AGACNP Board Review Test Exam: Critical Care Questions and Answers, Exams of Nursing

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AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Types of Anemia by MCV - CORRECT ANSWERS Micro: < 80- iron deficiency and thalassemia Normo: 80-100- B12 or folate deficiency (etoh, liver failure, drugs) Macro: >100- Anemia of chronic disease, sickle cell, renal failure, blood loss, etc. Normal Hgb - CORRECT ANSWERS Men: 14-18 Women: 12-16 Normal Hct - CORRECT ANSWERS Men: 40-54% Women: 37-47% Normal TIBC - CORRECT ANSWERS 250-450 ug/dL Normal Serum Iron - CORRECT ANSWERS 50-150 ug/dL Normal MCV - CORRECT ANSWERS 80-100 fL - microcytic < 80; Marcocytic > 100 Normal MCHC - CORRECT ANSWERS 32-36% Normal MCH - CORRECT ANSWERS 26-34 pg AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Labs for Iron Deficiency Anemia - CORRECT ANSWERS - Low Hgb - Low Hct - Low MCV- microcytic - Low MCHC- hypochromic - Low RBC - Low Serum Iron - Low Serum Ferritin - High TIBC Tx of Iron Deficiency Anemia - CORRECT ANSWERS - Ferrous Sulfate 300- 325 mg 1-2 hr after meals - Food decreases iron absorption - Do not take with antacids - Taking with vitamin C increases absorption - Foods high in Iron: raisins, green leafy veggies, red meat, citrus, iron fortified bread/cereal Beta Thalasemia - CORRECT ANSWERS - Beta chains are not produced leading to hemoglobin with four alpha chains. Thalassemia Minor: - Only 1 copy of gene, mild anemia, may mimic iron deficiency Major (Cooley's Anemia): AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Anti-IF (intrinsic factor) and anti-parietal cell antibody test) Pernicious Anemia Tx - CORRECT ANSWERS - B12 (cyanocobalamin) 100 mg IM daily x 1 wk - Maintenance- life long administration Anemia of Chronic Disease Labs - CORRECT ANSWERS - Low Hgb - Low Hct - Normal MCV- normocytic - Normal MCHC- normochromic - Low serum Iron and TIBC - High serum ferritin ( > 1000) Anemia of Chronic Disease Tx - CORRECT ANSWERS - Tx associated disease - Nutritional support - If all else fails- Epoetin Alpha Sickle Cell Labs - CORRECT ANSWERS - Low Hgb - Peripheral smear shows sickle-shaped RBCs - Normocytic normochromic Sickle Cell Tx - CORRECT ANSWERS - Tx acute and chronic complications Acute: AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Fluids for dehydration - Analgesics for pain - O2 for hypoxemia Von Willebrand Disease - CORRECT ANSWERS Genetic disorder characterized by the decreased ability to make clots due to a mutation of deficiency in Von WiIllebrand Factor and Factor VIII S/S of Von Willebrand Disease - CORRECT ANSWERS - Frequent, prolonged, or severe bleeding episodes - Easy bruising Tx of Von Willebrand - CORRECT ANSWERS - Desmopressin - Recombinant von Willebrand factor and clotting factor VIII What is the most common acute leukemia and it's remission rate? - CORRECT ANSWERS - AML (80% of acute leukemias in adults) - Remission Rates 50-85% - Long term survival 40% Hallmark of Acute Lymphocytic Leukemia (ALL) - CORRECT ANSWERS - Pancytopenia w/ circulation blasts - More difficult to cure in adults than children Hallmark of Chronic Myelogenous Leukemia - CORRECT ANSWERS - PHILADELPHIA CHROMOSOME AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - 65% are alive after 5 yrs - Occurs most often in people < 40 y/o What is the most common leukemia in adults and it's hallmark? - CORRECT ANSWERS - Chronic Lymphocytic Leukemia (CLL) - Median Survival 10 yr - Occurs in middle/old age - Hallmark: Lymphocytosis (WBC > 30,000) Staging lymphoma (Ann Arbor) - CORRECT ANSWERS I: Localized to single lymph node or group II: More than 1 lymph node group involved; confined inside of the diaphragm III: Lymph nodes on both sides of the diaphragm involved or the spleen is involved IV: Liver or Bone Marrow Involvement Where do we bleed first? - CORRECT ANSWERS - Gums - Kidneys (urine dipstick) Non-Hodgkin's Lymphoma - CORRECT ANSWERS - Unknown cause, maybe viral AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Random Plasma Glucose >/= 200 w/ signs of hyperglycemia Plasma Glucose >/= 200 measured 2 hrs after glucose load of 1.75 g/kg in OGTT A1C > 6.8% Type 1 will have ketones Somogyi Effect - CORRECT ANSWERS - Nocturnal hypoglycemia develops stimulating a surge of counter regulatory hormones which raise the blood sugar - pt will be hypoglycemic at 3 am and hyperglycemia at 7 am - Tx: reduce or omit bedtime dose of insulin Dawn Phenomenon - CORRECT ANSWERS - Results when tissues become desensitized to insulin nocturnally - BG becomes progressively elevated through the night, resulting in a high BG at 7 am - Tx: add or increase bedtime insulin Metabolic Syndrome - CORRECT ANSWERS - Waist Circumference (Men >/= 40in, Women >/= 35) - BP >/= 130/85 - Triglycerides >/= 150 - FBG >/= 100 AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - HDL < 40 in men and < 50 in women Biguanide - CORRECT ANSWERS - Metformin - DOC for DM2 - Lowers basal and post prandial glucose levels by affecting glucose absorption and hepatic glucogenesis - May cause wt loss and lower LDLs - Caution with use in pts w/ excess alcohol consumption - Discontinue 1-2 days before contrast - BBW: LACTIC ACIDOSIS GLP-1 Agonists - CORRECT ANSWERS - Incretin Mimetics - Dulaglutide (1xwk), Exenatide (fewer GI SE), Liraglutide (daily), Semaglutide (1xwk) - Stimulate glucose-dependent insulin release, reduce glucagon, and slow gastric emptying - May cause wt loss w/ metformin or sulfonylurea - SE: GI disturbances and pancreatitis - BBW: THYROID CA - Risk Evaluation and Mitigation Strategy Program (REMS)- Pancreatitis Tx of HHS - CORRECT ANSWERS - Protect airway, administer O2 - Isotonic fluids- at least 1L in first hr, then 500 ml/hr - If BG > 500, use 1/2 NS after first hr - WHen BG < 250 switch to D51/2 NS AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - 0.1 u/kg regular insulin bolus followed by 0.1 u/kg/hr - If BG does not fall by 10% in hr, repeat bolus - Supportive Tx - Likely to come off insulin gtt before