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ANCC AGACNP - Frances Guide Review
You want to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee? a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team - ANS-a. stress importance of team What is the best way for the AGACNP to get involved in policy making? a. attend legislative days at the state capitol b. join a hospital committee c. write your local congressman d. review literature and give more in-services - ANS-b. join a hospital committee What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. join a hospital committee b. petition the government c. bill for independent services d. start your own practice - ANS-c. bill for independent services Which of the following is considered a high acuity role for the AGACNP? a. primary care clinic b. cardiology office c. community health department d. minute clinic - ANS-b. cardiology office What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility - ANS-d. start at your facility Answers are worded differently. "decrease bias in healthcare" "create in-servises in healthcare" "obtain funding to increase access" Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight c. see if the p-value is less than the alpha-coefficient d. determine the error rate - ANS-a. consider the sample size When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder b. keep all of the patient's records for a minimum of five years
c. send a certified letter with a return receipt requested d. provide names of other providers for future care - ANS-c. send a certified letter with a return receipt requested Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem - ANS-d. formulating the research problem A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander - ANS-a. libel Can you tell the patient's wife, for her protection, that her husband has HIV? - ANS-No, not without his permission How can the ANCP prepare to get involved in future mass casualty event? - ANS-Pre enroll in disaster volunteer program An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? - ANS-Medicaid Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: - ANS-Pays after insurance and 3rd party payers have paid You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that workds. What ethical principles does this challenge? - ANS-Veracity and fidelity Health literacy - ANS-Average american: 8th grade level Quality assurance - ANS-A process for evaluating the care of patients using established standards of care to ensure quality CPI - ANS-Measures structure, processes, and outcomes A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based policies to establish clinician-family communication standards in the unit. These policies should
NP working on ESRD research project. A colleague renal specialist asks for patient info on your patients: - ANS-HIPAA breach Who enforces HIPAA? - ANS-Office of Civil Rights/Dept Health and Human Services Who isn't covered by HIPAA? - ANS-Law enforcment/municipal offices, CPS/Schools, employers/workman's comp, life insurance Insurance company calling to verify some patient appointments? - ANS-Answer by picking out that there is already a medical release signed by the patient and give the requested information to them Benchmarking - ANS-How institution compares with similar organizations Managed care - ANS-Know what this is and how it has improved costs, something about putting caps on payments Peer review - ANS-Timely, not anonymous, and NP knows how peer review will impact yearly evaluation Sensitivity vs specificity - ANS-Sensitivity: true positives, specificity: true negatives There was a question where a patient had a multinodular goiter and wanted to know why the NP was not going to do periodic US and fine needle biopsy in monitoring for some kind of cancer or complication. The answer I picked was that these tests were not very specific to detect the cancer Reliability - ANS-When implementing a new study, tested over and over, the consistency of a measurement or the degree to which an instrument measures the same way over time Validity of results in an article - ANS-P-value, probability of falsely rejecting the null hypothesis, want it to be <0. Statistical significance - ANS-Look at sample size and p value Privileging - ANS-May be granted in full or part by the hospital, credentialing committee is made of physicians Who determines scope of practice? - ANS-State practice acts but institutional bylaws may further restrict practice (facility limited scope of practice) Informed consent - ANS-A state indicating patient has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such, includes risks and benefits, competence: ability to communicate, understand, reason, differentiate good and bad
Case management - ANS-Mobilize, mointor, and control resources that a patient uses during course of an illness while balancing quality and cost, "move patients through the system appropriately" 50 - 60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? a. consult CM b. Consult SW c. refer to Oncology d. refer to Hospice - ANS-a. consult CM Nondisclosure - ANS-Not disclosing patient PHI without permission Negligence - ANS-Failure of individual to do what any reasonable person would do, resulting in injury to the patient When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? - ANS- Nonmaleficence Living will - ANS-Health care proxy/POA NP sees a patient for HF and performs an H&P. What % is expected to be paid? - ANS- Medicare pays 80% of the total bill, pt pays 20%, NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure 80% of that 85% Focus of palliative care - ANS-Basic improvement in QOL of anyone with an illness at any stage Hospice - ANS-<6m to live Scope of practice: integration of care across the acute illness continuum with: a. collaboration b. coordination of care c. research based clinical practice - ANS-a. collaboration Collaboration - ANS-True partnership in which all players have the desire power, share common goals, and recognize/accept separate areas of responsibility/activity Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to: - ANS-Coordinate services Government is moving towards being cost effective. What is the best way? - ANS-Allow NP to treat a wider variety of patients
Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves life, but states that the patient would not want to be on a ventilator. What should you do? a. consult neurology to come interview the family b. document the situation carefully in the chart c. call a clergy member to offer support d. call the ethics committee - ANS-d. call the ethics committee A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years". You: a. refer her to a gynecologist b. schedule her to come back next week for the PAP at another appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno - ANS-b. schedule her to come back next week for the PAP at another appt A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno - ANS-a. refer to gynecologist Discharge planning is udnerway for a patient who has been very dehabilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? a. hospice b. home health care c. SNF d. private duty RN - ANS-c. SNF Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych - ANS-b. XR the wrist Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych d. treat him without prejudice - ANS-d. treat him without prejudice
The medical resident obtained consent for an operative procedure. on your visit, the patient is confused/ refusing the procedure a. cancel the surgery b. have the wife sign another consent c. call the resident to clarify the patient was not confused when he signed the first consent d. consult neurology - ANS-c. call the resident to clarify the patient was not confused when he signed the first consent Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also that he plans to kill her when he gets home. How do you respond? a. call the police b. consult psych c. consult social work d. document his statements - ANS-b. consult psych Your clinical student breaks the sterile field. HOw do you handle this situation? a. discuss it with the student b. report it to the charge nurse c. report it to the unit manager d. inform the faculty in charge of the student - ANS-a. discuss it with the student You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call? a. the ER physician b. anesthesia c. an NP present on another unit currently d. the attending MD who is at home - ANS-d. the attending MD who is at home A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation? a. schedule an in service to discuss common code mistakes b. meet with each team member individually c. set up exercises to increase collaboration during a code d. meet with all who participated in the code and have a one-time briefing - ANS-d. meet with all who participated in the code and have a one-time briefing Your patient is not doing well and family/wife is at bedside crying. Yo are preparing to talk to the family. What do you do first? a. place a social work consult b. explicitly explain the situation, the outcomes and care involved c. ask if the patient has an advanced directive d. set up a family meeting in a room with a specific time and date - ANS-c. ask if the patient has an advance directive
The NP's most effective intervention si to: - ANS-Arrange follow up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? - ANS-Fine needle biopsy A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP: - ANS-Contacts the ID MD to determine the appropriate abx duration 32yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt reports the shot was an accident during hunting. What should the NP do? - ANS-Report to the police. All GSW must be reported What is the most important when assessing status? - ANS-Level of alertness or hx of symptoms A woman of child bearing age c/o abdominal pain. What level of exam do you document? - ANS-Detailed A diabetic patient complains of abd pain. Which type of exam do you conduct? - ANS- Comprehenxive What qualifies patient for HHC - ANS-Home bound, has a prescription, requires care services, wound care, select care Patient is refusing care? - ANS-Let them refuse, educate, and search for alternatives Guy in ER needs refill on ritalin - ANS-research alternatives Knowledge deficit in ICU, what would you do for nurses? - ANS-In services A patient has advanced dementia, ESRD, and HF, what do you do for him? - ANS- Transfer from acute to palliative care Your 24m patient has been out hiking on vacation. He shows you the following rash, and thinks he has Rocky Mountain Spotted Fever. What is his diagnoses? - ANS-Lyme disease (Erythema migrans/bullseye rash), both are treated with doxycycline Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to? a. shame because she feels the illness is her fault b. embarrassment from the examination c. a sign of respect d. a normal response - ANS-c. a sign of respect
