Leik previously taught in the nurse practitioner (NP) program at the Florida International University Graduate School of Nursing. Part Adult Gerontology Nurse Certification Intensive Review: Quick Facts and Practice Questions, Third Edition.
AMERICAN NURSES CREDENTIALING CENTER
In addition, the candidate must hold an active RN license in any state or territory of the United States. If he or she is educated and/or licensed outside the United States, there are additional requirements.
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
Military nurses who want to take the exam outside the United States are allowed to take their exams at one of Prometric's "global" testing centers. AANPCB exams are administered by PSI Services LLC, which has more than 300 locations throughout the United States and Canada.
EXAM BACKGROUND INFORMATION
I highly recommend that you try the free sample exams on the ANCC website even if you are only planning to take the AANPCB exam. If you want to familiarize yourself with the AANPCB exam format, you can buy their practice with 75 subjects.
COMPARING THE ANCC VERSUS THE AANPCB EXAM
AANC: ANCC has an app that can be used to apply for the exam. Both ANCC and AANPCB allow you to reschedule your exam (only once) and you will be charged a reschedule fee.
COMMON QUESTIONS ABOUT THE NURSE PRACTITIONER CERTIFICATION EXAMS
If you do not retake the exam in that time, you will need to re-apply for the exam (like the first time) and pay the full fee. If you are getting married after you have applied for the exam, it is better to wait to change the name on your driver's license until you have taken and passed the exam.
CERTIFICATION RENEWAL
If you do not have enough clinical hours, another method you can use to recertify is to retake the exam combined with the required continuing education hours. The ANCC recommends that you check with your state licensing board to see if you can continue to practice as an NP.
EXAM QUESTION CLASSIFICATION American Nurses Credentialing Center
In the AANPCB FNP exam, the age group with the highest number of questions is adults (50 questions). In the AANPCB AGNP exam, the age group with the least number of questions is youth (nine questions).
FAST FACTS: ANCC AND AABPCB EXAMS
Several emerging conditions that may arise in primary care will be on the exam. Example: When conducting the Mini-Mental State Exam, when the NP asks about "proverbs," the nurse assesses the patient's ability to understand abstract concepts.
MAXIMIZING YOUR SCORE
Pretend you've never seen the test before so you can start fresh mentally. Better yet, make sure you get enough sleep a few nights before, not just the night before.
PREPARING FOR THE EXAM Review Timeline
One of the most important pieces of advice I can give you is to make sure you get enough sleep the night before the exam. If you do not have the correct identification, you will not be allowed to take the exam.
OTHER TEST-TAKING ISSUES Test Anxiety
EVIDENCE-BASED MEDICINE (EBM) I. Discussion
- Example
- Correct Answer
- Question Dissection
- Correct Answer: Option C
An easy way to do this is to search for keywords in the question, such as 'meta-analysis', 'systematic review' or 'randomized controlled trials' in combination with 'Cochrane database', 'Medline database' and/or or Cumulative Index to Nursing and Allied Health Literature ("CINAHL"). The patient has risk factors for skin cancer, such as light-colored skin, and is from Australia, where skin cancer is common.
MULTIPLE-CHOICE QUESTIONS WITH MORE
The patient reports that the lesion is not itchy, but has been slowly enlarging over the past few years. Actinic keratosis is a precancerous stage of squamous cell carcinoma and is most commonly found on the scalp (males), face, and backs of the hands (dorsum); they appear as a crusty/scaly growth that slowly enlarges over time.
THAN ONE CORRECT RESPONSE I. Discussion
Correct Answer: Options A, D, and E
DIAGNOSTIC IMAGING I. Discussion
Correct Answer: Option B
Most of the middle lobe of the right lung is located in the anterior chest near the right nipple area. Look for a history of exposure to "atomized" water sources such as air conditioners, fountains, etc.
CULTURE I. Discussion
Correct Answer: Option D
In major health decisions, the head of the family is always involved in the health decision. Because of this cultural value, they should not directly agree with or question the health care provider.
