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APEA Pearls to help pass FNP boards Title
oxacin correct answer: fluoroquinolones terol correct answer: beta agonist tropium correct answer: inhaled anticholinergic "prevents bronchospasm" ipratropium (atrovent) one or ide correct answer: inhaled steriods -lol correct answer: beta blocker triptan correct answer: migraine (constricts cerebral arteries--to not overuse) mycin correct answer: macrolide -pam correct answer: benzo -dine correct answer: h2 blockers (famotidine) prazole correct answer: proton pump inhibitor -ide correct answer: thiazide diuretic -pril correct answer: ace inhibitor -sartan correct answer: ARB -lol correct answer: Beta Blocker
-pine correct answer: calcium channel blocker---first line for ISH -gliptan correct answer: diabetic med--no hypoglycemia -sin correct answer: alpha adrenergic blockers (tx BPH) 4 indications for cxr with acute cough correct answer: abnormal VS rales, consolidation
75 years old fever Who gets PPSV23 vaccine?? correct answer: -single dose 65 or older -single dose 19-64 if chronic illness, smoker, group home -Immunocompromised receive another dose at 5 YEAR interval -ALWAYS get dose at 65 even if received earlier doses as long as 5 Years has passed!! Bacteria responsible for most pneumonia deaths correct answer: Strep pneumonae (Gram -) Three most common bacteria - CAP correct answer: S. Pneumoniae Mycoplasma pneumoniae (walking pneumonia) Chlamydophila pneumoniae Best initial antibiotics for pneumonia if no antibiotic exposure in last 3 months correct answer: Doxycycine or Macrolide
What classifies persistent asthma? correct answer: >2 days /wk symptoms; nighttime sx >3 x month How do postitive PPD readings differ for immunocompromixed patients? correct answer: smaller size of induration positive if immunocompromized (>15 mm if healthy, >5mm if HIV) What does Baciille Calmette Guerin vaccine protect against? correct answer: BCG vaccine for TB. Given in other countries. At what age should you do a f/u CXR after treatment for pneumonia correct answer: Anyone over 40 Possible sequelae of long term inhaled steroid use correct answer: cataract formation osteoporosis rising A1C What cardiac class is bad for COPD /Asthma correct answer: - lol; Beta Blockers...opposite affect of SABA and LABAs Which patients typically should have higher h&h??? correct answer: Hgh altitudes, smokers, COPDers What population "generally" has lower h&h? correct answer:
Range of "normocytic" MCV rbc correct answer: 80-90fl <80 microcytic
96 Macrocytic
on a cbc, the size of rbc is described by the correct answer: MCV On a cbc, the hemoglobin content of RBCs is decribed by the correct answer: MCH (mean corpucular hgb) hypo/hyperchromic?? Normal Hgb correct answer: 11-15g/dl normal Hct correct answer: 33-45% RDW - what is it? What is normal? correct answer: indicates degree of variation in RBC size (<15 is normal) ...do not want large variation in rbc sizes! serum iron measures? correct answer: measure of iron in circulation (reciprocal with TIBC) egg carton serum ferritin measures? correct answer: iron in storage TIBC (transferrin) correct answer: total Iron binding capacity- reciprocal with iron level Microcytic , hypochromic anemia correct answer: Iron deficiency anemia Most common causes of iron deficiency anemia correct answer: hemolysis impaired rbc production blood loss poor iron absorption (celiac disease)
Pernicious anemia correct answer: B12 deficiency often ABSORPTION problem..not dietary deficiency! Macrocytic What other nutrient should you check with a B12? correct answer: Folate!! Elevated levels of MMA and homocystiene indicate what ???? correct answer: Sensitive measures of B12 deficiency...B needed for metabolism of these MCV>100 correct answer: Pernicious anemia s/s of pernicious anemia correct answer: dementia, neuopathy, weakness, elderly, vegans, alcholics, bariatric patients B12 supplementation correct answer: Vit B12 IM every day for one week----then weekly x4----than monthly for life when do monocytes elevate? correct answer: after 24 hours of illness what does it mean if polys and lymphocytes are close numerically? correct answer: think "viral" Another name for Neutrophils correct answer: segs or polys What if polys are high on WBC correct answer: bacterial what do bands mean? correct answer: bone marrow thinks you are SICK! Sending out immature cells for backup
