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AANP final exam, AANP exam, Exams of Nursing

University of Colorado - Colorado Springs (UCCS)Nursing

final exam AANP exam, AANP exam

Typology: Exams

2024/2025

Available from 07/03/2025

houenoume-houenoume 🇺🇸

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AANP exam

Erythropoetin

- 90 % renal, 10% hepatic, need supplementation when GFR is less than 49

Reticulocytes

- In health, make up 1-2 % of total RBCs, increased in response to anema. Absence of

reticulocytosis or presence of reticulocytopenia shows inadequate bone marrow

response.

Hemoglobin

- normal is 12 for females and 15 for males. Ratio to hematocrit is 1:3

MCV

- determines red blood cell size - normal is 80-96

MCH

- reflects hgb content and color, normal is 31-37

RDW

- variation of RBC size - normal is 11.5-15%

Normocytic, normochromic , normal RDW

- acute blood loss, anemia of chronic disease

Microcytic, hypochromic anemia, elevated RDW

- Iron deficiency anemia

Microcytic, hypochromic, normal RDW

- alpha or beta thalassemia minor

Macrocytic, normochromic, elevated RDW

- Vitamin B12 deficiency, folate deficiency, pernicious anemia

Macrocytosis without anemia

- use of medications like tegretol, AZT, depakote, dilantin, alcohol

Heart murmur seen in b12 deficiency

- Hemic murmur

Most common pathogen in CAP, ABRS, AOM

- S. pneumoniae

Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and

tobacco use

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AANP exam

Erythropoetin

90 % renal, 10% hepatic, need supplementation when GFR is less than 49 Reticulocytes
In health, make up 1-2 % of total RBCs, increased in response to anema. Absence of reticulocytosis or presence of reticulocytopenia shows inadequate bone marrow response. Hemoglobin
normal is 12 for females and 15 for males. Ratio to hematocrit is 1: MCV
determines red blood cell size - normal is 80- 96 MCH
reflects hgb content and color, normal is 31- 37 RDW
variation of RBC size - normal is 11.5-15% Normocytic, normochromic , normal RDW
acute blood loss, anemia of chronic disease Microcytic, hypochromic anemia, elevated RDW
Iron deficiency anemia Microcytic, hypochromic, normal RDW
alpha or beta thalassemia minor Macrocytic, normochromic, elevated RDW
Vitamin B12 deficiency, folate deficiency, pernicious anemia Macrocytosis without anemia
use of medications like tegretol, AZT, depakote, dilantin, alcohol Heart murmur seen in b12 deficiency
Hemic murmur Most common pathogen in CAP, ABRS, AOM
S. pneumoniae Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and tobacco use

H. influenzae, more than 30% now pcn resistant via beta lactamase production First line treatment for Acute Bacterial Rhinosinusitis
Augmentin 500/125 TID or 875/125 BID Second line treatment for Acute Bacterial Rhinosinusitis
Augmentin 2000/125 BID or doxy 100 mg BID or 200 mg QD Treatment for ABRS if allergic to PCN, Cephalosporins
Doxy, Levofloxacin, Moxifloxacin Treatment for ABRS if antibiotic resistance of failed initial therapy
Doxy, levofloxacin, moxifloxacin Presbycusis
slowly progressive hearing loss that is symmetric and high frequency 1st line controller therapy in allergic rhinitis
Intranasal corticosteriods like Flonase, Nasonex, Nasacort, Omnaris. Side effects are that nasal irritation and bleeding may occur. Optimal efficacy may take 1-2 weeks. 1st line rescue treatment in allergic rhinitis
Nasal antihistamines, esp if there is nasal congestion. sedation could occur. Drugs like astelin, Astepro, and patanase 1st generation oral antihistamines
significant potential to cause sedation and anticholinergic effects so not a first line therapy. Ex. benadryl, chlor trimeton, dimetapp, vistaril. 2nd generation oral antihistamines
These are preferred over because no anticholinergic effects but not as helpful with nasal congestion. Ex. claritin, clarinex, zyrtec, allergra Oral decongestants
alpha adrenergic agonist so vasoconstrictive. Take caution with the elderly, young children, HTN, bladder neck obstruction, glaucoma, and hyperthyroidism. Ex. sudafed Nasal decongestants
Alpha adrenergic agonist so vasoconstrictive. Can cause rebound congestion/medicamentosa so limit use to 5-7 days. Intranasal anticholinergics
reduce runny nose because of drying action. No effect on other nasal symptoms. Dryness can occur. Ex.. Atrovent Found on fundoscopic exam of person with angle-closure glaucoma

