ANCC AGACNP Certification 2023 with verified questions and answers

When should adults get the PNA vaccine? Age 19-64: smoker, asthma, COPD, DM, ETOH, is immunocompromised or living in facility Age 65+: PPSV23 AND PCV13 How often should you get a physical exam? Once from 11-14, 15-17, 18-21 Every 5-6 years from ages 20-59 Every 2 years from age 60+ When should you check lipid panel? Starting at age 20 and every 5 years unless 200 mg/dL When should mammography and prostate screening begin? Mammography: starting between 40-50 and continue as long as she has 10+ more years Prostate: At 40 if family hx of AA. At 50 for everyone else When should you have baseline ECG in place? Age 40 When should colorectal screening start? Age 50. Annual FOBT with flex sig q 5 years and colonoscopy q 10 years When should glaucoma testing start? Age 40 and yearly When should herpes zoster be given? Age 50-60 When can Pap smear be discontinued? Age 65-70 with three consecutive normal tests and no abnormal tests in last 10 years Top 4 killers in the US of everyone Heart disease, colorectal cancer, Lowe respiratory disease (COPD, asthma, flu, PNA), CVA stroke Cancer with highest mortality in both men and women? Lung What is the most common cancer in women in the US? Breast What is the most common cancer in men in the US? Prostate Who should get hep A vaccine? Military, travelers, men who have sex with men Who should have hep B vaccine? Healthcare workers and high risk patients What is ginger used for and what should you watch for? Nausea, dyspepsia, constipation, colic INCREASED RISK OF BLEEDING What is ginseng used for and what should you watch for? Increase overall well-being, Lower cholesterol, reduce fatigue, enhance libido INCREASED RISK OF BLEEDING, mania with MAOIs, May inhibit opioids What is St. John's wort used for and what should you watch for? Depression, anxiety, sleep disorders, BPH INCREASED RISK OF CLOTTING, many drug interactions, may increase efficacy of opioids What is echinacea used for and what should you watch for? Common cold Anaphylaxis, hepatotoxicity, nephrotoxicity, increased sedation during anesthesia What is gingko Biloba used for and what should you watch for? Memory and concentration, claudication and glaucoma INCREASED RISK OF BLEEDING, increased blood pressure Black cohosh use and warning Menopausal discomfort INCREASED RISK OF BLEEDING Large amounts may cause seizures, visual changes and bradycardia What is evening primrose used for and what should you watch for? Menopausal discomfort May elevate blood glucose May increase the risk of seizures What is kava kava used for and what should you watch for? Improve relaxation without messing with clarity High doses can lead to HTN, liver damage, visual impairment and dry skin Do not use with ETOH May worsen Parkinson's What is garlic used for and what should you watch for? Indigestion, respiratory complaints, increase energy INCREASED RISK OF BLEEDING What are the two titles of HIPAA? Title 1: projects health insurance coverage for workers and their families when they lose their job (Cobra) Title 2: requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers Who is required to follow HIPAA? Health care providers, clearinghouses, and health plans What are the two goals of healthy people 2020? 1) Increase the quality and years of healthy life 2) Eliminate health disparities among Americans What diagnoses must NPs report to the Department of Health? Gonorrhea Chlamydia Syphilis HIV TB Animal bites to animal control What is covered in Medicare A? Hospital, SNF, home care services and hospice What is covered by Medicare B? Known as supplemental medical insurance, pays for physicians visits, outpatient services, lab and diagnostics, medical equipment and flu shots Medicare pays 80% and patient pays 20% What is Medicare C? Medicare Advantage - combines A B into one plan What is Medicare D? Limited prescription drug coverage Monthly premium required, only available if you have part A What do the State Practice Acts do? - authorize boards of nursing in each to establish authority for licensure - define scope of practice and prescriptive authority How is licensure and certification different? Certification