ACTUAL AGACNP AACN Boards Exam
2025 Questions and Answers
3 steps of pain management - ANS 1. aspirin, tylenol, NSAIDs
2. codeine, hydrocodone, oxycodone, tramadol (only with NSAIDS)
3. morphine, hydromorphone, methadone, fentanyl
Breakthrough cancer pain management - ANS fentanyl
Metastatic bone pain management - ANS bisphosphonates
Tension headache symptoms & management - ANS symptoms - tight, back of head/neck
management - OTC analgesics and rest
Migraine headache types and treatments - ANS classic - WITH aura
common - WITHOUT aura
treatment - sumatriptan and analgesics
Cluster headache symptoms and management - ANS symptoms - occur at night, ipsilateral
congestion, rhinorrhea, and eye redness
Albumin levels <3.5 - ANS protein malnutrition
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
,Albumin <2.7 - ANS Edema
Complications of enteral nutrition - ANS aspiration, refeeding, dehydration
Complications of parenteral nutrition - ANS pneumothorax, hemothorax
Urine sodium >20 - ANS renal salt wasting (kidney is the problem)
Urine sodium <10 - ANS kidney isn't the problem
isotonic hyponatremia serum osmolality and causes - ANS serum osmolality - 284-295
causes - extreme hyperlipidemia or nhyperproteinemia
hypotonic hyponatremia serum osmolality and types - ANS serum osmolality <280
hypovolemic w/ sodium <10
hypovolemic w/ sodium >20
hypervolemic
hypovolemic w/ urine sodium <10 causes - ANS dehydration, diuresis, vomiting
hypovolemic w/ urine sodium >20 - ANS diuretics, ACE, mineralocorticoid deficiency
hypervolemic hypotonic hyponatremia - ANS edema, CHF, liver disease, renal failure
must restrict fluids
hypertonic hyponatremia serum osmolality and causes - ANS serum osmolality >290
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
,causes - HHS
hypokalemia causes, signs/symptoms, treatment - ANS causes - diuretics, GI losses, renal
loss, alkalosis
signs/symptoms - weakness, fatigue, cramps, broad T waves, u waves
treatment - oral replacement if >2.5, 40mEq/L/hr IV if severe
hyperkalemia causes, signs/symptoms, treatment - ANS causes - renal failure, drugs,
hypoaldosteronism
signs/symptoms - weakness, flaccid paralysis, abdominal distension, diarrhea, peaked T waves
treatment - ion resin exchange (kayexalate), insulin, D5W
hypocalcemia causes, signs/symptoms, treatment - ANS causes - pancreatitis, renal failure,
trauma, massive transfusions
symptoms - increased DTRs, cramps, convulsions, prolonged QT, Chvostek's and Trousseau's
sign
treatment - check for alkalosis, IV calcium gluconate if acute, oral supplements if chronic
hypercalcemia causes, signs/symptoms, treatment - ANS causes - vitamin D intoxication,
immobilization, thiazide diuretics
symptoms - fatigue, muscle weakness, constipation, coma, death
treatment - calcitonin if renal/card involvement, NS, loop diuretics, dialysis if severe
respiratory acidosis causes, signs/symptoms, treatment - ANS causes - hypoventilation
(pH<7.35, pCO2>45)
symptoms - somnolence, confusion, coma, myoclonus with asterixis
treatment - narcan if unknown cause, increased ventilator rate
Pg. 3 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, respiratory alkalosis causes, signs/symptoms, treatment - ANS causes - hyperventilation
(pH>7.45, pCO2<35)
symptoms - lightheadedness, tingling, tetany if severe
treatment - paper bag breathing, decreased ventilator rate
metabolic acidosis types, causes, treatment - ANS types:
increased anion gap - DKA, alcoholic ketoacidosis, lactic acidosis
normal anion gap - diarrhea, ileostomy, renal tubular acidosis, DKA recovery
treat with fluids
metabolic alkalosis causes, signs/symptoms, treatment - ANS causes - saline responsive, NG
suction, vomiting, diuretics
treatment - d/c diuretics, give NaCl and KCl, H2 blockers if GI loss
Gram positive bacteria - ANS streptococci, staphylococcus, enterococci, bacilli
Gram negative bacteria - ANS E. coli, klebsiella, pseudomonas, acinetobacter, enterobacter
anti-rejection meds following transplant - ANS 1. steroids
2. antimetabolites
3. calcineurin inhibitors OR mTOR inhibitor
Herpes Zoster (shingles) characteristics and treatment - ANS characteristics - grouped vesicle
eruption, with erythema and exudate, along dermatomal pathway
treatment - "cyclovir"; vaccine x2 if >50 years old
Pg. 4 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
