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rninme 7,396 Views

Joined Jun 12, '06. Posts: 1,690 (8% Liked) Likes: 209

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  • Mar 22

    Just wanted to say I passed. I studied for 1 month straight about 2-3 hours a day.

    i used Fitzgerald review books and leik.

    i studied through both books and did all their questions. I bought the books from Amazon and I bought the Fitzgerald review book handed out at the live sessions.

    After doing thoroughly studying through those books I took the AANP, APEA, Barkley predictors and readiness tests. I did the apea twice. I scored in the 70's which according to the scales is indicative of passing the real exam and I did.

    The test I felt was hard but manageable. You have to really read through the questions thoroughly because two of the 4 answer choices are usually thrown in to get you off track.

    If there is one thing you take away from this post, take the practice exams into consideration because it gives you rationales and if I remember correctly the structuring of the questions are very similar to the actual exams. Some questions are even word for word almost.

    Good luck everyone!

  • Mar 19

    If your putting in the time studying, the next thing is to be focused on what you need to be studying.

    I started out with the Leik and Fitz Review books and using text books also, doing questions every day also.

    Felt like I was studying all over the place, felt like I was retaining anything, ugh!

    Talked to some class mates who recently took the test, some took both...everyone used the online Fitz review course.

    Here's what I finally did and what worked for me, hope it helps:

    Main study would be Fitz online review course - I would study each topic for 2-3 days watching the video modules and following along in the work book. At the end I would then cross reference and make notes using the other two books (Leiks and Fitz review books). I would re-do the modules, look at notes, use text books and internet to get further clarification on a subject (Kahn Academy has some great videos). I quit doing questions everyday and focused knowing the material.

    I did the online practice exam that is included with the Fitz review a week or so before my exam date, did well and ran through my notes and re-watched some modules (they eventually became very monotonous and I realized that I had the information.

    Test Day: ANCC

    Used the highlighter tool to highlight pertinent information in each question, allowing me to slow down and focus on what the question was allowed me to even pick out the "gothca" answers for most of the questions.

    I would take a break every 50 or so questions, get up stretch, get a drink of water, use the bathroom, etc. I marked a total of maybe 10 questions, went through and answered them and hit submit. I took 3 breaks and felt I went slow and finished in 3hrs.

    * Make a plan and stick to it
    * Study one topic at a time (not multiple topics a day)
    * Know the material, don't memorize
    * Test Day, slow down, use highlighter tool, take a break to relax

    Good Luck!

  • Jan 11

    Welcome student NPs and prospective student NPs! Part 2

    This is the second part of a two part series, if you haven’t read the first installment, start there, if you have, welcome back.

    First off, a little about me. I am a board-certified Family Nurse Practitioner and I work in a mixture of both inpatient and clinic settings with a small independent adult internal medicine practice. I live in a state that requires a collaboration agreement but I practice almost fully independently (as fully as I am comfortable with, see below). I have been on the clinical and didactic faculty at a local NP program as well as a lecturer and clinical preceptor for a local medical school. I have been an active preceptor for most of my NP career. I am active in the local and national NP association. I am not, however, the be-all-end-all of NP advice, so take everything as the opinion of one person with some experience.

    Now on to the 10 questions I most frequently hear from students, both in school/practice and here at AN:

    • How do I find a clinical placement?
    • How much RN experience do I need before I start clinicals?
    • How do I prepare for my first clinical?
    • What is expected of me at my first clinical?
    • Do students really fail clinical?
    • What is the most important goal for my first clinical rotation?
    • What do I do if I am not sure about something?
    • How do I handle a disagreement with a preceptor?
    • What if I make a mistake?
    • What if my preceptor does something different from what I have learned in school?

    This is the second installment and I will address the latter five questions from above. If you have questions/thoughts/comments, please share.

    What is the most important goal for my first clinical rotation?

    At the start of each semester I sit down and discuss two goals with each of my students; their goal and my goal for them. For first semester student my goal is that they start to think and act like a safe provider.

