ANCC FNP Board Exam Study Guide Part 1 Questions &
Answers.
Treatment for chronic bronchitis - -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 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
Actinic keratosis - -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
-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.
Seborrheic keratosis - -soft, round, wart-like fleshy growths on trunk (mostly on back)
-can range in color from light tan to black
-appear to be pasted on
-asymptomatic
-benign
Fingernail hematoma treatment - -Trephination - make hole in nail through drilling or
piercing and allow blood to drain
Hypothyroid - -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
-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
Hyperthyroid - -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;
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
Increased risk of ectopic pregnancy - -Risk factors - previous ectopic, salpingitis, tubal
surgery, current IUD use, previous cervicitis, history of PID
-Symptoms - abdominal pain (worsens when supine or with jarring), vaginal bleeding,
amenorrhea, low grade fever, pain referred to right shoulder (may indicate rupture)
Hypertension Meds Part 1 - -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 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.
Hypertension Meds Part 2 - -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
-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
Hypertension Meds Part 3 - -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
-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
Risk factors for post-menopausal osteoporosis - -older women; white/Asian descent;
thin; small body frame; chronic steroids; androgen deficiency; hypogonadism; anorexia;
bulimia; gastric bypass; celiac disease; hyperthyroidism; ankylosing spondylitis; RA; low
Answers.
Treatment for chronic bronchitis - -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 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
Actinic keratosis - -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
-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.
Seborrheic keratosis - -soft, round, wart-like fleshy growths on trunk (mostly on back)
-can range in color from light tan to black
-appear to be pasted on
-asymptomatic
-benign
Fingernail hematoma treatment - -Trephination - make hole in nail through drilling or
piercing and allow blood to drain
Hypothyroid - -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
-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
Hyperthyroid - -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;
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
Increased risk of ectopic pregnancy - -Risk factors - previous ectopic, salpingitis, tubal
surgery, current IUD use, previous cervicitis, history of PID
-Symptoms - abdominal pain (worsens when supine or with jarring), vaginal bleeding,
amenorrhea, low grade fever, pain referred to right shoulder (may indicate rupture)
Hypertension Meds Part 1 - -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 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.
Hypertension Meds Part 2 - -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
-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
Hypertension Meds Part 3 - -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
-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
Risk factors for post-menopausal osteoporosis - -older women; white/Asian descent;
thin; small body frame; chronic steroids; androgen deficiency; hypogonadism; anorexia;
bulimia; gastric bypass; celiac disease; hyperthyroidism; ankylosing spondylitis; RA; low
