AANC Clinical Nurse Specialist (CNS) 2024 Board Exam Review, Exams of Nursing

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AANC Clinical

Nurse Specialist

(CNS) 2024 Board

Exam Review

Questions and

Answers 100% Pass

AANC Clinical Nurse Specialist (CNS)

2024 Board Exam Review Questions and

Answers 100% Pass

ventricular tachycardia - Answer>> 3 or more PVCs in a row Rate of 100- Can convert spontaneously Can be due to heart disease Treatment depends on severity-cardioversion, adenosine, unconscious may defibrillate systolic heart failure - Answer>> Left sided Decrease in volume of blood during contractions Sodium and fluid is retained due to aldosterone production Preload and afterload are increased Myocardium is stretched and thickened, causing ischemia pneumonia - Answer>> inflammation of the lung Can be primary or secondary Most common causes are strep pneumo, legionella, h. Influ, staph, mycoplasma, and viruses Lobar involves lobes Bronchial/lobular involves bronchioles Exudate involves adjacent lobules Interstitial affects interstitial and alveoli Cardiac metabolic requirements - Answer>> High due to central role of heart for the body Nourished first Primarily gets energy from glucose Fatty acids supply 60-70% of cardiac needs but require 10% more oxygen When glucose uptake is decreased due to stress or DM, fatty acid uptake increases and can result in ischemia

Person, environment, health, and nursing The person must adapt to be able to have a positive response to environmental changes Barthel Index of ADL - Answer>> 10 categories to assess functional ability: feeding, mobility, grooming, toileting, urinary control, fecal control, stairs, ambulatory status, transferring, and bathing Confusion Assessment Method (CAM) - Answer>> Tests for delirium. Looks at onset, attention, thinking, LOC, orientation, memory, disturbances, psychomotor abnormalities, sleep-wake cycle Risk factors for fecal incontinence - Answer>> Age Gender Neurological damage Dementia/Alzheimer's Physical disability hypotension - Answer>> systolic <90 and diastolic < Caused by hypovolemia, excessive vasodilation, decreased cardiac output Can included orthostasis, neurocardiogenic syncope(Vagal), postprandial hypotension(after a meal) non-alzheimers dementia - Answer>> Creutzfeldt-Jakob- quick Lewy body-May hallucinate and have rigidity Frontotemporal-personality and behavior Mixed Parkinson's Vascular-memory loss is less pronounced Normal pressure hydrocephalus- ataxia, urinary incontinence

premature ventricular contraction (PVC) - Answer>> early contraction of the ventricles Not a problem unless there is underlying heart problems or MI Often left untreated but can give lidocaine Caused by caffeine, nicotine, etoh Check the underlying rhythm 3rd degree AV block - Answer>> P wave independent of QRS Can lead to bradycardia, CHF, syncope, death Symptoms include dyspnea, CP, hypotension Atropine or ppm Effects of leukemia on blood and bone marrow - Answer>> 80% of cases are AML Elderly present with fever, malaise, pallor, weakness, confusion Cancer cells depress bone marrow function resulting in decrease in RBCs (anemia), neutrophils (infection), platelets (bleeding), and increase risk of fracture Effects of leukemia on organs, CNS, and metabolism - Answer>> Liver, spleen, and lymph glands- enlargement and fibrosis CNS- increases ICP leading to headaches, vomiting, papilledema, nuchal rigidity, coma, death Hypermetabolism-resulting in anorexia, weight loss, muscle atrophy, fatigue Chemo is hard on elderly Bone marrow transplant if < Abx for infection Older adults often relapse and die 1-2yrs after dx Comorbidities - Answer>> Secondary diseases that vary according to age

Sensory- damage to the nerves by menieres, viruses, fistula, autoimmune disorders. Presbycusis-bilateral high frequency hearing loss COPD - Answer>> emphysema and chronic bronchitis Symptoms are cough, dyspnea, orthopnea Assessment includes PFTs, ABGs, CXR, echo Treatment includes oxygen, beta2 agonists, anticholinergics, steroids, abx First degree AV block - Answer>> prolonged PR interval May result from CAD, digoxin, beta blockers, Amio, MI, hyperkalemia, or valvular edema Incidence is low in young adults, but higher in athletes than elderly Emphysema - Answer>> a condition in which the air sacs of the lungs are damaged and enlarged, leading to hypoxemia, hypercapnia, respiratory acodosis Centrilobular-most common. In central portion of respiratory lobule. Symptoms are right heart failure, hypoxemia, hypercapnia Panlobular- all air spaces. Barrel chest, wt loss neuropathic pain - Answer>> pain from damage to neurons of either the peripheral or central nervous system. Chronic pain. Often stabbing, burning, electric, shooting. DM, cancer visceral pain - Answer>> pain that originates from organs or smooth muscles neurological, GI, endocrine/metabolic complications of burns - Answer>> Neurological- due to lack of oxygen, blood volume, and sepsis. May have hallucinations, LOC, seizures, coma