    To me, a safe provider:
    1. listens to the patient,
    2. asks the appropriate questions regarding life threatening issues,
    3. identifies critical abnormals,
    4. rules out critical differentials,
    5. formulates a simple plan,
    6. knows when to ask for help.

    Listening to the patient is crucial for novice providers, especially now with the distractions of EMRs. Providers need to train themselves to really listen to what patients are saying, not giving a patient complete attention can lead to missing something important. It is also important to take patients seriously when they tell you something isn’t right. After a patient tells you they don’t feel right two things can happen: they can live or die. The latter is obviously what we want to avoid so take every complaint seriously. Patients can also give you important insights when you are new: have they had this before, what worked for them, etc.

    Learning to ask appropriate questions is one of the most important aspects of the role transition. It takes experience and time to develop the skill. In the beginning, I stress with students that they needs to ask the appropriate questions to rule out life threatening concerns. What do you need to ask to ensure that the patient’s cough is not a manifestation of PE or pneumothorax? What should you ask to make sure that a patient’s vertigo is not brain metastases? If the right questions aren’t asked then your risk of missing a life threatening diagnosis is elevated.

    As I mentioned above, in the first semester my focus is on the student identifying normal versus abnormal; in my view this is essential for entry to practice. Identifying critical abnormals spans the triage, the history, the physical exam, the diagnostics review, the plan, and the sum of all these components. When we are in clinic I expect students to identify a critical abnormal at any and all of these stages. You can be safe if you miss critical abnormals such as crushing chest pain on triage, a history with suicidal ideation, a surgical abdomen on exam, a hemoglobin of 6 on review of the CBC, or a major interaction of a medication in the plan. The best tip here is to take your time and be very cautious, just like you should be in practice.

    Just as alluded to above, I feel strongly that when a patient leaves a visit there needs to be no question about a life threatening diagnosis. It will never be absolute but there needs to be no reasonable doubt. If the patient presents with a cough, if you are going to diagnose him with bronchitis you should be able to clearly articulate why it is not a PE, acute heart failure, or pneumothorax.

    Developing a simple plan based on current EBP and guidelines develops with time and I don’t expect first semester students to be able to do it all the time, but I expect them to at least try, and when they can’t, I expect them to ask for help. The most important (in my opinion) still a novice provider can learn is to understand their own limitations and overcome any fear of asking for help.

    What do I do if I am not sure about something?

    As a student you are not expected to know every answer; once you are in practice you (hopefully) realize that you learn new things every day. With that in mind, the student should learn to handle this as a provider would. You will forget things you learned. You will see things you have never learned about or seen before. You will see complex and atypical presentations of common illnesses. You will be confronted (frequently) with things you don’t know from clinical presentations to physical findings to lab tests to medications and dosages.

    You should have readily accessible resources at the point of care, there are many of these available, I use UpToDate constantly but that is my personal preference. As a student you should use these resources before talking with your preceptor; it’s good habit. I spend the first week or two with my students saying “look it up and tell me, one day I won’t be here to ask”. Once you have researched then it’s time to talk to an experienced provider or colleague/mentor. Don’t be afraid to call radiology and ask, call the specialist and ask. It’s ok to not know, it is not ok to pretend you do. Another phrase I use on my first day with students is “no more faking-it-till-you-make-it”: when a provider fakes it people can die. If you don’t understand then you need to ask.

    How do I handle a disagreement with a preceptor?

    Disagreements with your preceptor, just like disagreement with your colleagues or your patients, may happen from time to time. The most important advice I can give to students is to handle these disagreements like a professional. Stay calm and objective. If you can, sit down and discuss the issue from a perspective of gaining understanding of your role in the issue and the opposite point of view.

    Remember you are a guest of the clinic you are in. Never escalate the situation. Speak immediately to your assigned faculty member without making accusations, again as calm and objective as you can. These can be a challenge, however, it is a challenge you will experience again and again in your career. I have to be honest, with some students, I will create a superficial disagreement and let it play out in a safe environment.

    What if I make a mistake?

