ANCC AGACNP - FRANCES GUIDE REVIEW| ACTUAL
EXAM QUESTIONS WITH CORRECT ANSWERS
GRADED A+
Patient presents with RLQ pain, 1-2 episodes of vomiting, and positive Psoas sign. What diagnostics are
confirmatory for appendicitis?
a. abd us and WBC 10-20
b. CT abd and elevated amylase
c. abd us and elevated amylase
d. ct abd and elevated amylase and lipase - answer :a. abd us and WBC 10-20 (key is WBC, a CT would
also work)
36yo with history of Crohn's disease arrives in the ER with c/o abd pain, frequent vomiting and water
bowel movements. You notice high-pitched, tinkling bowel sounds and a transabdominal US reveals a
partial SBO. Which is not necessary?
a. NPO and IVF
b. NGT for LIS
c. immediate surgical consult
d. monitor for spontaneous resolution - answer :c. immediate surgical consult
A nurse experiences a needle stick fro ma patient who has Non-a, non-b hepatitis. She has already had
the HepB vaccine series. What is the next step? - answer :Obtain blood samples from the patient and
the RN
42 yo male with epigastric pain that is better after he eats? - answer :Duodenal ulcer
,65 yo ETOH use with 25y smoking history has dysphagia and epigastric pain. What is diagnosis? - answer
:GERD
On CXR notes air under diaphragm? - answer :Pneumoperitoneum
Diverticulitis flare ups can be caused by? - answer :Smoking
What is the treatment of diverticulitis? - answer :NPO dependent upon condition, IVF, IV abx (flagyl,
cipro, ceftazidime, clinda, ampicillin)
True/false: barium enema is indicated in the conservative management of diverticulitis? - answer :False
Lab values of acute pancreatitis? - answer :GWGLA HBCABE
Prognostic signs on admission
Greater than 55yo
WBC>16
Glucose >200
LDH>350
AST>250
Prognostic signs during first 48h
Hct drop of >10
BUN increases >5
Calcium <8
Arterial O2 <60
,Base deficit >4
Estimated fluid sequestration >6k nL
Which disorder worsens epistaxis? - answer :Cirrhosis, HIV
Bowel obstruction antibiotic? - answer :Zosyn
49 yo male presents with c/o abdominal swelling that progressed over 2 days. Patient also reports
mucous-filled diarrhea and abdominal pain. Exam is significant for profound abd distention. You suspect
SBO. What type of bowel sounds are associated? - answer :High pitched, tinkling bowel sounds
Profuse vomiting and variable epigastric pain are 2 symptoms of what diagnosis? - answer :Proximal
SBO
What is the presentation and treatment of crohn's? - answer :diarrhea, abdominal pain, abscess/fistulas
Ts: flagyl/cipro
Who is at risk of toxic megacolon? - answer :Both crohn's and ulcerative colitis
48yo with fever, abdominal pain and bloody diarrhea with h/o chronic sinusitis, arthritis, and recent
DVT. Which represents the most likely diagnosis and test to order? - answer :Ulcerative colitis,
sigmoidoscopy
Young male with ulcerative colitis, what would be probable finding? - answer :Rectosigmoid stricture
Ulcerative colitis medications? - answer :Canasa (mesalamine) suppositories or enemas for 3-12 weeks,
hydrocortisone suppositories and enemas
What abx do you use for ulcerative colitis? - answer :Cipro/flagyl in severe colitis and high grade fever,
leukocytosis with extreme numbers of immature neutrophils (bands >700/microL), and peritoneal signs
or megacolon
, There is no role of abx in patients with severe colitis without signs/symptoms of systemic toxicity
Treatment for fulminant ulcerative colitis without s/s of systemic toxicity? - answer :IV steroids
WHen would you find "thumb printing sign" on abdominal xray? - answer :Mesenteric ischemia
(ischemic colitis), pseudomembraneous colitis, and IBD
Radiologic sign of bowel wall thickening
Both husband and wife abuse ETOH. Woman has liver disease but husband does not? - answer :Women
are likely to get liver disease while drinking less than men
What causes GI bleed in elderly? - answer :Thin gastric membranes
RF: Nsaid/asa/anticoagulant use
Do not use protonix long term due to? - answer :Increased risk of hip fracture
Why would you pick a PPI over phenergan for treatment? - answer :PPI can be used in combo with other
dugs to control symptoms
Patient on PD dialysis has an infected dialysis catheter. What is the first thing you do? - answer :Remove
the catheter
You are a preceptor who is mentoring a student. The patient's s/s are broad and variable and include
mild icteric symptoms. How should you educate your student? - answer :Have the student review the
clinical symptoms and query differential diagnosis
What are the s/s of the icteric phase of hepatitis? - answer :Jaundice, RUQ pain, clay stool, dark urine,
weight loss, low grade fever, hepatosplenomegaly
EXAM QUESTIONS WITH CORRECT ANSWERS
GRADED A+
Patient presents with RLQ pain, 1-2 episodes of vomiting, and positive Psoas sign. What diagnostics are
confirmatory for appendicitis?