a DKA pt Tx of DKA - CORRECT ANSWERS - Protect airway, administer O2 - Isotonic fluids- at least 1L in first hr, then 500 ml/hr - If BG > 500, use 1/2 NS after first hr - WHen BG < 250 switch to D51/2 NS - 0.1 u/kg regular insulin bolus followed by 0.1 u/kg/hr - If BG does not fall by 10% in hr, repeat bolus - Supportive Tx - Do not treat initial hyperkalemia - If pH < 7.1, bicarb gtt Interpreting Thyroid Radioactive Iodine Uptake - CORRECT ANSWERS Thyroid radioactive iodine uptake and scan is used to determine the etiology of hyperthyroidism High uptake: Grave's Disease Low Uptake: Subacute Thyroiditis Tx of Hyperthyroidism - CORRECT ANSWERS - Propranolol for symptomatic relief; begin dosing at 10 mg PO, may increase to 90 mg QID AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - COSYNTROPIN STIMULATION TEST Labs for pheochromocytoma - CORRECT ANSWERS - Normal TSH - Plasma -free metanephrines - Assay of Urine catecholamines, metanephrines, vanillymandelic acid (VMA), and creatinine; 24 hr urine > 2.2 ug metanephrile per mg creatinine AND > 5.5 ug VMA per mg creatinine - CT of adrenals to confirm/localize tumor Tx of pheochromocytoma - CORRECT ANSWERS - Tx of choice: surgical removal of tumor Prop may use alpha-adrenergic meds - Phentolamine 1-2 mg IV Q5min until controlled, then 1-5 mg IV Q12-24 H - Convert to PO asap- phenoxybenzamine Post op watch for: - Hypotension (depleted catecholamines) - Adrenal insufficiency - Hemorrhage Labs for SIADH - CORRECT ANSWERS - Decreased Na - Decreased serum Osom (<280) - Increased urine osom (> 100) - Increased Urine Na (>20) AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Labs for DI - CORRECT ANSWERS - Increased Na - Increased serum osom (> 290) - Decreased urine osom (<100) - Decreased urine Na - Decreased urine specific gravity (< 1.005) Tx for SIADH - CORRECT ANSWERS - Tx underlying cause - If Na > 120, restrict total fluids to 1000 ml/24 hr - If Na 110-120 w/o neuro symptoms, restrict to 500 ml/ 24 hr - If Na < 110 or neuro symptoms replace with isotonic or hypertonic saline and lasix at 1-2 mEq/hr - monitor K loss hourly and replace Tx of DI - CORRECT ANSWERS - Serum Na > 150, give D5W to replace 1/2 the total volume deficit in 12-24 hr - When Na < 150, substitute 1/2 NS for NS - DDVAP 1-4 mcg or IV Q12-24H in acute cases - Maintenance DDVAP is 10 ug Q12-24H intranasallly Tx of uncomplicated lower UTI - CORRECT ANSWERS - Nitrofurantoin 100 mg BID x 5 day OR - TMP-SMX D5 PO BID x3 day (avoid if resistance) OR - Fosfomycin 3g PO x 1 day AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Tx of pyelonephritis - CORRECT ANSWERS - Ciprofloxacin 500mg PO BID x7 d (if uncomplicated) - Levofloxacin- ok, but not moxifloxacin - Ceftriaxone 1g IV Q24H x 14 days If healthcare associated need to add pseudomonas coverage other than a fluoroquinolone (ampicillin and an aminoglycoside, cefepime, imipenem, meropenem, zoysn, etc.) When are systemic changes evident in renal failure? - CORRECT ANSWERS When renal function is < 20-25% of normal function RIFLE - CORRECT ANSWERS Risk: - SCR x1.5 or decreased GFR > 25% - UO < 0.5 ml/kg/hr for 6 hrs Injury: - SCrx2 of decreased GFR > 50% - UO < 0.5 ml/kg/hr for 12 hr Failure: - SCrx3 or decreased GFR > 75% - UO < 0.3 ml/kg/hr for 24 hr or anuria for 12hr Loss: Complete loss of kidney function > 4wk AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Tx of Kidney Stones - CORRECT ANSWERS - Depends on size, location, cause, etc. Analgesia and Hydration- trio 1. Morphine or Dilaudid 2. Toradol 3. Metoclopramide (acts of vagus n, BBW- EPS symptoms) - Lithotripsy for large stones PSA Values - CORRECT ANSWERS > 4ng/ml is abnormal; age specific ranges 40-49 y/o: < 2.5 50-59 < 3.5 60-69 < 4.5 70-79 < 6.5 approximately 40% of pts w/ prostate CA present with normal PSA - Transrectal U/S if palpable nodule or increased PSA Tx of BPH - CORRECT ANSWERS 1st line: Alpha Blockers (terazosin, prazosin, tamsulosin) - relax muscles of bladder/prostate 2nd line: Alpha reductase inhibitors (finasteride, dutasteride) AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Shrink large prostate - Surgery, TURP - Saw Palmetto - Avoid meds that worsen it (Benadryl, oxymetazoline spray, SSRIs, etc) Creatinine Clearance Formula - CORRECT ANSWERS Normal Values: Men- 97-137 ml/min Women- 88-128 ml/min Tx of Addison's Disease - CORRECT ANSWERS Inpatient: - Hydrocortisone 100-300mg IV w/ NS; replace volume w/ D5NS at 500 ml/hr x4hrs and then taper per condition - Vasopressors are usually ineffective - Tx underlying cause (often infection) Outpatient: - Specialist referral - Glucocorticoid and mineralocorticoid replacement - Hydrocortisone - Fludrocortisone acetate WHOs Ladder of Pain Management - CORRECT ANSWERS Step 1: ASA, Tylenol, NSAIDs +/- Adjuvants AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Step 2: Tylenol or ASA + codeine, hydrocodone, oxy, dihydrocodeine; tramadol +/- Adjuvants Step 3: Morphine, Hydromorphone, Methadone, Levorphanol, Fentanyl, Oxy +/- nonopioids and adjuvants - Breakthrough CA pain- fentanyl patch - Metastatic Bone CA- bisphosphonates Staging Pressure Ulcers - CORRECT ANSWERS Stage I: intact skin w/ erythema, does not blanch Stage II: Partial-thickness skin loss w/ exposed dermis Stage III: Full thickness skin loss; Adipose visible; slough/eschar Stage IV: Full thickness skin and tissue loss with exposed bone, muscle, or tendon. Eschar or slough may be present in some parts of wound bed. Unstageable: If entire wound bed covered by slough or eschar. This obscures the extent or tissue loss. Either a 3 or 4 DTI - CORRECT ANSWERS Non-blanchable deep red, maroon, or purple discoloration What do you do if your pt has a fever of unknown origin? - CORRECT ANSWERS - Do nothing until diagnosis is confirmed - WOrk the pt up Non-Infectious Causes of Post-op Fever - CORRECT ANSWERS - Post op atelectasis AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - CLABSI- PULL THE LINE Acetaminophen Intoxication - CORRECT ANSWERS - Asymptomatic in the