2025 Questions and Answers
3 steps of pain management - ANS 1. aspirin, tylenol, NSAIDs
2. codeine, hydrocodone, oxycodone, tramadol (only with NSAIDS)
3. morphine, hydromorphone, methadone, fentanyl
Breakthrough cancer pain management - ANS fentanyl
Metastatic bone pain management - ANS bisphosphonates
Tension headache symptoms & management - ANS symptoms - tight, back of head/neck
management - OTC analgesics and rest
Migraine headache types and treatments - ANS classic - WITH aura
common - WITHOUT aura
treatment - sumatriptan and analgesics
Cluster headache symptoms and management - ANS symptoms - occur at night, ipsilateral
congestion, rhinorrhea, and eye redness
Albumin levels <3.5 - ANS protein malnutrition
Pg. 1 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
,Albumin <2.7 - ANS Edema
Complications of enteral nutrition - ANS aspiration, refeeding, dehydration
Complications of parenteral nutrition - ANS pneumothorax, hemothorax
Urine sodium >20 - ANS renal salt wasting (kidney is the problem)
Urine sodium <10 - ANS kidney isn't the problem
isotonic hyponatremia serum osmolality and causes - ANS serum osmolality - 284-295
causes - extreme hyperlipidemia or nhyperproteinemia
hypotonic hyponatremia serum osmolality and types - ANS serum osmolality <280
hypovolemic w/ sodium <10
hypovolemic w/ sodium >20
hypervolemic
hypovolemic w/ urine sodium <10 causes - ANS dehydration, diuresis, vomiting
hypovolemic w/ urine sodium >20 - ANS diuretics, ACE, mineralocorticoid deficiency
hypervolemic hypotonic hyponatremia - ANS edema, CHF, liver disease, renal failure
must restrict fluids
hypertonic hyponatremia serum osmolality and causes - ANS serum osmolality >290
Pg. 2 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
,causes - HHS
hypokalemia causes, signs/symptoms, treatment - ANS causes - diuretics, GI losses, renal
loss, alkalosis
signs/symptoms - weakness, fatigue, cramps, broad T waves, u waves
treatment - oral replacement if >2.5, 40mEq/L/hr IV if severe
hyperkalemia causes, signs/symptoms, treatment - ANS causes - renal failure, drugs,
hypoaldosteronism
signs/symptoms - weakness, flaccid paralysis, abdominal distension, diarrhea, peaked T waves
treatment - ion resin exchange (kayexalate), insulin, D5W
hypocalcemia causes, signs/symptoms, treatment - ANS causes - pancreatitis, renal failure,
trauma, massive transfusions
symptoms - increased DTRs, cramps, convulsions, prolonged QT, Chvostek's and Trousseau's
sign
treatment - check for alkalosis, IV calcium gluconate if acute, oral supplements if chronic
hypercalcemia causes, signs/symptoms, treatment - ANS causes - vitamin D intoxication,
immobilization, thiazide diuretics
symptoms - fatigue, muscle weakness, constipation, coma, death
treatment - calcitonin if renal/card involvement, NS, loop diuretics, dialysis if severe
respiratory acidosis causes, signs/symptoms, treatment - ANS causes - hypoventilation
(pH<7.35, pCO2>45)
symptoms - somnolence, confusion, coma, myoclonus with asterixis
treatment - narcan if unknown cause, increased ventilator rate
Pg. 3 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
, respiratory alkalosis causes, signs/symptoms, treatment - ANS causes - hyperventilation
(pH>7.45, pCO2<35)
symptoms - lightheadedness, tingling, tetany if severe
treatment - paper bag breathing, decreased ventilator rate
metabolic acidosis types, causes, treatment - ANS types:
increased anion gap - DKA, alcoholic ketoacidosis, lactic acidosis
normal anion gap - diarrhea, ileostomy, renal tubular acidosis, DKA recovery
treat with fluids
metabolic alkalosis causes, signs/symptoms, treatment - ANS causes - saline responsive, NG
suction, vomiting, diuretics
treatment - d/c diuretics, give NaCl and KCl, H2 blockers if GI loss
Gram positive bacteria - ANS streptococci, staphylococcus, enterococci, bacilli
Gram negative bacteria - ANS E. coli, klebsiella, pseudomonas, acinetobacter, enterobacter
anti-rejection meds following transplant - ANS 1. steroids
2. antimetabolites
3. calcineurin inhibitors OR mTOR inhibitor
Herpes Zoster (shingles) characteristics and treatment - ANS characteristics - grouped vesicle
eruption, with erythema and exudate, along dermatomal pathway
treatment - "cyclovir"; vaccine x2 if >50 years old
Pg. 4 Copyright © 2025 Jasonmcconell. ALL RIGHTS RESERVED.
