ANCC FNP EXAM 4 QUESTIONS & CORRECT
ANSWERS GRADED A LATEST 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
ANSWERS GRADED A LATEST 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
