ANCC AGACNP-BC flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Anion gap formula

Anion gap equals serum sodium minus the sum of chloride and bicarbonate; normal is about 8 to 12 mEq/L, with elevation suggesting unmeasured anions such as ketones or lactate.

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate 30/min or more, systolic BP below 90 or diastolic 60 or less, and age 65 years or older.

qSOFA criteria

Sepsis screen positive with respiratory rate 22/min or more, altered mentation, or systolic blood pressure 100 mm Hg or less; two or more criteria indicate higher risk.

Wells score for PE

Clinical probability tool using DVT signs, PE likely, tachycardia, immobilization or surgery, prior VTE, hemoptysis, and malignancy; score guides D-dimer and imaging.

ABG compensation rule

If pH is low with high PaCO2, respiratory acidosis is present; rising bicarbonate indicates metabolic compensation. If pH is high with low PaCO2, respiratory alkalosis is present; falling bicarbonate indicates metabolic compensation.

HEART score use

Risk-stratifies chest pain using history, ECG, age, risk factors, and troponin; scores 0 to 3 suggest low risk and 7 to 10 high risk.

Diabetes A1c threshold

A hemoglobin A1c of 6.5 percent or higher confirms diabetes; 5.7 to 6.4 percent indicates prediabetes, and treatment targets are individualized.

DKA fluid and insulin

Give isotonic crystalloid first, then IV insulin infusion after confirming potassium is above 3.3 mEq/L; add dextrose when glucose falls below 200 to 250 mg/dL.

Septic shock initial bundle

Measure lactate, obtain cultures, give broad-spectrum antibiotics within one hour for septic shock, and administer 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or higher.

Acute asthma severe treatment

Give repeated inhaled short-acting beta agonist, ipratropium, systemic corticosteroids, and consider IV magnesium sulfate for severe exacerbation not responding to initial therapy.

Heart failure four pillars

For reduced ejection fraction, guideline-directed therapy includes an ARNI or ACE inhibitor/ARB, evidence-based beta blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Hypertension goal

The 2017 ACC/AHA guideline defines stage 1 hypertension as 130 to 139 over 80 to 89 mm Hg and recommends a goal below 130/80 for most adults, individualized for frailty.

Stroke thrombolysis window

IV alteplase or tenecteplase may be given within 4.5 hours of ischemic stroke onset in eligible patients; mechanical thrombectomy is considered up to 24 hours in selected large-vessel occlusion.

COPD exacerbation antibiotics

Antibiotics are indicated when COPD exacerbation includes increased sputum purulence plus increased dyspnea or sputum volume, or when mechanical ventilation is required.

Vancomycin AUC monitoring

For serious MRSA infections, target vancomycin area under the curve over 24 hours to MIC ratio of 400 to 600; trough-only monitoring is insufficient for many patients.

Warfarin INR target

Most atrial fibrillation and venous thromboembolism indications target INR 2.0 to 3.0; mechanical mitral valves often target 2.5 to 3.5, with bridging guided by thrombotic risk.

Metformin renal cutoff

Do not start metformin when estimated glomerular filtration rate is below 45 mL/min/1.73 m2; stop at or below 30, and hold before iodinated contrast if eGFR is 30 to 60.

ACE inhibitor adverse effects

Cough, hyperkalemia, hypotension, and angioedema are key adverse effects; ACE inhibitors and ARBs are contraindicated in pregnancy and should be avoided with bilateral renal artery stenosis.

Opioid overdose antidote

Naloxone reverses opioid-induced respiratory depression; repeat doses may be needed because naloxone has a shorter duration than many opioids, and monitor for recurrent toxicity.

Motivational interviewing core

A collaborative conversation using open questions, affirmations, reflections, and summaries to strengthen a patient's own motivation and confidence for behavior change.

Corticosteroid taper rule

Taper systemic corticosteroids after prolonged use above physiologic doses to allow adrenal recovery; abrupt withdrawal can cause adrenal crisis, especially after more than 2 to 3 weeks.

Colorectal cancer screening

Average-risk adults should begin colorectal cancer screening at age 45 and continue through 75; options include colonoscopy every 10 years or annual stool-based testing.

Lung cancer screening criteria

Annual low-dose CT is recommended for adults aged 50 to 80 with at least 20 pack-year smoking history who currently smoke or quit within 15 years.

Teach-back method

Ask patients to explain information in their own words to confirm understanding; it identifies gaps and improves recall, especially for medication and discharge instructions.

SBAR handoff

A structured communication format covering situation, background, assessment, and recommendation to improve safety during transitions and reduce omissions.

Medication reconciliation

Systematically compare a patient's current medications with new prescriptions at admission, transfer, and discharge; discrepancies are resolved to prevent adverse drug events.

Adult immunization schedule

Annual influenza vaccine for all adults, Tdap booster every 10 years, zoster vaccine at age 50, and pneumococcal vaccination at age 65 or with risk conditions.

APRN prescriptive authority

Scope of practice and prescriptive authority are determined by state law and may require a collaborative agreement, supervisory relationship, or independent practice status.

Informed consent elements

Valid informed consent requires capacity, disclosure of diagnosis, proposed treatment, risks, benefits, alternatives, and a voluntary decision without coercion.

EMTALA requirement

Medicare-participating hospitals must provide a medical screening examination and stabilizing treatment for emergency conditions regardless of insurance or ability to pay.

MIPS quality reporting

The Merit-based Incentive Payment System scores clinicians on quality, cost, improvement activities, and promoting interoperability; scores adjust Medicare payments.

Mandatory reporting duty

Clinicians must report suspected child abuse, elder abuse, and certain communicable diseases to designated authorities according to state law; failure can carry legal penalties.