Exudative pharyngitis

Caused by A, C, G streptococcus, viral, HHV-6, M. pneumo. 1st line therapy is PCN PO for 10 days or IM for 1 dose if problems with adherence. 2nd line: erythromycin for 10 days; 2nd generation cephalo for 4-6 days; azithromycin for 5 days, or clarithomycin for 10 days. If vesicular or ulcerative, usually viral. Chicken pox
2 - 3 mm vesicles that start on trunk, appear on limbs 2-3 days later. Non clustered and at a variety of stages. Mild to moderately ill. Small pox
2 - 3 mm vesicles with generalized distribution without a pattern. All lesions at same stage. Severe systemic illness. Actinic keratoses
mostly on sunexposed areas. Red or brown, scaly, often tender. Sometimes flesh colored. Can turn into SCC. Can remain unchanged, spontaneously change or progress. Can treat with topical 5-FU, 5% imiquimod cream, photodynamic therapy with topical acid. Can do cryosurgery, laser resurfacing, chemical peel. Basal Cell carcinoma
more common,, sun exposed areas, arise de novo, papule, nodule with or without central erosion, pearly or waxy appearance, telangiectasia, low mets risk. Squamous cell carcinoma
less common, sun exposed areas, can arise for actinic keratoses or de novo, red, conical hard lesions with or without ulceration, less distince borders, more chance of mets especially if located on lip, oral cavity, or genitalia. psoriasis tx and location
vitamin D derivative cream, anterior surface of knees scabies tx and location
permetherin lotion, over waist band area Verucca vulgaris treatment
Imiquimod cream Tinea pedis tx
Topical ketoconazole Rosacea tx
Topical metronidazole Keratosis pilaris tx

ammonium lactate lotion Eczema location
antecubital fossa Pityriasis rosea location
usually proceeded by a herald patch on the trunk Acanthosis Nigrans
hyperpigmented plaques with a velvet like appearance at the nape of the neck, axillary region, and groin. Check fasting BG. Contact dermitis
intensely pruiritic rash on both hands and right cheek. Scattered vesicles, small areas of crusting. Bactrim
best choice in antimicrobial therapy for a skin and soft tissue infection likely caused by MRSA. Brown Recluse spider bites
Central blistering with surrounding gray to purple discoloration at bite site. Surrounded by ring of blanched skin surrounded by large area of redness. TSH
normal level is 0.4-4.0. Reflects anterior pituitary lobe's ability to detect amount of circulating free thyroxine. Free T
Normal level is 10-27. Unbound metabolically active portion of thyroxine. Total T
Normal level is 4.5-12.0. Reflects the total fo protein bound and free thyroxine. Free T
Normal level is 3.5 to 7.7. unbound metabolically active portion of triiodothyronine (T3). Is about four times more metabolically active. Total T
Noraml is 95-190. Reflects the total of the protein bound and free triiodothyronine. Untreated hypothyroidism
low free T4 and high TSH. Give synthroid by dosing by weight, using ideal body wt in obesity, actual in underweight. 1.6 mcg/kg/day in adults, 4.0 mcg/kg/day in kids, 1. mcg/kg/day in elderly. 50% increase during pregnancy so send to high risk OB.