LAB RESULTS AND DIAGNOSTIC TESTS I. Discussion
Correct Answer: Option A
Step three: The differential diagnosis for microcytic anemia is iron deficiency and the alpha/beta or minor thalassemia trait for screening. In clinical practice, first rule out iron deficiency anemia (the most common anemia in the world for all ages/races/sex) before ordering hemoglobin electrophoresis.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Discussion
When speaking to a patient in the waiting room (or any other public area), use only the patient's name. If the patient's first and last name are used, option C would be an example of non-compliance with HIPAA.
WOMEN’S HEALTH I. Discussion
Microscopy in candidiasis will show a large number of WBCs, pseudohyphae and spores (“spaghetti and meatballs”).
MEDICATIONS I. Discussion
Examples
IDSA) and the American Thoracic Society (ATS) treatment guidelines recommend which of the following options is the preferred first-line treatment for this patient?. Which of the following antibiotics is the preferred treatment for healthy adults diagnosed with uncomplicated community-acquired pneumonia (CAP)?
Correct Answers
Note sudden or new onset of a dry cough in a patient with hypertension (without signs of a cold). Find a patient with a history of myocardial infarction (MI), heart failure and/or hypertension who complains of increased fatigue and depression (avoid if possible in depressed patients, pulse rate <50 beats/min, second or third degree heart block).
S. CENTERS FOR DISEASE CONTROL AND PREVENTION STATISTICS
This question is based on your recall of facts you have memorized (rote recall) Exclude breast cancer because it is not considered a gynecological cancer.
BENIGN PHYSIOLOGICAL VARIANTS I. Discussion
S. PREVENTIVE SERVICES TASK FORCE SCREENING GUIDELINES
USPSTF (2018) opposes routine screening for ovarian cancer in asymptomatic women who are not known to be at high risk for hereditary cancer syndrome. Hysterectomy (no cervix) Do not screen (if no precancerous or cervical cancer) Prostate cancer (2012) Routine screening not recommended.
FOLLOWING UP ON A PRESCRIPTION MEDICINE I. Discussion
The patient reports that her gastroenterologist's prescription for esomeprazole (Nexium) 40 mg daily ran out several days ago. The patient's severe symptoms are caused by the sudden discontinuation of the high dose PPI (rebound-type reaction).
TANNER STAGES I. Discussion
It is wrong to "reassure" a patient or a family member during the exam (poor therapeutic communication technique). Physiological gynecomastia findings from physical examination will show disc-like breast tissue that is mobile under each nipple/areola, the breast may be tender, and the breast may be asymmetrical (one breast is larger than the other).
QUESTIONS ABOUT FOOD I. Discussion
Rule out option A because it is inconsistent and these foods do not contain high levels of potassium: low-fat yogurt and soft cheeses (calcium) with green vegetables (vitamin K). Calcium (helps with osteopenia and osteoporosis, helps lower BP): Low-fat dairy products, low-fat milk, low-fat yogurt, cheeses.
CASE MANAGEMENT I. Discussion Only
A poor case management outcome is if the child misses school and/or is unable to play due to poor control of asthma symptoms. If the child is unable to attend school full time (frequent absences), this is a poor outcome for case management.
ALL QUESTIONS HAVE ENOUGH INFORMATION I. Discussion Only
With asthma, a good case outcome is for the child (or adult) to return to normal function. Diseases selected for case management are usually chronic conditions such as asthma, congestive heart failure (CHF), HIV infection, chronic psychiatric conditions, etc.
EMERGENT CASES I. Discussion
The patient complains of feeling hot. hives are noted on his chest and arms and legs. The rapid onset of symptoms, such as angioedema, after taking aspirin The classic signs and symptoms of anaphylaxis described in this case.
PRIORITIZING OTHER EMERGENT CASES I. Discussion
Any recent changes to LOC, even those as subtle as problems with normal conversation, should ring a bell in your head. Note the words "common conversation". Don't read the question and wonder what they mean by "normal conversation". Take that at face value.