early phase - At 24-48 hrs- n/v - RUQ pain - Hepatotoxicity: Jaundice, increased LFTs, increased PT, AMS Tx: - Activated charcoal (within 1 hr of ingestion) - N-acetylcysteine w/ loading dose orally Salicylate Intoxication - CORRECT ANSWERS S/S: n/v, tinnitis, dizzy, HA, dehydration, hyperthermia, apnea, cyanosis, increased LFTs, metabolic acidosis Tx: - activated charcoal - Sodium bicarb IV to correct severe acidosis Organophosphate Poisoning - CORRECT ANSWERS - INsectidcide: Malathion, parathion - S/S: n/v/d; cramping; excess salivation; HA; blurred vision and miosis (constriction); Bradycardia; AMS Tx: - wash skin AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - activated charcoal if ingested - DOC: ATROPINE Antidepressant Toxicity - CORRECT ANSWERS Amitriptyline, Fluoxetine, Imipramine, Bupropion S/S: AMS, blurred vision, hallucinations, urinary retention, hypotension, tachycardia, dysrhythmias, hypothermia, szs Tx: - Admit to ICU if CNS or cardiac toxicity - Activated Charcoal - Sodium bicard to counter dysrhythmias and maintain pH - BENZOS (diazepam) for szs - Serotonin SYndrome: Dantrolene sodium, clonazepam to tx rigor, cooling blankets, IVF Opioid Toxicity - CORRECT ANSWERS S/S: drowsy, hypothermia, respiratory depression, meiosis (pinpoint), coma, euphoria. - Cocaine- mydriosis Management: - Emetics C/I - Activated charcoal - Narcan AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Benzo OD - CORRECT ANSWERS S/S: drowsy, confused, slurred speech, respiratory depression, hyporeflexia Tx: - respiratory/BP support - FLUMAZENIL (romazicon) IV - Activated charcoal Ethylene Glycol OD - CORRECT ANSWERS Antifreeze 1st Stage (30 m-12h): neuro (loss of coordination, HA, n/v, slurred speech) 2nd Stage (12-24 h): irregular heartbeat, shallow breathing, changes in BP 3rd Stage (24-72h): Kidney Failure Tx: - Fomepizole; If not available may use Ethanol BB OD - CORRECT ANSWERS S/S: hypotension, bradycardia, delirium, coma, bronchospasm Tx: - charcoal AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Abx prophylaxis - CORRECT ANSWERS Colorectal, appendectomy (non- perforated) Staphylococci, Streptococci, enteric gram negative rods: Cefazolin MRSA screen + : vanc Enteric gram negative rods, anaerobes: - Cefoxitin, Cefotetan, or Cefazolin - PLUS Metronidazole Anti-Rejection Regimen - CORRECT ANSWERS Triple therapy 1. Corticosteroid (methylprednisone, prednisone) 2. Antimetabolite (azathioprine, mycophenolate mofetil, mycophenolate sodium, cyclophosphamide) 3. Calcineurin Inhibitor (tacrolimus, cyclosporine) OR Mammalian Target of Rapamycin (mTOR) Inhibitor ( sirolimus, lemsirolimus, everolimus) Herpes Zooster - CORRECT ANSWERS - Dermatomal Distribution - Regional lymphadenopathy may be present - Tx: Acyclovir (most common), Famiciclovir, Valacyclovir - If ocular involvement- IMMEDIATE referral to ophthalmologist - Post Herpetic neuroglia- Gabapentin, pregabalin AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Vaccination: >/= 50 y/o - 2nd dose > 6 months after 1st dose Actinic Ketatoses - CORRECT ANSWERS Premalignant; tx w/ liquid nitrogen Squamous Cell - CORRECT ANSWERS - Arise from firm, irregular papule/nodule; may have bleeding - Tx: biopsy, surgical excision (Mohs- examine layer by layer) Seborrheic Keratoses - CORRECT ANSWERS - Benign, no pain - Beige, brown, black plaques - Tx not necessary, may use liquid nitrogen Basal Cell - CORRECT ANSWERS - Most common skin CA - waxy, pearly - Tx: surgical excision, shave/punch biopsy Melanoma - CORRECT ANSWERS - Metastasize anywhere - Asymmetry - Border irrgular - Color- black - Diameter > 6mm - Elevation and Evolution AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Tx: biopsy and surgical excision Tension HA - CORRECT ANSWERS - vise-like - no neuro symptoms - usually last several hours - Tx: OTC analgesics, relax Migraine S/S - CORRECT ANSWERS - Dilation and excessive pulsation of branches of external carotid artery - Lasts 2-72 hrs; follow trigeminal nerve pathway - Associated w/ triggers - Unilateral, throbbing - Focal neuro disturbances - Visual disturbances - Photophobia - Phonophobia Classic vs Common Migraine - CORRECT ANSWERS Classic: w/ aura Common: w/o aura Prophylactic Migraine Management - CORRECT ANSWERS - Avoid Triggers - Use if get 2-3x a moth - Anticonvulsants: TOPIRAMATE, valproic acid - BB: ATENOLOL, metoprolol, nadolol, propranolol, timolol AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Hypervolemic: - Need to restrict H2O - Edematous stats- liver disease, CHF, advanced renal failure Tx of Hyponatremia - CORRECT ANSWERS - Based on cause - Hypovolemic- NS IVF - Urine Na > 20- tx cause - Hypervolemic- H2O restriction If symptomatic- NS IV w/ loop diuretic IF CNS symptoms- consider 3% NS IV w/ loop diuretics Hypernatremia Management - CORRECT ANSWERS - Usually due to excess H2O loss - Hyperosmolality - NS IV followed by 1/2 NS= severe - If euvolemic- free water (D5W) - If hypervolemic- free water + loop diuretics, may need dialysis Causes of Hypokalemia and Hyperkalemia - CORRECT ANSWERS Hypokalemia: - chronic diuretic use - GI losses - Excess renal losses AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Alkalosis Hyperkalemia: - Excess intake - Renal failure - Drugs (NSAIDs) - Hyperaldosteronism - Cell Death - Acidosis S/S of Hypokalemia and Hyperkalemia - CORRECT ANSWERS Hypokalemia: - muscular weakness -fatigue - muscle cramps - constipation or ileus d/t smooth muscle involvement Hyperkalemia: - weakness - flaccid paralysis - abdominal distension - diarrhea EKG changes in Hypokalemia and Hyperkalemia - CORRECT ANSWERS Hypokalemia: AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - WIde T waves - U waves - PVCs, VT, VF Hyperkalemia: - Tall, peaked T waves Tx of Hypokalemia - CORRECT ANSWERS - If > 2.5 and no EKG changes: PO K - If < 2.5 or severe S/S: 20 mEq/L/hr IV, EKG monitoring, check Q3H - Mg deficiency frequently impairs K correction Tx of Hyperkalemia - CORRECT ANSWERS - exchange resins (kayexalate)- if time - If > 