GI-Ileus and ulcerations due to poor circulation. Ileus resolves in 48-72 hours but if returns is indicative of sepsis Endocrine/metabolic-epi and norepi are released to increase cardiac output and cortisol for wound healing. Metabolic rate increases. Electrolytes phosphorus, calcium, sodium are lost. Increase in potassium. Glycogen depletion in 12-24 hours. Protein and muscle breakdown may occur lung cancer - Answer>> pulmonary malignancy commonly attributed to cigarette smoking Squamous- 40-50%. Central airways. Slow Adeno-30-35%. Bronchial/mucosal glands. More lethal. Large cell- 15%. Bronchial/mucosal Small/oat cell- submucosal tissue. Moves fast Symptoms depend on where and metastasis. Cough, respiratory obstruction, pain, SOB, hoarse, pleural effusion, dysphagia, fistula, arrhythmia, CHF DX: X-ray and ct, biopsy Treatment is surgery, chemo Sinus Tachycardia - Answer>> >100 (100-150) normal sinus rhythm Caused by acute blood loss, anemia, shock, hypovolemia, heart failure, hypermetabolism, fever, anxiety, exertion, medication Treatment is treating the cause and giving CCB and BB causes of urinary incontinence - Answer>> Pregnancy Post menopause Hysterectomy Interstitial cystitis

Etoh Myelodysplasia Atopic Dermatitis (Eczema) - Answer>> chronic inflammation of the skin; rash occurs in face, neck , elbows, knees, and upper trunk of the body along with itching Associated with dry air, cleaners, allergies Address triggers Dry lesions with aluminum acetate Moisturize skin Topical corticosteroids and antihistamines for flare ups Glaucoma - Answer>> increased intraocular pressure results in damage to the retina and optic nerve with loss of vision Risk factors are age greater than 40, family hx, CAD, steroid use, DM, African American (least likely in Caucasian) Open angle and close angle Symptoms are blurred vision, halos around lights, lack of focus, eye pain, headache May treat with topical beta blockers, micro a, surgery dry macular degeneration - Answer>> which accounts for 90% of these cases, is caused by the slow deterioration of the cells of the macula Central vision loss. May not be legally blind Can develop into wet macular degeneration Look for drusen

Vitamins A, D, E can slow progression wet macular degeneration - Answer>> an advanced form of dry AMD. New blood vessels growing beneath the retina leak blood and fluid, damaging the retinal cells. These small hemorrhages usually result in rapid and severe vision loss. Vitamins A, D, E May slow progression WBC - Answer>> white blood cells count Normal 4.8- Low may indicate viral infection immature neutrophils (bands) - Answer>> 1-3% increases with infection segmented neutrophils (segs) - Answer>> 50-62%- increases with infection Eosinophils - Answer>> 0-3%- decreased with stress and infection Basophils - Answer>> 0-1%- decrease during acute infection Lymphocytes - Answer>> 25-40%- increase in infection Monocytes - Answer>> 3-7%- increases during recovery of infection MMSE (Mini Mental State Examination)- - Answer>> simplified scored form of the cognitive functions of the mental status exam Remember names of objects

decreased elasticity=blood vessels recoil veins stretch and valves are less efficient Correlated with a fib/flutter, CHF Silent Generation - Answer>> youth of the 50's that seemed to conform to middle class culture without question. Rule oriented Trust worthiness is important Practical Baby Boomers - Answer>> People born between 1943 and 1960 Self centered Committed to the cause Won't compromise Focused on self More access to money and health care diastolic heart failure - Answer>> pulmonary congestion despite normal stroke volume and cardiac output Most common in women > EF greater than 40- urinalysis - Answer>> Color Appearance Odor Gravity- 1.015-1.025- increases in fever, dehydration pH- 4.5- Sediment- greater than 10 in UTI Glucose, ketones, protein, blood, Bili, nitrates- should be negative. May be positive in UTIs Urobilinogen- 0.1-

Burn classification - Answer>> Minor- less than 10% or 5% in older Moderate- 10-20% or 5-10 in older Major- more than 20 or 10 in older Nutritional assessment includes - Answer>> Total protein- 5- Albumin- 3.5-5.5 (less=deficiency) Prealbumin- same as albumin Transferrin- 200-400 (less=deficiency) Mini Nutritional Assessment (MNA) - Answer>> - A validated tool used for nutrition screening and assessment for the population > 65yo

• Screens for malnutrition or risk of malnutrition
• A short form used for quick determination of an individual's nutritional status Dietary habits, measurements Nutritional screening initiative - Answer>> Screens dietary info as well as eating alone, preparation of meals, etoh, income Subjective Global Assessment - Answer>> history, intake, GI symptoms, functional capacity, physical appearance, edema, weight change Genetic predictive testing - Answer>> Family cancer is 5-10% or cancers BRCA Gene= 80-90% chance of breast and ovarian cancer Erickson's stages of psychosocial development - Answer>> Trust/Mistrust, Autonomy/Shame, Initiative/Guilt, Industry/Inferiority, Identity/Role Confusion, intimacy/isolation, generatity/stagnation, ego integrity vs dispair