GERIATRICS I. Discussion
Which of the following drug classes is considered first-line treatment for unipolar depression in the elderly?. Answering this correctly is based on your recognition that unipolar depression is the same disease entity as major/minor depression.
CHOOSING THE BEST INITIAL INTERVENTION I. Discussion
The patient's asthma appears to be worsening (wheezing more than usual, early morning cough). If you suspect that the patient has allergic asthma, refer the patient to an allergist for a scratch test (evaluation).
SIGNS AND SYMPTOMS I. Discussion Only
There is a need to find out triggers, adherence to medication, comorbid conditions, what triggers the asthma and so on. The differential diagnosis of an early morning cough includes postnasal drip, allergic rhinitis, sinusitis, GERD and so on.
PICK OUT THE MOST SPECIFIC SIGN/SYMPTOM I. Discussion
Patients with asthma exacerbations whose PEF is less than 50% of predicted value after administration of albuterol/saline nebulized treatments should not be discharged. Which of the following is most likely to be found in patients with a long-standing case of iron deficiency anemia?
DERMATOLOGY QUESTIONS I. Discussion
The scarlet fever rash has a sandpaper-like texture and is accompanied by a sore throat, strawberry tongue, and peeling skin (desquamation) on the palms and soles. Parts of the body that are usually directly exposed to contaminated soil and sand, such as the soles, limbs, or buttocks, are the most common sites for larval migration.
CHOOSING THE CORRECT DRUG I. Discussion
Amoxicillin is the preferred first-line antibiotic for both AOM and acute sinusitis in children (for patients without risk factors for resistant organisms). The mitral region, sometimes called the apex of the heart, is the optimal location to hear S3.
GOLD STANDARD” TESTS I. Discussion
This area is located in the left fifth intervertebral space, along the midclavicular line. Once a sputum culture and sensitivity result are available, antituberculosis antibiotic therapy can be narrowed or modified.
ARE TWO NAMES BETTER THAN ONE?
The result of the Mantoux test (TB skin test) is negative due to the description of the soft and smooth skin (it is not indurated). The area must be indurated (firm texture) and of the correct size to be positive for TB.
SUICIDE RISK AND DEPRESSION I. Discussion
Although option C (“Do you have any close male or female friends?”) is a common question asked of depressed patients, it is incorrect because it does not provide specific information about specific suicidal or homicidal plans. The statement "Do you want to wait to tell me about your plans until you feel better?".
OTHER PSYCHIATRIC DISORDERS I. Discussion
The stem calls for the "first-line treatment" for depression, the SSRIs. SSRIs are also first-line treatment for OCD, generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (extreme shyness), post-traumatic stress disorder (PTSD, and premenstrual mood disorder (fluoxetine or Prozac).
ABUSIVE SITUATIONS I. Discussion
Choose the statement that is most specific to find out if the patient is suicidal or homicidal. Integrate them into the treatment plan if they are not harmful to the health of the patient.
THE “CAGE” MNEMONIC I. Discussion
A nurse who feels shaky when she wakes up and drinks a glass of wine to feel better.” That's the "E" in CAGE ("eye-opener"). A college student who tells his friend that he only drinks on weekends but thinks he should drink less. This fits the "C" in CAGE ("cut").
PHYSICAL ASSESSMENT FINDINGS I. Discussion
A college student who tells his friend that he only drinks on the weekends but feels he should drink less. A college student who tells his friend he only drinks on the weekends but feels he should drink less."
TWO-PART QUESTIONS I. Discussion
RMSF
NORMAL PHYSICAL EXAM FINDINGS I. Discussion
ADOLESCENCE I. Discussion
According to the CDC, motor vehicle accidents are the leading cause of death in this age group. The second most common cause of death among adolescents in the United States is suicide and the third is homicide.
