The Family Nurse Practitioner Exam consists of 175 multiple-choice questions, 25 of which are pretest items used to develop future versions of the exam. These questions do not count toward the final score.
The content of the Family Nurse Practitioner Exam is divided into five domains of practice:
- In the theoretical foundations of advanced nursing practice domain (37 questions, 25 percent of the exam), questions cover therapeutic communication; health promotion; growth, development, and life stages of individuals and families; influences affecting care of individuals and families (psychosocial, socioeconomic, cultural, and spiritual); and patient-centered education (individual, family, and group).
- In the domain of professional role (23 questions, 15 percent), the exam addresses the scope and standards of advanced nursing practice; safe practice; and advocacy, legal, and ethical issues.
- The healthcare policy and delivery domain (15 questions, 10 percent) reviews regulatory and reimbursement issues, access to care and healthcare policy, and documentation and informatics.
- The Family Nurse Practitioner Exam section on clinical assessment (30 questions, 20 percent) includes questions regarding health assessment, risk analysis, and advanced diagnostic reasoning.
- Clinical management (45 questions, 30 percent) covers evidence-based practice, advanced clinical decision-making, pharmacotherapeutics, clinical therapeutics, and coordination of care.
The exam is administered by computer at testing facilities around the country. The total testing time is four hours, although a half hour is spent learning the computer system. The raw score (the number of questions answered correctly) is placed on a scale using a formula that takes into account the relative difficulty of the test version. The minimum passing scaled score is 350. Scores are available immediately upon completion of the exam.
1. A seven-month-old baby shows decreased abduction of his left leg, thigh fold asymmetry, and disparity of leg lengths. Choose the test maneuver or sign to evaluate the baby for developmental hip dysplasia:
a. Barlow maneuver
b. Ortolani test
c. Allis’ sign
d. Adam’s forward bend test
2. To meet Medicare’s coverage requirements, the Nurse Practitioner’s services must be:
a. Provided subject to state restrictions and supervision requirements
b. Provided under direct supervision
c. Provided in a rural health clinic (RHC) or federally qualified health center (FQHC)
d. Billed through a physician-directed clinic, health agency, or hospital
3. Angiotensin-converting enzyme (ACE) inhibitors are contraindicated for patients with:
b. Diabetes mellitus
c. Heart failure
d. Renal failure
4. Patient-focused goal setting should be:
a. Mandated and controlled by the clinician
b. Reasonable, measurable, and achievable
d. Long-term rather than short-term
5. Your 20-year-old male patient has epistaxis. You observe him bleeding from both posterior nares and swallowing, so you apply topical vasoconstrictors and pack his nostrils. After 30 minutes, his bleeding stops. Choose the follow-up blood tests, if any:
a. No blood test is necessary for a simple nosebleed
b. Hematocrit and hemoglobin to determine his blood loss
c. Coagulation panel
d. Complete blood count
1. C: Allis’ sign. An infant older than three months who holds one knee higher than the other during flexion (Allis’ sign) has developmental hip dysplasia. The methods to assess an infant younger than three months are Barlow’s test (pressing on the child’s knees to pressurize the femoral head during hip flexion, causing posterior subluxation) and Ortolani test (rotating the child’s hips through range-of-motion and listening for a click during abduction, as the femoral head slips). Adam’s forward bending test is an assessment for scoliosis in children ages 10 to 15, which requires the child to bend over at the waist—as in toe touching—and the screener observes the hips to determine if there is a difference in height.
2. A: Provided subject to state restrictions and supervision requirements. Nurse Practitioners (NP) may bill Medicare for services in accordance with state restrictions and supervision requirements. The NP must bill using a National Provider Identification (NPI) number and meet the educational and licensing requirements for Nurse Practitioners. Some states require direct supervision by a physician on the premises while others require indirect or periodical supervision. The Centers for Medicare and Medicaid Services (CMS) pay for NP services that are: Medically necessary; equivalent to physician services; accurately documented on medical records; and billed correctly. Medicare may directly reimburse the NP, if state law allows it.
3. D: Renal failure. ACE inhibitors are contraindicated for patient with kidney failure, as one of their most serious side-effects is renal impairment, especially in patients who also take diuretics and NSAIDs. ACE inhibitors are commonly prescribed to treat hypertension and heart failure. They are often combined with diuretics, such as thiazide for hypertension or Lasix® for heart failure. ACE inhibitors are sometimes given to diabetics to prevent diabetic neuropathy.
4. B: Reasonable, measurable, and achievable. Patient-focused goal setting must be reasonable, measurable, and achievable. Patients are more motivated if they establish their own goals. The goals don’t have to be simple, but they should be very specific, with short-term goals. Long-term goals may be the ultimate plan, but reaching long-term goals through a series of short-term goals is often more effective, because the patient is able to see progressive results. For example, losing weight in five-pound increments are easier short-term goals to achieve than the long-term goal of losing 50 pounds in total. Imbue your patient with confidence that the goals are achievable, to increase his/her motivation.
5. B: Hematocrit and hemoglobin to determine his blood loss. Order hematocrit and hemoglobin to determine if his blood loss is significant. Kiesselbach’s plexus in the anterior nares has plentiful vessels and bleeds easily. Bleeding in the posterior nares is more dangerous and can result in considerable blood loss. Bleeding from the anterior nares is usually confined to one nostril. However, posterior nares bleeding may flow through both nostrils or backward into the throat, and the patient may be observed swallowing blood. Cocaine abusers suffer nosebleeds because of mucosal damage. Bleeding should stop within 20 minutes.