6.5 or cardiac toxicity or muscle paralysis- insulin 10 u w/ 1 amp D50 Causes of Hypocalcemia and Hypercalcemia - CORRECT ANSWERS Hypocalcemia: - Hypoparathyroidism - Hypomagnesemia - Pancreatitis - Renal failure - Severe trauma - Multiple blood transfusions AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ MUDPILES - CORRECT ANSWERS Create anion gap acidosis Methanol Uremia Dka Paraldehyde Iron/Isoniazide Lactic Acidosis Ethanol/Ethylene Glycol Salicylate Most common causes of a gastric perforation - CORRECT ANSWERS - Ruptured Diverticulum - Ruptures Appendix - Ulcerative Process Acid Anti-secretory Agents - CORRECT ANSWERS H2 Receptor Antagonists (ex: famotidine) - 1st line for PUD PPIs (ex: omeprazole) - BBW: osteoporitic hip fx - cognitive decline associated w/ older adults AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Mucosal Protective Agents - CORRECT ANSWERS - Give 2 hr apart from other meds - Sucralfate: 1g, 4xday; requires acidis environment; associated w/ decreased nosocomial pneumonia - Bismuth Subsalicylate: direct antibacterial against H. pylori; promotes prostaglandin production and stimulates gastric bicarbonats - Antacids H Pylori Therapy (not allergic to PCN and not previously received macrolide) - CORRECT ANSWERS 1. PPI BID + Clarithromycin 500 mg BID + amoxicillin 1000 mg BID x 14 days 2. PPI BID + Bismuth 525 mg QID + metronidazole 250 mg QID + Tetracylcine 500 mg QID x 10-14 days 3. PPI BID + clarithromycin 500 mg BID + amoxicillin 1000mg BID + Metronidazole 500mg x 10-14 d H. Pylori Therapy (Pts allergic to PCN and who have not previously received a macrolide or unable to tolerate bismuth quadruple therapy) - CORRECT ANSWERS PPI BID + Clarithromycin 500 mg BID + Metronidazole 500 mg TID x 10-14 days H. Pylori Therapy (Pts allergic to PCN and who have previously received a macrolide) - CORRECT ANSWERS PPI BID + Bismuth 525 mg QID + Metronidazole 250 mg QID + Tetracycline 500 mg QID x 10-14 days Causes of GERD - CORRECT ANSWERS - Incompetent LES AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Delayed gastric emptying Hepatitis A - CORRECT ANSWERS - Transmitted by fecal-oral route - Blood and stool infectious during 2-6 wk incubation period Serologies: Active: Anti-HAV, IgM Recovered: Anti-HAV, IgG Hepatitis B - CORRECT ANSWERS Blood borne DNA Virus Serologies: Active: HBsAg, HSeAg, Anti-HBc, IgM Chronic: HBsAg, Anti-HBc, Anti-HBe, IgM, IgG Recovered: Anti-HBc, Anti-HBs Hepatitis C - CORRECT ANSWERS - Blood Borne RNA virus Serologies: Acute: Anti-HCV, HCV RNA Chronic: Anti-HCV, HCVRNA Pre-icteric vs. Icteric - CORRECT ANSWERS Pre-Icteric: fatigue, malaise, n/v, HA, aversion to smoking and alcohol AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Frame Patter- LBO Management of Ulcerative Colitis - CORRECT ANSWERS - Lower GI tract - Mesalamine suppositories or enemas for 3-12 wks - Hydrocortisone suppositories or enemas Mesenteric Infarction - CORRECT ANSWERS - Blockage of a mesenteric artery resulting in necrosis of a portion of the bowel - S/S: sudden onset cramping, colicky abdominal pain; pain out of proportion to physical exam findings; n/v; tenderness; guarding; tenderness; Hyperactive to absent bowel sounds; Peritoneal findings increase as progress; shock Labs: - Increased amylase - Leukocytosis - No air on abdominal films - CT w/ Contrast EMERGENT surgical intervention McBurney's point - CORRECT ANSWERS - A point on the right side of the abdomen, about two-thirds of the distance between the umbilicus and the anterior bony prominence of the hip - Associated with Appendicitis AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Psoas Sign - CORRECT ANSWERS - RLQ pain with extension of right thigh indicative of appendicitis Obturator's sign - CORRECT ANSWERS RLQ pain on internal rotation of right thigh indicative of appendicitis Rosving's sign - CORRECT ANSWERS palpation of LLQ causes RUQ pain seen in appendicitis Heart Sounds - CORRECT ANSWERS S1: mitral/tricuspid (AV) valves close; aortic/pulmonic (semilunar) open S2: Aortic Pulmonic close; AV open Systole is the period between S1 and S2. Diastole is the period between S2 and S1 S3: "Ken-tuck-y"; increased fluid states (ex: HF, pregnancy) S4: "Ten-ne-ssee"; stiff ventricular wall (MIS, LV hypertrophy, Chronic HTN) Grading Mumors - CORRECT ANSWERS I/VI: Barely audible II/VI: Audible, but faint III/VI: Moderately loud, easily hear; no thrill AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ IV/VI: Loud; associated w/thrill V/VI: Very loud, heard when corner of stethoscope of chest VI/VI: Loudest Valvular Diseases - CORRECT ANSWERS Mitral: - Stenosis: loud S1 murmor, low-pitched, diastolic, apical crescendo - Regurgitation: systolic Aortic: - Stenosis: systolic, blowing, rought, rash murmor, may radiate to neck - Regurgitation: diastolic, blowing Mumors - CORRECT ANSWERS Mitral Stenosis Aortic Regurgitation Diastolic Mitral Regurgitation Aortic Stenosis Systolic AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ HF Management - CORRECT ANSWERS Non-Pharmacologic: - Na restriction - Rest/activity balance - Wt. reduction Pharmacologic: - Standards of care: Diuretic, BB, ACEI/ARB - Sacubitril/Valsartan (HFrEF) - Digoxin for some pts - Anticoagulation for Afib Types of Cardiomyopathy - CORRECT ANSWERS Dilated: Most common; Dilation of the heart muscle Hypertrophic: Hypertrophy of the LV and occasionally RV Restrictive: Scarring/ Stiffening of the heart muscle; Least common Acute Management of Cardiomyopathies and HF - CORRECT ANSWERS ABCs Symptom Relief: - preload/afterload reduction w/ vasodilators (nitrates, hydralazine, nipride, nesiritide, ACEI, ARBs, diuretics) AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Inhibition of neurohormonal activation (RASS and SNS) ( ACEI, ARBs, BB, Aldosterone agonists) Routine Management after Stabilization: - BB started in the hospital once euvolemic - 3 drug therapy: diuretic, ACEI/ARB, BB Management of Acute Pulmonary Edema - CORRECT ANSWERS - O21-2L/min while waiting ABG - Morphine 