No birds of prey and some avoid turkey Kosher Keep meat and dairy separated transverse and descending colon cancer - Answer>> Change in bowel habits, abd pain in LLQ, pencil thin stools, constipation, abd distention, intestinal obstruction, perforation, peritonitis Sigmoid and rectal cancer - Answer>> Tenesmus (painful ineffective straining to BM), rectal or perianal pain, feeling full/can't poop, alternating constipation and diarrhea, blood, pencil thin stools, abd pain, cramps, urinary symptoms, vaginal fistula Sexual dysfunction in older adults - Answer>> Vaginal atrophy, dryness, need more stimulation, ejaculate May decrease. Dyspareunia (painful intercourse)- vaginal estrogen and lube ED-caused by vascular dz, DM, smoking, UTI, etoh, obesity, lack of testosterone. Treatment is viagra, cialis, injections, intrauretheral medications, mechanical devices genitourinary system and aging - Answer>> -renal- 30-40% nephrons are lost, decreasing size. Function decreases. Excess potassium may be secreted leading to dehydration -neurological- full bladder may take longer to perceive and bladder spasms may be present -muscular atrophy-bladder and smuscles lose tone, resulting in frequent urination and incontinence -mechanical obstruction- enlarged prostate or prolapse of uterus or bladder may interfere with urination -nocturnal urine production increases NEGLECT OF BASIC NEEDS - Answer>> Active- intentional lack of caring. Borders on neglect and abuse Passive- unable to provide care needed

Sodium - Answer>> 135- Hyponatremia- insufficient intake or abnormal loss through diarrhea, vomiting, suctioning, burns, fever, SIADH, ketoacidosis. Symptoms are lethargy, AMS, dyspnea. Tx is replacement and treat the cause Hypernatremia- due to renal disease, diabetes insipidus, fluid depletion. Symptoms are irritability, AMS, seizures, flushing, weakness, spasms, thirst. Tx is fluid replacement and treat the cause Magnesium - Answer>> 1.3-2. Hypo-chronic diarrhea, renal disease, pancreatitis, excessive diuretics or laxatives, hyperthyroidism, hypoparathyoridism, burns, swearing. Symptoms are neuromuscular excitability, AMS, headaches, dizziness, seizures, tachycardia with ventricular arrhythmias. Tx is replacement and treat the cause Hyper-renal failure, DKA, hypothyroidism, addisons. Symptoms are weakness, seizures, decreased gag reflex, tachycardia, hypotension. Tx is treat the cause, IV fluids, dialysis Gastrointestinal hemorrhage - Answer>> bleeding within the gastrointestinal tract Main cause is PUD Other causes are NSAIDs, H. Pylori Symptoms are abd pain and distention, bloody stools, hypotension, tachycardia Tx is fluid replacement, flagyl for h pylori, stopping bleeds intellectual disability in older adults for thyroid, obesity, osteoporosis, mental health concerns - Answer>> Thyroid- dysfunction is common Obese- 48% are obese and increases risk of CV disease Mental health disorders- common.

Hematocrit - Answer>> percentage of blood volume occupied by red blood cells Make 45- Female 36- Mean Corpuscular Volume (MCV) - Answer>> 80- Size of RBCs Reticulocyte count - Answer>> Assessment of bone marrow function 0.5-1. erythrocyte sedimentation rate - Answer>> Increases with inflammation Males 0-15 and 0-20 older than 50 Females 0-20 and 0-30 older than 50 C-reactive protein (CRP) - Answer>> blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease 2.6-7. social exchange theory - Answer>> the theory that human interactions are transactions that aim to maximize one's rewards and minimize one's costs. Founded by homans Neurological changes of aging - Answer>> Nerve cells in brain and spinal cord decrease Reduction in brain mass Loss of neurons in frontal lobe specifically Decrease in cerebral blood flow Short term memory loss

Neurofibrillary tangles May be present Conduction of peripheral nerves is decrease (loss of sensation and slower reflexes) Reduced perspiration Norton Scale - Answer>> Physical and mental condition, activity, mobility, and continence Rated 1-4. Lower the better Age related changes to heart, lungs, brain, eyes, kidney/bladder - Answer>> Heart- muscle thickens, pumping rate decreases, blood oxygen levels decline Lung- between 40-70 breathing capacity decreases by 40% Brain- loss of axons and neurons. Short term memory loss Eyes- cataracts, far sightedness Kidneys/bladder- kidneys are less efficient and bladder capacity declines The Digit Repetition Test - Answer>> Assesses attention by asking the patient to repeat two numbers, then three, then four, and so on. Time & Change Test - Answer>> -Tell time on clock with hands set to 11:10. -Count out one dollar in change. (provide 3 quarters, 7 dimes, & 7 nickels) Calcium - Answer>> 8.8-10. Hypo-caused by hypoparathyroidism, thyroid/parathyroid surgery, pancreatitis, renal failure, vit D deficiency, magnesium deficiency,