ANCC FNP Board Exam Study Guide Part 1- Questions and Answers
-Chronic bronchitis is a type of COPD that is characterized by inflammation of the
bronchi, causing excess mucus; characteristics of chronic bronchitis include
diagnosis after age 35, obesity, copious amounts of purulent sputum, elevated Hct
Treatment for chronic bronchitis level
-Treat with SABA (albuterol), inhaled anticholinergics (ipratropium)
-Normal Findings of Lungs: Lower lobes vesicular breath sounds (soft and low)
Upper lobes; Bronchial breath sounds louder
-Older to elderly fair-skinned adults
-numerous dry, round, pink to red-colored, slow-growing lesions that do not heal
-lesions common on sun-exposed areas (cheeks, nose, face, arms, back)
-precancerous precursor of squamous cell carcinoma
Actinic keratosis -frequent sunburns as child places person at higher risk
-diagnosed with biopsy
-treat with cryotherapy (small number) or 5-FU(5% fluorouracil) cream (large
number)
follow up with derm.
-soft, round, wart-like fleshy growths on trunk (mostly on back)
-can range in color from light tan to black
Seborrheic keratosis -appear to be pasted on
-asymptomatic
-benign
Fingernail hematoma treatment -Trephination - make hole in nail through drilling or piercing and allow blood to drain
-Primary - elevated TSH; low T4; low or normal T3
-Subclinical - elevated TSH; normal T4; normal T3
-Common cause is Hashimoto's (autoimmune) - Hashimoto and Hypo both have O
Hypothyroid -Symptoms are variable - may include fatigue
-Treatment - levothyroxine (Synthroid) daily in AM on empty stomach
-Starting dose of levothyroxine (Synthroid) is 25-50mcg
-Check TSH every 6-8 weeks to monitor treatment
, -Primary - low TSH; high T4; normal or high T3
-Subclinical - low TSH; normal T4; normal T3
-Most common cause is Grave's Disease (autoimmune) - Grave and Hyper both have
R
-Common symptoms - female; rapid weight loss; increased heart rate; tremors;
sweating; irritability; anxiety; hyperactivity; insomnia; diarrhea; amenorrhea;
Hyperthyroid
hypertension; exophthalmos; heat intolerance; goiter
-Treatment - Propylthiouracil (PTU); Methimazole (Tapazole); Radioactive iodine
(causes hypothyroid for life, contraindicated in pregnancy)
-Thyroid Storm (thyrotoxicosis) - acute worsening of symptoms; may be caused by
stress or infection; look for LOC, fever, abdominal pain; life-threatening; immediate
hospitalization needed
-Risk factors - previous ectopic, salpingitis, tubal surgery, current IUD use, previous
cervicitis, history of PID
Increased risk of ectopic pregnancy
-Symptoms - abdominal pain (worsens when supine or with jarring), vaginal bleeding,
amenorrhea, low grade fever, pain referred to right shoulder (may indicate rupture)
-African-American with or without diabetes - initial choices include thiazide diuretic
or CCB
-Non-Black with or without diabetes - initial choices include thiazide diuretic, CCB,
ACE, or ARB
-Thiazide diuretic - "ide"; excellent synergist; avoid in sulfa allergy; favorable in
osteopenia/osteoporosis; side effects include hyperglycemia (caution in diabetics),
hyperuricemia (gout attack), hypertriglyceridemia and hypercholesteremia (check
Hypertension Meds Part 1 lipid profile), hypokalemia (potentiates digoxin toxicity and increases risk for
arrhythmia), hyponatremia (hold diuretic, restrict fluid, replace K+); lowers BP only 2-
8 points
-ACE inhibitor - "pril" and ARB - "sartan" - use in high renin states; drug of choice in
diabetics (protects kidneys); pregnancy category C/D; side effects include
dry/hacking cough (more with ACE), hyperkalemia, angioedema (rare, life-
threatening); contraindicated in moderate to severe kidney disease; do not use ACE
and ARB together.
-Beta blocker - "lol"; good as add-on medication, not uncomplicated HTN; avoid
abrupt discontinuation, wean slowly to avoid rebound HTN; contraindications
include asthma, COPD, chronic bronchitis, emphysema, second and third-degree
heart block (okay with 1st degree), sinus bradycardia; do not use Propranolol for HTN
Hypertension Meds Part 2
-Calcium channel blocker - "pine"; first choice for ISH (isolated systolic HTN); side
effects include headaches (vasodilation), ankle edema (vasodilation, benign), heart
block/bradycardia (depresses cardiac muscle and AV node), reflex tachycardia
(nifedipine); contraindicated in 2nd and 3rd degree heart block, bradycardia, CHF
-Heart Failure: ACEI or ARB as first-line, plus BB, plus diuretic
-DM: ACE/ARB first line, IF African American, can start with CCB or Thiazide
-CKD: ACE/ARB first line, can add CCB or Thiazide
Hypertension Meds Part 3 -Stroke Hx: ACE/ARB first line, add CCb or Thiazide as second-line drugs.
-African American even with DM Thiazides and CCBs.
