AGACNP Board Exam Prep with VERIFIED

SOLUTIONS.
Hypovolemic shock findings of
CVP
PAOP/PCWP
CO/CI
SVR
Sv02 ✔✔CVP- decreased
PAOP/PCWP-decreased
CO/CI-decreased
SVR-increased
Sv02-decreased

Cardiogenic shock findings of

CVP
PAOP/PCWP
CO/CI
SVR
Sv02 ✔✔CVP- increased
PAOP/PCWP- INCREASED (only shock with increased)
CO/CI- decreased
SVR- increased
Sv02- decreased
mainstay of initial shock treatment? ✔✔volume replacement
isotonic IVF

Obstructive shock findings of

CVP
PAOP/PCWP
CO/CI
SVR
Sv02 ✔✔CVP- increased
PAOP/PCWP- decreased
CO/CI-decreased
SVR-increased
Sv02-decreased

Distributive shock findings of

CVP
PAOP/PCWP
CO/CI
SVR
Sv02 ✔✔ALL DECREASED
CVP- decreased
PAOP/PCWP- decreased
CO/CI-decreased
SVR-decreased
Sv02-decreased
Triad of treatment for distributive shock? ✔✔#1 epinephrine
glucorticoids
antihistamine

Septic shock findings during HYPERDYNAMIC *warm* shock

CVP
PAOP/PCWP
CO/CI
SVR
Sv02 ✔✔CVP- increased
PAOP/PCWP-normal
CO/CI-increased
SVR-slightly decreased
Sv02- increased

SEPTIC shock findings of HYPODYNAMIC *cold* shock

CVP
PAOP/PCWP
CO/CI
SVR
Sv02 ✔✔ALL DECREASED
CVP- decreased
PAOP/PCWP-decreased
CO/CI-decreased
SVR-decreased
Sv02-decreased or increased

Normal SVR ✔✔900-1400 dynes/sec/cm5

Normal CI ✔✔2.5-4.2 L/min/m2

Normal PAOP (wedge) pressure ✔✔8-12 mm Hg

What shows resuscitation for septic shock? ✔✔lactic acid <2

What is the parkland formula? ✔✔Fluids for first 24hrs =

4ml x kg x %TBSA

50% over 8hrs

50% over next 16hrs

how do you ensure tissue perfusion in burn patient? ✔✔maintain urinary output
of 0.5ml/kg/hr

What is the rule of 9's with burns? ✔✔-head and neck 9%

-upper limbs 9% each
-trunk 36%
-genitalia 1%
-lower limbs 18% each
Patient is NPO due to aspiration risk and presents with need for nutritional support
for <6weeks inpatient, what type of tube should you anticipate using?
✔✔duodenal tube

Patient is NPO and plan for >6weeks of nutritional support (long term) is needed,
what type of feeding tube? ✔✔enterostomal tube

If you cannot use the gut for nutritional support, what is used in <2week nutritional
support needed?
What is used if >2 week nutritional support is needed? ✔✔A. PPN
B. TPN

Normal WBC? ✔✔5,000-11,000

Normal neutrophils ✔✔56-67%

normal eosinophil count? ✔✔1-3%

normal lymphocytes ✔✔22-33%

Firstline antibiotic for uncomplicated UTI? ✔✔sulfamethozazole/trimethoprim

(bactrim) 1 tab BID x3 days
or
Macrobid 100mg BID x5 days
Firstline antibiotic for complicated UTI? ✔✔Cipro 500mg PO BID or 400mg IV
q12hr
or
Levofloxacin 750mg PO or IV 7-14 days

Abx for high risk UTI that is complicated? ✔✔-invanz 1g iv daily

-zosyn 3.375 iv Q6hr
cefepime 2g iv q12hr

Normal serum sodium? ✔✔135-145 mEq/L

Normal serum osmolality ✔✔275-295 mOsm/kg

What is #1 electrolyte disturbance? ✔✔hyponatremia

What cacuses a positive chvoteks and trousseaus sign? ✔✔hypocalcemia

What electrolyte disturbance causes peaked T waves? ✔✔hyperkalemia

Hypernatremia occurs due to what? ✔✔loss of hypotonic fluid or decreased

accessed to free water leading to hypertonic state

Treatment for diabetes insipidus DI? ✔✔Desmopressin (DDAVP) or sodium

restriction
Indications for dialysis? AEIOU ✔✔A - Acidosis
E - electrolytes
I - ingestion
O - overload of fluid
U - Uremia

