AANP Chronic Disease Management

Question 1

A 58-year-old patient with type 2 diabetes has an HbA1c of 8.9%. Current treatment is metformin 1000 mg twice daily. Which is the most appropriate next step?

Accepted Answer

Add a GLP-1 receptor agonist

Answer

Adding a GLP-1 receptor agonist to metformin is guideline-recommended when HbA1c remains above goal; it provides cardiovascular and weight benefits with low hypoglycemia risk.

Question 2

A patient with stage 3 chronic kidney disease (eGFR 42 mL/min) and type 2 diabetes asks about medication adjustments. Which agent requires dose reduction or avoidance at this eGFR?

Accepted Answer

Metformin

Answer

Metformin is contraindicated when eGFR falls below 30 and requires caution/dose reduction between 30–45 mL/min due to risk of lactic acidosis.

Question 3

A 65-year-old with COPD is on a short-acting bronchodilator PRN. Spirometry shows FEV1/FVC < 0.70 and FEV1 55% predicted. He reports two exacerbations in the past year. What is the most appropriate maintenance therapy?

Accepted Answer

Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA)

Answer

GOLD guidelines recommend dual bronchodilation with LAMA+LABA for COPD group E patients (high symptom burden and ≥2 exacerbations), with ICS added only if eosinophils are elevated.

Question 4

A patient with heart failure with reduced ejection fraction (HFrEF, EF 35%) is already on an ACE inhibitor and beta-blocker at target doses. Which additional medication has been shown to reduce mortality in this patient?

Accepted Answer

Spironolactone

Answer

Aldosterone antagonists such as spironolactone reduce mortality in HFrEF when added to ACE inhibitor and beta-blocker therapy, per the RALES trial.

Question 5

A 72-year-old patient with hypertension and stage 3a CKD has a blood pressure of 148/88 mmHg on amlodipine 10 mg. Which antihypertensive class should be added first?

Accepted Answer

ACE inhibitor or ARB

Answer

ACE inhibitors and ARBs are preferred add-on agents in CKD with hypertension because they reduce proteinuria and slow progression of kidney disease.

AANP - American Association of Nurse Practitioners Practice Test

AANP - American Association of Nurse Practitioners Practice Test

AANP Chronic Disease Management