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ANCC AGACNP Frances Guide Review
Questions with Answers Latest 2025
You want to get more funding for your hospital's Rapid Response Team. How should you present this issue to the committee? a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team ✔ a. stress importance of team What is the best way for the AGACNP to get involved in policy making? a. attend legislative days at the state capitol b. join a hospital committee c. write your local congressman d. review literature and give more in-services ✔ b. join a hospital committee What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. join a hospital committee b. petition the government c. bill for independent services d. start your own practice ✔ c. bill for independent services Which of the following is considered a high acuity role for the AGACNP? a. primary care clinic b. cardiology office c. community health department d. minute clinic ✔ b. cardiology office What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility ✔ d. start at your facility Answers are worded differently. "decrease bias in healthcare" "create in-servises in healthcare" "obtain funding to increase access" Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight
c. see if the p-value is less than the alpha-coefficient d. determine the error rate ✔ a. consider the sample size When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder b. keep all of the patient's records for a minimum of five years c. send a certified letter with a return receipt requested d. provide names of other providers for future care ✔ c. send a certified letter with a return receipt requested Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem ✔ d. formulating the research problem A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander ✔ a. libel Can you tell the patient's wife, for her protection, that her husband has HIV? ✔ No, not without his permission How can the ANCP prepare to get involved in future mass casualty event? ✔ Pre enroll in disaster volunteer program An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? ✔ Medicaid Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: ✔ Pays after insurance and 3rd party payers have paid You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that workds. What ethical principles does this challenge? ✔ Veracity and fidelity Health literacy
Patient presents to the clinic for routine f/u and passes out. You revive the patient and admit overnight. Which of the following would qualify as incident to billing? ✔ Temperature and weight recording The NP program initiated, primarily, because of what issue in healthcare at the time? ✔ Pediatric physician shortage Elderly patient takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do? ✔ Ask him to speak candidly with you Patient calls to complain about bills and states he has Medicare, which should cover all costs. You explain: ✔ Since you are healthy, exams are not covered Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient... ✔ No, HIPPA Patient in ER not doing well, primary MD calls: ✔ Give him info NP working on ESRD research project. A colleague renal specialist asks for patient info on your patients: ✔ HIPAA breach Who enforces HIPAA? ✔ Office of Civil Rights/Dept Health and Human Services Who isn't covered by HIPAA? ✔ Law enforcment/municipal offices, CPS/Schools, employers/workman's comp, life insurance Insurance company calling to verify some patient appointments? ✔ Answer by picking out that there is already a medical release signed by the patient and give the requested information to them Benchmarking ✔ How institution compares with similar organizations Managed care ✔ Know what this is and how it has improved costs, something about putting caps on payments Peer review ✔ Timely, not anonymous, and NP knows how peer review will impact yearly evaluation
Sensitivity vs specificity ✔ Sensitivity: true positives, specificity: true negatives There was a question where a patient had a multinodular goiter and wanted to know why the NP was not going to do periodic US and fine needle biopsy in monitoring for some kind of cancer or complication. The answer I picked was that these tests were not very specific to detect the cancer Reliability ✔ When implementing a new study, tested over and over, the consistency of a measurement or the degree to which an instrument measures the same way over time Validity of results in an article ✔ P-value, probability of falsely rejecting the null hypothesis, want it to be <0. Statistical significance ✔ Look at sample size and p value Privileging ✔ May be granted in full or part by the hospital, credentialing committee is made of physicians Who determines scope of practice? ✔ State practice acts but institutional bylaws may further restrict practice (facility limited scope of practice) Informed consent ✔ A state indicating patient has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such, includes risks and benefits, competence: ability to communicate, understand, reason, differentiate good and bad Case management ✔ Mobilize, mointor, and control resources that a patient uses during course of an illness while balancing quality and cost, "move patients through the system appropriately" 50-60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? a. consult CM b. Consult SW c. refer to Oncology d. refer to Hospice ✔ a. consult CM