is granted by nongovernmental agencies once mastery of specialized knowledge is demonstrated. Licensure is by the state when a person is qualified. What are the components of decisional capacity? The ability to understand, reason, differentiate good and bad, and communicate Who was the first NP in the US? Loretta Ford, who worked with Dr. Henry Silver at the University of Colorado and began the NP in pediatrics in 1964 due to physician shortages How did the inpatient NP develop? As a result of managed care, hospital restructuring and decreases in medical residency programs Roles of NP Clinicians, consultants, educators, and researchers What makes an experiment study? Randomization and control group What is deductive reasoning? Vs. inductive Deductive reasoning uses general premises to make specific predictions Inductive is the process of developing a generalization after specific information has been studied What are the USPSTF recommendation grades? A recommended with high evidence of benefit, B recommended with moderate net benefit, C recommended in select individuals with small benefits, D not recommended due to harm, I insufficient evidence What does a sensitive test mean? - identifies those who have the disease (true positives) - it will have minimal false negatives - it helps rule out disease What does a test with high specificity mean? - identifies the true negatives - has minimal false positives - rules in the positive disease What is Nightingale's theory of nursing Based on creating a restorative environment Fresh air, light, nutrition, cleanliness, warmth What is Fay Abdullah's theory of nursing? Care for the whole person including physical, spiritual and social What is Orem's theory of nursing? Focused on professional and technological operations. The nurse diagnoses and plans the care and then manages it. What is Roger's theory of nursing? Individual is seen as an energy field existing within the universe What is Leininger's theory of nursing? Culture care Describe the WHO's ladder for pain management Step 1: aspirin, apap, or NSAID +|- adjuvants Step 1: maintain step 2 and add low opioid (codeine, hydrocodone, oxy, tramadol) Step 3: add stronger opioids What is a fever? What numbers should you watch for? - elevated body temperature above normal (37 Celsius) - 101.5 F = 38.3 C Tension headaches Most common type in adults. Mechanism is uncertain but though to be related to muscle contraction. Produces generalized bilateral pain that is described as frontotemporal band like discomfort. Pain is described as mild to moderate, non-throbbing pain, tightness, or pressure with a gradual onset that may last hours. It is associated with hunger, depression or stress. Treatment is over the counter analgesics and relaxation. Migraine headache description Unilateral, lateralized throbbing headache that occurs episodically; May be dull or throbbing. Builds up gradually and may last for several hours or longer Types of migraines classical (with aura) and common (without aura) How do you manage migraines? - avoid triggers - relaxation and stress management - prophylactic daily meds can be considered if attacks occur more than 3-4 times a month - for acute attach, rest in quiet dark room and take sumatriptan Cluster headaches Mostly affecting middle aged men May be precipitated by ETOH Severe, unilateral, periorbital pain occurring daily for several weeks Usually last less than 2 hours What is critical thinking in nursing practice? Patient driven, purposeful, outcome-focused thought based on both knowledge and experience What drug is used as PEP for anthrax? Doxycycline What are the symptoms and treatment of organophosphate poisoning? Symptoms: AMS, diaphoresis, lacrimation, miosis, urination, defecation, bradycardia and diffuse wheezing Treatment: atropine to block muscarinic effects, pralidoxime chloride reactivates the enzyme cholinesterase (reversing muscle paralysis and CNS depression) What do you use in cyanide poisoning? sodium nitrite What clinical features increase the likelihood of MI? Radiation of pain to both arms, a third heart sound, and hypotension What is the most likely finding in lab on a person with diarrhea Metabolic acidosis