    Mistakes are a part of life, we all make them, some are small others are tremendous, and I have yet to meet someone who has an absolute technique to avoid them. You and your preceptor will work very hard to avoid mistakes, but should one happen, there are a few important things to consider. The first thing you need to do when you realize you have made a mistake is admit it and get you preceptor and whomever you need to involved in fixing it. Maybe you just sent a medication to the pharmacy that a patient is allergic to or maybe you just missed a STEMI on an EKG. You can never, ever try and hide your mistake or hide from your mistake. The second thing to consider is how to make that mistake into a learning experience. You can learn from every mistake you just need to engage in self-reflective practice.

    What if my preceptor does something different from what I have learned in school?

    In all likelihood, during your first clinical rotation, you will see a preceptor do something different from what you learned in the classroom or from your textbook. There are a number of potential reasons (your textbook or lecture is out of date in their practice, your preceptor is out of date in his/her practice, your preceptor has adapted their practice to the specific patient or patient population, or the theoretical doesn't translate to the practical) but is likely multifactorial. First and foremost remember that you are their to learn the practical application of your theoretical knowledge. If you notice a difference, try and establish a dialogue with your preceptor about it. This dialogue is the cornerstone of your relationship: you learn from your preceptor and your preceptor learns from you. You may develop a relationship with your preceptor where you can challenge a him/her on these topics, but don’t start that way!

    That concludes my thoughts on 10 (five in part 1 and five in part 2) of the most frequently asked questions relating to a student nurse practitioner’s first clinical rotation. In closing I want to again reiterate that clinical rotations will be the foundation your career is built on and should be a fun. interesting, challenging, and active learning process. The habits you build during rotations will shape your practice. I know many students have commitments to family, school, and work, but I honestly feel that outside of family, your clinical rotation should be your primary focus. The more effort you engage the more you will get out of your rotation. I hope this has been some help to you and I wish you the best of luck as you move forward and transition into a role so many of us love.

  • Dec 17 '15

    Depends on your states BON and the hospitals regulations but in most cases, yes.

  • Sep 2 '15

    From I to A finally. Thanks for listening!!

  • Jul 23 '15

    I agree with you. I rarely find anything that I can relate to, it would be nice if there was a pre student nurse practitioner forum (wasn't there one awhile ago?) I don't bother posting half of the things I would like to, because they get off the front page so fast because of 'what school, where to go, no GRE, cheapest, fastest' threads. I feel like I have no real home on AN, but at least on the NP forum the NP's are awesome at helping out and answering stupid questions lol.

  • Jul 23 '15

    I passed ANCC ARNP-exam today...

    While I was preparing I was so nervous and some of the previous post regarding the ANCC FNP exam helped and some scared me to death. I made a promise to myself to post some of my experience so that It will be helpful for the NP students who are preparing for the test soon

    First of all I want to tell you all the test was not bad at all. I graduated on May 15 and registered for exam at the same time. my school took 15 days to send my official transcript to ANCC, as soon as they received my transcript they send me the OK letter to schedule the test in 2 days. In between I contact them to verify the status and they were nice...

    I took 2 week to study and these are the resources I used

    Leik book-- Excellent book , only needed info. breakdown nicely.. and the 650 questions at the end ...very useful. The last 2-4 chapters go over at least couple times.. you will never regret ( some minor errors noted in leiks book)

    Fitzgerald review-- I have to travel to a different town and stay in a hotel 3 days for live review... I will choose the online review much more affordable and wise. the spiral binder they gave you in the review very helpful.
    The Fitzgerald online tutorials about research and the leik book research chapter will cover the research topics pretty much for you...

    I borrowed Fitzerald 3 rd edition and read all chapters and did the answer the test questions (1400)...

    APEA online review (offered by school almost 3 months ago) -- Amelie is awesome and honestly the test did not look like what review questions...

    Exam edge- FNP review- I bought 10 test bundles. End up studying 10-15 different theories (some of them I even heard before and very fustrating). I scored 360-399 on these tests. very poorly constructed questions with lot of grammatical errors --the test questions in real exam is much more professional ( and ended up withno theories in my real test at all...)

    Here is my exam looked like (unable to provide exact details.. dont want to be in trouble)

    22 multiple choice
    hypertensive meds (CCB, HTCZ ACEI)
    5 drag
    3 exhibit
    10 pictures (derm and eye) pictures were good quality ...please make sure you review common eye conditions with pictures well
    billing and how choose CPT codes in primary care
    ANA position statements and research methods (meta analysis, case study etc..)
    atleast 20 cultural questions (leik book good resource but google it for more info)
    1 milestone peades, 1 obg question
    real test looked like fitzerald review test questions

    I finished 200 questions in 3 hours and took 30 mts to review the marked items
    once you finish the test, the proctor outside testing room will print a results for you..

    I know this post is bit longer... But if this will help my fellow NP students I am happy for it....
    best of luck for all of you....
    Finnay today I felt like I graduated....

  • Jun 22 '15

    Sure, there are no questions quoted, just numbers and my thoughts so it is my info, should not violate any copyrights. I am typing this on an iPad, which is not the best for this site, it won't let me back space, I have to erase and rewrite. So please forgive any typos in advance.

    Thirty eight questions are wrong in some way, either the answer of the rationale.

    18. The answer is correct but the time period is 15-20 weeks, so an aFP would never be obtained at 28 weeks. Maybe a typo, could be 18 weeks.

    19. Answer should be D

    28. The better answer would be GFR, which is calculated from the creatinine.

    38. A pap is not standard of care until 21 years.

    57. A is correct but it could also be a result of the mother having already received RhoGam in pregnancy.

    64. A is the most correct answer but it should actually be Tdap instead of Td.

    75. A is the best answer of those provided but it is actually fetal tissue before the placenta is even formed. The placenta forms after implantation, after 4 weeks. hCG is already present at 3 weeks, almost immediately after conception.

    112. A, presumptive signs, these are those felt by the women. She lists fetal movement as felt by the mother incorrectly as a probable sign, it is actually a presumptive sign. Fetal movement felt by the provider is a probable sign.

    162. D.

    173. A is the best provided answer but it should actually be Tdap instead of Td.

    175. D. By her own documentation, the mechanism of breast milk jaundice is not known, which makes it true and therefore the answer.

    191. There is no correct answer, C is the closest. But iron is not supplemented until 6 months.

    198. Both A and B are correct. Both CXR and cultures are confirmatory tests for a positive PPD TST.

    206. Rationale is incorrect.

    214. According to UpToDate, niacin as little effect on triglycerides.

    234. Rationale is not completely correct.

    244. Wrong answer, should be B. The Board of Nursing enforces the laws and regulates but only the state legislature has the ability and authority to pass the laws. The BON does not make the laws, only enforces them.

    251. C is the best available answer but "very sore " is not normal.

    257. The rationale is incorrect. The question asks about diagnosis and management, the Answer talks about screening.

    277. There is no correct answer, all choices are associated with EBV. See question 154.

    293. The cultures should have been obtained instead of a pap.

    313. B, second ICS, left stern all border, see page 147.

    319. B, see page 36.

    338. A 4 year old cannot ride a bike! See page 364, usually age 5 or 6.

    348. See rationale for 338.

    372. I could not find misoprostol in any treatment regimens, except for NSAID induce gastritis.

    380. C is also false.

    400. No correct answer because you have to treat for chlamydia as well, not just gonorrhea.

    419. B is the correct answer. Her rationale supports this as well.

    422. A single parent is not emancipated either.

    465. There is no right answer. Per AAP and ACOG, the correct answer is 2-3 years, which is not a choice.

    478. KOH is a better choice and usually available in primary care.

    499. C is the right choice, see the text on p 199.

    506. D should read Caucasians, not mediteranneans. You could argue that Spainards/Hisapincs are of mediteranneans descent, which would be incorrect. Just change it to Caucasians and it will be correct.