Which medicare is Hospice covered under? ✔ Medicare A A patient presents to the Er with c/o CP and SOB. The NP misinterprets the EKG and admits the patient fro further monitoring without consulting cardio. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for? ✔ Lack of skill Healthcare exchange ✔ Health insurance marketplaces, organizations in each state through which people can purchase health insurance You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem? a. ask the patients treated how care can be improved b. look back at prior treatment given to see how outcomes can be improved c. form a standardized tx plan for all patients that can be used by all healthcare staff d. form individualized tx plans that can be used by all healthcare staff ✔ c. form a standardized tx plan for all patients that can be used by all healthcare staff You have transferred a patient to the SNF. The MD in charge at that facility calls for info about the patient's medical care, what do you do? a. direct him to look it up in the EMR b. refuse to share protected health information c. instruct him to call the department head d. share the information he requests ✔ d. share the information he requests Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? a. administer PRBCs as needed b. call the ethics committee c. continue to research alternative treatments d. ask the family to give permission now that he's unconscious ✔ c. continue to research alternative treatments What is the best way to make sure a patient will follow up as instructed? a. instruct the patient to schedule the appointment b. ask the patient the best time they can go to an appointment c. have the office manager to schedule the appointment d. schedule the appointment for the patient ✔ d. schedule the appointment for the patient
Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves life, but states that the patient would not want to be on a ventilator. What should you do? a. consult neurology to come interview the family b. document the situation carefully in the chart c. call a clergy member to offer support d. call the ethics committee ✔ d. call the ethics committee A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years". You: a. refer her to a gynecologist b. schedule her to come back next week for the PAP at another appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno ✔ b. schedule her to come back next week for the PAP at another appt A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno ✔ a. refer to gynecologist Discharge planning is udnerway for a patient who has been very dehabilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? a. hospice b. home health care c. SNF d. private duty RN ✔ c. SNF Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych ✔ b. XR the wrist Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych
Your patient is not doing well and family/wife is at bedside crying. Yo are preparing to talk to the family. What do you do first? a. place a social work consult b. explicitly explain the situation, the outcomes and care involved c. ask if the patient has an advanced directive d. set up a family meeting in a room with a specific time and date ✔ c. ask if the patient has an advance directive Your patient is not conscious. HIs advance directive states he wants to be a DNR, but his family says they want him to be a full code. How do you respond? a. tell her the decision goes to the next of kin b. call the ethics committee c. comply with her wishes and make him a full code d. tell her you can't go against the advance directive ✔ d. tell her you can't go against the advance directive A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable. What do you do? a. transfer her to a tertiary facility b. contact her OB/GYN for treatment advice c. admit to l/d d. consult the nurse midwife ✔ a. transfer her to a tertiary facility Your 51F patient is getting ready to discharge when she tells you she hasn't had a mammogram in 3 years. What do you do? ✔ Refer to PCP for outpatient discharge Your patient's imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share the test results to spare him distress. How do you respond? ✔ Ask the patient what he wants to know about his prognosis 35yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your next action? ✔ Call security to ensure safety Adult child of a patient reports that her father has expressed desire to commit suicide and has a hx of ETOH and depression. The best response would be to? ✔ Hospitalize the patient and start pscyhotherapy You notice that another NP in your group is frequently contact by pharmacy for prescription errors. How do you handle the situation? ✔ Address it directly with the NP
Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What do you do? ✔ Consult case management 80yo patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the NP: ✔ Provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery A 40yo female patient with no PMH is admitted with bilateral PE. W/u reveals a psoitive result for lupus anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the appointments and the follow up care. The NP's most effective intervention si to: ✔ Arrange follow up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? ✔ Fine needle biopsy A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP: ✔ Contacts the ID MD to determine the appropriate abx duration 32yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt reports the shot was an accident during hunting. What should the NP do? ✔ Report to the police. All GSW must be reported What is the most important when assessing status? ✔ Level of alertness or hx of symptoms A woman of child bearing age c/o abdominal pain. What level of exam do you document? ✔ Detailed A diabetic patient complains of abd pain. Which type of exam do you conduct? ✔ Comprehenxive What qualifies patient for HHC ✔ Home bound, has a prescription, requires care services, wound care, select care Patient is refusing care? ✔ Let them refuse, educate, and search for alternatives Guy in ER needs refill on ritalin
b. alzheimer disease c. depression d. dementia ✔ c. depression Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium b. IV ativan c. PO librium d. lasix ✔ c. PO librium Your patient has developed a fever of unknown origin. What is the next step? a. PO abx b. IV abx c. do nothing until diagnosis is confirmed d. tylenol ✔ c. do nothing until diagnosis is confirmed How long will it take to begin to see healing in a pressure ulcer that has a clean, well- vascularized bed? a. 7 days b. 2-4 weeks c. 2 days d. 4-6 weeks ✔ c. 2 days The patient has been in a bar fight and has a human bite on his hand. What should you do next? a. order PO abx b. order wound culture c. order IV abx d. measure the wound depth and width ✔ a. Order PO abx Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication? a. compartment syndrome b. decrease in ROM ability c. septic shock d. osteomyelitis ✔ d. osteomyelitis What is the strongest predictor of functional impairment prior to discharge of the elderly patient?