have more than 2 migraines a month with disabling sxs more than 3 days, poor sx relief from other txs, present of other conditions like HTN, hemiplegic or basilar migraines. Use MRIs for

hemorrhage of days to weeks duration, AV malformation, carcinomatous meningitis, tumor, posterior fossa lesions CT without contrast
acute or chronic hemorrhage, edema, atrophy, ventricular size CT with contrast
tumor, abscess GERD
Eliminate offending meds: smooth muscle relaxers like CCBs, theophylline, nitrates, estrogen, progestin. Treat with H2RAs like pepcid, zantac. These are considered first line acid suppression therapy. Proton pump inhibitors are better than H2RAs at suppressing post-prandial acid surge. Protracted use association with B12, Ca, and Fe malabsorption. Alarm findings may warrant endoscopy: dysphagia, bleeding, wt loss, odynophagia GERD presentation
dyspepsia, chest pain, postprandial fullness, chronic hoarseness, sore throat, cough, wheezing. Nikolsky's Sign
positive when slight lateral pressure on the skin results in epidermal exfoliation. Markle's Sign
pt stands on tiptoes and falls back on heels. Positive if abdominal pain increases and localized with the maneuver and is suggestive of peritoneal inflammation. Blumberg's Sign
Gently and deeply palpate an area of abdominal tenderness then rapidly release the pressure. Pain is worse with release, indicating abdominal wall or peritoneal inflammation. Rebound tenderness. Murphy's Sign
Painful arrest of inspiration triggered by palpating the edge of inflamed gallbladder. Erosive gastritis
NSAID use, intermittent nausea, burning, and pain limited to upper abdomen, often worse with eating. Tender at epigastrium, LUQ, hyperactive bowel sounds. Acute Pancreatitis

drinks alcohol, acute onset of epigastric pain radiating to the back with bloating, nausea, vomiting. Epigastric tenderness, hypoactive bowel sounds, abdomen distended and hypertympanic Duodenal ulcer
history of intermittent upper abdominal pain described as burning, gnawing pain about 2 - 3 hours. Relief with food, antacids, Awakening at 1-2 am with sxs. Tender at epigastrum, LUQ hyperactive bowel sounds. IBD
Intermittent crampy abdominal pain, diarrhea, wt loss, fatigue. Increasing discomfort, fever, and tenesmus. Pale conjunctiva, tachycardia, hyperactive bowel sounds, diffuse abdominal tenderness without rebound. Diverticulitis
Intermittent left lower quadrant pain accompanied by fever, cramping, nausea and 4- 5 loose stools a day. Abdomen soft,, tender to LLQ palpation without rebound. CAP by S. pneumo
Effective treatments if not resistance: macrolides, standard dose amox, some cephalosporins, tetracyclines. If possible DRSP: high dose amox, respiratory FQ, Ketek. CAP by H. Influenzae
Treatment needs to be stable with beta lactamase production so cephalosporins, augmentin, macrolides, respiratory FQ, Tetracyclines - see more with tobacco related lung disease. CAP by M. pneumo or C pneumo or Legionella
macrolides, FQ, tetracyclines. Cephalosporins and PCN not effective. See more for those in correctional facilities or living in close proximity to others. CYP 450 3A4 inhibitors
macrolides CYP450 3A4 substrates
Viagra, statins, effexor, xanax CYP450 3A4 inducers
St John's wort. Can diminish effectiveness of oral contraceptives, antiretrovirals, and cyclosporine Pneumonia Consolidation findings
Dullness to percussion because of dense tissue

Reduces hepatic glucose production and intestinal glucose absorption. It is an insulin sensitizer. Monitor kidney function. Avoid in heart failure. Rare risk of lactic acidosis. Omit day of surgery and 48 hours after and reinitiate once baseline renal function obtained. Can be use preventatively. Thiazolidinedione (TZD, glitazones)
Insuilin sensitizer via receptors found in muscle, adipose, tissues. Edema risk. TZD can exacerbate heart failure. Proglitazone use for more than 1 year can cause bladder cancer. GLP 1 agonist (Byetta, Victoza)
Stimulates insulin production in response to increase in plasma glucose. Slows gastric emptying. Major SE is N/V. Contraindicated in gastroparesis. Exenatide can cause pancreatits. DPP4 Inhibitor (gliptins)
Use in combination with metformin or TZD. Watch for pancreatitis. Alpha glucosidase inhibitors (Acarbose)
Delays intestinal carb absorption. Taken with first bite of a meal. Does not enhance insulin secretion or sensitivity. Flatulaence is a problem. Avoid in IBD, impaired renal function. When to initiate insulin use
At time of dx if gluose betwee 250- 300 When acutely ill because glucose should be kept between 140- 180 When more than 2 agents at optimized use are inadequate. Short Acting Insulin/ rapid(Lispro - humalog)
Onset: 15-30 minutes Peak: 30 minutes to 2.5 hours Duration: 3-6.5 hours Short acting, rapid (Aspart - Novolog)
Onset: 10-20 minutes Peak: 1-3 hours Duration: 3-5 hours Short Acting /Rapid (Apidra)
Onset: 10-15 minutes Peak: 1-1.5 hours Duration: 3-5 hours Short Acting (regular, Humulin R, Novolin R)
Onset: 30 mins to 1 hour Peak" 2-3 hours