    514. Very poorly written question, hard to see what she is asking for.

    566. C is the correct answer, there are only first and second degree burns here, no full thickness (third degree).

    606. You, the NP, are required to report, not "she" , the mother.

    620. ATA says you only need the TSH. also her other questions, see #257.

    Sent from my iPad

  • Jun 22 '15

    Since many members of AN helped me a lot with formulating my own study plan, I promised that I will share my study plan as well once I pass the board exams. Here's a quick summary of my study plan:

    1) Studied each body system at a time. I started with listening to Hollier's CD lecture (because she is waaaay easier to understand than
    Fitzgerald or any book). So for example, i listened to her full dermatology lecture first as my warm up.

    2) I would then study the dermatology lecture on my Leik Book. OMG! Best book ever! If you know the book from cover to cover, you are guaranteed to pass the exam. Be careful with some typos or wrong answers at the back of the book though. The errors were minimal and i was able to recognize that they were incorrect.

    3) Then after reading and understanding the concepts in dermatology, i then listened to Fitzgerald's lecture on dermatology. I have two versions of her CD so i listened to both versions. I think this was the best strategy because when you listen to her (after listening to Hollier and reading the Leik book), it was easier to understand the topic. This strategy reinforced what I already know about the topic (in this case, dermatology). So while i was listening to her, i found myself saying "oh yeah, that's why...." Or "oh my god, now i understand why this rash is different from rubella...". Or sometimes i'd also say, "dang, i gotta review that topic again."

    4.) After the steps above, i answered all of the qbank questions under dermatology. I kept track of my score for each topic. Seeing the scores improve gave me confidence whenever i feel overwhelmed and depressed about studying.

    5.) Then i answered Leik's questions (they made an app for this but they are the same questions in the back of the book) on dermatology. I also kept track of my scores for each topic.

    6.) Then those topics that I got low scores on, i decided to skim through and review again using Leik's book.

    7.) Then i answered the qbank and leik questions again to test my knowledge. Surprisingly, i still got a lot of wrong answers even though they were repeat questions. So i wrote those questions that i missed in a small notebook to serve as my study guide later.

    8.) Then i took the time to really understand why those questions that were missed. I had to really know the concept behind those topics so I could remember them.

    9.) Then took the same questions until i got an 85% and above on each
    topic. I also purchased the AGNP (83%) and FNP (89%) sample exams from the AANP website (I was determined to pass this test!). I also took the two practice exams (50% and 71%) given to us by the APEA website (I scored low on these though because it was late at night when i took them).

    10.) The day before the exam: I studied my study guide in the morning. Then I spent my afternoon with hubby and we also watched a movie!

    11.) On the day of the exam, i went to the gym at 5am. Then i studied my study guide again for an hour. Then i went to breakfast, took my mind off of studying completely. I tried to relax for an hour but I was having really bad palpitations! I had to take multiple deep breaths and meditation exercises. I listened to my favorite songs during my drive to the testing center.

    12.) I arrived at the Prometric Center at 10 am (my appointment was 11). They checked me in at 1030. Felt like I was in prison because i had to empty my pockets and go through the metal detectors. You also have to check in/out, show ID, and go through the search process every time you take a break. I told myself I was gonna give myself a mini break during the exam but i was so anxious to just be done with it. I had to mentally get my mind off of the test a few times because my brain started going through bouts of mental fatigue (especially when i got to question number 80).

    I was so relieved when I saw the word "PASSED" at the end of the exam. Before that though they asked me if I wanted to take a survey and i
    clicked NO! I wanted to know first if i passed or not. Cmon! That was
    gonna be torture if i took the survey. Lol.

    I had tears of joy right after leaving the testing center. I'm so glad this exam is behind me. I could finally get my LIFE back ;-)

    By the way, I studied for a total of 4 weeks. I had to work 1-2 days each week. I saw my friends maybe only 2-3x during this study period. I stayed home most of the time!

    Good luck to all those who are taking the exam!

    Sent from my iPhone

  • May 28 '15

    @BDWilliams - I respectfully disagree. In my area (central IL) at the tertiary 900 bed hospital, FNPs abound in-pt. Our large (19 MD, 1 PA, 2 FNP, 2 CNS) practice utilizes all of us both in and out of the hospital - in fact we go to five hospitals in three systems.