2-4mg IVP repeat 20-30 min PRN, stop if hypercapneic - Furosemide 40mg IVP repeat in 10min if no response - If severe bronchospasm- inhaled sympathomimetics - If severe, after load and preload reduction with nitroprusside, hydralazine . -If Cardiac index remains low, dobutamine 2.5-20mcg/kg/min; if SBP <100 dopamine 5-20mcg/kg/min is preferred. S/S HTN - CORRECT ANSWERS "Silent Killer" - increased BP - If severe, may have suboccipital pulsating HA, occurring early in am and resolving throughout the day - EPISTAXIS - Dizzy - S4 r/t LV hypertrophy - AV NICKING AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ BP Categories - CORRECT ANSWERS HTN Management by Race and Comorbities - CORRECT ANSWERS Non- AA: Thiazides, ACEI, ARBs, CCBs AA: Thiazides, CCBs Diabetic: ACEI, ARBs Adults >/= 18 w/ CKD: ACEI Hypertensive urgency vs emergency - CORRECT ANSWERS Urgency: over 180 or 120 without end organ damage Emergency: with end organ damage Hypertensive Emergency Management - CORRECT ANSWERS - ICU admission + IV drugs (nicardipine, nitroprusside, etc.) - For compelling conditions (aortic dissection, preeclampsia, eclampsia, or pheochromocytoma crisis): SBP should be decreased to < 140 in first hr and to < 120 in aortic dissection - W/o compelling condition: Reduce SBP by no more than 25% in first hr, then if stable, to 160/100 in the next 2-6 hr, then cautiously to normal in the next 24-48hrs Types of Angina - CORRECT ANSWERS Stable (Classic/chronic)- Most common, exertional AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Moderate Intensity Statins - CORRECT ANSWERS Atorvastatin 10-20mg Rosuvastatin 5-10mg Simvastatin 20-40mg Pravastatin 40-80mg Lovastatin 40mg Fluvastatin XL 80mg Fluvastatin 40mg BID Pitavastatin 2-4mg Lowers LDL by 30-49% Low-Intensity Statins - CORRECT ANSWERS Simvastatin 10 mg Pravastatin 10-20 mg Lovastatin 20 mg Fluvastatin 20-40 mg Pitavastatin 1 mg Lowers LDLs by < 30% Bile Acid Sequestrants - CORRECT ANSWERS - Mostly decrease LDLs; May increase triglycerides - Cholestyramine, colestipol, colesevelam Fibrates - CORRECT ANSWERS Decreases triglycerides; slightly decreases LDLs; Possibly increases HDLs AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Gemfibrozil Fenofibrate Fenofibric Acid Cholesterol Absorption Inhibitor - CORRECT ANSWERS - Used in combination w/ statin to lower LDL Ezetimibe Niacin - CORRECT ANSWERS - Decrease LDLs and Triglycerides; Increase HDLs - Immediate and extended preparations - "flushing" sensation at high doses- may be unpleasant EKG changes w/ MI/ACS - CORRECT ANSWERS - Peaked T waves = ST elevations - Q wave development I, aVL: Lateral II, III, aVF: Inferior V leads, V3, V4: Anterior V1, V2: Septal AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Heart Blocks - CORRECT ANSWERS 1st Degree: PR > 0.25s (R is far from P) 2nd Degree Type 1 (Wenckeback/Mobitz 1): PR interval gradually gets longer until the QRS is dropped (Longer, longer, drop) 2nd Degree Type 2 (Mobitz II): atrial rhythm is regular, the PR interval is constant, but the ventricular rhythm is irregular; dropped QRS. (no Ps don't get through) 3rd Degree: Ps and Qs don't agree Tx: MI and ACS - CORRECT ANSWERS 1. ASA 325 mg tab 2. Nitroglycerin Q5Min x3 3. O2 therapy, IV access - 12 lead EKG - MOrphine 2.4 mg IVP - If pulmonary edema- 40 mg IV Lasix - If not C/I: start 5mg IV metoprolol x 3 doses at 2 minute intervals; then 50 mg PO Q6H starting 15 min after last IV dose - ACEI- prevents ventricular remodeling - Herparin vs. LMWH - Monitor Coags Coags - CORRECT ANSWERS INR: normal: 0.8-1.2 s AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Edema after prolonged standing - Night cramps -TROPHIC CHANGES w/ BROWN DISCOLORATION - Stasis leg ulcers - Edema of LE - Dematits - Cool to touch Management of PVD - CORRECT ANSWERS stop smoking/all tobacco use Exercise to develop collateral circulation trental (pentoxifylline Pletal (Cilostazol) weight reduction bypass surgery angioplasty amputation Management of CVI - CORRECT ANSWERS - management is directed at reducing venous stasis and preventing ulcerations. - Any measure that increases the venous flow is utilized such as: elevation of leg, compression of superficial veins with elastic compression stockings or unna boots. - Wt. Reduction - Tx dermatitis or ulcers AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Acute Weeping dermatitis: - tap water compressed - hydrocolloid dressing - for less acute- hydrocortisone cream Fever + heart murmor - CORRECT ANSWERS A diagnosis of endocarditis must be considered until proven otherwise S/S Pericarditis vs. Endocarditis - CORRECT ANSWERS Pericarditis: - very localized retrosternal/precordial chest pain that is pleuritic in nature - Pain increased w/ deep inspiration, coughing, swallowing, or in recumbinant position - Pain relieved sitting forward - SOB secondary to pain w/ inspiration Endocarditis: - fever and malaise - night sweats - wt. loos - "sick" feeling Physical Finding Pericarditis - CORRECT ANSWERS - Pericardial Friction Rub - May have pleural friction rub - May have fever depending on the cause AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Physical Findings Endocarditis - CORRECT ANSWERS - Murmor (usually, but not always) - Med-high Fever - Oslers Nodes: painful, red nodules in distal phalanges - petechiae, purpura, pallor - Splinter Hemorrhages: linear, subungal, splinter appearing - Splenomegaly in 50% of pts - Janeway Lesions: rare; small and non-painful macules on palms/soles - Roth spots: Small retinol infarcts, white in color, encircled by areas of hemorrhage Ts of Pericarditis - CORRECT ANSWERS 1. NSAIDs (indomethacin, Ibuprofen, Ketorlac) 2. Corticosteroids only when total failure of high dose NSAIDs over several wks and w/ relapsing pericarditis; can increase viral replication 3. Abx if bacterial cause (most commonly viral) MONITOR FOR TAMPONADE S/S Cardiac Tamponade - CORRECT ANSWERS - Hypotension - Increased JVD (increased CVP) - Muffled/ distant heart sounds - Pulsus paradoxus Tx