NU 577 / AANP Exam Pearls Latest Exam Prep

NU 577 / AANP Exam Pearls Latest Exam Prep. Exam Format AANP: Exam Pearls  AANP FNP exam contains very few nonclinical questions  Certification tests are designed for entry-level practice  AANP has 15 pilot questions which are not graded [there is NO WAY to identify the pilot test questions from the graded questions]  New clinical info [treatment and/or guidelines] released in the last 10 months won’t be on the exam  Questions will be on primary care disorders – if you are guessing, AVOID PICKING EXOTIC DIAGNOSIS AS AN ANSWER Labs  Normal lab results pertinent to a question WILL ONLY BE LISTED ONCE. Use your scratch sheet of paper to jot down these values if given.  Follow the LAB NORMS GIVEN BY AANP not what you learned in NP school  Learn the significance of abnormal lab values AND type of follow-up needed [i.e. elderly gentleman with c/o scalp tenderness + indurated temporal artery, NP suspects temporal arteritis. Screening test is sed rate – which is expected to be MUCH HIGHER than normal value] Good to Know  Expect one question related to dental injury [i.e. completely avulsed permanent tooth should be reimplanted ASAP! It can be transported to dentist in cold milk (not frozen milk)  May be a question on epidemiologic terms (i.e. sensitivity is defined as the ability of a test to detect a person who has the disease. Specificity is defined as the ability of a test to detect a person who is healthy or detect the person without the disease)  Learn definition of some research study designs : cohort follows a group of people who share some common characteristics to observe the development of a disease over time – Framingham nurses health study  Emergent conditions that will present in primary care clinics will be on the exam: navicular fracture, MI, cauda equina syndrome, anaphylaxis, angioedema, meningococcal meningitis  Know some anatomic areas : trauma to Kiesselbach’s plexus = anterior nosebleed  Some questions ask about “gold-standard test” or the “diagnostic test for the condition”: sickle cell anemia, G6PD anemia, and alpha/beta thalassemia = hgb electrophoresis  Disease states are usually presented in their “full-blown classic” textbook presentation: acute mononucleosis, teen will have classic triad of sore throat, prolonged fatigue, and enlarged cervical nodes. If patient is older with same signs/symptoms, it is still mononucleosis reactivated type  Ethic background may provide clues to disease: alpha thal = southeast Asia / Filipinos; beta thal = Mediterranean  NO ASYMPTOMATIC or BORDERLINE CASES OF DISEASE STATES WILL BE ON THE EXAM: IDA in “real life” don’t present often with pica or spoon-shaped nails, on the exam they NU 577 / AANP Exam Pearls will have these clinical findings  Be familiar with lupus and SLE: malar rash (butterfly) = lupus. Instruct patient to avoid / minimize sun exposure r/t photosensitivity.  Be familiar with polymyalgia rheumatica (PRM): 1 st line tx is long-term steroids. Long-term, low-dose steroids are commonly used to control symptoms (pain, severe stiffness in shoulders / hip girdle). PMR patients are at HIGH RISK FOR TEMPORAL ARTERITIS. NU 577 / AANP Exam Pearls  Gold standard exam for temporal arteritis: biopsy + refer patient to optho for management.  Learn the disorders for which maneuvers are used and what a positive report means : o Finkelstein’s test—positive in De Quervain’s tenosynovitis o Anterior drawer maneuver and Lachman maneuver—positive if anterior cruciate ligament (ACL) of the knee is damaged. The knee may also be unstable. o McMurray’s sign—positive in meniscus injuries of the knee  Conditions that NEED a radiologic test : damaged joints – order Xray 1 st (but MRI is the gold standard)  Abnormal eye findings in DM (diabetic retinopathy) and HTN (hypertensive retinopathy) should be MEMORIZED and learn to distinguish each one: o Diabetic retinopathy = neovascularization, cotton wool spots, microaneurysms o Hypertensive retinopathy = AV nicking, silver and/or copper wire arterioles  Become knowledgeable about physical exam “normal” and “abnormal” findings: o Checking DTRs in patient w/severe sciatica or diabetic peripheral neuropathy: ankle jerk reflex (Achilles reflex) may be absent or hypoactive. Scoring absent (0), hypoactive (1), normal (2), hyperactive (3), and clonus (4).  ONLY A FEW QUESTIONS WILL BE ON BENIGN or PHYSIOLOGIC VARIANTS: benign S4 heart sounds may be auscultated in some elderly pt. Torus palantinus and fishtail uvula may be seen during the oral exam in a few patients.  If the question is asking for the initial or screening lab test , it will probably be a “ cheap ” and readily available test : CBC (complete blood count (CBC) to screen for anemia  There are some questions on theories and conceptual models : Stages of change or “decision” theory (Prochaska) includes concepts such as precontemplation, contemplation, preparation, action, and maintenance.  