-Bilateral Renal artery stenosis: ACE AND ARB will WORSEN or cause acute renal
failure. CONTRAIN
-older women; white/Asian descent; thin; small body frame; chronic steroids;
Risk factors for post-menopausal androgen deficiency; hypogonadism; anorexia; bulimia; gastric bypass; celiac
osteoporosis disease; hyperthyroidism; ankylosing spondylitis; RA; low calcium intake; vitamin D
deficiency; inadequate physical activity; alcohol/caffeine intake; smoking
-Chronic bronchitis is a type of COPD that is characterized by inflammation of the
bronchi, causing excess mucus; characteristics of chronic bronchitis include
diagnosis after age 35, obesity, copious amounts of purulent sputum, elevated Hct
Treatment for chronic bronchitis level
-Treat with SABA (albuterol), inhaled anticholinergics (ipratropium)
-Normal Findings of Lungs: Lower lobes vesicular breath sounds (soft and low)
Upper lobes; Bronchial breath sounds louder
-Older to elderly fair-skinned adults
-numerous dry, round, pink to red-colored, slow-growing lesions that do not heal
-lesions common on sun-exposed areas (cheeks, nose, face, arms, back)
-precancerous precursor of squamous cell carcinoma
Actinic keratosis -frequent sunburns as child places person at higher risk
-diagnosed with biopsy
-treat with cryotherapy (small number) or 5-FU(5% fluorouracil) cream (large
number)
follow up with derm.
-soft, round, wart-like fleshy growths on trunk (mostly on back)
-can range in color from light tan to black
Seborrheic keratosis -appear to be pasted on
-asymptomatic
-benign
Fingernail hematoma treatment -Trephination - make hole in nail through drilling or piercing and allow blood to drain
-Primary - elevated TSH; low T4; low or normal T3
-Subclinical - elevated TSH; normal T4; normal T3
-Common cause is Hashimoto's (autoimmune) - Hashimoto and Hypo both have O
Hypothyroid -Symptoms are variable - may include fatigue
-Treatment - levothyroxine (Synthroid) daily in AM on empty stomach
-Starting dose of levothyroxine (Synthroid) is 25-50mcg
-Check TSH every 6-8 weeks to monitor treatment
, -Primary - low TSH; high T4; normal or high T3
-Subclinical - low TSH; normal T4; normal T3
-Most common cause is Grave's Disease (autoimmune) - Grave and Hyper both have
R
-Common symptoms - female; rapid weight loss; increased heart rate; tremors;
sweating; irritability; anxiety; hyperactivity; insomnia; diarrhea; amenorrhea;
Hyperthyroid
hypertension; exophthalmos; heat intolerance; goiter
-Treatment - Propylthiouracil (PTU); Methimazole (Tapazole); Radioactive iodine
(causes hypothyroid for life, contraindicated in pregnancy)
-Thyroid Storm (thyrotoxicosis) - acute worsening of symptoms; may be caused by
stress or infection; look for LOC, fever, abdominal pain; life-threatening; immediate
hospitalization needed
-Risk factors - previous ectopic, salpingitis, tubal surgery, current IUD use, previous
cervicitis, history of PID
Increased risk of ectopic pregnancy
-Symptoms - abdominal pain (worsens when supine or with jarring), vaginal bleeding,
amenorrhea, low grade fever, pain referred to right shoulder (may indicate rupture)
-African-American with or without diabetes - initial choices include thiazide diuretic
or CCB
-Non-Black with or without diabetes - initial choices include thiazide diuretic, CCB,
ACE, or ARB
-Thiazide diuretic - "ide"; excellent synergist; avoid in sulfa allergy; favorable in
osteopenia/osteoporosis; side effects include hyperglycemia (caution in diabetics),
hyperuricemia (gout attack), hypertriglyceridemia and hypercholesteremia (check
Hypertension Meds Part 1 lipid profile), hypokalemia (potentiates digoxin toxicity and increases risk for
arrhythmia), hyponatremia (hold diuretic, restrict fluid, replace K+); lowers BP only 2-
8 points
-ACE inhibitor - "pril" and ARB - "sartan" - use in high renin states; drug of choice in
diabetics (protects kidneys); pregnancy category C/D; side effects include
dry/hacking cough (more with ACE), hyperkalemia, angioedema (rare, life-
threatening); contraindicated in moderate to severe kidney disease; do not use ACE
and ARB together.
-Beta blocker - "lol"; good as add-on medication, not uncomplicated HTN; avoid
abrupt discontinuation, wean slowly to avoid rebound HTN; contraindications
include asthma, COPD, chronic bronchitis, emphysema, second and third-degree
heart block (okay with 1st degree), sinus bradycardia; do not use Propranolol for HTN
Hypertension Meds Part 2
-Calcium channel blocker - "pine"; first choice for ISH (isolated systolic HTN); side
effects include headaches (vasodilation), ankle edema (vasodilation, benign), heart
block/bradycardia (depresses cardiac muscle and AV node), reflex tachycardia
(nifedipine); contraindicated in 2nd and 3rd degree heart block, bradycardia, CHF
-Heart Failure: ACEI or ARB as first-line, plus BB, plus diuretic
-DM: ACE/ARB first line, IF African American, can start with CCB or Thiazide
-CKD: ACE/ARB first line, can add CCB or Thiazide
Hypertension Meds Part 3 -Stroke Hx: ACE/ARB first line, add CCb or Thiazide as second-line drugs.
-African American even with DM Thiazides and CCBs.
-Bilateral Renal artery stenosis: ACE AND ARB will WORSEN or cause acute renal
failure. CONTRAIN
-older women; white/Asian descent; thin; small body frame; chronic steroids;
Risk factors for post-menopausal androgen deficiency; hypogonadism; anorexia; bulimia; gastric bypass; celiac
osteoporosis disease; hyperthyroidism; ankylosing spondylitis; RA; low calcium intake; vitamin D
deficiency; inadequate physical activity; alcohol/caffeine intake; smoking
