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