of Endocarditis - CORRECT ANSWERS Subacute: - empiric therapy not started until culture identifies a pathogen AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ TIA classification: Vertebrobasilar - CORRECT ANSWERS - Occurs as a result of inadequate blood flow from vertebral arteries - Presentation: vertigo, ataxia, dizzy, visual field deficits, weakness, confusion, etc. TIA Classification: Carotid - CORRECT ANSWERS - Due to carotid stenosis - Presentation: aphasia, dysarthria, altered LOC, weakness, numbness, etc. Carotid Endarectomy - CORRECT ANSWERS - Decreases risk of stroke in pts w/ recent TIA - Symptomatic, low-risk surgical pts w/ 50-90% stenosis - Asymptomatic pts w/ 70-99% stenosis CVA infarct - CORRECT ANSWERS - subtle, progressive or sudden neurological deficits >80% CVA are ischemic - changes in LOC - Motor weakness/paralysis - visual alterations - Changes in VS Hemorrhagic CVA - CORRECT ANSWERS - usually presents with acute onset of focal neurologic deficits - Sudden increased ICP (AMS, HA, n/v) - Left: R. hemiparesis, aphasia, dysarthria, difficulty reading and writing (LEFT= LANGUAGE AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Right: L. hemiparesis, R visual field changes, spatial disorientation Time of CVA onset and Interventions - CORRECT ANSWERS Up to 4.5 hr - TPA Up to 6 hr- Mechanical Embolectomy for all 6-24 hr- Mechanical Embolectomy for some What should the MAP be to tx cerebral vasospasm? - CORRECT ANSWERS 110-130 mmHg Indications for ICP monitoring - CORRECT ANSWERS Moderation: severe head injury who can't be serially neurologically assessed Severe head injury (GCS < 8 and abnormal HCT) Severe head injury (GCS < 8 and abnormal HCT) if 2 are present: - age > 40 y/o - BP < 90 - abnormal motor posturing Vasospasm Tx: What is it and why is it a standard of care? - CORRECT ANSWERS Nimodipine- CCB - prevents Ca from entering smooth muscle and causing contraction AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Partial Sz - CORRECT ANSWERS focal/local Simple: common w/cerebral lesions; NO LOSS OF CONCIOUSNESS; rarely lasts > 1 min; Motor symptoms start in single muscle group and spread to the muscle groups on that same side; paresthesia; flashing lights; vocalization; hallucinations Complex: IMPAIRED LOC after; may have aura, staring, or automatisms General Sz - CORRECT ANSWERS Absence (petit mal): sudden arrest of motor activity w/blank stare Tonic Clonic (grand mal): - may have aura - tonic contraction (repetitive involuntary contraction) followed by loss of consciousness, and clonic contractions (maintained involuntary contraction) - incontinence may occur - usually 2-5 m - postictal state Status Epilepticus - CORRECT ANSWERS - Sz > 5 min or more than 1 sz in a 5 min w/o return to normal LOC - Medical emergency AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - should be tapered when discontinuing Cushing's triad - CORRECT ANSWERS - Widening pulse pressure - Decreased RR - Decreased HR Neuro Changes in Elderly - CORRECT ANSWERS - Decrease in number of neurons and neurotransmitters - Modifications in cerebral dendrites, glial support cells, synapses - Compromised thermoregulation - Decreased sense of touch - Increased pain tolerance Myasthenia Gravis Labs/Management - CORRECT ANSWERS - Antibodies to acetylcholine receptors (achR-ab) are found in the serum of 85% of pts - Neuro referral - Anticholinesterase drugs block the hydrolysis of acetylcholine and are used from symptom improvement (pyridostigmine bromide) - Immunosuppressives - Plasmapheresis - Vent may be needed in crisis MS Labs/ Diagnostics - CORRECT ANSWERS - Diagnosis not based solely on labs - Mild lymphocytosis is common AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Slightly elevated protein in CSF - Elevated CSF IgG - MRI Tx of MS - CORRECT ANSWERS - No tx to prevent progression, help tx symptoms - Recovery from acute relapses hastened by steroids DOC: antispasmodics and interferon therapy - Immunosuppressive therapy - Plasmapheresis gullian-barre syndrome Tx - CORRECT ANSWERS - Supportive while myelin is regenerated - Symptoms begin to recede within 2 wks w/ recovery in 2 yrs - Neuro consult Causes of Bacterial Meningitis - CORRECT ANSWERS -Streptococcus pneumoniae - Hemophilis INfluenzae - Neisseria Meningitidis - Listeria Monocytogenes (not in Barkley book) the triad of meningitis - CORRECT ANSWERS Fever AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Nuchal Rigidity AMS Kernig's Sign - CORRECT ANSWERS a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down - pain and spasms of hamstring muscles - positive if meningitis Brudzinski's sign - CORRECT ANSWERS pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine Lumbar Puncture for Meningitis - CORRECT ANSWERS Tx: Meningitis - CORRECT ANSWERS </= 50 y/o; N. meningtidis; S. pneumonias - Vanc + ceftriaxone > 50 y/o; S. pneumoniae, N. meningtidis, L. monocytogenes, gram negative enterics (E. coli, Klebsiella, Enterobacter) - Vanc + Ceftriaxone + Ampicillin Management of SCI - CORRECT ANSWERS - Neuro/ NSGY referral - Methyl prednisone 30 mg/kg IV bolus, followed by infusion of 5.4 mg/kg for 23 hrs. Improves neuro recovery when administered within 8 hr of injury. Contraversial AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Alzheimer's Disease - CORRECT ANSWERS Development of multiple cognitive defects characterized by memory impairment plus at least 1 of the following: 1. Aphasia 2. Apraxia (tast) 3. Agnosia (recognize) 4. Inability to plan, organize, sequence, and make abstract difference Management of Alzheimers - CORRECT ANSWERS Neuro Consult Cholinesterase Inhibitors ( increase available acetylcholine): - DONEPEZIL- all stages, maintain memory - Galantamine, Rivastigmine- mild to moderate N-methyl-D- Asparate (NMDA) Antagonist: - Memantine for moderate to severe Combo: Memantine- Donepezil for moderate to severe Family/Pt counselling CAGE questionnaire - CORRECT ANSWERS Have you ever felt you should Cut down on your