as the stool due to the loss of alkaline salts A pregnant woman comes in with a soft 2/6 ejection systolic murmur. When should you be concerned? This is normal along with an S3. Do not be concerned unless symptoms of HF develop. Diastolic murmurs and S4 are abnormal however. What should you recommend for an incidental adrenal mass? Overnight dexamethasone suppression test What symptoms and monitoring indices are consistent with cardiac tamponade? - Diastolic equalization of right atrial, pulmonary artery diastolic and PAWP - distant heart sounds, pulsus paradoxus, distended jugular veins Which ion is primarily responsible for rapid depolarization if the cardiac myocyte? Sodium What findings are associated with pericarditis? Sharp, pleuritic chest pain that is improved with leaning forward or sitting up, widespread ST Elevation or PR depression and a pericardial friction rub The length of time recommended for fibrinolytic therapy in a thrombotic CVA is: 3.5-4 hours What is the optimal hemoglobin level? 11-12 What is HBsAg, and what does it indicate? Hep B surface antigen. Protein on the surface of the virus. Detected in both acute and chronic Hep B infections. INDICATES THAT THE PERSON IS INFECTIOUS. what is Anti-HBs? Antibody to HBsAg; indicates recovery and immunity to hepatitis B. What is anti-HBc? Total Hep B core antibody. Appears at onset of infection and persists for life. What is HBeAg, and what does it indicate? It indicates that the virus is replicating and the person is contagious What is the treatment for active, chronic Hep B? Tenofovir or entecavir What is spasticity? clasp knife when the limb is rapidly moved. It moves freely for a short distance, "catches momentarily" and forces the practitioner to use more force until it reaches a point of release What is the DESC model of conflict resolution? D describe the situation E express concerns S suggest alternatives C state the consequences IgM antibody to hepatitis B core antigen (IgM anti-HBc) Positivity indicates recent infection with hepatitis B virus (6 mos). Its presence indicates acute infection. What is normal calcium level? 8.5-10.5 mg/dL What is calcitriol? the active form of Vit D (1,25 (OH)2 D3). There is a deficiency of this with hypoparathyroidism which means it should be given after thyroidectomy to increase the absorption of calcium. What is calcitonin? a hormone secreted by the thyroid that has the effect of lowering blood calcium What is a Lisfranc injury? An injury involving the lisfranc joint, which is composed of 5 tarsometarsal joints. What side effects do you worry about with Bactrim? SJS, bone marrow suppression, electrolyte abnormality, nausea, hepatotoxicity, photosensitivity What are the SEs of ciprofloxacin? Diarrhea, headache, drowsiness, insomnia, QT prolongation When should women have screening for osteoporosis? Screening every 2 years with Dexa bone scan in women 65 years old When is lung cancer screening recommended? annual screening with low-dose CT for adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within the past 15 years What volume is normal in the pericardial sac? 50 ml What is first degree heart block? Prolonged but fixed PR interval .20 seconds (5 little boxes); prolonged conduction of atrial impulses without loss of any impulses What is second degree heart block? Wenkebach (mobitz 1): PR continues to get longer and longer until a QRS is dropped. "Longer longer longer drop, that is a wenkebach" Mobitz type 2: the PR is lengthened but constant. But then a dropped QRS occurs What is third degree AV block? Complete heart block. No conduction (relationship) between the atria and ventricles. P-waves and QRS are unrelated on ECG. P-waves at normal rate (SA node pace); QRS 40-60 beats/min (AV node pace). When should you consider a G tube? If supplemental feeding is needed 6 weeks When should parenteral nutrition be used? When GI tract cannot be used. And use the central line if 2 weeks. What is normal sodium? 135-145 mEq/L What is normal urine sodium? 10-20 mEq/L What is normal serum osmolality? 