Duration: 4-6 hours I Intermediate acting (Humulin N or Novolin N)

Onset: 1-2 hour Peak: 6- 14 Duration: 16-24 hours DM additional Care
Aspirin, ACEI, or ARB Beta blocker or alpha beta blocker Statin - check renal function, GFR, CR, microalbuminuria, fasting lipid profile annually Foot exam with every visit Sodium recommendation in HTN
2.4 g sodium or 6 gr sodium chloride Diuretics (HCTZ)
lower volume sodium depletion that leads to PVR reduction Can have negative impact on lipids, glucose control. Monitor Na, K, Mg. Calcium sparing. Less effective for advanced renal impairment and should be swapped to loop diuretic. Can make gout worse Beta Adrenergic Antagonists( Beta blockers)
Use with caution in COPD, asthma, untreated heart block. In DM, benefit of beta blocker use outweighs the risk of worsening insulin resistance or masking hypoglycemia sxs. Taper dose over 10-14 days. Alpha beta adrenergic antagonist (Carvedil)
Use with caution in COPd, asthma, untreated heart block. Less insulin resistance inducing properties when compared to standard beta blockers ACEI
Don't use in presence of bilateral renal stenosis, modest hyperkalemia risk, Can cause cough. No use during pregnancy. Tanner Stage 1
Prepuberty for both male and female. Tanner Stage 2
Female: Breast buds and papilla elevated, downy pigmented pubic hair along labia majora Male: Testes enlarge, scrotal skin reddening with change in texture, sparse growth of long pubic hair at base of penis Tanner Stage 3

dysuria, itching, irritation, pain with sex, yellow-green vaginal discharge, cervical petechial hemorrhages (strawberry spots), sometimes no sxs. Alkaline pH. Tx with metronidazole as one time dose. Syphilis
Primary stage: chancre (firm, round, painless with clean base and indurated margins accompanied by localized lymphadenopathy, last about 3 weeks and resolves without therapy. Secondary stage: nonpruritic skin rash, palms and soles, as well as mucus membrane lesions. Fever, lymphadenopathy, sore throat, patchy hair loss, HA, wt loss, muscle aches, fatigue. Latent stage: neuro issues. Tx with injectible PCN or doxy if allergic. Genital warts (HPV 6/11)
May go unrecognized. Tx with podofilox, liquid nitrogen, cryoprobe, tricholoroacetic, acid, podophyllin resin, surgical remove, imiquiod. Trichloroacetic acid and cryoprobe preferred during pregnancy. Pelvic Inflammatory Disease
Irritative voiding, fever, abdominal pain, cervical motion tenderness, vaginal discharge,. Can cause infertility, tubal scarring. Tx: rocephin IM plus doxy for 14 days with or without metronidazole.for 14 days. UTI in nonpregnant women
Primary: if resistance to Bactrim is low and no allergy, give bactrim twice a day for 3 days. If resistance high or if there is an allergy, give nitrofurantoin for 5 days or fosfomycin for 1 dose. Alternative: Can give FQ for 3 days or Aumentin 875/125 for 5-7 days or an oral cephalosporin. Uncomplicated pyelonephritis
usually women 18-40 with fever greater than 102 with CVA tenderness. Primary: Cipro 500 mg bid for 7 days, levaquin for 5 days. G6PD deficiency
Treat with a cephalosporin Epididymitis
Upper reproductive tract infection, usually younger than 35. Present with irritative voiding, painful swelling or epididymis and scrotum. Possible infertility after. Treat with Rocephin plus doxy, advise scrotal elevation. Plehn's sign - relief of discomfort with scrotal elevation. Epidymitis or epididymoorchitis
Age greater than 35 or insertive partner in anal intercourse. Present with irritative voiding, painful swelling or epididymis and scrotum. Possible infertility after. Tx with Cipro 550 or levo 750 for 10-14 days.

