ANCC Exam 2024 WITH ANS Latest
Version.
Types of prevention - Answer primary- car restraints, bicycle helmets, immunizations
secondary- prevent for those with RF-pap, mammo
tertiary-mgmt of established disease- meds, lifestyle
Primary - Answer Preventing the health problem, most cost effective form of healthcare
**IMMUNIZATIONS, ensuring adequate illumination at home (preventing falls)
Secondary - Answer Detecting disease in early asymptomatic stages, screenings
-Early cause finding of asymptomatic disease via the use of a screening test
Ex. highly abnormal mammo not final word
Tertiary - Answer Minimizing negative disease induced outcomes, potentially viewed as
a failure of primary prevention
Ex- rehab, PT, OT
Who should not receive influenza vaccine - Answer 4 mon old born at 32 weeks
gestation
receive flu- 6 mon and older
can give during pregnancy/lactation
give children 2x- 4 months apart
MMR - Answer preggers can't receive (no varicella, or zoster, smallpox, flu mist,
rotavirus), but lactation OK!
its live but weakened
give again to those born after 1957
Give to 6-11 month who are travelling outside US
May treat and have an innocent flat pink rash
2 doses ( at 12-15 mon and 4-6 years)
Tetanus - Answer can get from soil, a depth of the wound is important
Preggers- get a tdap in her thirst trimester to pass onto the unborn child (pertusis is a
bad outcome!), family members need to be up to date- can cause lockjaw
T-dap- 1 at 11-64 and then booster every 10
dTap-five doses
Pertussis- uncontrollable cough, vomitting, fatigue, dx: nasopharyngeal culture and PCR
testing
tx: Azithromycin
No pap smear - Answer prior to 21 or in elderly
,ANCC Exam 2024 WITH ANS Latest
Version.
Benadryl - Answer older, cross BBB, can cause sedation, urinary retention (bad for
BPH)
herpes zoster - Answer stronger chickenpox vaccine-zoster vaccine
post-herpetic neuralgia- persists after 1 month
Herpes keratitis is damage to the corneal epithelium caused by the herpes virus,
commonly shingles. The patient usually has acute onset of eye pain, photophobia, and
blurred vision in the affected eye.
primary open angle glaucoma - Answer peripheral vision loss, elevated intraocular
pressure, deep-cupping of optic disc, tx with beta-adrenergic antag (Timolol), alpha
agonists, prostaglandin analogues
Glaucoma screening test- Tonometry
Normative aging - Answer Need for increased illumination
Macular degeneration - Answer central vision loss, common cause of new onset
blindness in elderly
More females
Screening tests- Amsler grid test
Meniere's disease (idio) vs. Meniere's syndrome (secondary) - Answer dizziness,
tinnitius, nystagmus, vertigo RF: ototoxic drugs, tx: benzos for rest and corticosteroids
for anti-inflam
oral cancer - Answer ulcerated lesion with indurated margins, most common SCC, RF:
HPV 16, screening at dental visits
beta lacatams with allergic reactions - Answer penecillins, cephalosporins,
carbapenems
rashes with Epstein Barr
Otitis externa - Answer Caused by fungus- Candidia or Aspergillus/P. aeruginosa
hallmark is pain on palpating tragus
Tx--> fluoroquinolone
AOM - Answer S.penumoniae (gram pos)-40-50%, tx with amox/cephalo, macrolides,
resistance protein binding sites
H.influenza (gram neg)- can produce beta-lactamase
,ANCC Exam 2024 WITH ANS Latest
Version.
M.catarrhalis (gram neg)- also produces beta-lactamase, can get better without
antibiotic
Need abnormal ear drum (bulging TM) + pain (otalgia)/rubbing/tugging ear
tx- Acetaminophen and otic drops help with ST
Watchful waiting- 6 months or older, with non-severe illness, unilateral, fever <102.2,
otalgia <48
<6 months-begin antibiotic!! if allergy-Cefdinir], RF: pacifier use for 10 months, feedings
in the supine, smoke exposure, day care,
<2- 10 days
2-6 yrs- 7 days
>6 yrs- 5 days
1st line- Amox 90 BID, Amox clav BID
With PCN allergy- **Cefdinir (Cephlosporins)
Group A strep
(GABHS) - Answer Streptococcus pyogenes, risk for rheumatic fever and Glomerulo.,
peritonsillar abscess,
tx- amox then try macrolide if doesnt't improve
GOLD STANDARD IS THROAT CULTURE
indoor allergen - Answer dust mites (perennial), pets, cockroaches, mold spores
Acute Bacterial rhinosinusitis - Answer S.penumoniae**, RF-viral infection, allergies,
tobacco use, 1st line is Augmentin, penicillin allergy-Cefdinir
2nd line- if not better...Clindamycin and Cefixime
Mono - Answer 30-50 days ago was infected before sxs, give prednisone not amox
(rash), at least 50% present with spleen enlargement, wait 1 month to go back to sports
Anterior and posterior cervical lymph
Pharyngitis with exudate
right and left upper quadrant abdominal tendernes
Hepatomegaly in 10% of cases
Splenomegaly in 50% of cases
Asthma flare - Answer FEV1/Peak expiratory flow rate- drops early (even before patient
notices) and good indication of severity of asthma
, ANCC Exam 2024 WITH ANS Latest
Version.
