · Focused history and physical assessment

Source: CDC: Outpatient Clinical Care for Pediatric Populations — Treatment recommendations table: Acute otitis media, diagnosis

Answer: C. Urinalysis plus culture of a catheter-obtained specimen

Why C is right: For children 2 to 24 months, CDC’s recommendations require both a urinalysis suggesting infection and at least 50,000 CFU/mL of a single uropathogen from urine obtained by catheterization or suprapubic aspiration, not urine collected in a bag.

Why the other choices are wrong:

• A. A definitive diagnosis needs both the urinalysis and a qualifying culture.
• B. CDC specifically excludes bag-collected urine for a definitive diagnosis in this age group.
• D. Nitrites aren’t sensitive in children and can’t be used to rule out UTI.

Takeaway: Ages 2–24 months: suggestive urinalysis + culture from catheter or suprapubic aspiration. No bag specimens.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Source: CDC: Outpatient Clinical Care for Pediatric Populations — Treatment recommendations table: Urinary tract infection, diagnosis

Answer: D. Azithromycin 1 g orally in a single dose

Why D is right: CDC’s 2021 STI Treatment Guidelines list azithromycin 1 g orally in a single dose as the recommended regimen for chlamydia in pregnancy.

Why the other choices are wrong:

• A. That’s an alternative regimen for nonpregnant adults, not the pregnancy regimen.
• B. That’s the gonorrhea regimen. It doesn’t treat chlamydia.
• C. That’s the recommended regimen for nonpregnant adults and adolescents, not for pregnancy.

Takeaway: Chlamydia in pregnancy: azithromycin 1 g once.

ANCC domain: Implementation · Pharmacotherapeutic intervention

Source: CDC STI Treatment Guidelines: Chlamydial Infections — Pregnancy; recommended regimen; follow-up

Answer: D. 75%

Why D is right: Positive predictive value is true positives ÷ all positive results: 90 ÷ (90 + 30) = 90 ÷ 120 = 0.75, or 75%. It answers the question “If this test is positive, how likely is disease?”

Why the other choices are wrong:

• A. That’s specificity: 870 ÷ (870 + 30).
• B. That’s negative predictive value: 870 ÷ (870 + 10).
• C. That’s sensitivity: 90 ÷ (90 + 10).

Takeaway: PPV = TP ÷ (TP + FP): among all positive test results, how many are true positives?

ANCC domain: Planning · Evidence-based research appraisal

Source: CDC Case Studies in Applied Epidemiology: Screening—Student Guide — Page 2: sensitivity, specificity, PPV and NPV definitions

The study counts are hypothetical; the source supports the mathematical definitions.

Answer: C. 25

Why C is right: Absolute risk reduction = 10% − 6% = 4 percentage points, or 0.04. NNT = 1 ÷ 0.04 = 25. Based on these trial rates, treating 25 patients rather than giving placebo for 5 years prevents one additional stroke on average.

Why the other choices are wrong:

• A. That’s the absolute risk reduction in percentage points, not the NNT.
• B. That’s 1 ÷ 0.06, which uses the treated group’s event rate instead of the difference between groups.
• D. That’s the relative risk reduction as a percentage: (10 − 6) ÷ 10 = 40%.

Takeaway: NNT = 1 ÷ absolute risk reduction (as a decimal), for the stated time period.

ANCC domain: Evaluation · Analyze clinical data and patient-reported outcomes to assess treatment efficacy

Source: Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions — Sections 15.4.2 and 15.4.4.1: NNT definition and risk-difference method

The trial rates are hypothetical. NNT is an average comparative effect over the stated 5-year period, not a guarantee for each group of 25 patients.

Answer: A. Sildenafil is contraindicated because he uses nitrates

Why A is right: The sildenafil prescribing information lists use of organic nitrates in any form as a contraindication, because sildenafil potentiates their blood-pressure-lowering effect.

Why the other choices are wrong:

• B. Today’s blood pressure doesn’t change the interaction.
• C. A lower dose doesn’t make a contraindicated combination acceptable.
• D. The contraindication covers nitrates in any form, including as-needed use. Spacing doses doesn’t remove it.

Takeaway: Any nitrate use → no sildenafil.