5 P's of compartment syndrome? ✔✔Pain

Pallor
Paresthesia
Paralysis
Pulselessness

Normal Hgb A1C levels ✔✔Less than 5.5

Goal Hgb A1c for diabetes patients? ✔✔<7

metformin should not be given to patients with GFR below what? ✔✔<30

Goal glucose for diabetes patients? ✔✔140-180

Hyperosmolar Nonketotic State (HNS) can occur from what acute issues?
✔✔dehydration and acute renal failure

What is dawn phenomenon? ✔✔High blood sugar until morning glucose reveals
hypoglycemia
what is Somogyi effect? ✔✔normal glucose at bedtime,
hypoglycemia in the night (2am)
and hyperglycemia in the morning

Hypothyroidism labs? ✔✔TSH high

T4 low

Tx hypothyroidism? ✔✔synthroid

hypothyroidism can lead to what if not treated? ✔✔myxedema coma

Labs with myxedema coma? ✔✔high TSH

low T4

Thyroid storm (hyperthyroidism) can cause what? ✔✔delirium

hypertension
hyperthermia

hyperthyroidism labs? ✔✔Low TSH

High T4

Graves disease labs? ✔✔hyperthyroidism labs:

low TSH
Hight T4
what drug can cause hyperthyroidism and hypothyroidism? ✔✔amiodarone

What are adrenal cortex disorders? ✔✔Cushing's (hypercortisolism

and
Addisons (hypocoticolism)

Labs with cushings? ✔✔high cortisol

high acth
hypokalemia
hyperglycemia
leukocytosis
hypernatremia

Labs with addisons disease? ✔✔low cortisol

low acth
hyponatremia
hyperkalemia
hypoglycemia

Positive cosyntropin (ACTH) test ✔✔addisons

diagnostic for cushings syndrome? ✔✔24hr urine cortisol

What is 5 P's of pheochromocytoma? ✔✔Pressure (hypertension)

Pain (headache)
Palpitations (tachy and tremors)
Perspiration (profuse flushing)
Pallor (due to vasoconstriction)

First line diagnostic test for pheochromocytoma?

What test confirms? ✔✔24hr urine catecholamines
CT or MRI of adrenal confirm

Diabetes insipidus labs? ✔✔low ADH

Serum hypernatremia
serum hyperosmolality
urine hyponatremia
urine hypoosmolality
**GETTING RID OF WATER**

SIADH labs? ✔✔High ADH

Serum hyponatremia
Serum hypoosmolality
Urine hypernatremia
Urine hyperosmolality
**HOLDING ON TO WATER**

Diabetes insipidus is a dysfunction of what? ✔✔pituitary

Pheochromocytoma is a dysfunction of what? ✔✔Adrenals

Dexamethasone suppression tests diagnoses what disease? ✔✔cushings

Normal MCV? ✔✔80-100

Microcytic anemias? ✔✔Iron deficiency anemia

Thalassemia

Macrocytic anemias? ✔✔Pernicious anemia

folic acid deficiency anemia

Normocytic anemia? ✔✔Anemia of chronic disease

acute blood loss

Iron deficiency (microcytic) anemia labs? ✔✔low MCV

low iron
low ferritin
high TIBC

Thalassemia (microcytic) anemia labs? ✔✔low MCV

normal iron, ferritin, tibc

Pernicious (macrocytic) anemia labs? ✔✔High MCV

low b12
normal RDW

Folic acid deficiency (macrocytic) anemia labs ✔✔High MCV

normal RDW
Decreased RBC folate

What cancer has Reed-Sternberg cells? ✔✔Hodgkin lymphoma

Lymph nodes with hodgkin lymphoma? ✔✔single group/chain of lymph nodes

(cervical)

lymph nodes with Non-Hodgkin lymphoma? ✔✔multiple lymph node and

extranodal involvement

What cells are affected with non-hodgkin lymphoma ✔✔B cells

AML occurs in adults or children? ✔✔Adults

ALL occurs in adults or children? ✔✔Children

What leukemia's are insidious and slow onset? ✔✔CML and CLL

What is most common leukemia in adults? ✔✔CLL

COPD is FEV1/FVC of what after bronchodilator? ✔✔<70%

Normal FEV1: ✔✔4.15

Normal FVC ✔✔5.2

Normal FEV1/FVC ✔✔80%

Asthma is an FEV1 increase of what after beta2agonist administration?