S3 - Answer systolic dysfunction or early diastolic, common in HF (dyspnea, crackles,
tachycardia- 3 adject/s3),
marker of ventricular overload- best heard with bell
S4 - Answer diastolic dysfunction, common in poorly-controlled hypertension, recurrent
myocardial ischemia, unstable angina
Systolic Murmurs - Answer Mitral (rad to axilla) Mitral Benign is- negative hx
Regurgitation Valve lower grade
Physiologic Prolapse no radiation
Aortic (rad to neck) PMI WNL
Stenosis (harsh) softens w. position change
Systolic
Diastolic Murmurs - Answer Mitral
Stenosis (Rumble)
Atrial
Regurg (blowing)
Diastolic
Aortic stenosis - Answer young man, exercise tolerance, harsh systolic murmur, softer
when changing position, radiation to the neck (assume it came out of AORTIC VALVE)
LVH, congenital defect
RF- rheumatic fever, older adults-calcification
Calcific aortic stenosis - Answer 82 y/o woman, dizzy walking up a flight of stairs, harsh
systolic murmur radiation to neck,
Mitral Regurgitation - Answer 62 y/o male with HTN, HF, PMI displaced (big LV),
accentuated when rolled to the side, louder with hand grip, holosystolic, blowing murmur
Mitral Valve Prolapse - Answer 27 y/o woman, runner, oral contraceptive, funnel
chest/pectus excavatum, mid-late systolic murmur which moves forward upon position
change
HONKING (heard best at apex)
Marfan's syndrome, scoliosis
Tx: obtaining an echo is a prudent next step
Encourage aerobic activity
Version.
Types of prevention - Answer primary- car restraints, bicycle helmets, immunizations
secondary- prevent for those with RF-pap, mammo
tertiary-mgmt of established disease- meds, lifestyle
Primary - Answer Preventing the health problem, most cost effective form of healthcare
**IMMUNIZATIONS, ensuring adequate illumination at home (preventing falls)
Secondary - Answer Detecting disease in early asymptomatic stages, screenings
-Early cause finding of asymptomatic disease via the use of a screening test
Ex. highly abnormal mammo not final word
Tertiary - Answer Minimizing negative disease induced outcomes, potentially viewed as
a failure of primary prevention
Ex- rehab, PT, OT
Who should not receive influenza vaccine - Answer 4 mon old born at 32 weeks
gestation
receive flu- 6 mon and older
can give during pregnancy/lactation
give children 2x- 4 months apart
MMR - Answer preggers can't receive (no varicella, or zoster, smallpox, flu mist,
rotavirus), but lactation OK!
its live but weakened
give again to those born after 1957
Give to 6-11 month who are travelling outside US
May treat and have an innocent flat pink rash
2 doses ( at 12-15 mon and 4-6 years)
Tetanus - Answer can get from soil, a depth of the wound is important
Preggers- get a tdap in her thirst trimester to pass onto the unborn child (pertusis is a
bad outcome!), family members need to be up to date- can cause lockjaw
T-dap- 1 at 11-64 and then booster every 10
dTap-five doses
Pertussis- uncontrollable cough, vomitting, fatigue, dx: nasopharyngeal culture and PCR
testing
tx: Azithromycin
No pap smear - Answer prior to 21 or in elderly
,ANCC Exam 2024 WITH ANS Latest
Version.