a. abd us and WBC 10-20
b. CT abd and elevated amylase
c. abd us and elevated amylase
d. ct abd and elevated amylase and lipase - answer :a. abd us and WBC 10-20 (key is WBC, a CT would
also work)
36yo with history of Crohn's disease arrives in the ER with c/o abd pain, frequent vomiting and water
bowel movements. You notice high-pitched, tinkling bowel sounds and a transabdominal US reveals a
partial SBO. Which is not necessary?
a. NPO and IVF
b. NGT for LIS
c. immediate surgical consult
d. monitor for spontaneous resolution - answer :c. immediate surgical consult
A nurse experiences a needle stick fro ma patient who has Non-a, non-b hepatitis. She has already had
the HepB vaccine series. What is the next step? - answer :Obtain blood samples from the patient and
the RN
42 yo male with epigastric pain that is better after he eats? - answer :Duodenal ulcer
,65 yo ETOH use with 25y smoking history has dysphagia and epigastric pain. What is diagnosis? - answer
:GERD
On CXR notes air under diaphragm? - answer :Pneumoperitoneum
Diverticulitis flare ups can be caused by? - answer :Smoking
What is the treatment of diverticulitis? - answer :NPO dependent upon condition, IVF, IV abx (flagyl,
cipro, ceftazidime, clinda, ampicillin)
True/false: barium enema is indicated in the conservative management of diverticulitis? - answer :False
Lab values of acute pancreatitis? - answer :GWGLA HBCABE
Prognostic signs on admission
Greater than 55yo
WBC>16
Glucose >200
LDH>350
AST>250
Prognostic signs during first 48h
Hct drop of >10
BUN increases >5
Calcium <8
Arterial O2 <60
,Base deficit >4
Estimated fluid sequestration >6k nL
Which disorder worsens epistaxis? - answer :Cirrhosis, HIV
Bowel obstruction antibiotic? - answer :Zosyn
49 yo male presents with c/o abdominal swelling that progressed over 2 days. Patient also reports
mucous-filled diarrhea and abdominal pain. Exam is significant for profound abd distention. You suspect
SBO. What type of bowel sounds are associated? - answer :High pitched, tinkling bowel sounds
Profuse vomiting and variable epigastric pain are 2 symptoms of what diagnosis? - answer :Proximal
SBO
What is the presentation and treatment of crohn's? - answer :diarrhea, abdominal pain, abscess/fistulas
Ts: flagyl/cipro
Who is at risk of toxic megacolon? - answer :Both crohn's and ulcerative colitis
48yo with fever, abdominal pain and bloody diarrhea with h/o chronic sinusitis, arthritis, and recent
DVT. Which represents the most likely diagnosis and test to order? - answer :Ulcerative colitis,
sigmoidoscopy
Young male with ulcerative colitis, what would be probable finding? - answer :Rectosigmoid stricture
Ulcerative colitis medications? - answer :Canasa (mesalamine) suppositories or enemas for 3-12 weeks,
hydrocortisone suppositories and enemas
What abx do you use for ulcerative colitis? - answer :Cipro/flagyl in severe colitis and high grade fever,
leukocytosis with extreme numbers of immature neutrophils (bands >700/microL), and peritoneal signs
or megacolon
, There is no role of abx in patients with severe colitis without signs/symptoms of systemic toxicity
Treatment for fulminant ulcerative colitis without s/s of systemic toxicity? - answer :IV steroids
WHen would you find "thumb printing sign" on abdominal xray? - answer :Mesenteric ischemia
(ischemic colitis), pseudomembraneous colitis, and IBD
Radiologic sign of bowel wall thickening
Both husband and wife abuse ETOH. Woman has liver disease but husband does not? - answer :Women
are likely to get liver disease while drinking less than men
What causes GI bleed in elderly? - answer :Thin gastric membranes
RF: Nsaid/asa/anticoagulant use
Do not use protonix long term due to? - answer :Increased risk of hip fracture
Why would you pick a PPI over phenergan for treatment? - answer :PPI can be used in combo with other
dugs to control symptoms
Patient on PD dialysis has an infected dialysis catheter. What is the first thing you do? - answer :Remove
the catheter
You are a preceptor who is mentoring a student. The patient's s/s are broad and variable and include
mild icteric symptoms. How should you educate your student? - answer :Have the student review the
clinical symptoms and query differential diagnosis
What are the s/s of the icteric phase of hepatitis? - answer :Jaundice, RUQ pain, clay stool, dark urine,
weight loss, low grade fever, hepatosplenomegaly