ANCC domain: Implementation · Pharmacotherapeutic intervention

Source: Viagra prescribing information — Section 4.1: nitrates

Answer: B. Review every medicine and supplement she brings in from home

Why B is right: AHRQ’s brown bag medicine review has patients bring all prescription medicines, over-the-counter medicines, vitamins, supplements, and herbal medicines. Reviewing them together helps verify what the patient actually takes and catch errors and interactions. Ask about products she did not bring and verify how she actually uses each one.

Why the other choices are wrong:

• A. A year-old list can’t show what she’s taking now, which is the point of the review.
• C. The review specifically includes over-the-counter products, vitamins, supplements, and herbals.
• D. Fill history shows what was dispensed, not what she takes, and it usually misses over-the-counter products and supplements.

Takeaway: An accurate medication history includes everything the patient takes, checked against what they actually do.

ANCC domain: Assessment · Comprehensive history and physical assessment

Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 8: Brown Bag Medicine Reviews — Tool 8 instructions

Answer: A. No routine backup culture and no antibiotics for group A strep

Why A is right: CDC guidance says a throat culture after a negative RADT isn’t routinely indicated in adults, because acute rheumatic fever is very rare at that age. Without a positive test, antibiotics for group A streptococcal pharyngitis aren’t indicated.

Why the other choices are wrong:

• B. Repeating the test in a week doesn’t guide care for this illness and isn’t part of the recommended approach.
• C. Backup culture is recommended for children older than 3, not routinely for adults.
• D. Clinical features alone don’t confirm strep. Treatment follows a positive test.

Takeaway: The age cutoff matters: backup culture for children, not routinely for adults.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Source: CDC: Clinical Guidance for Group A Streptococcal Pharyngitis — Negative RADT; children older than 3 versus other ages; treatment

Answer: B. Behavioral counseling plus an FDA-approved medicine

Why B is right: For nonpregnant adults who use tobacco, the USPSTF recommends that clinicians advise them to stop and provide both behavioral interventions and FDA-approved pharmacotherapy (grade A, January 2021).

Why the other choices are wrong:

• A. The USPSTF finds insufficient evidence to assess e-cigarettes for tobacco cessation; this is not its recommended treatment plan.
• C. The recommendation pairs medicine with behavioral support.
• D. Advice alone leaves out both parts of the recommendation.

Takeaway: Nonpregnant adult ready to quit → counseling plus FDA-approved medicine.

ANCC domain: Planning · Evidence-based clinical guidelines and standards of care

Source: USPSTF: Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions — Recommendation summary

Answer: C. Stop metformin and adjust the diabetes regimen

Why C is right: ADA’s 2026 Standards state that metformin is contraindicated when eGFR is below 30 mL/min/1.73 m². His repeated eGFR of 28 is below that threshold, so stop metformin and select an appropriate alternative diabetes regimen.

Why the other choices are wrong:

• A. Below 30, the recommendation is discontinuation, not simply a dose reduction.
• B. The contraindication applies to metformin, whatever the formulation.
• D. Continuing ignores the below-30 contraindication.

Takeaway: Metformin: eGFR <30 → stop; eGFR 30 to <45 → do not initiate, and reassess benefits and risks if already taking it.

ANCC domain: Implementation · Pharmacotherapeutic intervention

Source: ADA Standards of Care in Diabetes—2026, Section 11: Chronic Kidney Disease and Risk Management — Printed S253: metformin and eGFR thresholds

Answer: D. Symptom care, with no antibiotic and no OTC cough medicine

Why D is right: CDC’s pediatric recommendations say antibiotics shouldn’t be prescribed for the common cold, and that over-the-counter cough and cold medicines have potential for harm and no proven benefit in children under 6.

Why the other choices are wrong:

• A. CDC reports potential harm and no proven benefit for these products in children under 6.
• B. CDC notes nasal discharge usually changes during a cold. Color doesn’t signal a bacterial infection.
• C. CDC notes low-dose inhaled corticosteroids don’t improve outcomes in children without asthma.

Takeaway: Colds in young kids: symptom care, no antibiotics, no OTC cough-and-cold products under 6.