Benadryl - Answer older, cross BBB, can cause sedation, urinary retention (bad for
BPH)
herpes zoster - Answer stronger chickenpox vaccine-zoster vaccine
post-herpetic neuralgia- persists after 1 month
Herpes keratitis is damage to the corneal epithelium caused by the herpes virus,
commonly shingles. The patient usually has acute onset of eye pain, photophobia, and
blurred vision in the affected eye.
primary open angle glaucoma - Answer peripheral vision loss, elevated intraocular
pressure, deep-cupping of optic disc, tx with beta-adrenergic antag (Timolol), alpha
agonists, prostaglandin analogues
Glaucoma screening test- Tonometry
Normative aging - Answer Need for increased illumination
Macular degeneration - Answer central vision loss, common cause of new onset
blindness in elderly
More females
Screening tests- Amsler grid test
Meniere's disease (idio) vs. Meniere's syndrome (secondary) - Answer dizziness,
tinnitius, nystagmus, vertigo RF: ototoxic drugs, tx: benzos for rest and corticosteroids
for anti-inflam
oral cancer - Answer ulcerated lesion with indurated margins, most common SCC, RF:
HPV 16, screening at dental visits
beta lacatams with allergic reactions - Answer penecillins, cephalosporins,
carbapenems
rashes with Epstein Barr
Otitis externa - Answer Caused by fungus- Candidia or Aspergillus/P. aeruginosa
hallmark is pain on palpating tragus
Tx--> fluoroquinolone
AOM - Answer S.penumoniae (gram pos)-40-50%, tx with amox/cephalo, macrolides,
resistance protein binding sites
H.influenza (gram neg)- can produce beta-lactamase
,ANCC Exam 2024 WITH ANS Latest
Version.
M.catarrhalis (gram neg)- also produces beta-lactamase, can get better without
antibiotic
Need abnormal ear drum (bulging TM) + pain (otalgia)/rubbing/tugging ear
tx- Acetaminophen and otic drops help with ST
Watchful waiting- 6 months or older, with non-severe illness, unilateral, fever <102.2,
otalgia <48
<6 months-begin antibiotic!! if allergy-Cefdinir], RF: pacifier use for 10 months, feedings
in the supine, smoke exposure, day care,
<2- 10 days
2-6 yrs- 7 days
>6 yrs- 5 days
1st line- Amox 90 BID, Amox clav BID
With PCN allergy- **Cefdinir (Cephlosporins)
Group A strep
(GABHS) - Answer Streptococcus pyogenes, risk for rheumatic fever and Glomerulo.,
peritonsillar abscess,
tx- amox then try macrolide if doesnt't improve
GOLD STANDARD IS THROAT CULTURE
indoor allergen - Answer dust mites (perennial), pets, cockroaches, mold spores
Acute Bacterial rhinosinusitis - Answer S.penumoniae**, RF-viral infection, allergies,
tobacco use, 1st line is Augmentin, penicillin allergy-Cefdinir
2nd line- if not better...Clindamycin and Cefixime
Mono - Answer 30-50 days ago was infected before sxs, give prednisone not amox
(rash), at least 50% present with spleen enlargement, wait 1 month to go back to sports
Anterior and posterior cervical lymph
Pharyngitis with exudate
right and left upper quadrant abdominal tendernes
Hepatomegaly in 10% of cases
Splenomegaly in 50% of cases
Asthma flare - Answer FEV1/Peak expiratory flow rate- drops early (even before patient
notices) and good indication of severity of asthma
, ANCC Exam 2024 WITH ANS Latest
Version.
S3 - Answer systolic dysfunction or early diastolic, common in HF (dyspnea, crackles,
tachycardia- 3 adject/s3),
marker of ventricular overload- best heard with bell
S4 - Answer diastolic dysfunction, common in poorly-controlled hypertension, recurrent
myocardial ischemia, unstable angina
Systolic Murmurs - Answer Mitral (rad to axilla) Mitral Benign is- negative hx
Regurgitation Valve lower grade
Physiologic Prolapse no radiation
Aortic (rad to neck) PMI WNL
Stenosis (harsh) softens w. position change
Systolic
Diastolic Murmurs - Answer Mitral
Stenosis (Rumble)
Atrial
Regurg (blowing)
Diastolic
Aortic stenosis - Answer young man, exercise tolerance, harsh systolic murmur, softer
when changing position, radiation to the neck (assume it came out of AORTIC VALVE)
LVH, congenital defect
RF- rheumatic fever, older adults-calcification
Calcific aortic stenosis - Answer 82 y/o woman, dizzy walking up a flight of stairs, harsh
systolic murmur radiation to neck,
Mitral Regurgitation - Answer 62 y/o male with HTN, HF, PMI displaced (big LV),
accentuated when rolled to the side, louder with hand grip, holosystolic, blowing murmur
Mitral Valve Prolapse - Answer 27 y/o woman, runner, oral contraceptive, funnel
chest/pectus excavatum, mid-late systolic murmur which moves forward upon position
change
HONKING (heard best at apex)
Marfan's syndrome, scoliosis
Tx: obtaining an echo is a prudent next step
Encourage aerobic activity