drinking? AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)? Change Model - CORRECT ANSWERS 1. Precontemplation (not yet recognizing behavior) 2. Contemplation (recognize need to change) 3. Preparation (make plan and gather support to change) 4. Action 5. Maintenance 6. Relapse CVP - CORRECT ANSWERS - Pressure exerted by fluid in the right atrium; indictive of right sided heart function - Normal: 0-6 mmHg - Elevated in conditions that cause an increase in the amount of fluid in the right atrium (fluid overload, cardiogenic shock) - Decreased in conditions that cause a decrease in the amount of fluid in the right atrium (dehydration, distributive shock) MAP equation - CORRECT ANSWERS (SBP + 2DBP)/3 PAP - CORRECT ANSWERS - A pressure of the systolic and diastolic pressures in the pulmonary artery - Normal 15-25/5-15 AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Elevated in conditions that increase the amount of fluid in the pulmonary artery or that decrease elasticity of the pulmonary artery (hypervolemia, pulmonary HTN) - Decreased in conditions that decrease the amount of fluid in the pulmonary artery (hypovolemia) PCWP or PAOP - CORRECT ANSWERS - Measure of pressure in the LV at end diastolic function (maximum stretch), indicative of Left sided heart function - Normal 6-12 mmHg - Increased in conditions that increase pressure in the LV at end diastolic (increased fluid, decreased elasticity of the ventricle) - Decreased in conditions that decrease pressure in the LC (hypovolemia) - PCWP is a reflection of the tendency to develop pulmonary edema CO - CORRECT ANSWERS - Amount of fluid in liters per minute that the heart pumps into systemic circulation - HR x SV = CO - Normal: 4-8 L/min - Increased by factors that increase HR or increase the amount of blood pumped w/ each beat (inotropic agents, excess fluid) - Decreased by factors that decrease HR or decrease the amount of blood pumped w/ each beat (drugs that decrease contractility, hypovolemia) CI - CORRECT ANSWERS The cardiac output/ body surface area; more accurate measure than CO b/c the value takes into account the body surface area - Normal 2.5-4 L/min AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Cardiogenic Shock Causes - CORRECT ANSWERS Loss of effective contractile function results in impaired CO, imparied O2 delivery, and decreased tissue perfusion - AMI (most common) - ventricular aneurysm - dysrhythmias - pericardial tamponade - hypoxemia - pulmonary edema - acute ventricular regurgitation - acute VSD Cardiogenic Shock values - CORRECT ANSWERS Low CO/CI High CVP High PCWP High SVR Low SVO2 Cardiogenic Shock Tx - CORRECT ANSWERS 1. Careful administration of IVF 2. Vasopressors Distributive Shock - CORRECT ANSWERS Characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Types: Septic, Anaphylactic, Neurogenic qSOFA - CORRECT ANSWERS - Used to identify pts w/ suspected infection who are at greater risk for poor outcome - a score > 2 is a greater risk - 1 pt for each: - Low BP (SBP </= 100) - High RR (>/=22) - AMS (GCS < 15) Septic Shock - CORRECT ANSWERS Type of distributive shock caused by infective organisms which involve the bloodstream and alter vascular tone; hypovolemia develops as a result of blood pooling in microcirculation High CO/CI (initally), low CVP, low PCWP, low SVR, low SVO2 Tx: 1. IVF (crystalloids) 2. upon diagnosis- Abx within 1 hr 3. Vasopressors Anaphylactic Shock - CORRECT ANSWERS - Type of distributive shock mediated by IgG AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Low CO/CI, low CVP, low PCWP, low SVR, low SVO2 - maintain airway - crystalloids for volume expansion - diphenhydramine 25-75 mg IV or IM - epi 0.3-0.5 mg (1: 1000) Sq or IM for respiratory distress - IV glucocorticoids - Consider H2 antagonists - Inhaled beta agonists for bronchospasm Neurogenic Shock - CORRECT ANSWERS - Distributive Shock; Loss of peripheral vasomotor tone as a result of SCI, regional anesthesia, etc. Low CO/CI, low CVP, low PCWP, low SVR, low SVO2 - Maintain airway - crystalloids for volume expansion - vasopressors Obstructive Shock causes - CORRECT ANSWERS Inadequate CO as a result of impaired ventricular filling - massive PE (most common cause) - tension pneumo - acute cardiac tamponade AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ CAM- ICU - CORRECT ANSWERS - Assesses for delirium (including AMS and disorganized thinking) Four features: 1. acute onset of mental status changes or fluctuating course 2. inattention 3. disorganized thinking 4. altered LOC Should be conducted every day/shift w/ ICU pts Clock Drawing Test - CORRECT ANSWERS - Used to assess cognitive impairment - Scored 1-6 - If > /= 3: cognitive deficit Katz Index of ADL - CORRECT ANSWERS Assessment of level of independent functioning and type of assistance required in six areas of ADL. Evaluator observes activity performance or interviews the individual about performance. Population: Adults and elders with chronic illness. 6 Self care functions: 1. bathing AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ 2. dressing 3. toileting 4. transferring 5. continence 6. feeding Get up and GO Test - CORRECT ANSWERS - Fall risk assessment - Rated 1-5; >/=3 indicates a risk of falling 1= normal 2= very slightly abnormal 3= mildly abnormal 4= moderately abnormal 5= severely abnormal Pain Assessment in Advanced Dementia - CORRECT ANSWERS 5 behaviors observed: breathing, negative vocalization, facial expression, body language, and consolability 1-3: mild pain 4-6: moderate pain 7-10: severe pain Durable Medical Equipment (DME) - CORRECT ANSWERS - Equipment for everyday or extended use AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ - Durable, used for medical reason, not usually useful to someone who is not sick/injured, used at home, expected lifetime at least 3 ys Ex: beds, canes, BGMs, Infusion pumps, nebs, O2, suction, commode, traction, etc. Assistive Devices - CORRECT ANSWERS Special equipment that helps a person who is ill or disabled to perform ADLS; also called