275-295 mOsm/kg What does high/low urine sodium mean? Greater than 20 means renal salt wasting (problem with the kidney). Less than 20 suggests renal retention to compensate What does hypotonic hypovolemia mean? Serum osm 280 = state of body water excess If urine Na 10: dehydration, diarrhea, vomit If urine Na 10: diuretics, ACE is, mineralcorticoid deficiency What causes hypervolemic, hypotonic hyponatremia? Edema, CHF, liver disease, advanced renal failure RESTRICT FLUIDS What causes hypertonic hyponatremia? Hyperglycemia What causes hypokalemia? 1. Reduced intake of K 2. Increased entry of K into the cell 3. Increased loss of K via the kidneys 4. Alkalosis 5. GI losses What signs on ECG suggest hypokalemia? Decreased amplitude, broad T waves, prominent U waves, PVCs, v-tach, or v fib What is the management of hypokalemia? - PO replace if 2.5 and no ECG changes - IV replacement at 10 mEq/hr if can't take PO - if 2.5 or severe symptoms, may give 40/L/hr If K is not improving with replacement, which electrolyte should you check? Mg++ What causes hyperkalemia? The most common cause is renal failure. Hyperkalemia is also common with massive cell destruction (e.g., burn or crush injury, tumor lysis); rapid transfusion of stored, hemolyzed blood; and catabolic states (e.g., severe infections). What finding on EKG suggests hyperkalemia? Tall, peaked T waves What is the treatment for hyperkalemia? - Kayexalate - insulin 10 units with one amp D50 Which electrolyte should be given in DKA? Potassium, unless K 5.5 What is Battle's sign? Bluish discoloration on the area behind the ears (mastoid process). Associated with basilar skull fracture. What are the signs of a basilar skull fracture? Racoon eyes = bilateral periorbital ecchymosis Battle's sign = retroauricular ecchymosis Clear rhinorrhea or otorrhea or blood begins the tympanic membrane. What medications often cause esophageal irritation or "pill esophagitis"? Tetracyclines (antibiotics ie doxycycline), NSAIDs, potassium chloride, iron, quinidine, alendronate What disease is heberden's nodes associated with? Osteoarthritis. These are hard bong swellings that develop in the DIPs. Bouchards are found in the PIPs. What joint deformity is found in Rheumatoid arthritis? Swan neck deformity of the fingers and boutonniere deformity of the thumb What is the most common cause of acute scrotal pain in adults? epididymitis and testicular torsion What is reactive arthritis? 1) Previously known as Reiter's Syndrome 2) inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis, uveitis), urethritis 3) most commonly a post-infectious complication after acute gastroenteritis or colitis What components make up the qSOFA score? SBP or = 100 RR or = 22 New or worsened mentation What is appropriate treatment for metastatic ovarian cancer? Surgical debulking followed by cisplatin or carboplatin plus paclitaxel chemotherapy regimen What is a reticulocyte? Immature red blood cell. Normal is 0.5-2.5% How do defamation, libel and slander differ? Defamation - the act of making a damaging, false statement about a person to someone else as if the statement is fact Slander - spoken Libel - written or printed Which electrolyte should be given in DKA? Potassium, unless K 5.5 What is Battle's sign? Bluish discoloration on the area behind the ears (mastoid process). Associated with basilar skull fracture. What are the signs of a basilar skull fracture? Racoon eyes = bilateral periorbital ecchymosis Battle's sign = retroauricular ecchymosis Clear rhinorrhea or otorrhea or blood begins the tympanic membrane. What medications often cause esophageal irritation or "pill esophagitis"? Tetracyclines (antibiotics ie doxycycline), NSAIDs, potassium chloride, iron, quinidine, alendronate What disease is heberden's nodes associated with? Osteoarthritis. These are hard bong swellings that develop in the DIPs. Bouchards are found in the PIPs. What joint deformity is found in Rheumatoid arthritis? Swan neck deformity of the fingers and boutonniere deformity of the thumb What is the most common cause of acute scrotal pain in adults? epididymitis and testicular torsion What is reactive arthritis? 