Patient Care
45%of exam
Vital SignsCritical ValuesBody PositionsPressure InjuryI&O + EliminationFeeding & Oxygen
Compliance, Safety & Professional Responsibility
20%of exam
Five RightsHIPAA & ChartingPatient ID GoalsAbuse & EthicsFire & Restraints
Infection Control
11%of exam
Chain of InfectionPrecaution TypesPPE OrderAsepsis LevelsBiohazard & Sharps
Phlebotomy
14%of exam
EKG
10%of exam
Quick Facts
- Exam
- CPCT/A
- Items
- 120 (100 scored + 20 pretest)
- Time
- 2 hours
- Pass
- 390/500 scaled
- Fee
- $165 application
- Retest
- 30-day wait
- Cert
- 2 yrs / 10 CE
- Provider
- PSI or live remote
Stroke Recognition
Face -> Arm -> Speech -> Time
Face: droopingArm: weaknessSpeech: difficultyTime: call the nurse
PROM vs AROM
PROM
- Caregiver moves the joint
- Patient cannot move it
- Passive range of motion
AROM
- Patient moves independently
- Patient is able
- Active range of motion
Who is doing the moving
Critical Value Escalation
- SpO2 below 90%→Report to nurse now
- Systolic BP <90 or >180→Report immediately(critical value)
- Heart rate <50 or >120→Report immediately
- Glucose <70 or >400→Report immediately
- New confusion or sudden SOB→Report right away(never baseline)
Normal Vital Sign Ranges
- Temperature
- 97.0-99.0°F oral
- Pulse
- 60-100 bpm
- Respirations
- 12-20 breaths/min
- Blood pressure
- under 120/80 mmHg
- SpO2
- 95-100%
- Apical pulse
- infants, irregular rhythms
Critical Values: Report Now
- SpO2
- below 90%
- New fever
- above 100.4°F
- Systolic BP
- below 90 or above 180
- Heart rate
- below 50 or above 120
- Resp rate
- below 10 or above 24
- Glucose
- below 70 or above 400
Basic Body Positions
- Semi-Fowler's
- HOB 30-45 degrees
- High Fowler's
- eases COPD breathing
- Sims'
- semi-prone, left side
- Trendelenburg
- head lower, order only
- Supine
- standard EKG position
Pressure Injury Staging
- Stage 1
- non-blanchable redness, intact
- Stage 4
- full-thickness, exposed bone
- Unstageable
- obscured by slough/eschar
- Deep tissue injury
- purple, intact or open
- Reposition
- at least every 2 hrs
I&O + Elimination Red Flags
- Urine output
- at least 30 mL/hr
- Healthy stoma
- red/pink, moist
- Report stoma
- pale, dusky, purple, bleeding
- Ostomy irrigation
- outside PCT scope
- I&O units
- always measured in mL
- Abnormal stool
- black/tarry or bright red
Feeding, O2 & Suction
- HOB during feeding
- at least 30-45 degrees
- Post-feeding upright
- 30 to 60 minutes
- Thickened liquids
- for dysphagia patients
- Nasal cannula
- 1-6 L/min
- Non-rebreather mask
- 10-15 L/min
- Yankauer suction
- only while withdrawing
Fire Response
Rescue -> Alarm -> Confine -> Extinguish
Rescue: move patients firstAlarm: pull nearest stationConfine: close doorsExtinguish: small fires only
Before Applying a Restraint
- Patient safety at risk→Try alternatives first(alarms, sitter, reorient)
- Alternatives failed→Get a physician order(type + time limit)
- Restraint is necessary→Choose least restrictive type(mitts before vest)
- Restraint applied→Check at least q2h
- Behavior resolves→Discontinue the restraint(never for convenience)
Five Rights of Delegation
- Right task
- legally, safely delegable?
- Right circumstance
- patient stable now?
- Right person
- PCT trained, competent?
- Right direction
- clear instructions given?
- Right supervision
- nurse evaluates outcome?