Your patient speaks only spanish and you need to evaluate his pain. What do you do? a. ask a family member to translate for you b. utilize the hospital's interpreter service c. call over the Hispanic housekeeper and ask her to translate d. Use a visual pain scale - ANS-D. use a visual pain scale 58yo Japanese male with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the Ed warrant admission? a. age b. gender c. pain level d. ethnicity - ANS-d. ethnicity (underestimates pain, taught to be stoic, pain is probably much more severe) A 77yo male patient's wife cares for him at home .Which statement by the wife indicates a need for a SNF? a. my husband needs more help with his ADLs b. I can't lift him out of bed anymore c. he has lost 20 pounds d. he has trouble swallowing and I'm worried he will choke on his food - ANS-a. my husband needs more help with his ADLs Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? a. bipolar disorder b. alzheimer disease c. depression d. dementia - ANS-c. depression Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium b. IV ativan c. PO librium d. lasix - ANS-c. PO librium Your patient has developed a fever of unknown origin. What is the next step? a. PO abx b. IV abx c. do nothing until diagnosis is confirmed d. tylenol - ANS-c. do nothing until diagnosis is confirmed How long will it take to begin to see healing in a pressure ulcer that has a clean, well- vascularized bed? a. 7 days b. 2-4 weeks c. 2 days
What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing - ANS-c. aid in post op healing Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium - ANS-b. dextrose Protein in nutrition for what reason? - ANS-maintain nitrogen balance along with metabolic needs, adjust protein weekly by measuring urinary urea nitrogen Which electrolyte are you most concerned about monitoring in cachexic patient? a. mag b. ca c. na d. k - ANS-d. k refeeding syndrome, hypokalemia and hypophosphatemia Which electrolyte do you monitor in refeeding syndrome? - ANS-Phosphorous (or potassium) Which lab do you monitor daily in a patient on nutritional supplements? a. BMP b. cbc c. abg d. blood culture - ANS-a. BMP (and monitor LFT's weekly) What alternative therapy can you order to relax the patient prior to procedure? a. massage b. aromatherapy c. music d. muscle relaxant - ANS-c. music What alternative therapy can you use to help/distract them from their pain during the procedure? - ANS-Guided imagery Which alternative therapy helps Parkinson's patients with coordination? a. acupuncture b. tai chi c. relaxation techniques d. hypnotherapy - ANS-b. tai chi (also helps prevent falls in elderly)
Which 2 headaches are treated with triptans? - ANS-Migraines and cluster What kind of dressing do you use on a decubitus ulcer with necrotic tissue? - ANS- Hydrocolloid 45yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site - ANS- Neuropathic pain What does the leg/foot look like in a hip fracture - ANS-Internally or externally rotated Pt has a post op fever... - ANS-Give fluids WHO pain ladder... - ANS-Fentanyl patch for breakthrough cancer pain Best pain indicator... - ANS-Patient self report Best alternative therapy to decrease pain in clavicle fracture: - ANS-Therapeutic touch/reiki (hand or palm healing that transfers 'universal energy' has been used for cancer, emotional, or physical healing) Picture of gunshot wound to the R lung area - ANS-The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration Another answer was to let air blow out during inhalation Cocaine induced psychosis - ANS-s/s parnoia, delusions, hallucinations, 'cocaine bugs' under skin, mydriasis Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils - ANS-Sympathomimetic (cocaine or meth) Antidepressant OD - ANS-s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (can't see, can't pee, can't spit, can't shit) Antidepressant OD treatment - ANS-ICU if CNS or cardio toxic, activated charcoal NaHCO3 for dysrhythmias and maintain pH, benzos (valium) for seizure (if serotonin syndrome: dantrium/dantrolene sodium) ASA overdose - ANS-s/s n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis ASA overdose treatment - ANS-activated charcoal, NaHCO3 for severe acidosis of <7.1, monitor ABGs
What is the leading cause of deaths in hispanics in the US? - ANS-Heart disease The most common cause of hyponatremic hyperosmolality a. hyperglycemia b. hyperthyroidism c. adrenal insufficiency d. k sparing diuretics - ANS-a. hyperglycemia What method should you use to treat hyponatremia related to SIADH? a. bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200ml/hr d. 3% hypertonic saline ,calculated - ANS-d. 3% hypertonic saline, calculated What is a potential cause of hyperkalemia? a. carafate b. NSAIDs c. centrally acting HTN meds - ANS-b. NSAIDs Your patient has a Na of 128 and was treated with colloids 3 days ago. What is a treatment? - ANS-Restrict free water A 68yo patient had sx three days ago to repair a AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFT's are normal, no s/s CHF, the patient's laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0. mg/dL, PaCO2 of 37mmHg. Which is the most appropriate method to deliver nutrition? a. central line b. PIV c. G tube d. enteral feeding to the duodenum via a nasogastric small-bore tube - ANS-d. enteral feeding to the duodenum via a nasogastric small bore tube Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na less than 10 mEq/L. You know that all of the following are possible explanations except: a. diarrhea b. diuretics c. dehydration d. vomiting - ANS-b. diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, urine na >20) A 61 year old female c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating 'abnormally' and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves.