What if wbc count normal, but shift to left or right?? correct answer: May be early in infection, or pt immunosuppressed. what is a shift to the left? correct answer: increase in number of bands or "baby" neutrophils in blood smear..indicative of active infection What is the major concerning sequelae from pseudotumor cerebri? correct answer: loss of vision characteristics of migraine correct answer: unilateral crescendo 4-72 hours n/v; photophobis acute treatment for migraine?? correct answer: triptans--arterial constriction; expensive...do not overuse or will become ineffective prophylaxis for migraines correct answer: Topiramat; depakote; beta-blockers who should NEVER get a tryptan?? correct answer: CAD!! or HTN h/a with band-like squeeze? correct answer: tension h/a Sudden severe brief unilateral facial pain?? intense, sharp, stabbing correct answer: trigeminal neuralgia --CN V --- trigeminal nerve
important w/u in assessment for dementia correct answer: TSH, B12, Folate, RPR, HIV, CBC, CMP..imaging to r/o injury or bleed how would you manage a migraine in a hypertensive patient? correct answer: Toradol. No tryptan!!! What cranial nerve might cause hearing loss and vertigo? correct answer: VIII-vestibulocochlear pneumonic for cranial nerves (dirty) correct answer: oh, oh, oh, to touch and feel vaginas get vinny all hot CNI correct answer: olfactory You have one nose, so the olfactory nerve is CN I CNII correct answer: Optic ---checked with snellen chart You have two eyes, so the optic nerve is CN II, which functions to produce vision. what does 20/200 vision mean? correct answer: at 20 ft...the person can see what a normal person can see at 200 feet. CNIII correct answer: oculomotor---eye movements, pupillary constriction, accommodation CNIV correct answer: Trochlear ---movemnt of superior oblique muscle
CNV correct answer: Trigeminal-sensation to face, cheek, and teeth. Motor---mastication CNVI correct answer: Abducens--lateral rectus muscle movement CN VII correct answer: Facial: facial muscles and taste---think Bells palsy CN VIII correct answer: Vestibulocochlear---hearing balance awareness of position The number 8 resembles an ear, so CN VIII, the vestibulocochlear/acoustic nerve is a sensory nerve for hearing. CN IX correct answer: Glossopharyngeal--sensation to tongue, pharynx and tympanic membrane CN X correct answer: Vagus---parasympathetic CN XI correct answer: Spinal accessory --- sternocleidomastoid/trapezius 11 looks like pair of arms /shoulders... test...shoulder shrug... CN XII correct answer: Hypoglossal motor fibers of tongue...stick out tongue The saying The tongue licks the wound is a reminder that when the hypoglossal nerve (CNXII) is damaged, the tongue deviates to the same side of a lesion to the cranial nerve. (eg, if the
Sulfonamides correct answer: Bactrim Gram -; MRSA!!!! What are the best options for MRSA correct answer: Clindamycin, Tetracyclines, Bactrim 1st gen Cephalosporin correct answer: Keflex---Gram + 2nd gen Cephalosporin correct answer: Cefuroxime, Gram + and Gram - Should you use cefuroxime to treat infection in pt. who has received antbx in last few months?? correct answer: NO...probably betalactamase producer.. 3rd generation cefalosporin correct answer: Cefixime (suprax), Ceftibuten ...weak gram -, gram +...beta lactamase!!! should you use ceftibuten to treat infection in pt. who has received antbx in last few months?? correct answer: YES! Beta lactamase cover Extended spectrum 3rd gen Cephalosporins correct answer: Rocephin (ceftriaxone), cefdinir Gram +, Gram -, B-lactamases!!! Macrolides (Later gen) correct answer: Azithromycin, Clarithromycin Atypical pathogens! NOT STREP!
Fluoroquinolones 2nd gen correct answer: Cipro---gram - ; atypical pathogens why is cipro a poor choice to treat CAP? correct answer: strep pneumo Gram+....doesn't cover for DRSP Respiratory Fluoroquinolones --3rd gen correct answer: Levofloxacin---the idiot's antibiotic! Kill everything except MRSA. SAVE AS LAST RESORT Resp Fluoroquinolones--4th gen. correct answer: moxifloxacin, gemifloxacin, gatifloxacin Gram+, Gram-, Atypicals, Beta lactamase, DRSP DO NOT USE BELOW THE BELT!! What is the most effective fasting time for lipid panel?? correct answer: Most accurate after 12 hour fast. What are the CHD equivalents when deciding whether or not to treat hyperlipidemia? correct answer: Diabetes symptomatic CAD PAD AAA What cardiac class may cause exercise intolerance correct answer: Beta Blockers -lol slows heart rate. What diuretic bp med should not be given to a patient with hx of severe reaction to bactrim correct answer: HCTZ...has a sulfonamide ring!!!
