BHPC Registration Exam cheat sheet

Standard of care = the degree of skill, care, and judgment a reasonably prudent practitioner with similar training would provide under similar circumstances.

Scope of practice is defined by state statute (nurse practice act), rule, employer policy, and certification body; the most restrictive applicable limit governs.

Delegation requires assessment by the licensed clinician, a task within the delegatee's training, clear instructions, and retained accountability for outcomes (e.g., five rights of delegation).

Documentation of care is a professional and legal duty; undocumented care is generally treated as care not rendered.

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof; it triggers root cause analysis.

Competency validation occurs at hire, annually or per policy, and whenever practice changes; competency is task-specific, not a one-time credential.

Professional boundaries separate therapeutic from personal relationships; boundary crossings should be disclosed and documented, boundary violations are reportable.

Evidence-based practice integrates best research evidence, clinician expertise, and patient values; clinical guidelines are preferred over individual anecdote.

Mandatory reporting duties (suspected abuse, impaired colleagues, communicable disease where required) override confidentiality obligations.

Four ethical principles: autonomy (self-determination), beneficence (do good), nonmaleficence (avoid harm), justice (fair distribution); veracity and fidelity are supporting duties.

Informed consent elements: capacity, voluntariness, disclosure of nature/purpose, risks, benefits, alternatives, and the right to refuse; the provider performing the procedure obtains consent.

HIPAA Privacy Rule permits disclosure for treatment, payment, and operations without authorization; minimum necessary standard applies to most uses.

HIPAA Security Rule covers electronic protected health information and requires administrative, physical, and technical safeguards plus breach notification within 60 days of discovery.

EMTALA requires a medical screening examination and stabilizing treatment for anyone presenting to an emergency department, regardless of insurance or ability to pay.

False Claims Act liability attaches to knowingly submitting false claims; the Anti-Kickback Statute and Stark Law restrict remuneration and self-referral arrangements.

Advance directives include living wills, durable power of attorney for healthcare, and POLST/MOLST orders; capacity is assessed per decision, not globally.

A minor's consent exceptions commonly include emergency care, emancipated minors, and specific services (reproductive health, mental health, substance use) as defined by state law.

Ethical decision frameworks: identify the dilemma, gather facts, apply principles and codes, consider stakeholders, choose and document a justified action.

Swiss cheese model: harm results when holes in multiple defensive layers align; interventions should add barriers, not blame individuals.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (sanction).

PDSA (Plan-Do-Study-Act) cycles test small changes before spread; the Model for Improvement pairs three questions with PDSA.

Six aims for improvement (IOM): safe, effective, patient-centered, timely, efficient, equitable.

Common measures: structure, process, and outcome; balancing measures detect unintended consequences of a change.

Never events and hospital-acquired conditions (e.g., wrong-site surgery, retained foreign body, stage 3-4 pressure injury) are typically non-reimbursable.

Root cause analysis is retrospective and system-focused; failure mode and effects analysis (FMEA) is prospective and scores severity x occurrence x detection.

High-reliability practices: safety huddles, standardized handoffs (SBAR), checklists, speak-up culture, and close-loop communication.

Error reporting systems are non-punitive and confidential where state law provides; reporting rates underestimate true error rates.

Subjective-objective-assessment-plan (SOAP) structure separates patient report from measured findings and clinician interpretation.

Vital sign reference ranges for adults: temperature 36.1-37.8 C, pulse 60-100/min, respirations 12-20/min, SpO2 95-100%, BP <120/<80 normal.

Pain is assessed with a validated tool matched to the patient (0-10 numeric, Wong-Baker FACES, PAINAD for advanced dementia).

Mental status: alert and oriented x4 (person, place, time, situation); changes in level of consciousness are the earliest sign of deterioration.

Early warning scores (e.g., NEWS) aggregate respiratory rate, oxygen saturation, systolic BP, pulse, and consciousness to trigger escalation.

Normal breath sounds are vesicular, bronchovesicular, and bronchial; adventitious sounds include crackles, wheezes, rhonchi, and pleural friction rub.