Acute bacterial prostatis less than 35 y.o.

irritative voiding, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. Treat with rocephin IM plus doxy for 10 days Acute bacterial prostatis older than 35.
irritative voiding, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. Treat with cipro or ofloxacin for 14 days. Chronic bacterial prostatis
irritative voiding, dull, poorly localized pain, suprapubic, perineal pain. Tx with Cipro BID for 4 weeks or levo qd for 6 weeks. Can treat with Bactrim twice a day for 1- 3 months. If doesn't work, consider prostatic stones. Delirium etiology
DRUGS:Anticholingergics like TCAs, 1st gen antihistamines, neuroleptics, atypical psychotics, opioids, benzos, alcohol EMOTIONAL: mood disorders, loss. ELECTROLYTE IMBALANCES: esp hyponatremia, LOW PO2, LACK OF DRUGS: withdrawal from alcohol, INFECTION: UTI, CAP, Retention of urine or feces. Reduced sensory input, seizures, undernutrition, metabolic, myocardial problems, subdural hematoma. Fractures, infections, and medications are most common causes. Lumbar spinal stenosis sx
back pain with standing, leg numbness, pain improvement iwth flexed forward position. For sxs lasting longer than 1 month, consider MRI, EMG. Do PT, NSAIDS, epidural steroid injection, maybe surgery. Seizure
longer than 5 minutes, aura or prodrome, usually no injury, may have urinary incontinence, elevated CK, postictal state. Syncope
less than 5 minutes, no warning, injury, no urinary incontinence, Normal CK, No disorientation after. Dizziness
sense of disturbed relationship to space but surroundings are not moving. "feels lightheaded" Treat underlying cause. Vertigo
Surroundings are moving, sensation of motion with eyes closed, "room is spinning" Usually an inner ear disturbance, treat cause. Depression in the elder

lifts head, holds head erect, follows objects through visual field, moro reflex fading, spontaneous smile, recognizes parents 3 - 5 months
reaches for objects, brings objects to mouth, respberry sound, sits with support, rolls from back to side, laughs, recognizes food by sight. 6 - 8 months
sits briefly without support, scoops small object with rake grip, some thumb use, hand to hand transfer, recognizes no 9 - 11 months
stands alone, imitates peek a boo, picks up small object with thumb and index finger, cruises, follow simple command like come here. able to self feed with simple finger foods. 12 - 15 months
walks solo, neat pincer grasp, place cube in cup, tower of two bricks, scribbles spontaneously, indicates wants by pointing, hands over objects on request. 15 - 20 months
points to several body parts, uses spoon with little spilling, walks up and down steps with help, understands two step commands, feeds self, seats self in chair, carries and hugs doll 24 months
kicks ball upon request, jumps with both feet, developing handedness, copies vertical and horizontal line. washes and dries hands, parallel play. 30 months
walks backwards, hops on one foot, copies circle, gives first and last name. 36 months
holds crayons with fingers, walks down stairs with alternating steps, rides tricycle, copies circles. Dresses with supervision. 3 - 4 years
responds to command to place object in, on or under a table, draws circle when one is shown, takes off jacket and shoes, washes and dries face, cooperative play, knows gender. 4 - 5 years
runs and turns while maintaining balance, stands on 1 foot for at least 10 seconds, counts to 4, draws a person without a torso, copies cross by imitation, buttons clothes, dresses self except tying shoes, can play without adult input for about 30 minutes,

verbalizes activities to do when cold, hungry, tired. 6-8 word sentences, names 4 colors, counts 10 objects correctly. 5 - 6 years

