ANCC Exam 2023 with complete solutions

Types of prevention - Answer- primary- car restraints, bicycle helmets, immunizations secondary- prevent for those with RF-pap, mammo tertiary-mgmt of established disease- meds, lifestyle Primary - Answer- Preventing the health problem, most cost effective form of healthcare **IMMUNIZATIONS, ensuring adequate illumination at home (preventing falls) Secondary - Answer- Detecting disease in early asymptomatic stages, screenings -Early cause finding of asymptomatic disease via the use of a screening test Ex. highly abnormal mammo not final word Tertiary - Answer- Minimizing negative disease induced outcomes, potentially viewed as a failure of primary prevention Ex- rehab, PT, OT Who should not receive influenza vaccine - Answer- 4 mon old born at 32 weeks gestation receive flu- 6 mon and older can give during pregnancy/lactation give children 2x- 4 months apart MMR - Answer- preggers can't receive (no varicella, or zoster, smallpox, flu mist, rotavirus), but lactation OK! its live but weakened give again to those born after 1957 Give to 6-11 month who are travelling outside US May treat and have an innocent flat pink rash 2 doses ( at 12-15 mon and 4-6 years) Tetanus - Answer- can get from soil, a depth of the wound is important Preggers- get a tdap in her thirst trimester to pass onto the unborn child (pertusis is a bad outcome!), family members need to be up to date- can cause lockjaw T-dap- 1 at 11-64 and then booster every 10 dTap-five doses Pertussis- uncontrollable cough, vomitting, fatigue, dx: nasopharyngeal culture and PCR testing tx: Azithromycin No pap smear - Answer- prior to 21 or in elderly Benadryl - Answer- older, cross BBB, can cause sedation, urinary retention (bad for BPH) herpes zoster - Answer- stronger chickenpox vaccine-zoster vaccine post-herpetic neuralgia- persists after 1 month Herpes keratitis is damage to the corneal epithelium caused by the herpes virus, commonly shingles. The patient usually has acute onset of eye pain, photophobia, and blurred vision in the affected eye. primary open angle glaucoma - Answer- peripheral vision loss, elevated intraocular pressure, deep-cupping of optic disc, tx with beta-adrenergic antag (Timolol), alpha agonists, prostaglandin analogues Glaucoma screening test- Tonometry Normative aging - Answer- Need for increased illumination Macular degeneration - Answer- central vision loss, common cause of new onset blindness in elderly More females Screening tests- Amsler grid test Meniere's disease (idio) vs. Meniere's syndrome (secondary) - Answer- dizziness, tinnitius, nystagmus, vertigo RF: ototoxic drugs, tx: benzos for rest and corticosteroids for anti-inflam oral cancer - Answer- ulcerated lesion with indurated margins, most common SCC, RF: HPV 16, screening at dental visits beta lacatams with allergic reactions - Answer- penecillins, cephalosporins, carbapenems rashes with Epstein Barr Otitis externa - Answer- Caused by fungus- Candidia or Aspergillus/P. aeruginosa hallmark is pain on palpating tragus Tx--> fluoroquinolone AOM - Answer- S.penumoniae (gram pos)-40-50%, tx with amox/cephalo, macrolides, resistance protein binding sites H.influenza (gram neg)- can produce beta-lactamase M.catarrhalis (gram neg)- also produces beta-lactamase, can get better without antibiotic Need abnormal ear drum (bulging TM) + pain (otalgia)/rubbing/tugging ear tx- Acetaminophen and otic drops help with ST Watchful waiting- 6 months or older, with non-severe illness, unilateral, fever <102.2, otalgia <48 <6 months-begin antibiotic!! if allergy-Cefdinir], RF: pacifier use for 10 months, feedings in the supine, smoke exposure, day care, <2- 10 days 2-6 yrs- 7 days >6 yrs- 5 days 1st line- Amox 90 BID, Amox clav BID With PCN allergy- **Cefdinir (Cephlosporins) Group A strep (GABHS) - Answer- Streptococcus pyogenes, risk for rheumatic fever and Glomerulo., peritonsillar abscess, tx- amox then try macrolide if doesnt't improve GOLD STANDARD IS THROAT CULTURE indoor allergen - Answer- dust mites (perennial), pets, cockroaches, mold spores Acute Bacterial rhinosinusitis - Answer- S.penumoniae**, RF-viral infection, allergies, tobacco use, 1st line is Augmentin, penicillin allergy-Cefdinir 2nd line- if not better...Clindamycin and Cefixime Mono - Answer- 30-50 days ago was infected before sxs, give prednisone not amox (rash), at least 50% present with spleen enlargement, wait 1 month to go back to sports Anterior and posterior cervical lymph Pharyngitis with exudate right and left upper quadrant abdominal tendernes