AGACNP review Questions & correct Answers

AGACNP review Questions & correct Answers Most important step in EBP Formulate a research question AANC Synergy model A conceptual framework that aligns patient needs with nurse competencies How does Synergy influence ANCC competencies (3 ways 1. develop nurse competencies 2. Develop certification test plans 3. Support certification renewal Neisseria Gonorrhea arthritis +ua and BC treatment Azithromycin oral with ceftriaxone 1gm q12 (use azithromycin to cover chlamydia if it is +) What is the coverage for HAP who is at high risk for VAP staph coverage with 2 antipseudomonal agents -zosyn, meropenum and vancomycin Refeeding syndrome and who are at risk potential lethal compilation of the metabolic and normal changes cause by the rapid refeeding. at risk: chronic malnutrition, cancer elder and preexisting hypophosphatemia and hypokalemia Classic sign of epidural hematoma a lucid interval between trauma and decline in consciousnesses Appropriate treatment of acute heart failure in the setting of hypoperfusion no vasodilators, need to give dopamine for a + inotrope response What is the end point of resuscitation for sepsis Lactic acid clearance, CVP 8-12, UPO 0.5ml/hr, mix venous oxygen 70-80% STD/Chlamydia treatment Azithromycin 1gm as a single dose What is QSEN and 6 competencies quality and safety education for nurses: 1. patient centered care 2. teamwork 3. collaboration 4. EBP 5. QI 6. safety and informatics Patient refusing rehab is an example of self determination (right to make own decision) Self determination right to make own decision Justice Justice is fairness and impartiality. Nurses must make impartial, fair decisions regarding patient care without regard to a patient's race, age, sexual orientation, or economic status Beneficence Beneficence is the act of doing what is good and right for the patient. This ethical principle encompasses charity and kindness, which require actions by the nurse to benefit others. Nonmaleficence Nonmaleficence means doing no harm (intentional or unintentional). Nurses must provide care that reflects standards to avoid or minimize risk to the patient, healthcare team, or organization. Examples of high intensity stating atorvastatin 40-80mg Rosuvastatin 20-40 mg What medication to avoid during a thyroid storm NSAIDS/ASA as these may bind to thyroid-binding globulin, causing increased levels of free thyroid hormone levels. Cause of hearing loss when aging thickening of the TM causing conductive hearing loss (low sounds) HF is associated with dec elasticity and efficiency of ossicular articulation How fast can a Dilantin infusion go not over 50mg/min d/t SE of cardiac depression Kerh's sign (irritated diaphragm) pain radiating to the shoulder classic sing for rupture spleen What is the normal ocular pressure 10-20 mg/hg What is a patient undergoing aggressive resuscitation with emergent surgery at risk for ? what would airway pressure, TV and uo look like 3 spacing, intestinal edema. Can progress to intestinal compartment syndrome. peak airway pressure, decreased TV, hypoxia, decreased UO, hypotension normal central venous pressure 0-6 mm/hg What mean arterial pressure (MAP) do we need to perfuse coronary arteries, brain, and kidneys? 65 Normal Pulmonary artery pressure 15-25/5-15 normal cardiac output 4-8 L/min normal cardiac index 2.5-4 L/min/m2 tidal volume Amount of air that moves in and out of the lungs during a normal breath 6-5 ml/kg) Ideal body weight Grey-Turner's sign is highly suggestive of which of the following conditions? A) Acute pancreatitis B) Acute appendicitis C) Acute diverticulitis D) Gastric cancer bruising in flank area (lower back area) acute pancreatitis or kidney injury BP with cardiac tamponade paradoxical BP Finding with aortic insufficiency new finding of aortic murmur compartment syndrome pressure finding 40mm/hg Otolaryngology surgery with retained packing, what likely bacteria causing TSS and antibiotic coverage strep or staph infection use clynda (due to need to cover gm+ aerobic Treatment of pericardiac tamponade pericardiocentesis What is the most important intervention for patient with CW deformity CT placement What is a good endpoint for resuscitation? closing metabolic acidosis, good UO, stable hemodynamics Most important intervention for sepsis 2 lg boar iv or /central line hypothermic patient best intervention rewarming (least invasive way) When do you need to use a regular chest tube? hemothorax, tension pnx and 40% pnx what does TACO stand for? transfusion associated circulatory overload What illicit drug can cause seizure cocaine degree of HOB for suspected head injury 30 degrees Rule of 9's for burns Head = 9% Arms = 18% (9% each) Back = 18%, Front/chest 18% Legs 36% (18% each) Genitalia = 1 How much output from fail chest requires immediate intervention 1.5L What spinal injury has sensation at the nipple line T4 What issues do you suspect with a widened mediastinum aortic rupture What vasomotor deficits with a