Barkley AG-ACNP Certification Review 2022

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Questions and Answers

Elderly have a blunted fever response to infection due to an impairment in which body system?

Nervous system

What is the prophylactic treatment of Pneumocystis jirovecii?

Co-trimoxazole (trimethoprim-sulfamoxazole)

What are the ECG changes in hypokalemia?

Broad T wave and prominent U waves

What are atypical UTI symptoms usually found in elderly patients? (Select all that apply)

Incontinence Signup and view all the answers

Acidosis and hyperthermia have what effect on the oxyhemoglobin dissociation curve?

Oxygen has a decreased affinity for hemoglobin, shifting the curve to the right. Signup and view all the answers

Alkalosis and hypothermia have what effect on the oxyhemoglobin dissociation curve?

Oxygen has a greater affinity for hemoglobin, shifting the curve to the left. Signup and view all the answers

What does a right shift in the oxyhemoglobin dissociation curve mean?

A higher PO2 is required to achieve hemoglobin saturation compared to baseline. Signup and view all the answers

What does a left shift in the oxyhemoglobin dissociation curve mean?

Less PO2 is required to achieve hemoglobin saturation compared to baseline. Signup and view all the answers

What is the JNC 8 threshold for treatment of hypertension in the elderly?

150/90 Signup and view all the answers

What is the immediate treatment after the diagnosis of pheochromocytoma?

Phentolamine to stabilize before surgery Signup and view all the answers

What are the criteria for diminished renal reserve?

Nephron loss of 50% and double baseline creatinine Signup and view all the answers

What are the criteria of renal insufficiency?

Nephron loss of 75% and mild azotemia Signup and view all the answers

What is the treatment of bacterial vaginosis?

Metronidazole or clindamycin Signup and view all the answers

What are the criteria for end-stage renal disease?

90% nephron loss, azotemia, and metabolic alterations Signup and view all the answers

What are the American Burn Association’s Burn Center Referral Criteria? (Select all that apply)

Burned children Signup and view all the answers

What is a dislocation?

Displacement of a bone from its joint Signup and view all the answers

What is a subluxation?

Partial dislocation Signup and view all the answers

What labs are associated with temporal arteritis?

High ESR and normal WBC Signup and view all the answers

What is the treatment for temporal arteritis?

High-dose steroids Signup and view all the answers

What is the normal central venous pressure (CVP)?

2-6 mmHg Signup and view all the answers

CVP is elevated in conditions that cause an ___________ in the amount of fluid in the right atrium.

increase Signup and view all the answers

What shock states cause an elevated CVP? (Select all that apply)

Fluid volume overload Signup and view all the answers

CVP is decreased in conditions that cause a(n) ___________ in the amount of fluid in the right atria.

decrease Signup and view all the answers

What shock states cause a decreased CVP? (Select all that apply)

Distributive shock Signup and view all the answers

What is the formula for Mean Arterial Pressure (MAP)?

(SBP + 2DBP)/3 Signup and view all the answers

What is the normal pulmonary wedge pressure (PWP)?

6-12 mmHg Signup and view all the answers

What shock states result in elevated PWP? (Select all that apply)

Cardiogenic shock Signup and view all the answers

What shock states cause low PWP? (Select all that apply)

Hypovolemic Signup and view all the answers

What does PWP measure?

Left ventricular function, end-diastolic left ventricular pressure Signup and view all the answers

PWP is increased in conditions that ____________ the pressure in the left ventricle at the end of diastole.

increase Signup and view all the answers

What conditions increase PWP? (Select all that apply)

Fluid volume overload Signup and view all the answers

PWP is decreased in conditions that _______________ the pressure in the left ventricle at the end of diastole.

decrease Signup and view all the answers

What is the normal central venous pressure (CVP) in mmHg?

2-6 mmHg Signup and view all the answers

What is the normal pulmonary wedge pressure (PWCP) in mmHg?

6-12 mmHg Signup and view all the answers

What is cardiac output?

HR x SV Signup and view all the answers

What is the normal cardiac output (CO)?

4-8 L/min Signup and view all the answers

What is the normal cardiac index (CI)?

2.5-4 Signup and view all the answers

What does SVR stand for?

The resistance of systemic circulation. Signup and view all the answers

What is the normal systemic vascular resistance (SVR)?

800-1200 Signup and view all the answers

Where is SvO2 measured?

Pulmonary artery Signup and view all the answers

What is SvO2?

A measurement of effectiveness of O2 delivery Signup and view all the answers

What is the normal SvO2?

