ANCC FNP BOARD ExAm REviEw
COmPREhENsivE PRACtiCE QuEstiONs &
vERiFiED ANswERs uPDAtED
2026
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)".
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
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)
Live attenuated (weaned) vaccines - ANSWER>>MMR, Varicella and intranasal Flumist.
Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER>>SCID (severe combined
immunodeficiency) or hx intussusception
COmPREhENsivE PRACtiCE QuEstiONs &
vERiFiED ANswERs uPDAtED
2026
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)".
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
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)
Live attenuated (weaned) vaccines - ANSWER>>MMR, Varicella and intranasal Flumist.
Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER>>SCID (severe combined
immunodeficiency) or hx intussusception