✔✔>12%

Life threatening PEV or FEV1 for asthma? ✔✔<25%

If a patient immigrated from high risk country, what induration would be positive
for TB? ✔✔>10

All patients with this induration are positive for TB ✔✔>15

Most common pathogens for CAP? ✔✔S. pneumoniae

H. influenzae

TX for CAP? ✔✔doxycycline

azithromycin, clarithromycin, erythromycin
amoxicillin
levofloxacin
CAP inpatient tx? ✔✔ceftriaxone IV
Severe: beta lactam plus macrolide

VT for ARDS? ✔✔4-8ml/kg

PH goal for ARDS? ✔✔7.30-7.45

Pa02/Fi02 ratio for mild ARDS? ✔✔<300

Pa02/Fi02 ratio for moderate ARDS? ✔✔<200

Pa02/Fi02 ratio for severe ards? ✔✔<100

Pneumothorax on chest xray is what color? ✔✔black- air

TX tenson pneumothorax? ✔✔emergent needle decompression

Pnsumothorax sounds like what to percussion? ✔✔hyperresonance

Hemothorax color on CXR?w ✔✔white- blood

Most common cause of PE? ✔✔DVT

S/S of PE includes what heart sound? ✔✔S4

DDimer of less than what rules out PE? ✔✔<500

What is INR goal with coumadin? ✔✔2-3

Normal INR? ✔✔0.7-1.8

Diagnostic study of choice for Pleural effusion? ✔✔cxr in decubitus view

Transudative pleural effusion causes? ✔✔CHF

Pericarditis
Cirrhosis

Exudative causes of pleural effusion? ✔✔lung parenchymal infection

malignancy
pulmonary embolism

You expect to find what (acidotic/alkalotic) with pulmonary embolism patient?

✔✔respiratory alkalosis

What does not cause hypoxemia? ✔✔hyperventilation

Absolute contraindication for fibrinolysis? ✔✔hx cerebrovascular event

nonhemorrhagic stroke or head trauma <3mo ago
cranial/spinal trauma <2mo
known bleeding diathesis
active internal bleeding

ST elevation in II, III, and AVF means what type of STEMI? ✔✔Inferior infarct

ST elevation in all leads indicated? ✔✔pericarditis

What is absolute contraindication for ACE I? ✔✔bilateral renal artery stenosis

edema from CHF is due to what? ✔✔increase in hydrostatic pressure

What is Becks triad? ✔✔elevated JVD (over 7)

distant heart sounds
hypotension

duodenal ulcer pain is described as what with eating? ✔✔relieved with eating

gastric ulcer pain is what with eating? ✔✔worse with eating

TX for PUD? ✔✔PPI

Cullen's or grey turners sign indicates what? ✔✔pancreatitis

Bowel obstruction causes? (HANG IV) ✔✔hernia
adhesions
neoplasm
gallstone ileus
intussusception
volvulus

SBO on xray? ✔✔dilated loops of small bowel- horizontal

LBO on xrray? ✔✔frame pattern of large bowel

Main tx for both UC and crohns? ✔✔Steroids

Which has bloody diarrhea- UC or crohns? ✔✔UC

for positive hepatits A, what tests must be positive? ✔✔Anti-HAV and IgM

To have active hepatitis C what tests must be positive? ✔✔Anti-HCV and HCV
RNA

What test is positive for patients with acute hepB infection? ✔✔IM=immediate
IgM anti HBc

Patient has positive HBsAg what does this indicate? ✔✔Actively infective
PPatient has positive anti-HBs, what does this indicate? ✔✔Immunity

Patient has positive anti-HBc what does this indicate? ✔✔exposed to live actual
virus

Patient has positive IgM anti-HBc what does this indicate? ✔✔acutely infected

What is the immediate triad for perforated ulcer s/s? ✔✔1. quiet rigid abdomen-
GI quits working
2. leukocytosis
3. free air in abdomen

Normal BUN/Cr ratio? ✔✔10:1-20:1

treatment for all acute renal failure patients? ✔✔HYDRATE

Prerenal BUN/Cr ratio? ✔✔>20:1 (HIGH)

Causes of prerenal ARF? ✔✔decrease in intravascular volume

hypoperfusion, low CO, GI losses, surgery

Post-renal BUN/Cr ratio? ✔✔Normal 10:1-20:1

Causes of post-renal ARF? ✔✔Obstruction in lower urinary tract

Intrarenal BUN/CR ratio? ✔✔<10:1 (LOW)