What is the earliest detectable glycemic abnormality in a patient with type 2 diabetes correct answer: postprandial hyperglycemia precedes fasting hyperglycemia Target blood pressure for diabetic correct answer: less than 130/80!!! How should ACE be managed as treatment for proteinuria in diabetic?? correct answer: Effect should be seen in 6-8 weeks. Titrate ACE upward til urine protein <500 or pt. has bad side effects from ARB or ACE. Second agent can be added if max dose reached without success. Monitor K and CRE levels with dose changes What are the ADA goal for diabetic lipid values?? correct answer: HDL >50 in women; >40 men LDL< Trigs < no rec for total Chol How do you dose T4? correct answer: Wt in kg. x 1.6 to calcluate daily requirement. Prescribe this unless elderly or with existing CAD. Dose lower. Triad for mono correct answer: fever, lymphadenopathy, pharyngitis what are the identifying otic characteristics of AOM? correct answer: Middle ear effusion AND erythema of TM
How will liver functions ALT/AST be altered in long term alcoholic correct answer: both are typically below 40. In alcoholic hepatitis AST:ALT ratio usually 2: What is Glucose-6-phosphate dehydrogenase deficiancy??? correct answer: x-linked disorder; m and f. most common enzymatic disorder of red cells. avoid asa, sulfa, fava beans...cause rapid lysis of cells How is iron best absorbed? correct answer: on an empty stomach What type of anemias are most likely in an elderly patient with history of chronic illnesses and poor health for over a decade?? correct answer: folic acid and pernicious----malabsorbption!!! Hallmark finding with B12 and folate deficiencies??? correct answer: macrocytosis 35 yo with normal paps since 18. Normal pap and hpv..when should she be tested again??? correct answer: 5 YEARS....ACOG says testing no more than every 5 years in women over 30 if BOTH tests are negative and adequate screening has taken place. If PAP ONLY ---rec is every 3 YEARS. HPV testing in combo with pap is more sensitive. HPV testing is more SPECIFIC in women over 30. HPV testing ALONE is NOT recommended. A localized tumor in the prostate gland associated with early stage prostate CA is likely to produce...
carotid bruit have double stroke risk. Other vessels should be evaluated. MORE LIKELY TO DIE OF CARDIOVASCULAR DISEASE THAN CEREBROVASCULAR DISEASE How long will it take to evaluate the effectiveness on acetylcholinesterase inhibitor drugs like donezepil used in Alzheimer's? correct answer: 6-12 months. Eval includes family report. MMSE, ADL assessment, and side effects. What are the presenting symptoms, treatment for temporal arteritis? correct answer: Dx with biopsy. Chronic vasculitis...new onset HA, abrupt visual disturbance, jaw claudication, unexplained fever or anemia, elveated sed rate. Avg. age of onset 72 yo. Which fingers are not affected by carpal tunnel? correct answer: Fifth finger (pinky) Anosmia...what cranial nerve should be evaluated. correct answer: I-olfactory (1 nose!) Elderly pt. at increased risk for stroke..Daily ASA is an example of what kind of prevention? correct answer: PRIMARY....would be secondary if history of stroke. When should you consider imaging for low back pain in a pt without red flags or hx or cancer, advanced age, or hx of trauma? correct answer: 4 weeks at earliest In what part of the hip does osteoarthritis cause pain? correct answer: The anterior hip.
Finkelstein test correct answer: DeQuervians tenosynovitis What is first line drug for osteo arthritis pain not relieved by nonpharm methods?? correct answer: Tylenol 650mg qid! Less risk than nsaids. Try first According to Ottawa ankle rules..when should you image a sprain? correct answer: midfoot pain/bone tenderness, bone tenderness at base of the 5th metatarsal or unable to bear weight for 4 steps Should you routinely screen TSH in pregnant women? correct answer: Only if hx of hypothyroidism, family hx, or s/s. NP scope of practice is influenced by a number of factors. Which of the following does not? a.code of ethics b.state and federal laws c.Court of law d.Educational preparation correct answer: c. Court of law it is established legally, ethically, and by boards of nursing and professional organizations. It sets the boundaries and indicates what is permitted legally, etc. It is NOT influenced by court of law and varies from state to state. Who determines NPs legal authority to practice in any state? correct answer: The state legislature of the state. rules and regs may be promulgated by state boards of nursing that reflect scope of practice of nurse practitioners specific to that state.