Other health theorists who have been included on the exams in the past are ( not inclusive ): o Alfred Bandura (self-efficacy), Erik Erikson, Sigmund Freud, Elisabeth Kübler-Ross (grieving), and others o If a small child expresses a desire to marry a parent of the opposite sex : the child is in the oedipal stage (Freud). Child’s age is about 5 to 6 years (preschool to kindergarten). o Starting at the age of about 11 years , most children can understand abstract concepts (early abstract thinking) and are better at logical thinking . o When performing the Mini-Mental State Exam , when the NP is asking about “proverbs,” the nurse is assessing the patient’s ability to understand abstract concepts.  Keep these good communication rules in mind : Ask open-ended questions, do not reassure patients, avoid angering the patient, and respect the patient’s culture.  There may be two to three questions relating to abuse : child abuse, domestic abuse, elderly abuse Antibiotics & Medications  Know the difference between 1 st and 2 nd line abx : AOM in 7 yr old treated with amoxicillin returns in 48hr without improvement (continued ear pain, bulging TM). Next step is to d/c amox and start child on 2 nd line abx Augmentin BID x10 days  Be familiar with alternative abx for PCN-allergic patients: If patient has gram+ infection, prescribe macrolides, clinda, quinolones = levo or moxi  Patient responds well to macrolides but thinks they’re allergic to erythromycin (nausea, GI upset): inform patient she had an adverse rx, not a true allergic (hives/angioedema): switch NU 577 / AANP Exam Pearls pt from erythromycin to azithromycin (z-pack)  Fails to respond to initial medication: add another medication per treatment guidelines (i.e. COPD pt prescribed Atrovent for dyspnea. On follow-up, patient complains symptoms are not relieved. Next step is to prescribe albuterol (Ventolin) or combo inhaler)  Commonly used drugs with rare (potentially fatal) adverse effects: ACE-I = angioedema. Common side effect of ACEIs = dry cough (up to 10%) NU 577 / AANP Exam Pearls  Learn the preferred and/or 1st line drug to tx some diseases: ACEI/ARB is preferred for HTN in DM and patients with mild-mod renal disease = renal protective properties  When meds are used in answer options, they will be listed either by name (generic and brand name) or by drug class alone: ipratropium (Atrovent) or an anticholinergic  Most of the drugs mentioned in the exam are the well-recognized drugs : o Penicillin : Amoxicillin (broad-spectrum penicillin), penicillin VK o Macrolide: Erythromycin, azithromycin (Z-Pack), or clarithromycin (Biaxin) o Cephalosporins: First-generation (Keflex), second-generation (Cefaclor, Ceftin, Cefzil), third generation (Rocephin, Suprax, Omnicef) o Quinolones : Ciprofloxacin (Cipro), ofloxacin (Floxin) o Quinolones with gram-positive coverage: Levofloxacin (Levaquin), moxifloxacin (Avelox), gatifloxacin (Tequin) o Sulfa: Trimethoprim-sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid) o Tetracyclines: Tetracycline, doxycycline, minocycline (Minocin) o Nonsteroidal anti-inflammatory drug (NSAID): Ibuprofen, naproxen (Aleve, Anaprox) o COX-2 inhibitor: Celecoxib (Celebrex)  Category B drugs are ALLOWED for pregnant or lactating women: Pain relief, pick acetaminophen (Tylenol) instead of NSAIDs such as ibuprofen (Advil) or naproxen (Aleve, Anaprox). Avoid nitrofurantoin and sulfa drugs during the third trimester (these increase risk of hyperbilirubinemia).  Preferred tx for cutaneous anthrax : ciprofloxacin 500 mg orally BID for 60 days or for 8 weeks. If the patient is allergic to ciprofloxacin, use doxycycline 100 mg BID. Cutaneous anthrax is not contagious ; it comes from touching fur or animal skins that are contaminated with anthrax spores. Follow national treatment guidelines for certain disorders:  Asthma: National Asthma Education and Prevention Program (NAEPP)  COPD: Global Initiative for Chronic Obstructive Lung Disease (GOLD Guidelines)  Diabetes: American Diabetes Association Clinical Practice Recommendations (ADA)  Ethics: Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application  Healthy People: Office of Disease Promotion and Health Prevention  Health Promotion: The Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force (USPSTF)  Hyperlipidemia: (ACC/AHA)  Hypertension: (JNC 8)  Mental Health: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (APA)  Pediatrics: American Academy of Pediatrics. (AAP – Bright Futures)  Sexually Transmitted Diseases (CDC) We offer online tutoring and solutions to assignments for all modules. For assistance contact: