Exam (elaborations)
AGACNP Exam Review
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Exam of 81 pages for the course AGACNP at AGACNP (AGACNP Exam Review)
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AGACNPEXAM REVIEW
Scope of Practice - answer- Based on legal allowances in each state, individual state
nurse practice acts providing guidelines for nursing practice
Key elements of the NP role include - answer- integration of care across the acute
illness continuum with collaboration and coordination of care; research based clinical
practices, clinical leadership, family assessment, and discharge planning
Standards of Advanced Practice are delineated by... - answer- American Nurses
Association which measure quality of practice, service, or education
State Practice Acts - answer- Authorize Boards of Nursing in each state to establish
statutory authority for licensure of RNs
State Practice Acts - authority includes: - answer- use of title, authorization for scope of
practice including prescriptive authority, and disciplinary grounds
States vary in practice requirements, such as - answer- certification
Prescriptive authority - answer- Ability and extent of NPs ability to prescribe meds
DEA has ruled that nurses in advanced practice may obtain.. - answer- registration
numbers, state practice acts dictate level of prescriptive authority allowed
Credentials encompass... - answer- required education, licensure and certification to
practice as an NP
,Credentials establish... - answer- minimal levels of acceptable performance
Credentialing is necessary to: - answer- ensure that safe healthcare is provided by
qualified individuals; comply with federal and state laws r/t APN
Credentials also... - answer- acknowledges the scope of practice of NP, mandates
accountability, enforces professional standards for practice
Licensure - answer- establishes that a person is qualified to perform in a particular
professional role
Licensure is granted as defined by rules and regulations set forth by - answer- a
governmental regulatory body (ie. state board of nursing)
Certification - answer- Person has met certain standards that signify mastery of
specialized knowledge
Certification is granted by nongovernmental agencies such as - answer- ANCC, AANP
Admitting privileges to hospitals (non physican) were granted - answer- 1983 by JC
Credentialing and privileging - answer- process which an NP is granted permission to
practice in an inpt setting
Credentialing with hospital privileges is granted by a - answer- Hospital Credentialing
Committee
Pt Medical Abandoment - answer- When caregiver-pt relationship is terminated w/o
making reasonable arrangements w an appropriate person so that care can be
continued
Determination of pt abandonment depends on factors such as: - answer- Whether NP
accepted pt assignment, whether NP provided reasonable notice before termination,
whether reasonable arrangements could have been made
Following do not constitute pt abandonment - answer- NP refuses to accept
responsibility for pt assignment when NP has given reasonable notice to proper
authority that NP lacks competence to carry out assignment; NP refuses assignment of
a double shift or addtl hrs beyond posted work schedule when proper notification has
been given..latter phrase can be controversial
Risk Mgmt - answer- Systematic effort to reduce risk begins w formal written risk mgmt
plan that includes: organizations goals, delineation of program's scope, components,
methods; delegating responsibility for implementation and enforcement; demonstrating
,commitment by the board; confidentiality and immunity from retaliation for those who
report sensitive info
Complications of parenteral nutrition - answer- Pneumothorax, hemothorax, arterial
laceration, air emboli, catheter thrombosis, catheter sepsis, hyperglycemia, HHNK
What is the most common electrolyte abnormality - answer- Hyponatremia
Urine sodium normal value - answer- 10-20
Sodium Osmolality normal value - answer- 2xs Na
275-285
Urine sodium >20 suggestive of what? - answer- Suggests renal salt wasting (problem
with kidneys)
Urine sodium <10 suggestive of what? - answer- Suggests renal retention of sodium to
compensate for extrarenal fluid loss (problem other than kidneys)
Isotonic hyponatremia what is it's other name? Lab value and causes and treatment -
answer- Pseudohyponatremia; serium osmo 284-295: lab artifact
Occurs with hyperlipidemia or hyperproteinemia, body water is normal and pts are
asymptomatic
Treatment: Cut down fat (no fluid restriction)
Hypotonic Hyponatremia normal lab value and definition - answer- Osmo <280. State of
body water excess diluting all body fluids: clinical signs arise from water excess.
Hypovolemic w/urine Na+ <10 causes? - answer- Dehydration, diarrhea, vomiting
Hypovolemic w/urine Na+ >20 is caused by? - answer- Low volume and kidneys cannot
conserve Na
Diuretics, ACE inhibitors, and mineralocorticoid deficiency
Hypervolemic, hypotonic hyponatremia treatment? What causes it? - answer- (restrict
water)
Edematous states, CHF, Liver disease, advanced renal failure
Hypertonic Hyponatremia lab value? What causes it? - answer- (Serum osmo >290)
Hyperglycemia: Usually HHNK
Osmo is high and Na is low
Management of hyponatremia - answer- Treat cause
if hypovolemic: give NS
if urine sodium > 20 treat cause
, if hypervolemic: restrict water
If symptomatic : give NS with IV loop diuretic
If CNS symptoms: give 3% with loop diuretic
Hypernatremia what causes it what are the indications - answer- Due to excess water
loss. Always indicates hyperosmolality (deficit of water) excessive sodium intake is rare
Treatment of Hypernatremia - answer- Free water if euvolemic
Hypernatremia with hypovolemia treatment - answer- Give NS followed by 1/2 NS
Hypernatremia with euvolemia Treatment - answer- Treat with free water
Hypernatremia with hypervolemia treatment - answer- Treat with free water (D5NS) and
loop diuretics....may need dialysis
Hypokalemia causes - answer- Causes: chronic use of diuretics, GI loss, excess renal
loss, and alkalosis
S/S of hypokalemia - answer- Muscle weakness, fatigue and muscle cramps
Constipation or ileum due to smooth muscle involvements
If severe (<2.5) may see flaccid paralysis, tetany, hyporeflexia, and rhabdomyolosis
Lab/Diagnostics of hypokalemia - answer- Decreased amplitude of ECG, broad T
waves, prominent U waves, PVCs, Vtach or Vfib
Management of hypokalemia - answer- Oral replacement if >2.5 and no ECG
abnormalities
IV replacement at 10mEq per hour if can't take PO
If <2.5 or s/s are present. Can give 40mEq/L/Hr IV, check every 3 hours and do
continuous ECG monitoring
Mg++ deficiency frequently impairs K correction
Hyperkalemia causes and what happens cellularly - answer- Causes: Excessive intake,
renal failure, drugs, hypoaldosteronism, cell death.Shifts of intracellular K+ to the
extracellular space occurs with acidosis. K+ increase 0.7 with each 0.1 drop in pH
Hyperkalemia S/S - answer- weakness, flaccid paralysis
Abdominal distention
diarrhea
Tall peaked waves on ECG
Management of Hyperkalemia - answer- Kayexalate
if >6.5 or cardiac toxicity or muscle paralysis is present, consider: Insulin 10U with one
amp D50 (pushes K into cell)
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