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AANP/AANP FNP/AANP AGPCNP PSI {|AANP: EXAM PEARLS|}

Name: AANP/AANP FNP/AANP AGPCNP PSI {|AANP: EXAM PEARLS|}
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AANP/AANP FNP/AANP AGPCNP PSI {|AANP: PEARLS|

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AANP/AANP FNP/AANP AGPCNP PSI {|AANP: PEARLS|

AANP/AANP FNP/AANP AGPCNP PSI {|AANP: EXAM PEARLS|}

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Exam Format AANP/AANP FNP/AANP AGPCNP PSI {|AANP: EXAM PEARLS |}  AANP FNP exam contains very few nonclinical questions  Certification tests are designed for entry -level practice  AANP has 15 pilot questions which are not graded [there is NO WAY to identify the pilot test questions from the graded questions]  New clinical info [treatment and/or guidelines] released on the last 10 months won’t be on the exam  Questions will be on primary care disorders – if you are guessing, AVOID PICKING EXOTIC DIAGNOSIS AS AN ANSWER Labs  Normal lab results pertinent to a question WILL ONLY BE LISTED ONCE. Use your scratch sheet of paper to jot down these values if given.  Follow the LAB NORMS GIVEN BY AANP not what you learned on NP school  Learn the significance of abnormal lab values AND type of follow -up needed [i.e. elderly gentleman with c/o scalp tenderness + indurated temporal artery, NP suspects temporal arteritis. Screening test is sed rate – which is expected to be MUCH HIGHER than normal value] Good to Know  Expect one question related to dental injury [i.e. completely avulsed permanent tooth should be reimplanted ASAP! It can be transported to dentist on cold milk (not frozen milk)  May be a question on epidemiologic terms (i.e. sensitivity is defined as the ability of a test to detect a person who has the disease. Specificity is defined as the ability of a test to detect a person who is healthy or detect the person without the disease)  Learn definition of some research study designs : cohort follows a group of people who share some common characteristics to observe the development of a disease over time – Framingham nurses health study  Emergent conditions that will present on primary care clinics will be on the exam: navicular fracture, MI, cauda equina syndrome, anaphylaxis, angioedema, meningococcal meningitis  Know some anatomic areas : trauma to Kiesselbach’s plexus = anterior nosebleed  Some questions ask about “gold -standard test” or the ―diagnostic test for the condition‖: sickle cell anemia, G6PD anemia, and alpha/beta thalassemia = hgb electrophoresis  Disease states are usually presented on their “full -blown classic” textbook presentation: acute mononucleosis, teen will have classic triad of sore throat, prolonged fatigue, and enlarged cervical nodes. If patient is older with same signs/symptoms, it is still mononucleosis reactivated type  Ethic background may provide clues to disease: alpha thal = southeast Asia / Filipinos; beta thal = Mediterranean  NO ASYMPTOMATIC or BORDERLINE CASES OF DISEASE STATES WILL BE ON THE EXAM: IDA on ―real life‖ don’t present often with pica or spoon -
shaped nails, on the exam they will have these clinical findings  Be familiar with lupus and SLE: malar rash (butterfly) = lupus. Instruct patient to avoid / minimize sun exposure r/t photosensitivity.  Be familiar with polymyalgia rheumatica (PRM): 1st line tx is long -term steroids. Long -term, low-dose steroids are commonly used to control symptoms (pain, severe stiffness on shoulders / hip girdle). PMR patients are at HIGH RISK FOR TEMPORAL ARTERITIS.  Gold standard exam for temporal arteritis: biopsy + refer patient to optho for management.  Learn the disorders for which maneuvers are used and what a positive report means : o Finkelstein’s test—positive on De Quervain’s tenosynovitis o Anterior drawer maneuver and Lachman maneuver —positive if anterior cruciate ligament (ACL) of the knee is damaged. The knee may also be unstable. o McMurray’s sign—positive on meniscus injuries of the knee  Conditions that NEED a radiologic test: damaged joints – order Xray 1st (but MRI is the gold standard )  Abnormal eye findings on DM (diabetic retinopathy) and HTN (hypertensive retinopathy) should be MEMORIZED and learn to distinguish each one: o Diabetic retinopathy = neovascularization, cotton wool spots, microaneurysms o Hypertensive retinopathy = AV nicking, silver and/or copper wire arterioles  Become knowledgeable about physical exam ―normal‖ and ―abnormal‖ findings: o Checking DTRs on patient w/severe sciatica or diabetic peripheral neuropathy: ankle jerk reflex (Achilles reflex) may be absent or hypoactive. Scoring absent (0), hypoactive (1), normal (2), hyperactive (3), and clonus (4).  ONLY A FEW QUESTIONS WILL BE ON BENIGN or PHYSIOLOGIC VARIANTS: benign S4 heart sounds may be auscultated on some elderly pt. Torus palantinus and fishtail uvula may be seen during the oral exam on a few patients.  If the question is asking for the initial or screening lab test, it will probably be a ―cheap ‖ and readily available test: CBC (complete blood count (CBC) to screen for anemia  There are some questions on theories and conceptual models : Stages of change or ―decision‖ theory (Prochaska) includes concepts such as precontemplation, contemplation, preparation, action, and maintenance.  Other health theorists who have been included on the exams on the past are (not inclusive ): o Alfred Bandura (self-efficacy), Erik Erikson, Sigmund Freud, Elisabeth Kübler -Ross (grieving), and others o If a small child expresses a desire to marry a parent of the opposite sex: the child is on the oedipal stage (Freud). Child’s age is about 5 to 6 years (preschool to kindergarten). o Starting at the age of about 11 years , most children can understand abstract concepts (early abstract thinking) and are better at logical thinking . o When performing the Mini -Mental State Exam , when the NP is asking about ―proverbs,‖ the nurse is assessing the patient’s ability to understand abstract concepts.  Keep these good communication rules on mind : Ask open -ended questions, do not reassure patients, avoid angering the patient, and respect the patient’s culture.  There may be two to three questions relating to abuse : child abuse, domestic abuse, elderly abuse Antibiotics & Medications  Know the difference between 1st and 2nd line abx: AOM on 7 yr old treated with amoxicillin returns on 48hr without improvement (continued ear pain, bulging TM). Next step is to d/c amox and start child on 2nd line abx Augmentin BID x10 days  Be familiar with alternative abx for PCN -allergic patients: If patient has gram+ infection , prescribe macrolides, clinda, quinolones = levo or moxi  Patient responds well to macrolides but thinks they’re allergic to erythromycin (nausea, GI upset): inform patient she had an adverse rx, not a true allergic (hives/angioedema): switch pt from erythromycin to azithromycin (z-pack)  Fails to respond to initial medication: add another medication per treatment guidelines (i.e. COPD pt prescribed Atrovent for dyspnea. On follow -up, patient complains symptoms are not relieved. Next step is to prescribe albuterol (Ventolin) or combo inhaler)  Commonly used drugs with rare (potentially fatal) adverse effects: ACE -I = angioedema. Common side effect of ACEIs = dry cough (up to 10%)

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