adaptive devices. wheelchairs, prostheses, hearing aids Life Support Devices - CORRECT ANSWERS Devices used by healthcare professionals to support life in the critically ill balloon pump (C/I in aortic valve insufficiency); VAD; Dialysis; Transvenous pacer Informatics Compentencies - CORRECT ANSWERS Begining Nurse: - computer literacy, info management, know how to use nursing specific software, ability to use pt care technologies (monitors, pumps, med dispensers) Experienced Nurse: - skilled in info management and compute technology r/t specific areas of practice Informatics Nurse Specialist: AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ III: floating face - will need tertiary care facility, will need plastics, RD,speech, etc. Goals of Healthy People 2030 - CORRECT ANSWERS - Increase the quality and years of healthy life - Eliminate health disparities among Americans Diagnoses that must be reported to the department of health - CORRECT ANSWERS 1. Gonorrhea 2. Chlamydia 3. Sphyllis 4: HIV 5. TB 6. COVID-19 Palliative vs. Hospice - CORRECT ANSWERS -Palliative care can begin at diagnosis and at the same time as treatment (chronic and progressive medical conditions). -Hospice begins after treatment of the disease has stopped and it is clear that the person is not going to ultimately survive. Coding - CORRECT ANSWERS Codes match the level of service provided to the complexity of the presenting pt problem AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Medicate A - CORRECT ANSWERS - 65 years or older - Covers inpatient hospitalization, SNF, home health, and/or hospice associated w/inpatient event Medicare B - CORRECT ANSWERS - Covers physician services, outpatient hospital services, labs/diagnostics, medical equipment, and some health services - Supplemental medical insurance requiring recipients to pay a premium - NPs and CNs receive 85% of physician reimbursement for services provided in collaboration w/ a physician - Medicare pays 80% of pts bill and pt pays 20% Medicare C - CORRECT ANSWERS A + B aka Medicare Advantage - Can receive all healthcare services through one of the provider organizations under part C Medicare D - CORRECT ANSWERS - Limited prescription drug coverage - Monthly premium required - Co-pay on each prescription required Incident-to-billing - CORRECT ANSWERS • Are services supervised by certain non-physician practitioners such as PA, NP, CNS, nurse midwives, or clinical psychologist. • To qualify as "incident to" services must be part of your patient's normal course of treatment, during which a physician personally performed an initial service and remains active. AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ • Bill under physician • Physician must be in the same building • 100% • Not allowed in the hospital setting Case Management - CORRECT ANSWERS - Involves Comprehensive and systematic approach to provide quality care - Purpose: mobilize, monitor, and control resources that a pt can use during a course of an illness while balancing quality and cost Quality and Safety Education for Nurses (QSEN): 6 competencies - CORRECT ANSWERS 1. Pt-centered Care 2. Teamwork and Collaboration 3. EBP 4. Quality Improvement 5. Safety 6. Informatics Root Cause Analysis - CORRECT ANSWERS - Tool for identifying prevention strategies to ensure safety - Process that is part of the effort to build a culture of safety and move beyond blame Involves and Incorporates: - interdisciplinary experts from frontline services - those most familiar w/ the situation AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ 4. Qualitative/Cohort 5. Case controlled studies 6. Editorial PICOT - CORRECT ANSWERS P: Population I: Intervention C: Comparison O: Outcome T: Time Type 1 and 2 Errors - CORRECT ANSWERS type 1 = false positive; Incorrectly rejecting the true null hypothesis type 2 = false negative; Failing to reject a null hypothesis which is false Level of Significance - CORRECT ANSWERS The probability level of which the results of statistical analyses are judged to indicate a statistically significant difference between groups The probability of false rejection of the null hypotheses is a statistical test P < 0.05 is significant Reliability vs. Validity - CORRECT ANSWERS reliability (consistency): AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ The consistency of a measurement or the degree to which an instrument measures the same way over time w/ the same subjects/ test/retest (same scores; internal consistency validity (accuracy): The degree to which a variable measures what it is intended to measure Libel vs. Slander - CORRECT ANSWERS Libel: Written Slander: Spoken Sensitivity vs. Specificity - CORRECT ANSWERS Sensitivity : - True Positives - The degree to which those who have a disease screen/test positive Specificity: - True Negatives - The degree to which those who do not have the disease screen/test negative Incidence vs. Prevalence - CORRECT ANSWERS Incidence (#) is the frequency of which a disease/disorder appears in a particular population or area at a given time Prevalence (%) is the proportion of the population that is affected by disease/disorder at a particular time. AGACNP Board Review Test Exam with 490Questions and Answers BRAND NEW Latest Update 2024 RATED A+ Ominous Signs of Asthma - CORRECT ANSWERS - fatigue - absent breath sounds - paradoxical chest/abdominal movement - inability to maintain recumbency - cyanosis - etc. Labs/ Diagnostics for asthma - CORRECT ANSWERS Slight WBC count elevation w/ eosinophilia PFTs - Hospitalization is recommended if FEV1 does not improve after initiating bronchodilation - Hospitalization is recommended if peak flow is < 60 L/min initially or does not improve after tx - Initially Respiratory alkalosis w/ mild hypoxemia. Once they stop breathing, respiratory acidosis Step 1: Managing Asthma - CORRECT ANSWERS SABA PRN - consider low-dose ICS when SABA used Step 2: Managing asthma - CORRECT ANSWERS Preferred: Low-dose ICS (budesonide, fluticasone, triamicnolone)