ANCC FNP BOARD EXAM LATEST REAL EXAM 200+
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES|ALREDY GRADED A+
Dose of Tetanus Immune Globulin (TIG) - ANSWER: 250 units IM
How many doses of Tdap or Td IM needed for protection after clean minor wounds. -
ANSWER: Three doses needed. If <3, unknown, or >10 years since last dose give dose
of Tdap or Td for clean minor wounds. No need to give TIG.
Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of
Tdap/Td. - ANSWER: Tdap or Td IM & TIG
Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles,
burns, frostbite) - ANSWER: If <3 doses Tdap or Td give both Tdap and TIG 250 units.
If 3 doses in past, but none in the last 5 years then given Tdap or Td. No need to give
TIG If 3 or > doses in the past
When to switch from DTap to Tdap in children - ANSWER: Age 7 or > given Tdap
A woman becomes pregnant and received Tdap during her last pregnancy 1 year
ago. When should she receive her next dose. - ANSWER: Tdap is recommended for
each pregnancy.
"Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)? - ANSWER: IPV, MMR, varicella
A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)? - ANSWER: IPV, vaccinia (smallpox)
A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations
(IZ)? - ANSWER: Hepatitis B
A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? -
ANSWER: varicella zoster (zostavax) and MMR
Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn.
What other interventions/meds should be considered during anaphylaxis? -
ANSWER: Supine, 911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
, >30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
s/s anaphylaxis - ANSWER: Skin: pruritus, urticaria, angioedema
Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
PCV-13 - ANSWER: Prevnar. Greater protection, Narrower coverage. Pneumococcal
conjugate.
PCV23 - ANSWER: lesser protection, broader coverage
Which type of vaccine boosts immune response better? conjugate vs. polysaccharide
- ANSWER: conjugate (example: prevnar)
Live attenuated (weaned) vaccines - ANSWER: MMR, Varicella and intranasal Flu-
mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER: SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER: hand washing!; viral shed in stool in first week
post-vaccination
Shingrix: timing and dosing - ANSWER: =/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? - ANSWER:
Feb
What s/s are associated with leukemia? - ANSWER: fever, wt loss, fatigue, bone pain,
bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? - ANSWER: WBCs
>20,000 (think through common causes of leukocytosis: infection, stress,
inflammation) --> get a peripheral smear (AKA manual diff)
if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis;
enlarged liver, spleen, or lymph nodes; or constitutional symptoms.
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES|ALREDY GRADED A+
Dose of Tetanus Immune Globulin (TIG) - ANSWER: 250 units IM
How many doses of Tdap or Td IM needed for protection after clean minor wounds. -
ANSWER: Three doses needed. If <3, unknown, or >10 years since last dose give dose
of Tdap or Td for clean minor wounds. No need to give TIG.
Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses of
Tdap/Td. - ANSWER: Tdap or Td IM & TIG
Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles,
burns, frostbite) - ANSWER: If <3 doses Tdap or Td give both Tdap and TIG 250 units.
If 3 doses in past, but none in the last 5 years then given Tdap or Td. No need to give
TIG If 3 or > doses in the past
When to switch from DTap to Tdap in children - ANSWER: Age 7 or > given Tdap
A woman becomes pregnant and received Tdap during her last pregnancy 1 year
ago. When should she receive her next dose. - ANSWER: Tdap is recommended for
each pregnancy.
"Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)? - ANSWER: IPV, MMR, varicella
A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)? - ANSWER: IPV, vaccinia (smallpox)
A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations
(IZ)? - ANSWER: Hepatitis B
A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)? -
ANSWER: varicella zoster (zostavax) and MMR
Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn.
What other interventions/meds should be considered during anaphylaxis? -
ANSWER: Supine, 911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
, >30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
s/s anaphylaxis - ANSWER: Skin: pruritus, urticaria, angioedema
Resp: dyspnea, wheezing (bronchospasm), stridor
End-organ dysfunction: hypotension, collapse, syncope, incontinence
PCV-13 - ANSWER: Prevnar. Greater protection, Narrower coverage. Pneumococcal
conjugate.
PCV23 - ANSWER: lesser protection, broader coverage
Which type of vaccine boosts immune response better? conjugate vs. polysaccharide
- ANSWER: conjugate (example: prevnar)
Live attenuated (weaned) vaccines - ANSWER: MMR, Varicella and intranasal Flu-
mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER: SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER: hand washing!; viral shed in stool in first week
post-vaccination
Shingrix: timing and dosing - ANSWER: =/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? - ANSWER:
Feb
What s/s are associated with leukemia? - ANSWER: fever, wt loss, fatigue, bone pain,
bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? - ANSWER: WBCs
>20,000 (think through common causes of leukocytosis: infection, stress,
inflammation) --> get a peripheral smear (AKA manual diff)
if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis;
enlarged liver, spleen, or lymph nodes; or constitutional symptoms.