    I do realize that the ANCC Consensus Model dictates that unless you have specific in-pt training (during clinical) that it is preferred that FNPs do outpt care. Per the ANCC site:

    "Scope of practiceof the primary care or acute care CNP is not setting specific but is based on patient care needs."

    There are many misconceptions about the Consensus Model and LACE. It is really important that we, as practicing APRNs know our scope of practice and stay within it.

  • Jun 15 '14

    Quote from Dranger
    That's the thing, no one wants to do the scut work. You have all these eager pre-nursing/nursing students who want to be RNs and as soon as they get their toes wet (1-2 years experience) many try to ditch bedside nursing for the next best thing which is a provider role. I see it all the time on here and at my job. Almost every newer nurse on my floor has a plan to leave bedside nursing within a year or two and either leave healthcare or become an NP.

    It's just how it is and greedy for-profit schools as well as accreditation happy governing bodies are more than willing to accept them because after all they won't be offering them jobs when everything is said and done.
    Your comment "no one wants to do the scut work... And many ditch bedside nursing after 1 or 2 years."
    Well they ALL should leave bedside nursing to better themselves. WHY do you have a problem with that? Jealous maybe? Why don't you join them and get the education?

    Look the problem is with the for profit hospitals and is mentality. In the hospitals Nurses are nothing but the room charge to the customers. "Their mentality," Yes sharp words but the truth. ICU nurses are getting 3 pts each and is ok that the pts has a 25% greater risk. that's ok odds for the hospitals, and don't get me started with med surge and the other floors with 6, 7 or more patient & it's charting.
    You call these "schools greedy" when just the opposite is true. It's the hospitals that is truly greedy. Did you read the news about CHS just acquiring dozens of more hospitals now numbering 206 and it costing them billions? Their are no unemployed nurse practitioners in the country, so why wouldn't every nurse want to be one when the starting salary is around $90,000.00
    My wife has BA with duel majors ( sociology and anthropology) and a BSN-RN degree and her starting salary in ICU was 24.00 an hour. Wow and that's with 18 years of previous medical experience as a CNA and Telemetry Monitor Tech. So don't tell me is about the money when someone starts in a NP program and wants to leave beside care. It's about having all that responsibility and not getting the money for that responsibility . So you move on and that is what that these Nurses are doing. Moving on to better themselves. Moving on to make a bigger difference in people's lives by providing health care directly to people.

  • Jun 15 '14

    I think it is great to do an online program if that is what fits your needs. Personally, I finish my first master's degree with an FNP in 9 weeks, and I am transitioning directly into a DNP program where I am getting a post-master's in acute care along the way. All of my schoolwork s/p associate's degree has been online, and I wouldn't have done it any other way. I do not deny that it is not for everyone, but it certainly has its place.

    In terms of people speaking against online/for-profit programs, I believe the criticism is a bit too generalized. Each program has to be evaluated on its own merits and shortcomings. It is a bit naive to think that if a school is for profit it is somehow beneath a nonprofit school. Even state schools are very concerned about money, just ask any professor who has to juggle teaching with bringing in grants/funds. All of the schools I have/am attending are state schools, but I don't think that makes my program any better or worse than any other based solely upon that fact. I looked at reviews, how programs are run, and a lot of other factors.

    Good luck with your program.

  • Mar 25 '14

    I am not an APRN but I do work in corrections. The FNP that works with me has concerns similar to yours in terms of losing some of her clinical skills in our setting. However, remember that corrections is really a branch of public health. What type of job are you looking for? I hope the right position comes forth Corrections is NOT a flunky job. It requires excellent skills with a population that can be very difficult to manage on all levels.

    I would like to go to NP school but I have worked in corrections so long I have lost a lot of traditional book knowledge though I consider myself an excellent RN. At 53 I'm not sure it's worth it. Any feedback about NP school after corrections?

    Best wishes

  • Feb 5 '14

    What article are you looking for, provide specs, and I can try to access if for you.

  • Feb 5 '14

    Do you know the name of the author of the article? If the author is a faculty member or a public figure, you can search their contact information with a google search. Then you can ask for the article by email.