Occasionally you also note prominent U waves. Of the following, which is the most likely diagnosis? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypermagnesemia - ANS-a. hypokalemia Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except: a. hypernatremia b. pneumothorax c. HHNK d. GI bleed - ANS-d. GI bleed 65yo male with c/o n/v/constipation x several days and a six pound weight loss. Pt s/p TKR severral weeks ago and reports not getting off the couch. What electrolyte is altered? - ANS-Hypercalcemia secondary to immoblity Pt with s/s of abd distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the patient has a fluid and electorlyte problem. Which of the following is he most likely experiencing? - ANS-Hyperkalemia ABG reads high HCO3 and pCO2 55mmHg. What electrolyte abnormality is most likely associated with these values? - ANS-Hypokalemia r/t metabolic alkalosis Pt has a fever and tachycardia, and hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status - ANS-Extracellular dehydration deficit Low serum Na and high serum osmolality - ANS-Hyperglycemia (Probably HHNK) A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give: - ANS-NS Low protein = Low BUN = - ANS-hypoosmolar hyponatremia (probably edematous, expect edema in Albumin <2.7) A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9kg), is intubated and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2o. Clinical signs include tachycardia and hypotension. The initial treatment is to: - ANS-Replenish the volume by infusing a 0.9% sodium chloride solution Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse patient? - ANS-Hyponatremia What electrolyte should be monitored prior to administering succinylcholine? - ANS-K
c. wbc 19 d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol - ANS-d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol In cushing's, pituitary does not respond to dexamethasone. Which of the following is NOT a criteria of metabolic syndrome? a. BP>140/ b. waist >40 in c. TG> d. HDL <40 - ANS-a. BP>140/ It's 130/ What are Cushing's labs/symptoms? - ANS-Increased BG, increased Na, decreased K Central obesity, moon face with buffalo hump, purple striae, amenorrhea What are Addison's disease labs/diagnosis/tx? - ANS-Decreased BG, decreased Na, increased K Cosyntropin test, positive if serum cortison <18mcg/dL in the morning Tx: florinef, hydrocortisone, steroid bolus Patient is hypotensive with Addison's disease. What is the treatment? - ANS-IVF (D5NS), dopaine/pressors don't work What is SIADH, lab values, and treatment? - ANS-Inappropriate water retention Hypothermia, hyponatremia, decreased serum Osm, increased urine Osm, urine sodium >20 mEq (kidney's trying to excrete water via salt) Tx: 3% hypertonic saline calculated Urine Na 28, serum Osm 250, urine Osm 115. What is suspected dx? - ANS-SIADH 23 yo female presents with DKA. Abg pH 7.3, glucose 520, BP 90/65, HR 120, and she is confused. Which of the following are not included in the initial management of DKA? a. isotonic fluids b. insulin infusion c. sodium bicarbonate d. supportive care - ANS-c. sodium bicarbonate Only indicated for DKA if pH <7.
24 yo male presents with DKA. He is now confused and irritable. AbgL 7.29/33/22. Received isotonic fluids x 1 hour, BP 110/70, HR 90. Blood glucose is 550. What is the best IV fluid indicated? - ANS-1/2 NS because BG> HHNK: what fluids should you use? - ANS-NS for massive fluid volume deficit, then 1/ NS to hydrate the cell, then D51/2NS if on insulin gtt What are Hyperthyroidism labs? - ANS-High T3, high T4, resin uptake TSH >5, low TSH What are Hypothyroidsim labs? - ANS-Low T4, low resin uptake (T3 is not a reliable test), high TSH What are the s/s of thyroid storm/crisis? - ANS-Fever, goiter, tachycardia, low TSH What is the treatment for myxedema coma? - ANS-Loading synthroid followed by maintenance dose Patient with BP 210/110, headache, then BP decreases below 160s, what is 1st treatment? - ANS-Alpha blockers preoperatively, regitine/phentolamine, likely pheochromocytoma What is the first test you run when you see s/s of pheochromocytoma? - ANS-TSH What diagnostic test confirms pheochromocytoma? - ANS-CT DKA fluids? - ANS-IVF first, 1L in first hour, then 500mL/hr, use 1/2 NS if BG> What is the Somogyi effect? - ANS-Hypoglycemic at 3am then rebounds to hyperglycemia at 7am 15 year old patient with DMI reports increased BG in AM. The ACNP determines hyperglycemia is d/t dawn phenomenon? What should you do to his tx regimen? - ANS- Increase the insulin dosage at bedtime Your patient has a history of coagulopathy and is about to go to surgery. Which order is appropriate for DVT/bleeding prophylaxis? a. Heparin gtt b. lovenox c. coumadin d. pneumatic stockings - ANS-d. pneumatic stockings Which of the following is least likely to experience a DVT? a. 24yo Female on oral contraceptives b. 74 yo male post hip replacement c. 58 yo male liver patient
