AANP Chronic Disease Management 3

Question 1

A 70-year-old patient with stage 3b CKD (eGFR 38) and hyperkalemia (K+ 5.8 mEq/L) is on an ACE inhibitor for diabetic nephropathy. What is the most appropriate immediate management?

Accepted Answer

Reduce ACE inhibitor dose and add a potassium binder if needed

Answer

In mild-to-moderate hyperkalemia with clear indication for ACE inhibitor (diabetic nephropathy), dose reduction combined with potassium binders (e.g., patiromer) allows continuation of renoprotective therapy.

Question 2

A patient with heart failure with preserved ejection fraction (HFpEF, EF 58%) presents with dyspnea and lower extremity edema. What is the primary pharmacologic treatment for symptom relief?

Accepted Answer

Loop diuretics

Answer

Loop diuretics are the cornerstone of symptomatic treatment in HFpEF by reducing volume overload, as no therapy has yet demonstrated mortality reduction in HFpEF.

Question 3

A patient with asthma is classified as having moderate persistent disease. He is currently on a low-dose inhaled corticosteroid (ICS) with persistent symptoms. What is the next step per NAEPP guidelines?

Accepted Answer

Step up to low-dose ICS plus a long-acting beta-agonist (LABA)

Answer

NAEPP Step 3 therapy for moderate persistent asthma is low-dose ICS combined with a LABA, which improves symptom control compared to ICS monotherapy.

Question 4

A 62-year-old patient with type 2 diabetes and established cardiovascular disease has an HbA1c of 8.2%. He is on metformin. Which agent should be added for its proven cardiovascular mortality benefit?

Accepted Answer

Empagliflozin (SGLT-2 inhibitor)

Answer

SGLT-2 inhibitors such as empagliflozin have demonstrated cardiovascular mortality reduction in patients with T2DM and established ASCVD in landmark trials (EMPA-REG OUTCOME).

Question 5

A 55-year-old patient with gout has a serum uric acid of 9.8 mg/dL and two gout flares in the past year. He is not on urate-lowering therapy. What is the appropriate treatment goal?

Accepted Answer

Serum uric acid < 6 mg/dL with allopurinol

Answer

ACR guidelines recommend initiating urate-lowering therapy (first-line allopurinol) in patients with ≥2 flares/year, with a target serum urate < 6 mg/dL to prevent crystal deposition and flares.

AANP - American Association of Nurse Practitioners Practice Test

AANP - American Association of Nurse Practitioners Practice Test

AANP Chronic Disease Management 3