Hepatomegaly in 10% of cases Splenomegaly in 50% of cases Asthma flare - Answer- FEV1/Peak expiratory flow rate- drops early (even before patient notices) and good indication of severity of asthma S3 - Answer- systolic dysfunction or early diastolic, common in HF (dyspnea, crackles, tachycardia- 3 adject/s3), marker of ventricular overload- best heard with bell S4 - Answer- diastolic dysfunction, common in poorly-controlled hypertension, recurrent myocardial ischemia, unstable angina Systolic Murmurs - Answer- Mitral (rad to axilla) Mitral Benign is- negative hx Regurgitation Valve lower grade Physiologic Prolapse no radiation Aortic (rad to neck) PMI WNL Stenosis (harsh) softens w. position change Systolic Diastolic Murmurs - Answer- Mitral Stenosis (Rumble) Atrial Regurg (blowing) Diastolic Aortic stenosis - Answer- young man, exercise tolerance, harsh systolic murmur, softer when changing position, radiation to the neck (assume it came out of AORTIC VALVE) LVH, congenital defect RF- rheumatic fever, older adults-calcification Calcific aortic stenosis - Answer- 82 y/o woman, dizzy walking up a flight of stairs, harsh systolic murmur radiation to neck, Mitral Regurgitation - Answer- 62 y/o male with HTN, HF, PMI displaced (big LV), accentuated when rolled to the side, louder with hand grip, holosystolic, blowing murmur Mitral Valve Prolapse - Answer- 27 y/o woman, runner, oral contraceptive, funnel chest/pectus excavatum, mid-late systolic murmur which moves forward upon position change HONKING (heard best at apex) Marfan's syndrome, scoliosis Tx: obtaining an echo is a prudent next step Encourage aerobic activity 16 y/o male basketball player, which finding on a cardiac exam would warrant immediate eval - Answer- LOUD S4- problem! S4 is the sound of diastolic dysfunction Murmur gets louder with position change (from sitting to standing) ----> HCM Murmurs (mitral regurgitation) - Answer- common in LVH (also PMI shifts would see dyspnea upon exertion) RF: rheumatic heart disease, endocarditis, calcific annulus sports- depends on degree of LVH Asthmastic - Answer- 1st test- FEV or PEFV because its the earliest sign/drops early so best estimation of severity compared to Oxygen sat/ABGs (which drop late) Leadership role - Answer- A process by which a person influences a group of individuals to achieve a common goal Ex. Collaborating with the regional public health department on a initiative to combat obesity through a community-based exercise program (Keyword-collaborating) Support for NP practice - Answer- Focus on output--> NP practice outcomes Research design - Answer- Ranking- highest to lowest Meta-analysis/Systematic Reviews, RCTs, cohort studies, case-control series, case series/reports, expert opinions Research Utilization: Identify the problem Assess published research Design the innovation Evaluate the situation Decide whether to use the innovation Utilization review - Answer- the process of evaluating the appropriateness of inpatient hospitalization. Proof of the medical necessity for the patient's hospitalization is done mainly through chart reviews and is part of the utilization review process. A claim can be denied under this process if the reviewer and the payer do not agree with the decision for hospitalization. Payment could be denied to the healthcare facility if utilization review does not deem the treatment necessary. Avoid accidental burn injuries in home - Answer- home hot water set at no more than 120 (takes 5 mins in length to cause 3rd degree burn) second degree burns- moist, red skin with peeling borders third degree- you debrided Community/herd immnity - Answer- Describes the state in which a sufficient proportion of a pop is immune through vaccination or prior illness- even individuals that aren't vaccinated (infants, immunocompromised) are offered some protection because everyone Active Immunity - Answer- In response to an antigen, presence of an antibody produced in the host (waiting to protect you, 1 month from getting the dose, but LIFELONG=BETTER) Passive Immunity - Answer- Immunity conferred by an antibody produced in another host, acquired naturally by an infant from mother (onset is within hours of getting dose but time limited only 6-9 months) Treatment of analphylaxis - Answer- Immediately administer EPI then administer Benadryl then call 911 Pneumonia vaccine - Answer- Not contra in immunosupressed, does not protect against most pneumonia-causing pathogens (just ococcal), *can give during antimicrobial therapy Flumist - Answer- Only for 2-49 and not