DIFFERENTIAL DIAGNOSIS I. Discussion
There is a lack of history of aggravating factors such as the intake of certain medications such as NSAIDs, aspirin, bisphosphonates or alcohol (rule out esophagitis).
CLASSIC PRESENTATION I. Discussion
Pulsating mass located in the middle of the abdomen, associated with a bruit Patient demographics. Some of the risk factors for AAA are male gender (age older than 60 years), smoking, uncontrolled hypertension, white race, genetic diseases such as Marfan syndrome, and family history.
ETHNIC BACKGROUND I. Discussion
Know that the eGFR is a better test of kidney function compared to the serum creatinine concentration. The serum creatinine is affected by age (less sensitive in the elderly), gender (higher in men), ethnicity (higher with African background) and other factors.
SENTINEL EVENTS I. Discussion
If you're not sure of the answer, one way to guess is to look for a pattern or for contextual clues. For example, one of the most common drug interactions in the primary care setting is between warfarin sodium (Coumadin) and trimethoprim-sulfamethoxazole (Bactrim).
ORAL DRUGS: FIRST-PASS HEPATIC METABOLISM
Learn about clinically relevant drug "safety" issues such as drug-drug interactions, disease-disease interactions, and adverse events that occur in primary care. The drugs included in the reviews are usually "legacy" drugs that have been in use for several years to several decades (eg doxycycline, amoxicillin).
OR FIRST-PASS EFFECT)
DRUG METABOLISM (BIOTRANSFORMATION)
DRUG EXCRETION
PHARMACOLOGY TERMS
POTENT INHIBITORS: CYP450 SYSTEM
70 or jaw pain (osteonecrosis); take only after waking up with 8 oz of water (not juice) before breakfast; do not lie down for 30 minutes afterwards; do not mix with other drugs; take first thing in the morning before breakfast. Do not mix with grapefruit juice; Higher drug-induced hepatitis or rhabdomyolysis if mixed with azole antifungals.
DRUGS USED TO TREAT HEART DISEASE Cardiac Glycosides: Digoxin (Lanoxin)
Do not mix with nitrates (nitroglycerin, isosorbide dinitrate) and some alpha blockers; erection longer than 4 hours - see ED. Dietary issues: Be sure to review the patient's daily intake of vitamin K foods (kale, spinach, kale/mustard/beet greens, raab broccoli); a high intake of vitamin K will reduce the anticoagulant effect of warfarin (it will lower the INR).
CLINICAL PEARLS
DIURETICS
Combination: Triamterene and HCTZ (Dyazide), amiloride and HCTZ (Moduretic) Black Box Warning: Hyperkalemia, which can be fatal; higher risk with kidneys. Use caution with combinations of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARBs) or NSAIDs; increases the risk of hyperkalemia.
DRUGS USED TO TREAT HYPERTENSION Beta-Blockers (Beta-Antagonists)
Black Box Warning: ACEIs can cause death/damage to the developing fetus in the second and third trimesters; discontinue ACEIs and ARBs promptly if pregnant. Contraindications: See table 3.3; ACEI/ARB-associated angioedema, hereditary. ACEIs and ARBs are drugs of choice for hypertension in diabetics (diabetic nephropathy) and in patients with CKD.
ANTIBIOTICS
Otitis media (first line), rhinosinusitis (first line) Otitis media/rhinosinusitis (first to second line) Cystitis. They are effective against gram-positive bacteria as well as some gram-negative bacteria (H. influenzae, E. coli, P. mirabilis).
CLINICAL PEARL
Inhalation of bioterrorism-related anthrax spores (post-exposure prophylaxis) is treated with ciprofloxacin 500 mg every 12 hours × 60 days (treatment within 48 hours). Usually asymptomatic, but may present with secondary hemolysis/jaundice after treatment with a sulfa drug or after eating beans.
ANTIBIOTIC CASE SCENARIOS Case 1
The patient reports a history of an allergic reaction to penicillin with .. swollen lips” accompanied by pruritic urticaria. Pneumococcal polysaccharide vaccine (Pneumovax) D) Oxygen by nasal cannula .. The correct answer is option A: A) Short-acting beta-2 agonists Best clue.