1) Previously known as Reiter's Syndrome 2) inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis, uveitis), urethritis 3) most commonly a post-infectious complication after acute gastroenteritis or colitis What components make up the qSOFA score? SBP or = 100 RR or = 22 New or worsened mentation What is a pheochromocytoma? A catecholamine-secreting tumor of the adrenal medulla. Usually presents with headaches, palpitations, diaphoresis, and severe hypertension that occur in spells. Others symptoms include tremors, weakness, anxiety or abdominal pain What is Cushing's syndrome? Elevated cortisol in the blood elevated glucose higher insulin needs risk for DM and CVD What are the symptoms of Cushing's syndrome? Central obesity, moon face with buffalo hump, poor wound healing, hypertension, weakness, headache What is Addison disease? Adrenal insufficiency. Autoimmune adrenalitis. Symptoms include fatigue, weakness, weight loss, orthodontic hypotension, N/V. If not caught, can lead to hypotension, hyponatremia, hyperkalemia, and hypoglycemia. what does VDRL test for? syphilis (specifically neuro?) What is normal calcium levels (total and ionized)? Total: 8.5-10.5 mg/dL Ionized: 4.5-5.5 mg/dL What are the symptoms of hypocalcemia? THINK INCREASED. Increased DTRs, muscle cramps, carpopedal spasm (trousseaus sign - when you put tourniquet on and wrist spasms), convulsions, chvosteks sign (sustained cheek blink), prolonged QT interval Signs of hypercalcemia are SLUGGISH: lethargy, headache, weakness, muscle flaccidity, heart block, anorexia, nausea, and vomiting. What is the treatment for hypercalcemia? Underlying cause. Normal saline with furosemide if Ca 12 (is emergency). In malignancy, bisphosphonates are safe and effective. Calcitonin. What is the cause and what are the labs of respiratory acidosis? Decreased ventilation (somnolence and confusion) pH 7.35 PCO2 45 What is the cause and what are the labs of respiratory alkalosis? Hyperventilation (anxiety and tingling) pH 7.45 pCO2 35 What labs are associated with metabolic acidosis? Low pH Low bicarbonate (HCO3) Seen in diarrhea and DKA What is an anion gap? When the two largest negatives are subtracted from the largest positive are greater than the number 12. [(Na+) + (K+)] - [(HCO3 + Cl-)] Calculated in metabolic acidosis What is metabolic alkalosis? High pH, high HCO3 26 usually caused by an excessive loss of metabolic acids (from vomit, suction, diuretics) How do you remember respiratory vs. metabolic in acid/base imbalances? ROME: respiratory opposite, metabolic equal What are the categories of burns? 1st degree: dry red no blisters 2nd: partial thickness with blisters! 3rd: full thickness with dry leathery black pearly waxy can extend to muscle and bone What is the rule of 9's in burn management? 9 head, 9 left arm, 9 right arm, 18 anterior torso, 18 posterior torso, 1 genitals, 18 left leg, 18 right leg Describe fluid resuscitation in burns - Fluid resuscitation begins at the time of the burn injury. - Use the parkland formula: 4 mL/kg * TBSA in the first 24 hours - half of all fluids should be given in the first 8 hours When should a burn patient be treated at a burn center? Partial thickness burn over 10% of body Burn on face, hands, feet, genitals or major joints Chemical burn Third degree/Full thickness burns Inhalation injury Any concomitant trauma or complicating medical disorders Any patients requiring additional support that is unavailable When should you prescribe antibiotics for bites? If bite is on face, hand, or there are any signs/symptoms of infection, you should prescribe 3-7 days of abx with coverage of both staph and anaerobes. What are the most common organisms of inpatient cellulitis? Gram negative organisms, s. aureus, strep Which drug has the greatest sensitivity/specificity for CA-MRSA? Trimethoprim/sulfamethoxazole (Bactrim) What is Ipecac? It is a substance that induces vomiting (usually prolonged). What are the s/s and treatment of a acetaminophen intoxication? S/S: around 24-48 hours: nausea and vomiting with RUQ pain and signs of hepatotoxicity Treatment: emesis for recent ingestion, gastric lavage and activated charcoal What are the s/s and treatment of a salicylate (aspirin) intoxication? S/S: n/v, tinnitus, dizziness, headache, dehydration, hyperthermia, apnea, metabolic acidosis Treatment: emesis for recent ingestion, gastric lavage and activated charcoal