AGACNP FINAL EXAM REVIEW 2024 /ACTUAL EXAM
WITH 100% CORRECT VERIFIED AND DETAILED
ANSWERS /LATEST UPDATE/A+ GRADE
Tx of infectious Post-op fever - Correct Answer-#1 Supportive fluid therapy and APAP
#2 Treat underlying source
#3 Gram stain and C & S all invasive lines or catheters as indicated.
What is the best intervention for fever of unknown origin? - Correct Answer-Nothing until
the diagnosis is confirmed.
Major syndromes causing fever - S/S of each and TX - Correct Answer-Serotonin
syndrome - SSRI use, clonus, hyperreflexia, ataxia, mental status changes,
restlessness, confusion, agitation, coma, seizure, diaphoresis, hyperthermia, mydriasis,
labile bp
- tx: dantrolene sodium, clonazepam for rigor, cooling blankets
Malignant Hyperthermia - happens in the OR; after succinylcholine IV then fry brain to
104 F. IVF, pack them with ice then send to PACU with Dantrolene
Neuroleptic Malignant Syndrome - associated with dopamine antagonists -
bradykinesia, "lead-pipe" muscle rigidity
- on anti psychotic; IVF priority to flush toxins out, and this is true to every toxic
Other rando causes of fever to consider - Correct Answer-Temporal arteritis - high ESR,
normal WBC, fever as high as 104!!! - HA, scalp tenderness, visual complaints. - 15% of
all cases of FUO in pts > 65 years
,Pt w/ vise-like, tight, generalized HA that is most intense in the neck or back of the
head, w/ no focal symptoms and that lasts for several hours. What is it / what do you
do? - Correct Answer-Tension HA. No dx for this. Manage w/ OTC analgesics and
relaxation.
Female w/ unilateral episodic HA that is dull or throbbing, builds up gradually and lasts
for several hours. Has some field defects, visual hallucinations such as stars, sparks,
and zigzag lights, APHASIA, numbness, tingling, clumsiness and weakess, also n/v, and
photophobia and phonophobia. What is it / what do you do? - Correct Answer-Classic
Migraine (migraine with aura) (NOT COMMON MIGRAINE). This is r/t dilation and
pulsation of branches of external carotid and follows the trigeminal nerve pathway.
If new or different than previous HA's -- Head CT!!!
,BMP, CBC, VDRL, ESR, and anything else indicated by hx and physical exam
If Migraine confirmed, then....
#1 avoid triggers
#2 relax/manage stress
#3 Prophylactic therapy is ATTACKS > 2-3x PER MONTH (Elevil - monitor QT interval;
Depakote, Inderal Tofranol, Catapres, Veramapil, Topamax, Neurontin, Methysergide,
Magnesium).
In ACUTE ATTACK: rest, take ASA right away (some relief), Sumitriptan 6mg SQ or
25mg PO at onset (STANDARD ABORTIVE TX), SQ may be repeated.
Middle-aged male w/ unilateral, periorbital HA, no family hx of HA or migraine, but
possible ETOH use. Describes pain as "severe" and reports suicidal thoughts when the
pain comes on. Also causes him nasal congestion, rhinorrhea, and eye redness. What
is it / what do you do? - Correct Answer-Cluster HA. No diagnostics. Eye will be red, and
he will have rhinorrhea.
PO meds ineffective.
Give 100% o2 (so about 12-15L on non-rebreather for about 15 min).
Subq Sumitriptan 6mg
Inhalation Ergostat
Albumin level for protein malnutrition / Albumin level for edema? - Correct Answer-<
3.5 / < 2.7 (will see falling out hair, ridged nails, muscle wasting, dry mucous
, membranes, slow healing).
Nutritional considerations for the acutely ill: - Correct Answer-In times of physiological
stress, pts caloric needs double from baseline d/t their hypercatabolic state
Goal of nutritional therapy is to sustain pts existing weight, even if pt is obese
Typical caloric requirement is to sustain existing weight is 30-35kcal/kg or body weight
daily, so hospital patients will require 60-70 kcal/kg daily
Pt getting feedings with duo tube, ND tube, NG tube, or PEG what should you watch out
for? - Correct Answer-Complications of Enteral nutrition support related to the solution.
-aspiration
-diarrhea
-emesis
-GI bleeding (didn't know that, d/t PEG?)
-mechanical obstruction of tube
-hypernatremia (know this!!)