OVER-THE-COUNTER (OTC) DRUGS AND HERBS Topical Nasal Decongestants
In COPD patients with mild dyspnea, the initial treatment options are a short-acting beta-2 agonist (albuterol, levalbuterol) or a short-acting anticholinergic (ipratropium bromide), or both. If not effective, the next step is a long-acting beta-2 agonist (salmeterol) or a long-acting anticholinergic (tiotropium), or both.
EXAM TIPS
It can take up to 4 weeks to work; may cause a temporary burning sensation; do not use on broken skin; advise patient to wash hands with soap and water immediately after using capsaicin cream and to avoid touching eyes, nose, and mouth. Extended-release Tylenol (8 hours; 650 mg each): Take two caps every 8 hours PRN; do not take more than six caps in 24 hours (maximum dose is 3,900 mg [3.9 g] in 24 hours) Duration: Do not use for more than 10 days unless directed by healthcare provider Avoid if: chronic hepatitis B/C/ D, dehydration, liver disease, cirrhosis, heavy drinkers.
IMMUNE SYSTEM DRUGS Glucocorticoids (Steroids)
Ultrapotent steroids (Temovate, etc.) should not be discontinued for more than 2 weeks (risk of hypothalamic-pituitary axis [HPA] suppression). Acutely inflamed joints (knees/hips/shoulders/elbows) can be treated with intra-articular triamcinolone (Kenalog) injections up to three times a year.
OTHER DRUGS AND SAFETY ISSUES Drugs That Require Eye Examination
ILLEGAL DRUGS
S. FDA DRUG ENFORCEMENT AGENCY (DEA)
For all controlled substances: Must have the prescriber and the supervising prescriber's name/DEA number with the clinic address on the block; cannot be preceded by or. Women and men of reproductive potential: Include information on the effect of the drug on fertility, pregnancy testing/loss (if available) and birth control.
PRESCRIPTION PADS
Almost all of the drugs on the 2016 edition of the exams were released before the PLLR came into effect. In general, FDA Category X drugs are drugs that interfere with or block hormones (finasteride, misoprostol, Lupron), contain estrogen (birth control pill, HRT), are live virus vaccines, interfere with cell growth (methotrexate, chemotherapy, radiation), or are derivatives of vitamin A (e.g. roaccutane, high-dose vitamin A supplements).
COMPLEMENTARY AND ALTERNATIVE MEDICINE
S. HEALTH STATISTICS Mortality Statistics *
Homicide (14.3%): Non-fatal and fatal violence is much more common among young people than in other age groups.
CANCER STATISTICS Prevalence
SCREENING TESTS Sensitivity
HEALTH PROMOTION/DISEASE AND DEATH PREVENTION
S. PREVENTIVE SERVICES TASK FORCE
Baseline mammogram: Start at age 50 and repeat every 2 years until age 74. Baseline: from age 50 to age 75 (older age is the most common risk factor).
RISK FACTORS Breast Cancer
Beginning at the onset of sexual activity High-intensity behavioral counseling for sexually active adolescents and adults who are at high risk for STIs. Osteoporosis (being updated) Onset at age 65 years or older May begin earlier if a younger woman has a fracture risk equal to or greater than that of a 65-year-old Caucasian woman (ie, chronic steroids) Ovarian cancer (September 2012) Against routine screening Do not screen for ovarian cancer.
VACCINES AND IMMUNIZATIONS (TABLE 4.3) Hepatitis B Vaccine
Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax): All adults aged 65 years or older or at high risk for pneumococcal disease (ages 2-64 years). Give one dose at age 60 or older (even if the patient has already had herpes).
DANGER SIGNALS EYES
Acute onset of erythematous swollen eyelid with proptosis (bulging of the eyeball) and ocular pain in the affected eye. Inability to perform full range of motion (ROM) of the eyes (examination of abnormal extraocular movement [EOM]) with pain when moving the eyes.