60-80% Signup and view all the answers

What does low SvO2 indicate? (Select all that apply)

Increased tissue extraction of O2 Signup and view all the answers

What does high SvO2 indicate? (Select all that apply)

Increased O2 supply Signup and view all the answers

What are the hemodynamic characteristics of hypovolemic shock?

SVR high, CO/CI low, CVP low, PWP low, SvO2 low Signup and view all the answers

What are the hemodynamic characteristics of cardiogenic shock?

LOW CO/CI & SvO2, everything else high (CVP high, PWP high, SVR high) Signup and view all the answers

What are the hemodynamic characteristics of septic shock?

CO/CI: High then low, everything else: low then high Signup and view all the answers

What are the hemodynamic characteristics of anaphylactic shock?

Everything low Signup and view all the answers

What are the hemodynamic characteristics of obstructive shock?

LOW CO/CI and normal to low PWP; everything else HIGH (CVP high, SVR high, SvO2 high) Signup and view all the answers

What are the hemodynamic characteristics of neurogenic shock?

Everything low Signup and view all the answers

Which herbal agents increase the risk of bleeding? (Select all that apply)

Garlic Signup and view all the answers

Which herbal agent increases clotting?

St. John's Wort Signup and view all the answers

What are the uses of St. John's Wort? (Select all that apply)

BPH Signup and view all the answers

What are the normal platelets (Plts)?

150,000-400,000/mm3 Signup and view all the answers

What are the drugs used for lower UTI treatment? (Select all that apply)

Trimethoprim-sulfamethoxazole (Bactrim) Signup and view all the answers

What are the drugs used for upper UTI treatment? (Select all that apply)

Ceftriaxone (IV) Signup and view all the answers

Match the following prerenal diagnostics with their values:

Serum BUN:Cr = >10:1 Urine Na = 1.015 Fractional Excretion of Na = 40 mmol Specific Gravity (SG) = 3 Urine Sediment = Granular with white casts Signup and view all the answers

Match the following postrenal diagnostics with their values:

Serum BUN:Cr = 10:1 Urine Na = >40 mmol Specific Gravity (SG) = 3 Signup and view all the answers

What is the management of prerenal AKI?

Expand volume Signup and view all the answers

What is the management of intrarenal AKI?

Maintain perfusion, stop nephrotoxic drugs, RRT Signup and view all the answers

What is the management of postrenal AKI?

Remove obstruction Signup and view all the answers

What are the criteria for dialysis? Match the criteria with their abbreviations.

A = Acidosis (metabolic) E = Electrolyte abnormalities I = Intoxication O = Oliguria (140 OR >90) Signup and view all the answers

What is the first line medication for hypertension?

Thiazide diuretics Signup and view all the answers

What is the management of hypertension urgency?

Oral medications like clonidine (Catapres) Signup and view all the answers

What is the treatment of hypertension emergency?

IV Nicardipine, Nitroprusside, or labetalol Signup and view all the answers

What is Prinzmetal's angina?

Coronary artery vasospasm Signup and view all the answers

What are the lipid panel normals? (Select all that apply)

Triglycerides 185 Signup and view all the answers

What is the medication management of peripheral vascular disease (PVD)?

Cilostazol (pletal) Signup and view all the answers

What is the normal ankle-brachial index (ABI)?

0.9-1.3 Signup and view all the answers

Study Notes

Elderly Responses and Infections

Elderly individuals exhibit a blunted fever response to infections due to nervous system impairments.

Pneumocystis jirovecii Prophylaxis

Co-trimoxazole, a combination of trimethoprim and sulfamoxazole, is the prophylactic treatment for Pneumocystis jirovecii.

ECG and Hypokalemia

Hypokalemia is indicated by ECG changes such as broad T waves and prominent U waves.

Atypical UTI Symptoms in the Elderly

Lethargy, decreased appetite, and incontinence are common atypical symptoms of urinary tract infections in older patients.

Oxyhemoglobin Dissociation Curve and Acidosis/Hyperthermia

Acidosis and hyperthermia reduce oxygen's affinity for hemoglobin, shifting the oxyhemoglobin dissociation curve to the right, enhancing oxygen delivery to tissues.

Oxyhemoglobin Dissociation Curve and Alkalosis/Hypothermia

Alkalosis and hypothermia increase oxygen's affinity for hemoglobin, shifting the curve to the left, restricting oxygen delivery to tissues.

Right Shift in Oxyhemoglobin Curve

A rightward shift necessitates a higher PO2 for hemoglobin saturation, indicating that oxygen is more readily released to tissues.

Left Shift in Oxyhemoglobin Curve

A leftward shift means less PO2 is needed for hemoglobin saturation, indicating that oxygen is less readily released to tissues.

