Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
Evaluate is now 15% of the scored exam, 20 of 135 items. Its questions begin once a plan is running: is it working, what is monitored and when, and what changes if it is failing.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
Effectiveness: does the outcome show the plan worked, partly worked or failed?
Monitoring and change: which values to recheck, when, and how to modify the plan on the result.
Typical stems: “Which finding indicates treatment success”, “Which finding requires a change”, “When should this be rechecked”.
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13 Evaluate questions
0 / 13 answered13 questions
Tap an option: why each one is right or wrong appears under it.
Evaluate · 15%
A 60-year-old man with newly diagnosed hypertension has been on lisinopril for 4 weeks. Which finding best indicates the need for treatment modification?
Mild morning fatigue is nonspecific and does not show the regimen is failing.
Blood pressure still above goal after an adequate trial at a full dose means the regimen needs titration or a second drug.
Occasional mild dizziness is common early in treatment and calls for a check of standing BP, not necessarily a change.
A potassium of 4.8 mEq/L is within the normal range and expected on an ACE inhibitor; it is not a reason to change therapy.
A 40-year-old man treated for cellulitis returns at 72 hours. Which finding indicates treatment failure requiring a change?
Redness that keeps spreading, with more pain and fever after 72 hours, signals treatment failure: consider MRSA coverage, an abscess, or deeper infection such as necrotizing fasciitis.
Some warmth can persist for days after treatment starts; residual warmth alone does not mean the antibiotic is failing.
Mild itching is common as inflammation settles and is not a sign of failure.
Fading redness at the margins shows a response to therapy.
A 45-year-old man with severe obstructive sleep apnea has used CPAP for 3 months. His device shows use of 6.5 hours on 92% of nights with a residual AHI of 3 events/hour and minimal mask leak. His Epworth Sleepiness Scale score is still 14. What is the most appropriate next step?
An oral appliance is an alternative for patients who cannot use CPAP; he uses it well and it works.
Raising the pressure is for a high residual AHI; at 3 events per hour the apnea is already controlled.
Modafinil is considered only after treated apnea and other causes of sleepiness have been addressed.
With good adherence, little leak, and a residual AHI under 5, CPAP is working; persistent sleepiness calls for a search for other causes (insufficient sleep, sedating drugs, depression, hypothyroidism, another sleep disorder) before a wake-promoting drug.
A 27-year-old woman with seasonal allergic rhinitis has used an intranasal corticosteroid for 4 weeks. Which finding best indicates successful treatment?
Still needing a daily oral antihistamine on top of the steroid suggests incomplete control.
Less congestion and less need for antihistamines after several weeks of an intranasal corticosteroid show the treatment is working; congestion is the symptom it controls best.
Improvement only when pollen counts are low means the steroid is not controlling symptoms during exposure.
Total absence of all symptoms is an unrealistic target; success is control that allows normal function.
A 75-year-old man on prescribed balance exercises is evaluated. Which finding indicates the program should be modified?
Mild muscle fatigue is an expected response to training.
Normal progression means the program is working as planned.
Increasing unsteadiness during the exercises signals a fall risk or an exercise that is too hard; the program needs to be modified and new causes of imbalance considered.
Variation in when and in what order he does the exercises does not affect safety or benefit.
A 30-year-old man with plaque psoriasis on the elbows and knees (4% body surface area) has applied clobetasol ointment twice daily for 2 weeks with good improvement. What is the most appropriate plan now?
Twice-daily superpotent steroid indefinitely risks skin atrophy, striae, and tachyphylaxis; clobetasol is limited to short courses.
Systemic steroids are not used for plaque psoriasis because withdrawal can trigger a severe flare, including pustular psoriasis.
After control is reached, a vitamin D analog on weekdays with clobetasol on weekends maintains improvement while limiting steroid adverse effects.
Superpotent steroids are avoided on the face, where the skin is thin and atrophy and telangiectasia develop quickly.