Edema is graded 1+ (2 mm) to 4+ (8 mm) pitting; dependent edema suggests fluid overload or venous insufficiency.

Documentation must be timely, accurate, objective, complete, and legible, with late entries labeled as such and never altered retrospectively.

ISBAR/SBAR handoff covers identify, situation, background, assessment, and recommendation.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; break any link to prevent transmission.

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask/eye protection based on exposure risk, and safe sharps handling.

Transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcus), airborne (TB, measles, varicella).

Hand hygiene per WHO five moments; alcohol-based rub is preferred except for C. difficile, norovirus, and visible soiling, where soap and water are required.

Personal protective equipment order: don gown, mask/respirator, goggles/face shield, gloves; remove gloves first, then goggles, gown, mask; perform hand hygiene after.

N95 respirators require fit testing and seal check; airborne infection isolation rooms need negative pressure and 6-12 air exchanges per hour.

Sterile technique vs clean technique: sterile fields require sterile supplies and avoid contact with non-sterile surfaces; clean technique is used for routine care.

Needlestick injury: wash with soap and water, report immediately, and initiate post-exposure prophylaxis evaluation; HIV PEP is most effective when started within hours.

Surgical site infection prevention: appropriate antibiotic prophylaxis within 60 minutes of incision, normothermia, glucose control, and hair removal by clipping.

Closed-loop communication: sender gives message, receiver repeats back, sender confirms accuracy.

SBAR standardizes escalation: Situation, Background, Assessment, Recommendation.

Teach-back confirms patient understanding by asking the patient to explain in their own words.

Health literacy best practices: plain language, chunking, limiting to 3-5 key points, and avoiding jargon.

Interpreters must be qualified medical interpreters, not family members, for clinical discussions; document interpreter use.

Assertive escalation tools (CUS: concerned, uncomfortable, safety issue) and two-challenge rules support speaking up across hierarchy.

TeamSTEPPS core skills: leadership, situation monitoring, mutual support, and communication.

Conflict resolution proceeds from direct clarification to chain of command; patient safety concerns are escalated regardless of rank.

Cultural humility requires self-reflection plus inquiry about the patient's beliefs, language, decision-making preferences, and family involvement.

Release of information requires a valid authorization: patient identifier, description of information, purpose, expiration, signature, and right to revoke.

Minimum necessary standard limits uses and disclosures to the least information needed for the purpose.

Protected health information identifiers include 18 HIPAA identifiers such as names, dates, geographic data, and device identifiers.

The legal health record is the organization's designated record set; the medical record is generally the property of the facility while the patient has a right to access.

Retention schedules are set by state law and payer contracts; documentation must never be destroyed during litigation holds.

Coding accuracy drives reimbursement; upcoding and unbundling are compliance risks subject to audit and recoupment.

Staffing models balance acuity, skill mix, and budget; nurse-to-patient ratios are mandated in some states.

Quality metrics and pay-for-performance programs link reimbursement to measures such as readmission rates and hospital-acquired conditions.

Incident reports are internal quality documents, generally not part of the medical record, and are not referenced in the patient chart.

Emergency operations plan follows an all-hazards approach and is built on the preparedness cycle: mitigation, preparedness, response, recovery.

Incident command system uses a common structure: incident commander, operations, planning, logistics, and finance/administration.

Hospital emergency incident command activation defines roles, communication channels, and reporting to the incident commander.

Triage systems (e.g., ESI 1-5) sort by acuity; ESI 1 requires immediate life-saving intervention.

Mass casualty triage tags use color codes: red immediate, yellow delayed, green minor, black expectant/deceased.

Fire response is RACE (rescue, alarm, confine, extinguish/evacuate) with PASS for extinguisher use (pull, aim, squeeze, sweep).

Evacuation types: horizontal (to another zone on the same floor) precedes vertical and full building evacuation.

Risk management strategies: avoid, reduce, transfer (insurance), and accept; incident reporting supports claims defense and prevention.

Decontamination and surge planning address staff safety, PPE caches, and bed/ventilator capacity during disasters.