catches ball, knows age, knows right hand from left hand, draws person with 6-8 parts including torso, able to complete simple chores, sense of gender, identifies best friend, likes teacher. 6 - 7 years
copies triangle, draws person with at least 12 parts, prints name, reads multiple single syllable words, counts to 30 and beyond, ties shoe laces, plays well with peers, no big behavior problems at school, names career 7 - 8 years
copies diamond, able to read simple sentences, draws person with at least 16 parts, ties shoes, knows days of the week. 8 - 9 years old
able to add, subtract, borrow, carry, teamwork, able to give response to a question such as what to do if an object is accidentally broken. Language 1-6 months
coos in response to voice lang 6-9 months
babbles lang 10-11 months
imitates sounds, nonspecific mama, dada lang 12 months
specific mama, papa, 2-3 syllable words imitated lang 13-15 months
4 - 7 words, jargon, less than 20% of speech understood by strangers lang 16-18 months
extensive jargon, 20-25% of speech understood by strangers lang 19-21 months
20 words, 50% of speech understood by strangers lang 22-24 months
more than 50 words, 2 word phrases, less jargon, 60-70% of speech understood lang 2-2.5 yrs

Toddler/preschoolers: forward facing seats with harnesses up to highest ht and wt allow by manufacturer School aged: booster until 4 ft 9 inches and between 8 and 12 y.o. Older children: seat belts and rear seats until 13 y.o. scarlet fever

scarletina form or sandpaper like rash with exudative pharyngitis, fever, HA, tender, localized ant cervical lymphadenopathy. Rash usually erupts on day 2 of pharyngitis and peels a few days later. PCN or macrolide if allergy. Roseola
Discrete rosy pink macular or maculopapular rash lasting hours to 3 days that follows a 3 - 7 day period of fever, often quite high. usually in kids less than 2. supportive tx. Rubella
fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting about 3 days, post cervical and postauricular lymphadenopathy 5-10 days prior to onset of rash. arthralgia in 25%. incubation period of 14-21 days with disease transmissable for 1 week prior to onset of rash to weeks after rash appears. generally self limiting. danger to fetus with 1st trimester exposure. Measles - rubeola virus
acute with fever, nasal, discharge, cough, general lymphadenopathy, conjunctivits, photophobia, koplik spots (white spots with blue rings held within red spots in oral mucosa), mild pharyngitis without exudate. maculopapular rash 3-4 days after onset of sxs. incubation period of 14-21 days with disease transmissable for 1 week prior to onset of rash to weeks after rash appears. CNS and resp tract complications common. Risk of neruo impairment or death. supportive tx. Mono
fever, shaggy purple white exudative pharyngitis, malaise, diffuse lymphadenopathy, hepatic and splenic tenderness, monospot test. If given amox or ampicillin, rash will occur. Avoid contact sports for more than one month because of risk of splenic rupture. Systolic Murmurs
MR=Mitral regurg P= physiologic AS=Aortic Stenosis S=Systolic MVP=Mitral Valve Prolapse Diastolic Murmurs
MS = Mitral Stenosis AR=Aortic regurg D=Diastolic

Harsh Murmur

use bell and diaphragm - aortic stenosis Rumble
low so heard best with bell - mitral stenosis Blowing
High so heard best with diaphragm - aortic regurg Pregnancy Cat A meds
well controlled human study fails to demonstrate fetal risk in first trimester - levothyroxine, insulin Pregnancy Cat B meds
animal studies have not demonstrated fetal risk but no controlled study in humans OR animal studies have shown adverse effect but not demonstrated in human study = PCN, Cephalosporins, Macrolides except for clarithromycin, tylenol, ibuprofen, Macrobid or macrodantin except at term b/c of hemolysis, Pulmicort but not fluticasone Pregnancy Cat C
No controlled study in humans available. Studies in animals have revealed adverse effects on fetus = clarithromycin, FQs, SSRIs Pregnancy Cat D
positive evidence of human fetal risk. May use if benefits outweigh risk like lifethreatening disease = ACEI and ARB in 2nd, 3rd,Tetracyclines, Tegretol, Depakote, Lithium, Paroxetine Pregnancy Cat X
Accutane, Talidomide, Statins

AANP final exam, AANP exam, Exams of Nursing

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