Hypertension Treatment Threshold in Elderly

The JNC 8 sets the threshold for hypertension treatment in elderly patients at 150/90 mmHg.

Pheochromocytoma Treatment

Immediate management after pheochromocytoma diagnosis includes administering phentolamine for stabilization prior to surgical intervention.

Renal Reserve Criteria

Diminished renal reserve is defined by a nephron loss of 50% with a doubling of baseline creatinine.

Renal Insufficiency Criteria

Renal insufficiency occurs with a nephron loss of 75% and presents mild azotemia.

Bacterial Vaginosis Treatment

Metronidazole or clindamycin are the treatments of choice for bacterial vaginosis.

End-Stage Renal Disease Criteria

Criteria include 90% nephron loss, azotemia, and metabolic dysfunction.

American Burn Association Referral Criteria

Referral is required for burns exceeding 10% TBSA, third-degree burns, electrical/chemical burns, inhalation injuries, burns in children, and other complications.

Joint Displacement Definitions

Dislocation refers to the complete displacement of a bone from its joint, while subluxation refers to a partial dislocation.

Temporal Arteritis

Labs reveal high ESR and normal white blood cell count in temporal arteritis, treated with high-dose steroids.

Central Venous Pressure (CVP)

Normal CVP ranges from 2-6 mmHg; abnormal levels indicate different pathological states.

Shock States and CVP

Elevated CVP is seen in cardiogenic and obstructive shock, while decreased CVP occurs in distributive and hypovolemic shock.

Mean Arterial Pressure (MAP) Calculation

MAP is calculated using the formula: (SBP + 2DBP)/3.

Pulmonary Wedge Pressure (PWP)

Normal PWP is between 6-12 mmHg and reflects left ventricular function.

Elevated PWP occurs in cardiogenic shock. PWP decreases in hypovolemic, obstructive, anaphylactic, and neurogenic shock.

Cardiac Outputs and Norms

Cardiac Output (CO) calculated as HR x SV, with normal values ranging from 4-8 L/min. Cardiac Index (CI) ranges from 2.5-4.

Systemic Vascular Resistance (SVR)

SVR indicates the resistance in systemic circulation, with a normal range of 800-1200.

SvO2 Metrics

SvO2, measured in the pulmonary artery, indicates the effectiveness of oxygen delivery, with normal values between 60-80%.

Interpretation of SvO2 Levels

Low SvO2 suggests increased tissue oxygen extraction or decreased delivery, while high SvO2 indicates decreased extraction or increased delivery.

Hemodynamic Profiles of Shock States

Hypovolemic shock shows high SVR and low CO/CI. Cardiogenic shock reveals low CO/CI and high CVP/PWP. Septic shock presents initially high CO/CI, then low. Anaphylactic and neurogenic shock show low values across most parameters.

Herbal Agents and Bleeding Risk

Herbal agents starting with "G" (e.g., ginger, ginkgo biloba, garlic, ginseng) increase bleeding risk.

Clotting and Herbal Agents

St. John’s Wort is known to increase clotting.

Normal Platelet Count

Normal platelets range from 150,000-400,000/mm3.

UTI Drug Resistance

Resistance rates for trimethoprim-sulfamethoxazole (Bactrim) are around 20%; Fosfomycin is an alternative but costly.

Prerenal and Postrenal Diagnostics

Prerenal diagnostics show a serum BUN:Cr ratio >10:1, while postrenal diagnostics reveal a ratio of 10:1.

Management Strategies for AKI

Prerenal AKI management focuses on volume expansion, intrarenal on maintaining perfusion and avoiding nephrotoxins, while postrenal AKI requires obstruction removal.

Dialysis Indication Criteria

Acidosis, electrolyte abnormalities, intoxication, and oliguria are key reasons for initiating dialysis.

Initial Hypertension Management

Thiazide diuretics serve as the first-line medication for hypertension.

Acute Hypertension Response

For hypertension urgency, oral medications like clonidine are recommended while emergencies may require IV medications to rapidly reduce BP.

Prinzmetal’s Angina

This condition is characterized by coronary artery vasospasm.

Peripheral Vascular Disease (PVD) Management

Cilostazol (pletal) is used in managing PVD.

Ankle-Brachial Index (ABI)

A normal ABI range is between 0.9-1.3, indicating adequate blood flow to the extremities.

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Description

Prepare for the Barkley AG-ACNP certification with this comprehensive flashcard quiz. Test your knowledge on key topics such as fever response in the elderly, prophylactic treatments, and ECG changes related to hypokalemia. Ideal for nursing and advanced practice candidates aiming to enhance their understanding of critical concepts.