AACN AGACNP Review Exam Study Guide Grade A Certified 2025/26

Hx of severe/poorly controlled HTN or severe, uncontrolled arterial HTN SBP180 and DBP 110 Ischemic stroke 3 months ago. Trauma or major surgery in the last 3 weeks. Puncture of a non-compressible vessel. Hemorrhagic ophthalmic condition. PT 15 sec or current use of anticoagulants. Known or suspected pregnancy. subarachnoid hemorrhage (SAH) - correct answers Bleeding into the subarachnoid space secondary to a cerebral aneurysm or head injury. Thunder clap headache. Vomiting. Confusion/LOC. Seizures. Treatment: BP Control Surgical intervention. Epidural Hematoma - correct answers Temporal or parietal skull fracture Middle meningeal artery injury. Rapid blood accumulation from arterial source between the dura mater and the skull. Headache TRANSIENT LOC Unilateral fixed pupil Nausea/vomiting Dizziness Treatment: BP Control Surgical intervention. Subdural Hematoma - correct answers Damage to the bridging veins causing blood to accumulate under the dura mater. Can be acute or chronic. Headache Gradual LOC/change in mental status Seizures Treatment: Surgical intervention Watch and wait. Anti-seizure prophylaxis. Kernig's Sign - correct answers Sign of meningitis; positive when the leg is fully bent at the hip and knee, and subsequent extension of the knee leads to pain. Brudzinski's Sign - correct answers Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. Bacterial Meningitis - correct answers Glucose 45 mg/dl Protein 50 mg/dl Opening pressure is markedly high. Cell count 200-20,000 PMN/microliter. Viral Meningitis - correct answers Glucose Normal Protein 50 mg/dl and purulent. Opening pressure Normal/slightly elevated. Cell count 100-1000 lymphocytes/microliter Physiologic (AKA innocent/functional) - correct answers Grade 1-3/6 early to midsystolic murmur. Heard best at LSB but usually audible over precordium No radiation. Softens or disappears with standing. Increases in intensity with activity, fever, anemia. S1 and S2 intact. PMI normal. Aortic Stenosis Murmur - correct answers Grade 1-4/6 harsh systolic murmur, usually crescendo-decrescendo pattern. Heard best at 2nd RICS, apex, and softens with standing. Radiates to carotids, may have diminished S2, slow filling carotid pulse, narrow pulse pressure, loud S4, heaving PMI. Great the degree of stenosis the later the peak of murmur. Younger adults due to bicuspid valve. Older adults due to calcific /rheumatic. Dizziness and syncope are an ominous sign pointing to severely decreased cardiac output. Aortic sclerosis - correct answers Grade 2-3/6 systolic ejection murmur best heard at RICS. Carotid upstroke full, not delayed, no S4, absence of symptoms. Benign thickening of the aortic valve leaflets. No change in valve pressure gradient. 50 over 50 (found in 50% of those over 50) Aortic regurgitation - correct answers Grade 1-3/4 high pitched blowing diastolic murmur heard best at 3rd LICS. May be enhanced by forced expiration, leaning forward. Usually S3, wide pulse pressure, sustained thrusting apical impulses. More common in men usually from rheumatic heart disease and occasionally due to tertiary Syphilis. Mitral Stenosis Murmur - correct answers Grade 1-3/4 low pitched late diastolic murmur best heard at the apex. Short crescendo-decrescendo rumble like a bowling ball rolling down an alley or distant thunder. Often with an opening snap, accentuated S1 in the mitral area. ENHANCED by LEFT LATERAL DECUBITUS POSITION, squat, cough, immediately post Valsalva. Nearly all rheumatic in origin. Protracted latency period then gradual decrease in exercise tolerance leading to a rapid downhill course due to low cardiac output. AF common. Atrial Septal Defect ASD - correct answers Grade 1-3/6 systolic ejection murmur in the pulmonic area. Widely split S2, right ventricular heave. Typically without symptoms and then middle aged HF. Persistent ostium secundium in mid septum. Will resolve with ASD correction. Pulmonary Hypertension - correct answers Narrow splitting S2, murmur of tricuspid regurgitation. SOB nearly universal. Seen RVH, RAH as identified on EKG/echo. Secondary PH may be a consequence of Redux "Phen/fen" use