ANCC domain: Implementation · Pharmacotherapeutic intervention

Source: CDC: Outpatient Clinical Care for Pediatric Populations — Treatment recommendations table: Common cold/nonspecific URI

Answer: D. Ask about new falls and reassess gait, balance, and barriers

Why D is right: CDC’s STEADI approach follows up after intervention to review the care plan, encourage fall-risk reduction, and address barriers. Outcomes such as new falls and changes in gait and balance show whether the plan is helping.

Why the other choices are wrong:

• A. That checks a process step, not whether she’s improving.
• B. Satisfaction matters, but it doesn’t measure falls or function.
• C. Scheduled visits don’t show whether she attended or improved.

Takeaway: Evaluate outcomes (falls, function) and barriers, not just whether referrals happened.

ANCC domain: Evaluation · Non-pharmacologic intervention and treatment outcomes

Source: CDC STEADI: Pocket Guide for Clinicians — Pages 1–2: screen, assess, intervene; follow-up

Answer: B. Screen for osteoporosis now with bone density testing

Why B is right: The USPSTF recommends osteoporosis screening for postmenopausal women younger than 65 who are at increased fracture risk as estimated by clinical risk assessment (grade B, January 2025). She meets both conditions.

Why the other choices are wrong:

• A. Screening at 65 is for all women, but the USPSTF also recommends earlier screening when a clinical risk assessment shows increased risk.
• C. Screening comes first. Treatment decisions depend on the result.
• D. A calcium level doesn’t measure bone density, so it can’t screen for osteoporosis.

Takeaway: Postmenopausal and under 65 with increased risk on a clinical tool → screen now.

ANCC domain: Assessment · Evidence-based health promotion and screening of the population

Source: USPSTF: Osteoporosis to Prevent Fractures: Screening — Recommendation summary; two-step approach for postmenopausal women younger than 65

Answer: D. Echocardiogram

Why D is right: The murmur suggests aortic stenosis. An echocardiogram is the most common test to diagnose heart valve problems because it shows how the valves look and work.

Why the other choices are wrong:

• A. A Holter monitor records heart rhythm. It doesn’t show valve structure or function.
• B. Radiation of the murmur to the carotids is a feature of the heart sound. It doesn’t point to carotid disease.
• C. An exercise test doesn’t show the valve’s structure or how narrowed it is. Echocardiography does.

Takeaway: Suspected valve disease → echocardiogram.

ANCC domain: Diagnosis · Selecting appropriate diagnostic tests and procedures

Source: NHLBI: Heart Valve Diseases—Diagnosis — Echocardiography and other diagnostic tests

Answer: A. Prescribe a statin for primary prevention

Why A is right: The USPSTF recommends a statin for adults aged 40 to 75 who have one or more cardiovascular risk factors (such as dyslipidemia or hypertension) and an estimated 10-year risk of 10% or greater (grade B, August 2022). She meets all three conditions. Discuss benefits and harms and initiate moderate-intensity therapy when the patient agrees.

Why the other choices are wrong:

• B. She already meets the criteria today.
• C. The USPSTF threshold for this recommendation is 10%.
• D. This recommendation is about primary prevention, before any cardiovascular event.

Takeaway: Age 40–75 + a risk factor + 10-year risk ≥10% → statin (USPSTF grade B).

ANCC domain: Planning · Evidence-based clinical guidelines and standards of care

Source: USPSTF: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults — Recommendation summary; clinician implementation

Answer: A. Amoxicillin

Why A is right: CDC’s pediatric recommendations list amoxicillin as first-line for AOM in children who haven’t received it in the past 30 days.

Why the other choices are wrong:

• B. CDC reserves it for amoxicillin use in the past 30 days, concurrent purulent conjunctivitis, or recurrent AOM unresponsive to amoxicillin. None applies.
• C. Azithromycin isn’t among the AOM options CDC lists.
• D. Cefdinir is among the options for children with a non-type I penicillin hypersensitivity. She has no allergy.

Takeaway: Uncomplicated AOM being treated → amoxicillin, unless a specific exception applies.

ANCC domain: Implementation · Pharmacotherapeutic intervention

Source: CDC: Outpatient Clinical Care for Pediatric Populations — Treatment recommendations table: Acute otitis media, management