in presence of airway disease Immune globulin (passive) - Answer- concentration solution of antibodies derived from pooled donated blood product (SAFE!) Gardasil - Answer- Quadrivalent vaccine- 6, 11, 16, 18 6 and 11-wart virus 16 and 18- malignancy virus Males- get 9-26, get three dose series Hep B vaccine - Answer- previously unvaccinated adults with DM should be vaccinated immediately upon diagnosis (because can be in group type settings/lancets/equipment not cleaned) PPD and MMR - Answer- IF MMR vaccine is given on the previous day or earlier, the PPD TST should be delayed for at least one month (false positive) Elderly with RF - Answer- Given PPSV23 (Pneumovax) 1 year ago, should be given a dose of PCV13 (Prevnar) today- gives an additional boost Live virus - Answer- MMR, Varicella, FluMist, Zoster Contra-Pregnancy, Immuno/HIV only less than 200, Rotavirus- oral vaccine given to infants Restating - Answer- "You said that you got angry when your boyfriend came home last last night" keyword- YOU OPen ended questions - Answer- What's on your mind Clarification - Answer- I don't think i see the connection. Can you explain that to me again? Alcohol Abuse Lab results *** - Answer- AST/ALT- 3x ULN 83/50 (normal 0-31) MCV- 105 (normal 80-96) Hypertriglyceridemia- TG= 325 (normal <150) Transtheoretical Model of Change - Answer- Precontemplation- not interested, minimizes problem Contemplation- considering Preparation- changes in behavior Action- Maintenance/relaspse Ask/Advise/Assess/Assist/Arrange Cancer - Answer- New Cases- Female breast Male prostate Deaths- M=lung, prostate, colon, pancreas F=lung, breast, colon, pancreas Endometrial cancer- unexpected post-menopausal bleeding (represents 50% of all gyno ca) USPSTF recommendations - Answer- women with average risk should have a baseline mammogram at age 50 years. Follow-ups should occur every 2 years. Mammograms can stop at age 74. The American Cancer Society continues to recommend mammograms begin at age 40. Breast screening - Answer- women at high risk (greater than 20% lifetime risk) should get a MRI and mammo q yr Sensitivity vs. specificity - Answer- with a condition vs. without a condition Prevalence vs. Incidence - Answer- proportion with disease vs. # of new cases think "p"revalence " p"roportion Reduced RBC production - Answer- Nutrition, vitamin B12- use of **medications such as Metformin and chronic PPIs (b12 and iron malabsorption) PPI use- increased fracture risk, low magnesium- muscle cramps palpitations Most important source of body's iron supply - Answer- Recycled iron content form aged red blood cells need B12 supplements 78 y/o woman with fatigue, spoon-shaped nails, and lab results MCV low, RDW incr - Answer- Microcytic hypochromic anemia --> examples erosive gastritis menorrhagia so answer is GI blood loss ...then look at Ferritin because its probably IDA Iron maximum absorbs - Answer- on an empty stomach Hemic murmur - Answer- happens with anemia, dehydration, pregnancy goes away with tx 68 y/o woman with peripheral numbness, oral irritation, macrocyctic - Answer- Pernicious anemia cause is Vit 12 deficiency 65 y/o woman with RA with poor control who is on DMARDS - Answer- Anemia of chronic disease Types of anemia - Answer- Iron deficiency anemia-micro, RDW high, Folate deficiency anemia-macro Alpha thalassemia minor- micro Beta thalassemia minor- micro, pale cells Meditarrean HGB HCT 10:30 12:36 15:45 Normocytic (MCV-80-96, RDW= 11.5-14.5) MCHC: 32-36 - Answer- MCV=NL MCHC=NL RDW=NL normochromic anemia with NL RDW Most common etiology: acute blood loss or anemia or chronic disease 1) Acute blood loss or GI bleed 2) Lupus Microcytic (MCV<80) high RDW - Answer- MCV low, MCHC low, RDW high hypochromic anemia with elevated RDW** Most common etiology: 1) Iron deficiency anemia- Low ferritin, high TIBC 2) erosive gastritis, menorrhagia Microcytic (MCV<80) NL RDW - Answer- MCV low, MCHC low, RDW NL Hypochromic anemia with NL RDW** Most common etiology: 1) Alpha thalassemia minor (asian, african) 2) beta thalassemia minor (African, middle eastern, Mediterranean) Macrocytic (MCV>96) high RDW - Answer- MCV high, MCHC NL, RDW high Normochromic anemia with elevated RDW Most common etiology: 1) Pernicious anemia 2) Dietary induced Vit B12 deficiency (numbness of fingertips and oral irritation***)- most common 3) folate deficiency anemia- alcohol abusers Alcoholics- AST 80 (0-31) MCV 103 (80-96) Drug induced macrocytosis usually without anemia - Answer- MCV high, MCHC NL, RDW NL Meds--> Phenytoin/Dilantin, Valproic Acid/Depakote