Causes of intrarenal ARF? ✔✔renal ischemia

nephrotoxic injury
ischemic injury

Chronic renal failure staging based on GFR:

1.
2.
3.
4. ✔✔1. >90
2. 60-89
3. 30-59
4. 15-29 (GET READY FOR DIALYSIS)
5. <15- DIALYSIS

Reperfusion therapy for stoke must begin how long after symptom onset?
✔✔Within 4.5hrs

If patient presenting with stroke in need of rtPA, bp 200/120 can they have
treatment? ✔✔no hold treatment and treat BP to bring it down prior to qualifying
for treatment

Contraindications for rtPA for acute ischemic stroke? ✔✔current ICH

SAH
active internal bleeding
recent (3mo) head trauma, intracranial or intraspinal sx
presence of intracranial conditions that increase risk of bleeding
bleeding diathesis
current severe uncontrolled hypertensionq2q

which intracranial bleed often occurs from trauma and patient with have transient
LOC and unilateral fixed and dilated pupil? ✔✔epidural hematoma

which intracranial bleed is a thunderclap headache? ✔✔SAH

which intracranial bleed can occur gradually and can be acute or chronic and is
commonly seen in elderly or alcohol abuse patients? ✔✔subdural hematoma

Can you perform LP on patient with possible meningitis that has papilledema?
✔✔no, sign of increased ICP

labs for bacterial meningitis LP ✔✔200-20,000 PMN

<45 glucose
>50 protein
HIGH opening pressure

labs for viral meningitis LP ✔✔100-1000 lymphocytes

normal glucose
>50 protein- not purulent
normal or slightly elevated opening pressure
Autonomic dysreflexia is injury (usually traumatic MVC) where? ✔✔above T6

S/s autonomic dysreflexia ✔✔-exaggerated autonomic response

-above the level of injury (diaphoresis and flushing)
-below the level of injury (chills and vasoconstriction)
-generalized (HTN, bradycardia, H/a, nausea)

-Brown-sequard syndrome is injury- usually penetrating- to what? ✔✔spinal

cord

s/s of brown sequard syndrome ✔✔-ipsilateral motor disturbance

-contralateral loss of pain/temp

Central cord syndrome is usually hyperextension injury to what and located where?
✔✔cervical spinal cord, above T6

Patient presents with bells palsy symptoms, this affects what nerve? ✔✔VII

Cranial nerves ✔✔CNi: Olfactory

CNII: Optic
CNIII: Oculomotor
CNIV: Trochlear
CNV: trigeminal
CN VI: Abducens
CN VII: Facial
CN VIII: vestibulocochlear
CN IX: Glossopharyngeal
CN X: Vagus
CN XI: accessory
CN XII: hypoglossal

MR PASS (Murmurs) ✔✔Mitral

Regurgitation
Physiologic
Aortic Stenosis
Systolic

MR PASS wins MVP ✔✔Mitral

Valve
Prolapse

*also systolic

MR PASS hangs with MS ARD ✔✔Mitral

Stenosis
Aortic
Regurgitation
Diastolic

Why is a paitent with aortic stenosis SAD? ✔✔symptoms are:

Syncope
Angina
Dyspnea

What is beneficence? ✔✔help people in need,

doing good

What is nonmaleficence? ✔✔principle of doing no harm

Autonomy ✔✔right of competent person to choose plan of care

Who can take away competency? ✔✔only a judge

Justice means? ✔✔all people are to be treated the same

utilitarianism means? ✔✔actions that provide the most good for the most people
"for the greater good"

What is veracity ✔✔ethical duty to be honest

What is a significant P value? ✔✔<0.05

what is a general standard? ✔✔a power of 80%

A confidence level of 5 equals what level of confidence? ✔✔95%

What is a prospective study? ✔✔exploring looking forward

what is a retrospective study? ✔✔looking backwards at data that already exists

Normal PMI ✔✔5th intercostal space, midclavicular line

What do deep S waves and Tall R waves mean? ✔✔BIG left ventricle

If you cannot palpate the PMI, how do you have the patient position? ✔✔left
lateral decubitus position

Why is PMI displaced? ✔✔usually misplaced laterally due to LV hypertrophy or

pressure overload from HTN

MTAP stands for? ✔✔Mitral

Tricuspid
Aortic
Pulmonic

Is a physiologic S2 split normal or abnormal? ✔✔can be normal.

a pathologic split S2 if often seen in what? ✔✔atrial septal defect, LBBB

Pathologic S3 sound is from? ✔✔often in heart failure but patient must also have
symptoms such as dyspnea, tachycardia, and crackles
-can resolve with treatment

S4 sound is heard when? ✔✔A patient has uncontrolled HTN or myocardial

ischemia
-can resolve with treatment

A systolic murmur can be what? ✔✔benign or pathologic

diastolic murmur is always what? ✔✔pathologic

murmur grading: ✔✔I: faint

II: quiet but immediately heard
III: moderately loud without thrill
IV: Loud with thrill
V: very loud with thrill
VI: audible without stethoscope.