Extinguisher Use
Pull -> Aim -> Squeeze -> Sweep
Pull: the safety pinAim: at the baseSqueeze: the handleSweep: side to side
HIPAA & Charting Rules
- Privacy Rule
- governs PHI use
- Security Rule
- governs ePHI safeguards
- Minimum necessary
- only PHI needed
- Charting error fix
- single line, sign, date
- Do-Not-Use list
- e.g. 'U' for unit
Patient ID & Safety Goals
- Identifiers required
- 2: name + DOB
- Never accept
- room or bed number
- Time-out
- before invasive procedures
- Critical results
- read-back confirmation
- Hand hygiene
- before and after contact
Abuse Reporting & Ethics
- Mandated reporter
- report suspicion, not proof
- Physical abuse sign
- multi-stage-healing bruising
- Financial exploitation
- missing money, will changes
- Autonomy
- patient's right to choose
- Beneficence
- act for patient benefit
- Nonmaleficence
- do no harm
- Justice
- fair, equal treatment
Fire Codes & Restraints
- Code Blue
- cardiac/respiratory arrest
- Code Red
- fire
- Restraint order
- physician-ordered, time-limited
- Restraint checks
- at least every 2 hrs
- Restraints
- always the last resort
PPE Donning Order
Gown -> Mask -> Goggles -> Gloves
Don: gown, mask, goggles, glovesDoff: gloves, goggles, gown, maskGloves off first: most contaminated
Medical vs Surgical Asepsis
Medical Asepsis
- Reduces organism numbers
- Clean technique
- Most PCT tasks
Surgical Asepsis
- Eliminates all organisms
- Sterile technique
- Includes bacterial spores
Clean vs completely sterile
Which Precaution Type?
- MRSA, C. diff, or VRE→Contact precautions(gown + gloves)
- Flu, pertussis, or meningitis→Droplet precautions(surgical mask)
- TB, measles, or varicella→Airborne precautions(N95 + neg-pressure room)
- Any patient, any time→Standard precautions(baseline, always on)
Chain of Infection (6 Links)
- Infectious agent
- the pathogen itself
- Reservoir
- where agent lives
- Portal of exit
- leaves the reservoir
- Mode of transmission
- travels to new host
- Portal of entry
- enters the new host
- Susceptible host
- cannot resist the agent
Droplet vs Airborne
Droplet
- Large respiratory particles
- Short travel distance
- Surgical mask only
Airborne
- Small droplet nuclei
- Travels farther, stays suspended
- N95 + neg-pressure room
Mask type is the tell
Transmission-Based Precaution Types
- Contact
- MRSA, C. diff, VRE
- Droplet
- flu, pertussis, meningitis
- Airborne
- TB, measles, varicella
- Contact PPE
- gown + gloves
- Droplet PPE
- surgical mask
- Airborne PPE
- fit-tested N95, neg-pressure room
Standard vs Transmission-Based
Standard Precautions
- Every patient, every time
- Baseline hand hygiene + gloves
- Applies regardless of diagnosis
Transmission-Based
- Added for known pathogen
- Contact, droplet, or airborne
- Stacked on top of standard
Baseline vs added-on
PPE Don/Doff Sequence
- Don 1st
- gown
- Don 2nd
- mask or respirator
- Don 3rd
- goggles or face shield
- Don 4th
- gloves
- Doff 1st
- gloves (most contaminated)
- Doff last
- mask or respirator
Asepsis & Disinfection Levels
- Medical asepsis
- reduces microorganisms
- Surgical asepsis
- eliminates all, incl. spores
- Sterile field border
- outer 1 inch contaminated
- C. diff hand hygiene
- soap and water only
- C. diff disinfectant
- 1:10 bleach dilution
- Disinfectant contact time
- must reach full dwell time
Biohazard & Sharps Safety
- Sharps container
- replace at 3/4 full
- Needle recapping
- never recap by hand
- Needlestick response
- wash site immediately
- Exposure reporting
- report right away
- Exposure Control Plan
- reviewed at least annually
Order of Draw
Stop, Light, Red, Green, Light-Purple, Gray
Yellow: blood cultureLight blue: citrateRed/gold: SSTGreen: heparinLavender: EDTAGray: fluoride
Arterial vs Venous Blood
Arterial
- Bright red color
- Pulsating flow
- Stop, do not draw
Venous
- Dark red color
- Steady, non-pulsing flow
- Routine draw target
Pulsing bright red means stop
Order of Draw Decision
- Blood culture ordered→Draw yellow tube first
- Coagulation panel (PT/PTT)→Draw light blue second
- First tube is coag→Fill a discard tube(prevents underfill)
- Chemistry or serology→Draw red/gold third
- CBC ordered→Draw lavender EDTA fifth
- Glucose or lactate→Draw gray tube last
CLSI Order of Draw
- 1st
- Yellow, blood culture (SPS)
- 2nd
- Light blue, citrate
- 3rd
- Red/gold, SST clot activator
- 4th
- Green, heparin
- 5th
