ANCC MedSurg-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 sodium minus the sum of chloride and bicarbonate; normal is 8 to 12 mEq/L, and elevation suggests anion-gap metabolic acidosis from lactate, ketones, or toxins.

SIRS criteria

Two or more of: temperature above 38 C or below 36 C, heart rate over 90, respiratory rate over 20 or PaCO2 under 32, WBC over 12,000 or under 4,000, or over 10% bands.

Winter formula expected PaCO2

In metabolic acidosis, expected PaCO2 equals 1.5 times the bicarbonate plus 8, plus or minus 2; a measured value outside this range signals a second acid-base disorder.

Orthostatic hypotension criteria

A drop of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing defines orthostatic hypotension, suggesting volume depletion or autonomic dysfunction.

BNP interpretation

A BNP below 100 pg/mL makes heart failure unlikely, while values above 400 pg/mL strongly suggest it, although renal failure and advanced age elevate levels independently.

Corrected sodium in hyperglycemia

Add 1.6 mEq/L to the measured sodium for every 100 mg/dL of glucose above 100, because hyperglycemia dilutes sodium and underestimates the true sodium deficit.

Glasgow Coma Scale scoring

Scores range from 3 to 15 by combining eye, verbal, and motor responses; a total of 8 or less warrants airway protection and consideration of intubation.

SAAG interpretation

A serum-ascites albumin gradient of 1.1 g/dL or greater indicates portal hypertension as the cause of ascites; lower values suggest peritoneal malignancy, tuberculosis, or pancreatic disease.

DKA insulin infusion rule

Start regular insulin infusion at 0.1 units/kg/hour only after potassium is at least 3.3 mEq/L, and add dextrose when glucose falls below 200 to 250 mg/dL.

Hyperkalemia with ECG changes

Give IV calcium gluconate first to stabilize the myocardium, then insulin with glucose, albuterol, and dialysis to shift and remove excess potassium.

Heparin aPTT target

Unfractionated heparin is titrated to an aPTT of 1.5 to 2.5 times control, with platelet counts monitored because a drop over 50% suggests heparin-induced thrombocytopenia.

Warfarin INR targets

INR target is 2.0 to 3.0 for most indications and 2.5 to 3.5 for mechanical mitral valves; vitamin K reverses excessive anticoagulation from warfarin.

Parkland burn formula

Give 4 mL of lactated Ringer per kg per percent total body surface area burned over 24 hours, with half infused in the first 8 hours after injury.

Chest tube tidaling

Fluctuation of fluid in the water seal chamber with breathing is normal; continuous bubbling there indicates an air leak and should be reported.

VAP prevention bundle

Keep head of bed at 30 to 45 degrees, provide oral care, and maintain endotracheal cuff pressure at 20 to 30 cm H2O to reduce ventilator-associated pneumonia.

PRBC transfusion effect

One unit of packed red blood cells raises hemoglobin by about 1 g/dL and hematocrit by about 3 percent in an average-sized adult.

Compartment syndrome pressure threshold

A compartment pressure above 30 mmHg, or within 30 mmHg of diastolic pressure, accompanied by pain on passive stretch signals compartment syndrome requiring urgent fasciotomy.

Urine output resuscitation goal

Adequate resuscitation is suggested by urine output of at least 0.5 mL/kg/hour in adults, roughly 30 mL/hour for a 60 kg patient.

COPD oxygen saturation target

Target an SpO2 of 88 to 92 percent in patients with COPD to preserve hypoxic drive while avoiding hypercapnia and oxygen toxicity.

Transfusion reaction first action

Stop the transfusion immediately, keep the IV line patent with normal saline, reassess vital signs, and notify the provider and blood bank.

Teach-back evaluation method

Asking the patient to restate instructions in their own words confirms comprehension more reliably than asking whether they have any questions.

Pain reassessment timing

Reassess pain about 30 minutes after IV analgesia and about 1 hour after oral analgesia to evaluate effectiveness and the need for adjustment.

Heparin monitoring frequency

Check aPTT roughly 6 hours after starting heparin and after each rate change until two consecutive results fall within the therapeutic range.

Braden scale reassessment

The Braden score is reassessed every shift in acute care; lower scores indicate higher pressure injury risk and trigger a prevention plan.

Informed consent responsibility

The provider performing the procedure obtains informed consent; the nurse witnesses the signature and confirms the patient understands and volunteered freely.

Five rights of delegation

Right task, right circumstance, right person, right direction and communication, and right supervision and evaluation determine whether a nursing task may be delegated.

Mandatory reporting examples

Nurses must report suspected abuse or neglect of children, older adults, and dependent adults, plus specified communicable diseases, to designated agencies.

SBAR handoff

Situation, background, assessment, and recommendation structure a concise, complete handoff that reduces omissions during transitions of care between providers.

Never events examples

Serious reportable events include wrong-site surgery, retained foreign objects, transfusion with the wrong blood type, and stage 3 or 4 pressure injuries acquired during care.

Surgical time-out purpose

Immediately before incision the team verifies patient identity, procedure, site, consent, and allergies aloud to prevent wrong-site surgery and other errors.

Nurse Practice Act authority

State law defines scope of practice, licensure requirements, and disciplinary authority for nurses, making it the primary legal standard for nursing practice.

Ethical principle autonomy

Autonomy is the right of a competent patient to make self-determined decisions about care, including refusal, even when the choice conflicts with clinician recommendation.