Most common murmur grade? ✔✔II and III

upon auscultation of heart the provider hears a HARSH murmur that radiates to the
neck, what is this? ✔✔aortic stenosis

upon auscultation of heart the provider hears and rumble murmur what is this?
✔✔mitral stenosis
upon auscultation of the heart the provider hears a blowing murmur, what is this?
✔✔aortic regurgitation

if a murmur radiates to the axilla, this is often coming from where? ✔✔mitral
valve

provider hears a Mid-systolic click with late systolic murmur, murmur moves
forward with position change, what is this? ✔✔mitral valve prolapse

If you have a grade 2/6 midsystolic murmur that increases with intensity with
position change from supine to standing accompanied by S4 heart sound, what is
this? ✔✔hypertrophic cardiomyopathy

McMurray test is to test for what? ✔✔meniscal tear- think KNEE

Talar test is to test for what? ✔✔Ankle instability

Spurling test is to test for what? ✔✔cervical nerve root compression- NECK

Tinnels sign ✔✔tests for carpal tunnel syndrome

Lachmans test ✔✔tests for ACL tear (KnEE)

straight-leg raising test ✔✔lumbar nerve root compression or lumbar

radiculopathy
Drop arm test? ✔✔rotator cuff eval

finkelstein test? ✔✔De-quervains tenosynovitis (thumb base)

Which has an abnormal neuro exam: lumbar radiculopathy or lumbar sacral strain?
✔✔lumbar radiculopathy

Normal bone marrow density BMD: ✔✔T-score -1.0 and above

osteopenia BMD t-score ✔✔-1.0 to -2.5

osteoporosis bmd t score ✔✔below -2.5

What causes joint space narrowing on xray? ✔✔OA

Grade 1-3 ankle sprain ✔✔1: mild stretching with microscopic tears
2. incomplete tear of ligament, mild joint instability
3. complete tear of ligament, complete ankle instability

What act made restraints used only for patient safety? ✔✔omnibus reconciliation
act 1987

t/f advanced directives are not recognized in all states? ✔✔true

patent having a hard time accepting inevitability of death, this is a theory by who?
✔✔Levinson

Parkinsons is an imbalance in what ? ✔✔dopamine and acetylcholine

t/f multiple falls in elderly are associated with higher mortality? ✔✔true

Stage 1 - 4 of pressure ulcers ✔✔Stage 1 = skin intact but red. *Blanches w/

pressure*
Stage 2 = blister or break in the dermis, epidermal loss
Stage 3 = SubQ destruction, full thickness loss
Stage 4 = involvement of joint or bone and muscle

t/f pharmacokinetics change with age? ✔✔true

Which meds do you want to avoid in elderly? ✔✔anticholinergic

Which antibiotics have a risk of torsades de pointes especially in women?

✔✔macrolides (erythromycin and clarithromycin)

max dose on citalopram?

max dose of citalopram for over 60yo ✔✔-40mg/day
-20mg/day

PPI's should not be used longer than what timeframe? ✔✔2mo due to risk of
fractures and inability to discontinue
hyperkalemia ekg findings? ✔✔tall tented T waves

t/f TMP-SMX can cause hyperkalemia? ✔✔true

62yo man presents with cellulitis on right cheek and nose. Suspected streptococcal
infection the most appropriate tx ✔✔IV linezolid

what is paronychia? ✔✔abscess at the nail bed

Tests for lyme disease? ✔✔ELISA screening and western blot assay to verify

Tension pneumo shows what on xray? ✔✔Heart pushed over to opposite side

What is CURB-65 (criteria to admit patient with pneumonia)? ✔✔Confusion

Urea >20
RR >30
BP low <90 systolic or <60 diastolic
65 years or older

Would changing ACEI to once daily in AM help with patients having increasing
potassium? ✔✔Yes- excrete potassium naturally at night