A 62-year-old woman with primary open-angle glaucoma started latanoprost drops nightly 4 weeks ago. Her intraocular pressure fell from 26 to 18 mm Hg, meeting her target. She reports mild eye redness and longer, darker eyelashes. What is the most appropriate plan?
Oral acetazolamide is reserved for short-term use because of paresthesias, kidney stones, and metabolic acidosis.
Longer, darker lashes are a harmless prostaglandin-analog effect and do not justify stopping a drug that reached the pressure target.
Mild redness and lash growth are expected effects, and the pressure has reached target, so latanoprost is continued.
A second drug is added when the target pressure is not reached; her pressure is at goal.
A 62-year-old man with BPH has taken finasteride for 18 months. His PSA was 3.6 ng/mL before treatment, fell to 1.8 ng/mL at 6 months, and is now 2.9 ng/mL on repeat testing. Rectal exam shows a smooth enlarged prostate without nodules. He is adherent. What is the most appropriate next step?
Any confirmed PSA rise from the nadir on a 5-alpha reductase inhibitor in an adherent man needs urologic evaluation for prostate cancer.
On finasteride, PSA is roughly halved, so 2.9 ng/mL corresponds to about 5.8; a value under 4 does not reassure on a 5-alpha reductase inhibitor.
Stopping the drug does not answer the question raised by the rising PSA and delays evaluation.
A confirmed rise from the nadir while adherent is a warning sign; waiting 2 years risks missing prostate cancer.
A 42-year-old woman with systemic sclerosis on mycophenolate has had some improvement in skin thickening. She still has painful color changes of her fingers several times a day despite warm gloves and avoiding cold, but no digital ulcers. BP is 118/74 mm Hg. What is the most appropriate addition?
Verapamil is a nondihydropyridine calcium channel blocker with little peripheral vasodilating effect, so it is less effective here than nifedipine.
When warmth and cold avoidance fail, a dihydropyridine calcium channel blocker such as extended-release nifedipine is first-line drug therapy for Raynaud phenomenon in systemic sclerosis.
Decongestants such as pseudoephedrine cause vasoconstriction and worsen Raynaud attacks.
Beta-blockers can worsen vasospasm and are avoided in Raynaud phenomenon.
A 60-year-old woman treated for community-acquired pneumonia is reassessed at 72 hours. Which finding indicates treatment failure needing a change?
Fatigue can last weeks after pneumonia even when treatment is working.
A brief drop in appetite is part of normal recovery and does not mean the antibiotic is failing.
A cough can persist for weeks after the infection has cleared.
Persistent high fever with worsening breathing at 72 hours means the patient is not responding; reassess for a resistant organism, an effusion or empyema, or the need for admission.
A running total sits here; it fills in after your last pick.
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One patient, step four: follow-up
The patient: a 58-year-old woman started lisinopril for hypertension four months ago. She now reports a dry, tickling cough of six weeks that keeps her awake. The same case runs through all four task pages. Lisinopril was stopped and an angiotensin receptor blocker started.
Blood pressure: rechecks, with home readings in between, until the target is reached.
Labs: potassium and creatinine after starting the new agent, because it acts on the same system.
The cough: expected to fade over the following weeks. If it persists well beyond that, return to the differential (asthma, reflux, upper airway causes) and add the chest radiograph.
A1C: at least twice a year when at goal, quarterly when therapy changed or the goal is not met (ADA Standards of Care 2026).
TSH on levothyroxine: 4 to 8 weeks after starting or changing the dose (AACE/ATA hypothyroidism guideline, 2012).
Lipids on a statin: 4 to 12 weeks after starting or changing the dose, then every 3 to 12 months (ACC/AHA cholesterol guideline, 2018).
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Evaluate errors to avoid
Escalating before checking adherence and technique. A missed dose or a poor inhaler technique looks like treatment failure.
Judging too early. Many treatments need weeks before a fair verdict; the stem's timeline matters.
Treating a side effect as a new disease. A new drug started for a symptom caused by another drug is a prescribing cascade; the fix is often to stop the first one.
Reading one value in isolation. A single reading, good or bad, is weighed against the trend and the patient's report.