a. advanced age b. incontinence c. cognitive impairment d. poor balance ✔ c. cognitive impairment Your patient has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.2) a. give IVF b. antipyretic c. abx d. ice packs to groin and axilla ✔ a. give IVF (Flush it out, this is neuroleptic malignant sydnrome) You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention? a. stop the TPN, remove the line, and place a new line for TPN b. start abx c. send cx d. change the guidewire ✔ a. stop the TPN, remove the line, and place a new line for TPN Your patient has a fever 3 days post op, WBC are 15k, blood cultures negative, and Eos 9%. What is the diagnosis? a. viral infection b. bacterial infection c. malignant hyperthermia d. drug fever ✔ d. drug fever (eos=allergic reaction, normal is 1-4%) What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing ✔ c. aid in post op healing Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium ✔ b. dextrose Protein in nutrition for what reason? ✔ maintain nitrogen balance along with metabolic needs, adjust protein weekly by measuring urinary urea nitrogen
What does the leg/foot look like in a hip fracture ✔ Internally or externally rotated Pt has a post op fever... ✔ Give fluids WHO pain ladder... ✔ Fentanyl patch for breakthrough cancer pain Best pain indicator... ✔ Patient self report Best alternative therapy to decrease pain in clavicle fracture: ✔ Therapeutic touch/reiki (hand or palm healing that transfers 'universal energy' has been used for cancer, emotional, or physical healing) Picture of gunshot wound to the R lung area ✔ The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration Another answer was to let air blow out during inhalation Cocaine induced psychosis ✔ s/s parnoia, delusions, hallucinations, 'cocaine bugs' under skin, mydriasis Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils ✔ Sympathomimetic (cocaine or meth) Antidepressant OD ✔ s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (can't see, can't pee, can't spit, can't shit) Antidepressant OD treatment ✔ ICU if CNS or cardio toxic, activated charcoal NaHCO3 for dysrhythmias and maintain pH, benzos (valium) for seizure (if serotonin syndrome: dantrium/dantrolene sodium) ASA overdose ✔ s/s n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis ASA overdose treatment ✔ activated charcoal, NaHCO3 for severe acidosis of <7.1, monitor ABGs How do you treat group A strep on skin
✔ TMP/SMX or Doxy/mino + beta lactam (1st generation cephalosporin, PCN, or amoxil) Pt has cellulitis of lower extremity with a wound, what do you treat with? ✔ Based on the hospital sensitivity Mallampati grades for visualization of oral cavity: ✔ 1. complete soft palate
- complete uvula
- uvula base only
- none Osteomalacia ✔ Softening of bones (PEDS rickets), most common cause is vitamin D deficiency (also phos, Ca, UVB light) Hospice vs palliative care ✔ Pallitiatve care are still receiving treatment. Hospice is no curative treatment, has death dx, and <6m to live Venous stasis ulcer ✔ Use compression stocking Indication for tetanus shot ✔ Dirty wound and haven't had a tetanus shot in five years Tdap vaccine is an example of what type of immunity ✔ Active immunity How often should a woman between the ages of 20-39 have a PAP with HPV ✔ Q5y, PAP with cytology q3y If born on or after what year is it indicated to receive 2 doses of mumps vaccine? ✔ 1957 What age does an individual receive zostavax? ✔ 50 one time dose When should PSA levels be initiated and how often? ✔ PSA levels every year >50y (and DRE) Annual PSA and DRE are indicated in what group? ✔ African-american >40 and family hx of prostate cancer Pt has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to DC?
Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na less than 10 mEq/L. You know that all of the following are possible explanations except: a. diarrhea b. diuretics c. dehydration d. vomiting ✔ b. diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, urine na >20) A 61 year old female c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating 'abnormally' and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely diagnosis? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypermagnesemia ✔ a. hypokalemia Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except: a. hypernatremia b. pneumothorax c. HHNK d. GI bleed ✔ d. GI bleed 65yo male with c/o n/v/constipation x several days and a six pound weight loss. Pt s/p TKR severral weeks ago and reports not getting off the couch. What electrolyte is altered? ✔ Hypercalcemia secondary to immoblity Pt with s/s of abd distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the patient has a fluid and electorlyte problem. Which of the following is he most likely experiencing? ✔ Hyperkalemia ABG reads high HCO3 and pCO2 55mmHg. What electrolyte abnormality is most likely associated with these values? ✔ Hypokalemia r/t metabolic alkalosis Pt has a fever and tachycardia, and hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status
✔ Extracellular dehydration deficit Low serum Na and high serum osmolality ✔ Hyperglycemia (Probably HHNK) A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give: ✔ NS Low protein = Low BUN = ✔ hypoosmolar hyponatremia (probably edematous, expect edema in Albumin <2.7) A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9kg), is intubated and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2o. Clinical signs include tachycardia and hypotension. The initial treatment is to: ✔ Replenish the volume by infusing a 0.9% sodium chloride solution Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse patient? ✔ Hyponatremia What electrolyte should be monitored prior to administering succinylcholine? ✔ K ASA overdose, which electrolyte do you monitor? ✔ K (if low will prevent hte alkalinization of urine, which is the mainstay of treatment) What sx is associated with hepatotoxicity s/p acetaminophen toxicity? ✔ Delirium Patient at high risk for hyperkalemia? ✔ NSAIDs then ACEi Tube feeding side effects ✔ Diarrhea: decrease the osmolality of the tube feeding What patient requires labs to be monitored closely after intiating Tf? ✔ Alcoholic with decreased intake over the past 2-3 weeks What disorder can be ruled out using the Cosyntropin stimulation test? a. Cushing's b. DI c. Adrenal insufficiency d. SIADH ✔ c. Adrenal insufficiency