coupe counter coupe injury vasomotor deficits with lowering vascular tone, need IVF and vasoactive agents (IE dopamine) To integrate palliative care what question could you as the patient what do you understand about your diagnosis What type of prevention is a vaccine primary Primary prevention examples immunizations, pollution control, nutrition, exercise Secondary prevention examples Screenings, redirectional therapies, medications teritary prevention examples mastectomy, limit the impact of the disease Patient age 50-74 mammogram recommendations biennial Tinel's sign A distal tingling sensation on percussion of median nerve of the inner wrist; characteristic of carpal tunnel syndrome Phalen's test Median nerve compression in carpal tunnel Hepatitis A serology active: anti-HAV, igm recovered anit-HAV, igg Hepatitis B Serology Active infection: HBsAg, HBeAG, anti HBC, IgM Chronic: HBsAg, Anti-HBc, Anti-HBe, IgM, IgG recovered: anti-HBc, anti HBs Hepatitis C serology Active Hep. C Anti-HCV, HCV RNA Chronic Hep. C Anti-HCV, HCV RNA order to treat tobacco dependency (the A's) ask, advise, assess, assist, arrange What vaccine is required by asplenia patients pneumovacc most important prevention of HAP on vent SBT every 24 hours what screening is required for smokers lung ct What is an 85 year old with increased blood glucose at risk for hypoglycemia What type of drugs are Alzheimer's drugs cholinesterase inhibitors What is the St. Thomas risk assessement fall risk for the elderly (STRATFY) What is important to know about a patient going to cholecystectomy that has CHF dry weight What does LEARN stand for? Listen Explain Acknowledge Recommend Negotiate what does ETHNIC stand for Explanation Treatment Healers Negotiate Intervention Collaboration what effect does epinephrine have (alpha, beta or both) both Which government office enforces HIPPA OCR Office of civil rights What must critical billing include? a clear description of the critical assessment what is the first thing to do if a testicular torsion is suspected consult urology What did the Balanced Budget Act of 1997 do? allow NPs to bill What accounts as the cause for 60-70% of all ICH's hypertension Transtheoretical Model (TTM) five stages of progression (1) pre-contemplation- no thought of change (2) contemplation-owning the problem/evaluate options (3) preparation- plan of action (4) action-changes are attempted (5) maintenance-behavior sustained usually 6 mos or longer What statin is used for a patient that is HIV + on HAART therapy and had MI Atorvastatin, Pravastatin, rosuvastatin or fluvastatin what is used for a 24 year old cocaine OD with increased blood pressures phentolamine What medication is used for a patient with pulmonary Htn to reduced risk for PE? Plavix to prevent platelet adhesion Treatment of latent TB isoniazid and b12 x 6 months Does medicare part a cover IP OP or both only inpatient Janeway lesions - diagnosis? nontender hemorrhagic lesions - fingers, toes, nose, earlobes - associated with endocarditis Kaposi's sarcoma malignant tumor of the blood vessels associated with AIDS Critical care code 99291 What must be done first to try and change a policy formal policy analysis What is most influential on health care of a person? socioeconomic status What is the drug of choice for cardiogenic shock Dobutamine due to increased myocardial contractility Myxedema coma AMS, hypothermia, no fever, precipitating event (such as CHF exacerbation), hypoventilation, hypotension, hyponatremia and bradycardia PSDA Cycle steps 1. plan: managers must evaluate the current process and make plans based on any problems they find. Document procedures, collect data, and identify problems. 2. Do: during the implementation process, managers should document all changes made and collect data for evaluation. 3. Study: study the data collected and see whether the plan is achieving the goals established in the plan phase. 4. Act: act on the basis of the results of the first three phrases by communicating the result to other members of the company and then implement the new procedure if it has been successful. PICOT elements P - Problem/Patient/Population I - Intervention/Indicator C - Comparison O - Outcome T - Time element or type of Study use to create search strategies for database NDNQI National Database of Nursing Quality Indicators, first largest nursing quality indicator NQF National Quality Forum set of quality indicators to implement national strategies What ABI is considered critical 0.3 Side effect of Atrovent (anticholinergic) urinary retention What phase are the first controlled clinical studies done phase II What is the first step if Temporal pain and giant cell arteritis is suspected Methyl prednisone 1 gm (bx can be delayed up to two weeks) Definition of HTN emergency increase BP with end organ damage Beneficence (Definition) act in best interest of others (do good) Non-maleficence (to do no harm) Autonomy (giving the patient the freedom to choose freely, where they are able)