FNP ANCC boards Exam Study Guide

FNP ANCC boards Exam Study Guide 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)". GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 2/23 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 GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 3/23 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) GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 4/23 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. GRACEAMELIA 2024/2025 ACADEMIC YEAR ©2024. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER, 2024 Page 5/23 Which 2 chronic childhood diagnoses are associated with ALL and AML? - Answer-Downs syndrome and neurofibromatosis What are 3 main risk factors for leukemia - Answer-radiation (equivalent to 2 to 3 CTs), toxin /household pesticide exposure in utero/early childhood. Acute Leukemia: ALL or AML cancer and symptoms/PE findings - Answer-2 types: Acute Lymphoblastic Leukemia or Acute Myelogenous Leukemia. BLASTs on peripheral smear/bone aspiration in both ALL and AML. AML also presents with Auer rods on peripheral smear. Acute leukemia can also present with leukopenia, combin