EARS, NOSE, AND SINUSES Cholesteatoma
Young adult with new or intermittent loss of vision in one eye (optic neuritis) alone or accompanied by nystagmus or other abnormal eye movements. Sudden onset of a flurry of floaters associated with "seeing through a curtain" sensation with sudden flashes of light (photopsia).
PHARYNX
NORMAL FINDINGS EYES
EARS
NOSE
SINUSES
MOUTH
SALIVARY GLANDS
TONSILS
POSTERIOR PHARYNX
BENIGN VARIANTS
Painless midline bony bump on the hard palate (roof of the mouth); can be asymmetric; the skin should be normal. Uvula is divided into two parts and looks like a fish tail May be a sign of an occult cleft palate (rare).
ABNORMAL FINDINGS Papilledema
Opacity of the lens of the eye, which can be central (nuclear cataract) or on the sides (cortical cataract). Elongated papillae on the lateral sides of the tongue that are pathognomonic for HIV infection.
EENT TERMINOLOGY
EVALUATION AND TESTING VISION TESTING
Any kind of obstruction (or conduction) of the sound waves will cause conductive hearing loss. Damage (or aging) to the cochlea/vestibule (presbycusis, Ménère's disease) and/or to the nerve pathways (CN VIII or acoustic nerve) causes sensorineural hearing loss.
DISEASE REVIEW EYES
Other causes include blockage of the outer ear (ceruminosis, otitis externa) or fluid inside the middle ear (otitis media, serous otitis media). The patient is given a copy of the Amsler grid (focus the eye on the center point and look at the grid 12 inches from the eyes).
THROAT
Apply triple antibiotic ointment or petroleum jelly in front of the nose with a cotton swab for several days. Acute rheumatic fever: Inflammatory response to strep infection that can affect the heart and valves, joints and the brain.
EARS AND SINUSES
Type of AOM infection that is more painful due to the presence of blisters (bullae) on a red and bulging eardrum. If TM is ruptured, purulent discharge from affected ear (and relief of ear pain) Treatment Plan.
ACUTE BACTERIAL RHINOSINUSITIS (ABRS)
Sinuses: They are sensitive to palpation on the front (maxillary) face or in the area of the frontal sinus above the inner canthus of the eye. Carbamide peroxide (similar to hydrogen peroxide) is one of the most common OTC treatments for ceruminosis.
DANGER SIGNALS
If a herpetic rash is seen on the tip of the nose, assume it is shingles until proven otherwise. The hot tip is gently pushed down (90-degree angle) until a 3- to 4-mm hole is burned onto the nail.
NORMAL FINDINGS Anatomy of the Skin
If the hematoma covers more than 25% of the nail surface, there is a high risk of permanent ischemic damage to the nail matrix if the blood is not drained. The nail is gently pressed down until most or all of the blood is drained or aspirated with a small needle.
SKIN LESIONS Screening for Melanoma
Advise the patient to avoid shaving the beard too short and too close to the skin. Vesicle: A raised superficial skin lesion less than 1 cm in diameter and filled with serous fluid.
DERMATOLOGY TERMS
SKIN: CLINICAL FINDINGS Urticaria (Hives)
Soft, wart-like, fleshy growths on the trunk, mostly located on the back. Diffuse velvety thickening of the skin, usually located behind the neck and in the armpit.
TOPICAL STEROIDS
Hereditary skin disorder that results in extremely dry skin and may involve mucosal surfaces such as the mouth (xerostomia) or the conjunctiva of the eye (xerophthalmia). When twisted or traumatized (ie, caught in a necklace), it can become necrotic and fall off the skin.
DISEASE REVIEW Psoriasis
Intertrigo/intertriginous areas of the body (or overlying areas of skin that rub together) may be infected with fungal (candidal intertrigo) and/or bacterial organisms. Be aware of injuries to the hands with a clenched fist (may include injuries to the joint capsule and tendons).
