AGACNP Board prep Exam with
Complete Solutions
Normal WBC count - ANS-4-11 or 4,000-11,000
Neutrophils ROLE - ANS-Destroy bacteria
Lymphocytes ROLE - ANS-Destroy viruses
Monocytes Role - ANS-Clear cellular debris. They eat dead cells
Eosinophils ROLE - ANS-Combat allergens/parasites
Basophils ROLE - ANS-Undetermined. Have a role in anaphylaxis
BANDS on a WBC differential - ANS-Immature neutrophils. They sneak out before they
are fully developed. Increase in Bands means something bad is happening. Usually
bacteria
Legal Authority: Certification - ANS-Does not provide legal authority to practice. it just
shows that you have a knowledge base
Legal authority: State licensure - ANS-Grants the NP the authority to practice in a state.
Defined by the individuals state's nurse practice act
Legal authority: prescriptive authority - ANS-Changes from state to state. Most need a
license to prescribe. Most need a collaborative agreement.
Legal authority: credentialing - ANS-Provide practice authority in a particular institution.
Enables insurance reimbursement. Defines hospital privileges.
Systematic review (meta analysis) - ANS-#1 Highest form of research. A massive
review of published research, in one place.
Randomized controlled trial - ANS-#2 Evaluates the effectiveness of an intervention
Cohort study - ANS-#3 prospective or retrospective study that evaluates variables and
outcomes.
Case-Control Study - ANS-#4 a retrospective study which evaluates cases. Compares
risk factors
,Case series - ANS-#5 Retrospective study examining the experiences of a group
Case Report - ANS-#5 CLinical narrative of a single patient case
Editorial - ANS-#6 An essay that addresses a specific topic from a qualified individual or
group of individuals
Expert opinion - ANS-#6 Essay of a topic of concern from a qualified individual
Null hypothesis - ANS-What you are trying to DISPROVE
alternative hypothesis - ANS-What you are trying to prove
P value >0.05 - ANS-Fail to reject the null hypothesis. The null hypothesis is true. You
are unable to disprove what you wanted to disprove
P value < 0.05 - ANS-reject the null hypothesis. The alternative hypothesis is true. You
are able to disprove what you wanted to disprove. This result is statistically significant
Quantitative studies - ANS-Used to establish a correlation by evaluating the null
hypothesis and alternative hypothesis.
Relies on numerical and measurable data
Qualitative studies - ANS-Rely on personal accounts or details in how people think and
respond. You want data saturation with no new ideas emerging. NO STATISTICS
What three things need to happen for an issue to be malpractice? - ANS-1) there needs
to be a duty to the patient
2) Violation in standard of care
3) injury or death resulted due to that violation of care
Beneficence - ANS-Obligation to help people in need
Best thing to do for the patient
Autonomy - ANS-Patients right to make decisions
veracity - ANS-being truthful and giving the patient full disclosure
non-malfeasance - ANS-Ethical concept requiring that an action do no harm, or do less
harm than good
justice - ANS-patient gets what they deserve
,Insurance: Claims made policy - ANS-Cheapest form of insurance. Will cover you when
the claim is made if it was also the same policy in effect at the time of the incident.
Insurance: Occurrence based policy - ANS-Basically as long as the policy was active
during the event, you are covered
Insurance: Tail coverage - ANS-Extends the life of the claims made policy up until the
end of the statue of limitations. Most expensive coverage
WBC differential: Left shift - ANS-Significant increase in neutrophils. Most likely a
bacterial infection
WBC differential: Right shift - ANS-Significant increase in lymphocytes. Most likely a
viral infection
Most common cause of fever in the acute care setting - ANS-Bacterial infections
Most common cause of fever in immunocompromised patients - ANS-Fungal infection.
insidious onset that last much longer.
