ANCC FNP cheat sheet

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP). Positive and negative predictive values shift with disease prevalence even when sensitivity and specificity are fixed.

Likelihood ratio positive = sensitivity/(1 − specificity); LR negative = (1 − sensitivity)/specificity. LR+ above 10 or LR− below 0.1 materially changes post-test probability.

Number needed to treat = 1/absolute risk reduction; number needed to harm = 1/absolute risk increase.

Anion gap = Na − (Cl + HCO3), normal 8–12 mEq/L; add 2.5 mEq/L to the reported gap for every 1 g/dL that albumin falls below 4.0 g/dL.

Corrected sodium = measured Na + 1.6 × [(glucose − 100)/100]; hyperglycemia dilutes serum sodium and can mask coexisting hyponatremia.

BMI = weight(kg)/height(m)²; BMI 25.0–29.9 = overweight, ≥30 = obesity, ≥40 = class III obesity.

Standard screens: PHQ-9 ≥10 = moderate depression; GAD-7 ≥10 = moderate anxiety; AUDIT-C positive at ≥4 (men) or ≥3 (women); CAGE ≥2 suggests alcohol use disorder.

McIsaac/Centor criteria for pharyngitis: tonsillar exudate, tender anterior cervical nodes, fever, and absence of cough. Score ≥3 supports rapid antigen testing rather than empiric antibiotics.

Ottawa ankle rules: malleolar-zone pain plus bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight four steps, indicates need for radiography.

ADA diabetes: A1c ≥6.5%, fasting plasma glucose ≥126 mg/dL, 2-hour 75-g OGTT ≥200 mg/dL, or random glucose ≥200 mg/dL with classic symptoms. Prediabetes = A1c 5.7–6.4% or FPG 100–125 mg/dL.

ACC/AHA blood pressure: normal <120/<80; elevated 120–129/<80; stage 1 = 130–139 or 80–89; stage 2 = ≥140 or ≥90; crisis ≥180/120.

Metabolic syndrome requires 3 of 5: waist >102 cm (men)/>88 cm (women), triglycerides ≥150 mg/dL, HDL <40 (men)/<50 (women) mg/dL, BP ≥130/85, fasting glucose ≥100 mg/dL.

Chronic kidney disease = eGFR <60 mL/min/1.73 m² or a damage marker such as urine albumin-to-creatinine ratio ≥30 mg/g, persisting ≥3 months.

Persistent airflow obstruction is a post-bronchodilator FEV1/FVC <0.70; in a symptomatic adult with exposure history this establishes COPD.

BNP <100 pg/mL makes heart failure unlikely; >400 pg/mL strongly supports it; values of 100–400 pg/mL require correlation with exam, renal function, and age.

Subclinical hypothyroidism = elevated TSH with normal free T4; levothyroxine is generally indicated when TSH exceeds 10 mIU/L.

WHO anemia thresholds: hemoglobin <13 g/dL in men and <12 g/dL in nonpregnant women; MCV <80 fL defines a microcytic process (iron deficiency, thalassemia, chronic disease).

Acute otitis media requires acute onset plus middle-ear effusion plus a bulging tympanic membrane or new-onset otorrhea not attributable to otitis externa.

Uncomplicated cystitis: nitrofurantoin 100 mg BID × 5 days, or trimethoprim-sulfamethoxazole DS BID × 3 days where local E. coli resistance is <20%. Avoid nitrofurantoin when CrCl <30 mL/min.

Outpatient community-acquired pneumonia without comorbidity: amoxicillin 1 g TID or doxycycline 100 mg BID. With comorbidity: beta-lactam plus macrolide, or a respiratory fluoroquinolone.

Acute coronary syndrome: chewed non-enteric aspirin 162–325 mg immediately; door-to-balloon ≤90 minutes at a PCI center or door-to-needle ≤30 minutes if fibrinolysis is used.

Statin therapy: moderate intensity for adults 40–75 with diabetes or 10-year ASCVD risk ≥7.5%; high intensity when 10-year risk is ≥20%.

Treatment targets for most adults: A1c <7% (nonpregnant), BP <130/80 mmHg, LDL <100 mg/dL, or <70 mg/dL in very high-risk ASCVD.

Immunizations: influenza annually from age 6 months; Tdap every 10 years; recombinant zoster 2 doses at ≥50 years; PCV20 at ≥65; HPV series through age 26.

Atrial fibrillation anticoagulation: CHA2DS2-VASc ≥2 in men or ≥3 in women warrants anticoagulation; a direct oral anticoagulant is preferred, with warfarin targeting INR 2.0–3.0.

Cancer screening: colorectal from age 45; cervical cytology from 21 or HPV testing from 25–65; mammography biennially from 40–74.

Asthma: every patient receives inhaled corticosteroid–containing controller therapy; short-acting beta agonist alone is no longer a recommended strategy at any severity.

ACE inhibitor or ARB: basic metabolic panel 1–2 weeks after initiation or titration; a creatinine rise up to 30% is acceptable, but hold the drug if potassium exceeds 5.5 mEq/L or the rise exceeds 30%.

Metformin: contraindicated at eGFR <30 mL/min/1.73 m², dose-reduced at 30–45; hold around iodinated contrast when eGFR <30 or acute kidney injury is present.

Levothyroxine: recheck TSH 6–8 weeks after any dose change; titrate in 12.5–25 mcg increments based on the result.

Statin: obtain baseline ALT; check CK only for myalgia or weakness, and stop when CK exceeds 10 times the upper limit of normal with symptoms.

A1c surveillance: every 3 months when therapy changes or goals are unmet, every 6 months once stable at goal; the value reflects roughly 2–3 months of glycemia.

Depression: reassess symptoms 4–6 weeks after starting or adjusting an SSRI; an adequate trial is 6–8 weeks at a therapeutic dose before switching agents.

Acute otitis media: reassess at 48–72 hours if symptoms persist on amoxicillin; switch to amoxicillin-clavulanate rather than repeating the same agent.

Hypertension follow-up: stage 1 with lifestyle change alone → recheck in 3–6 months; stage 2 or high risk → follow up within 1 month of starting medication.

Warfarin: INR weekly during initiation and after dose changes, then every 4 weeks once stable; aim for time in therapeutic range ≥70%.