- Lavender/pink, EDTA
- 6th (last)
- Gray, fluoride
Implied vs Informed Consent
Implied Consent
- Routine venipuncture
- Extending the arm implies
- No signature required
Informed Consent
- Invasive procedures
- Explicit signed agreement
- Risks explained first
Routine vs invasive procedure
Tube Inversion Counts
- Citrate (blue)
- 3-4 inversions
- SST (gold)
- 5 inversions
- Heparin/EDTA/fluoride
- 8-10 inversions
- Plain red top
- no inversion
- Rule
- invert gently, never shake
Vein Selection & Site Prep
- First-choice vein
- median cubital
- Last-choice vein
- basilic
- Tourniquet placement
- 3-4 inches above site
- Tourniquet release
- within 1 minute
- Needle angle
- 15-30 degrees
- Antiseptic
- 70% isopropyl alcohol
Capillary Puncture Rules
- Capillary order 1st
- EDTA lavender
- Finger site
- distal, lateral 3rd/4th finger
- First drop
- wipe away, discard
- Heel site
- medial or lateral plantar
- Heel depth limit
- under 2.0 mm
- Avoid
- posterior heel curvature
Complications & Specimen Handling
- Adverse reaction
- stop, release, remove, support
- Hemolysis causes
- hematoma, shaking, small needle
- Labeling rule
- at bedside, in presence
- Attempt limit
- 2 tries, then escalate
- Light-sensitive analyte
- e.g. bilirubin, protect
- Sites to avoid
- mastectomy side, active IV
VT vs VF
V-Tach (VT)
- Wide, regular QRS
- 100-250 bpm
- May still have pulse
V-Fib (VF)
- Chaotic, no QRS
- No cardiac output
- Always pulseless
Check the pulse to tell
Dangerous Rhythm Response
- Wide, regular, fast rhythm→Check pulse immediately(VT vs VF risk)
- No pulse, chaotic QRS→Start CPR + AED(VF = cardiac arrest)
- Flatline noted→Confirm in 2 leads(rule out lead-off)
- Any lethal rhythm seen→Call the code team(don't wait for order)
Conduction System Rates
- SA node
- 60-100 bpm, primary pacemaker
- AV node
- 40-60 bpm, delays impulse
- Purkinje fibers
- 20-40 bpm, last resort
- SA node role
- produces the P wave
- AV node role
- allows ventricular filling
12-Lead Placement Landmarks
- RA/LA/RL/LL
- the 4 limb leads
- V1
- 4th ICS, right sternal border
- V2
- 4th ICS, left sternal border
- V4
- 5th ICS, midclavicular line
- V3
- midpoint between V2 and V4
- V5/V6
- level with V4, lateral
EKG Machine Settings
- Paper speed
- 25 mm/second standard
- 1 small box
- 0.04 second
- 1 large box
- 0.20 second
- Sensitivity
- 10 mm/mV standard
- Calibration pulse
- 10 mm tall square wave
- Skin prep order
- clean, dry, shave, abrade
Waveforms & Intervals
- P wave
- atrial depolarization
- QRS complex
- ventricular depolarization
- T wave
- ventricular repolarization
- PR interval
- 0.12-0.20 second
- QRS duration
- under 0.12 second
Life-Threatening Rhythms
- VT
- wide, regular, 100-250 bpm
- VF
- chaotic, no pulse, no output
- Asystole
- flatline, confirm in 2 leads
- VF / pulseless VT
- CPR + defibrillation now
- PCT response
- start BLS, don't wait
Common Traps
Room Number vs Patient Identifier
Room number is invalid ≠ Name + DOB required
Standard vs Transmission Precautions
Standard applies to everyone ≠ Transmission-based is added on
Hand Sanitizer vs C. diff
Sanitizer misses spores ≠ Soap and water works
PROM vs AROM
PROM: caregiver moves it ≠ AROM: patient moves alone
VT vs VF Pulse
VT: may have pulse ≠ VF: always pulseless
Droplet vs Airborne Mask
Droplet needs surgical mask ≠ Airborne needs fit-tested N95
EDTA Before Citrate Error
EDTA first corrupts coag ≠ Citrate always drawn second
Tourniquet Timing
Applied 3-4 inches above ≠ Released within one minute
Capillary First Drop
First drop gets discarded ≠ Diluted with tissue fluid
Restraint Without an Order
Never a PCT's choice ≠ Always needs physician order
Last Minute
- 1.120 items: 100 scored, 20 pretest
- 2.2-hour limit; passing score 390/500
- 3.Patient Care = 45%, largest domain
- 4.Donning order: gown, mask, goggles, gloves
- 5.Doffing order: gloves, goggles, gown, mask
- 6.Blood cultures are always drawn first
- 7.Gray fluoride tube is always last
- 8.Tourniquet: release within 1 minute
- 9.CPR ratio is 30:2 compressions
- 10.Compressions: 100-120/min, 2-2.4 inches deep
- 11.Two identifiers required: name and birthdate
- 12.SpO2 below 90% needs immediate report
- 13.V1-V2 sit at the 4th ICS
- 14.V4 sits at the 5th ICS
- 15.Restraints always need an MD order
- 16.Restraint checks: at least every 2h
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