Non-infectious causes of fever - ANS-Autoimmune
Inflammatory
Drug reactions
Post operative causes of fever: Bacterial - ANS-Will see: fever (high fever), leukocytosis
with neutrophilla (left shift), surgical site drainage
Diagnostic workup: Pan cultures
TX: ANTBX only with signs of bacterial infection. Remove offending items
Post operative causes of fever: Volume contraction - ANS-Will see: fever (mild),
azotemia, decreased skin tugor (except in elderly), decreased PO intake, inadequate IV
hydration
Diagnostic workup: Metabolic panel, replace EBL, eval I&O. Urine output is the best
indicator of tissue perfusion
TX: Isotonic IV fluids and increase PO intake
Post operative causes of fever: Atelectasis - ANS-Will see: fever (mild), Atelectasis
present on CXR, Lack of incentive spirometer use, cough, SOB, decreased lung sound
Diagnostic work up: eval incentive spirometer use
diagnostic exclusion
may consider CXR
, TX: encourage use of incentive spirometer, OOB to chair and ambulation, educate on
splinting, eval med use
STreptococcus pneumoniae - ANS-Gram-positive. anaerobic
Common sites we see streptococcus pneumoniae - ANS-bacterial menigitis
otitis media
community acquired pneumonia
URI
sinusitis
What drugs would treat streptococcus pneumonia - ANS-beta-lactam
haemophilus influenza - ANS-Gram negative anaerobe
Common site for haemophilus influenza - ANS-bacterial mengitis
pneumonia
URI
sinusitis
What drugs treat haemophilus influenza - ANS-Amoxicillin
rifampicin
co-trimoxazole
ciprofloxacin
aztreonam
cefalosporins
pipercillin-tazobactam
carbapenems
Aminoglycosides - ANS-Streptomycin, Gentamycin.
Gram - coverage
Bacteremia, abdominal infections
Tetracyclines - ANS-Tetracycine, Doxycycine
Gram -/+ coverage
Lyme Disease, PID, STIs
Penicillins - ANS-Ampicillin, Amoxicillin
Gram +/-
ENT, Skin, Urinary infections
Complete Solutions
Normal WBC count - ANS-4-11 or 4,000-11,000
Neutrophils ROLE - ANS-Destroy bacteria
Lymphocytes ROLE - ANS-Destroy viruses
Monocytes Role - ANS-Clear cellular debris. They eat dead cells
Eosinophils ROLE - ANS-Combat allergens/parasites
Basophils ROLE - ANS-Undetermined. Have a role in anaphylaxis
BANDS on a WBC differential - ANS-Immature neutrophils. They sneak out before they
are fully developed. Increase in Bands means something bad is happening. Usually
bacteria
Legal Authority: Certification - ANS-Does not provide legal authority to practice. it just
shows that you have a knowledge base
Legal authority: State licensure - ANS-Grants the NP the authority to practice in a state.
Defined by the individuals state's nurse practice act
Legal authority: prescriptive authority - ANS-Changes from state to state. Most need a
license to prescribe. Most need a collaborative agreement.
Legal authority: credentialing - ANS-Provide practice authority in a particular institution.
Enables insurance reimbursement. Defines hospital privileges.
Systematic review (meta analysis) - ANS-#1 Highest form of research. A massive
review of published research, in one place.
Randomized controlled trial - ANS-#2 Evaluates the effectiveness of an intervention
Cohort study - ANS-#3 prospective or retrospective study that evaluates variables and
outcomes.
Case-Control Study - ANS-#4 a retrospective study which evaluates cases. Compares
risk factors
,Case series - ANS-#5 Retrospective study examining the experiences of a group
Case Report - ANS-#5 CLinical narrative of a single patient case
Editorial - ANS-#6 An essay that addresses a specific topic from a qualified individual or
group of individuals
Expert opinion - ANS-#6 Essay of a topic of concern from a qualified individual
Null hypothesis - ANS-What you are trying to DISPROVE
alternative hypothesis - ANS-What you are trying to prove
P value >0.05 - ANS-Fail to reject the null hypothesis. The null hypothesis is true. You
are unable to disprove what you wanted to disprove
P value < 0.05 - ANS-reject the null hypothesis. The alternative hypothesis is true. You
are able to disprove what you wanted to disprove. This result is statistically significant
Quantitative studies - ANS-Used to establish a correlation by evaluating the null
hypothesis and alternative hypothesis.