-dehydration (know this!!)
WITH 100% CORRECT VERIFIED AND DETAILED
ANSWERS /LATEST UPDATE/A+ GRADE
Tx of infectious Post-op fever - Correct Answer-#1 Supportive fluid therapy and APAP
#2 Treat underlying source
#3 Gram stain and C & S all invasive lines or catheters as indicated.
What is the best intervention for fever of unknown origin? - Correct Answer-Nothing until
the diagnosis is confirmed.
Major syndromes causing fever - S/S of each and TX - Correct Answer-Serotonin
syndrome - SSRI use, clonus, hyperreflexia, ataxia, mental status changes,
restlessness, confusion, agitation, coma, seizure, diaphoresis, hyperthermia, mydriasis,
labile bp
- tx: dantrolene sodium, clonazepam for rigor, cooling blankets
Malignant Hyperthermia - happens in the OR; after succinylcholine IV then fry brain to
104 F. IVF, pack them with ice then send to PACU with Dantrolene
Neuroleptic Malignant Syndrome - associated with dopamine antagonists -
bradykinesia, "lead-pipe" muscle rigidity
- on anti psychotic; IVF priority to flush toxins out, and this is true to every toxic
Other rando causes of fever to consider - Correct Answer-Temporal arteritis - high ESR,
normal WBC, fever as high as 104!!! - HA, scalp tenderness, visual complaints. - 15% of
all cases of FUO in pts > 65 years
,Pt w/ vise-like, tight, generalized HA that is most intense in the neck or back of the
head, w/ no focal symptoms and that lasts for several hours. What is it / what do you
do? - Correct Answer-Tension HA. No dx for this. Manage w/ OTC analgesics and
relaxation.
Female w/ unilateral episodic HA that is dull or throbbing, builds up gradually and lasts
for several hours. Has some field defects, visual hallucinations such as stars, sparks,
and zigzag lights, APHASIA, numbness, tingling, clumsiness and weakess, also n/v, and
photophobia and phonophobia. What is it / what do you do? - Correct Answer-Classic
Migraine (migraine with aura) (NOT COMMON MIGRAINE). This is r/t dilation and
pulsation of branches of external carotid and follows the trigeminal nerve pathway.
If new or different than previous HA's -- Head CT!!!
,BMP, CBC, VDRL, ESR, and anything else indicated by hx and physical exam
If Migraine confirmed, then....
#1 avoid triggers
#2 relax/manage stress
#3 Prophylactic therapy is ATTACKS > 2-3x PER MONTH (Elevil - monitor QT interval;
Depakote, Inderal Tofranol, Catapres, Veramapil, Topamax, Neurontin, Methysergide,
Magnesium).
In ACUTE ATTACK: rest, take ASA right away (some relief), Sumitriptan 6mg SQ or
25mg PO at onset (STANDARD ABORTIVE TX), SQ may be repeated.
Middle-aged male w/ unilateral, periorbital HA, no family hx of HA or migraine, but
possible ETOH use. Describes pain as "severe" and reports suicidal thoughts when the
pain comes on. Also causes him nasal congestion, rhinorrhea, and eye redness. What
is it / what do you do? - Correct Answer-Cluster HA. No diagnostics. Eye will be red, and
he will have rhinorrhea.
PO meds ineffective.
Give 100% o2 (so about 12-15L on non-rebreather for about 15 min).
Subq Sumitriptan 6mg
Inhalation Ergostat
Albumin level for protein malnutrition / Albumin level for edema? - Correct Answer-<
3.5 / < 2.7 (will see falling out hair, ridged nails, muscle wasting, dry mucous
, membranes, slow healing).
Nutritional considerations for the acutely ill: - Correct Answer-In times of physiological
stress, pts caloric needs double from baseline d/t their hypercatabolic state
Goal of nutritional therapy is to sustain pts existing weight, even if pt is obese
Typical caloric requirement is to sustain existing weight is 30-35kcal/kg or body weight
daily, so hospital patients will require 60-70 kcal/kg daily
Pt getting feedings with duo tube, ND tube, NG tube, or PEG what should you watch out
for? - Correct Answer-Complications of Enteral nutrition support related to the solution.
-aspiration
-diarrhea
-emesis
-GI bleeding (didn't know that, d/t PEG?)
-mechanical obstruction of tube
-hypernatremia (know this!!)
-dehydration (know this!!)
