FNP ANCC BOARDS EXAM
- Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles,
burns, frostbite)
If <3 doses Tdap or Td give both Tdap and TIG 250 units. If 3 doses in past, but none in the last 5 years then given Tdap or Td. No need to give TIG If 3 or > doses in the past - A woman becomes pregnant and received Tdap during her last pregnancy 1 year
ago. When should she receive her next dose.
Tdap is recommended for each pregnancy.
“Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)”. - A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)?
IPV, vaccinia (smallpox) - A person with a hx of anaphylaxis to bakers yeast should avoid which immunizations
(IZ)?
Hepatitis B - A person with a hx of anaphylaxis to gelatin should avoid which immunizations (IZ)?
Varicella zoster (zostavax) and MMR - Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn. What
other interventions/meds should be considered during anaphylaxis?
-Supine, 911, give epinephrine:
-7.5-15kg: give 0.1 mg IM x1
-15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1 ->30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
-H1/H2 blocker po (diphenhydramine, ranitidine)
-IV access for fluids, Oxygen.
-Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
- Signs and Symptoms anaphylaxis
-Skin: pruritus, urticaria, angioedema
-Resp: dyspnea, wheezing (bronchospasm), stridor
-End-organ dysfunction: hypotension, collapse, syncope, incontinence - PCV-13
Prevnar. Greater protection, Narrower coverage. Pneumococcal conjugate. - PCV23
Lesser protection, broader coverage - Which type of vaccine boosts immune response better? conjugate vs.
polysaccharide
Conjugate (example: prevnar) - Live attenuated (weaned) vaccines
MMR, Varicella and intranasal Flu-mist. Zostavax is also live. Shingrix is NOT live. - When is rotavirus vaccine contraindicated?
SCID (severe combined immunodeficiency) or hx intussusception - Precautions after rotavirus
Hand washing!; viral shed in stool in first week post-vaccination - Shingrix: timing and dosing
=/> 50 year old, 2 doses, 2nd dose two to six months after 1st dose.
Under age 50 year old gets shingles; think immune compromise vs. stress. - What month does the CDC release a new vaccination schedule each year?
Feb - What signs and symptoms are associated with leukemia?
Fever, weight loss, fatigue, bone pain, bleeding, bruising. - What bloodwork should be obtained in suspected leukemia?
-WBCs >20,000 (think through common causes of leukocytosis: infection, stress,
inflammation) –> get a peripheral smear (AKA manual diff)
-if WBCs >20,000 and with associated anemia; thrombocytopenia; thrombocytosis;
enlarged liver, spleen, or lymph nodes; or constitutional symptoms. - Which 2 chronic childhood diagnoses are associated with ALL and AML?
Downs syndrome and neurofibromatosis