Relies on numerical and measurable data
Qualitative studies - ANS-Rely on personal accounts or details in how people think and
respond. You want data saturation with no new ideas emerging. NO STATISTICS
What three things need to happen for an issue to be malpractice? - ANS-1) there needs
to be a duty to the patient
2) Violation in standard of care
3) injury or death resulted due to that violation of care
Beneficence - ANS-Obligation to help people in need
Best thing to do for the patient
Autonomy - ANS-Patients right to make decisions
veracity - ANS-being truthful and giving the patient full disclosure
non-malfeasance - ANS-Ethical concept requiring that an action do no harm, or do less
harm than good
justice - ANS-patient gets what they deserve
,Insurance: Claims made policy - ANS-Cheapest form of insurance. Will cover you when
the claim is made if it was also the same policy in effect at the time of the incident.
Insurance: Occurrence based policy - ANS-Basically as long as the policy was active
during the event, you are covered
Insurance: Tail coverage - ANS-Extends the life of the claims made policy up until the
end of the statue of limitations. Most expensive coverage
WBC differential: Left shift - ANS-Significant increase in neutrophils. Most likely a
bacterial infection
WBC differential: Right shift - ANS-Significant increase in lymphocytes. Most likely a
viral infection
Most common cause of fever in the acute care setting - ANS-Bacterial infections
Most common cause of fever in immunocompromised patients - ANS-Fungal infection.
insidious onset that last much longer.
Non-infectious causes of fever - ANS-Autoimmune
Inflammatory
Drug reactions
Post operative causes of fever: Bacterial - ANS-Will see: fever (high fever), leukocytosis
with neutrophilla (left shift), surgical site drainage
Diagnostic workup: Pan cultures
TX: ANTBX only with signs of bacterial infection. Remove offending items
Post operative causes of fever: Volume contraction - ANS-Will see: fever (mild),
azotemia, decreased skin tugor (except in elderly), decreased PO intake, inadequate IV
hydration
Diagnostic workup: Metabolic panel, replace EBL, eval I&O. Urine output is the best
indicator of tissue perfusion
TX: Isotonic IV fluids and increase PO intake
Post operative causes of fever: Atelectasis - ANS-Will see: fever (mild), Atelectasis
present on CXR, Lack of incentive spirometer use, cough, SOB, decreased lung sound
Diagnostic work up: eval incentive spirometer use
diagnostic exclusion
may consider CXR
, TX: encourage use of incentive spirometer, OOB to chair and ambulation, educate on
splinting, eval med use
STreptococcus pneumoniae - ANS-Gram-positive. anaerobic
Common sites we see streptococcus pneumoniae - ANS-bacterial menigitis
otitis media
community acquired pneumonia
URI
sinusitis
What drugs would treat streptococcus pneumonia - ANS-beta-lactam
haemophilus influenza - ANS-Gram negative anaerobe
Common site for haemophilus influenza - ANS-bacterial mengitis
pneumonia
URI
sinusitis
What drugs treat haemophilus influenza - ANS-Amoxicillin
rifampicin
co-trimoxazole
ciprofloxacin
aztreonam
cefalosporins
pipercillin-tazobactam
carbapenems
Aminoglycosides - ANS-Streptomycin, Gentamycin.
Gram - coverage
Bacteremia, abdominal infections
Tetracyclines - ANS-Tetracycine, Doxycycine
Gram -/+ coverage
Lyme Disease, PID, STIs
Penicillins - ANS-Ampicillin, Amoxicillin
Gram +/-
ENT, Skin, Urinary infections
