ANCC FNP BOARD EXAM
Dose of Tetanus Immune Globulin (TIG) - ANSWER 250 units IM
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 Flu-
mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER hand washing!; viral shed in stool in first
week post-vaccination
Shingrix: timing and dosing - ANSWER =/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? -
ANSWER Feb
What s/s are associated with leukemia? - ANSWER fever, wt loss, fatigue, bone
pain, bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? - ANSWER WBCs
>20,000 (think through common causes of leukocytosis: infection, stress,
inflammation) --> get a peripheral smear (AKA manual diff)
if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis;
enlarged liver, spleen, or lymph nodes; or constitutional symptoms.
Which 2 chronic childhood diagnoses are associated with ALL and AML? - ANSWER
Downs syndrome and neurofibromatosis
What are 3 main risk factors for leukemia - ANSWER radiation (equivalent to 2 to 3
CTs), toxin /household pesticide exposure in utero/early childhood.
Dose of Tetanus Immune Globulin (TIG) - ANSWER 250 units IM
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 Flu-
mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER hand washing!; viral shed in stool in first
week post-vaccination
Shingrix: timing and dosing - ANSWER =/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? -
ANSWER Feb
What s/s are associated with leukemia? - ANSWER fever, wt loss, fatigue, bone
pain, bleeding, bruising.
What bloodwork should be obtained in suspected leukemia? - ANSWER WBCs
>20,000 (think through common causes of leukocytosis: infection, stress,
inflammation) --> get a peripheral smear (AKA manual diff)
if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis;
enlarged liver, spleen, or lymph nodes; or constitutional symptoms.
Which 2 chronic childhood diagnoses are associated with ALL and AML? - ANSWER
Downs syndrome and neurofibromatosis
What are 3 main risk factors for leukemia - ANSWER radiation (equivalent to 2 to 3
CTs), toxin /household pesticide exposure in utero/early childhood.
