Free AGACNP-BC Exam Flashcards

Normal pH is 7.35-7.45. Below 7.35 = acidemia; above 7.45 = alkalemia. Always assess pH first, then PaCO2 and HCO3 to identify the primary process and any compensation.

Anion gap = Na+ minus (Cl- + HCO3-). Normal range is 8-12 mEq/L. A gap above 12 mEq/L signals a high-anion-gap metabolic acidosis (e.g., DKA, lactic acidosis, toxic ingestion, uremia).

Winters' formula: expected PaCO2 = 1.5(HCO3) + 8, +/-2. Here: 1.5(12) + 8 = 26, +/-2, so PaCO2 24-28 mmHg is appropriate compensation. A PaCO2 outside that range points to a mixed acid-base disorder.

Prerenal AKI: FeNa <1%, low urine sodium (kidneys appropriately conserve sodium/water). ATN: FeNa >2%, high urine sodium (tubular damage impairs reabsorption).

Sudden, severe 'tearing' or 'ripping' chest/back pain, often with a systolic blood pressure differential greater than 20 mmHg between arms. Requires urgent CT angiography for diagnosis.

Impaired hepatic clearance allows ammonia (and other gut-derived neurotoxins) to accumulate and cross the blood-brain barrier, causing neurotoxicity and altered mental status; treated with lactulose and/or rifaximin.

Hold warfarin and give oral vitamin K. IV vitamin K plus prothrombin complex concentrate is reserved for major or life-threatening bleeding, not an asymptomatic elevated INR alone.

ACE inhibitors block breakdown of bradykinin, which accumulates in the airway and triggers a dry, persistent cough. Switching to an ARB (which does not affect bradykinin) typically resolves it.

Stop all heparin products immediately (including flushes) and start a non-heparin anticoagulant such as argatroban. Warfarin alone is avoided until platelets recover, due to venous limb gangrene risk.

Atypical presentation is common: dyspnea, confusion, fatigue, or syncope may occur without classic chest pain, which can delay diagnosis and treatment.

The Beers Criteria flag potentially inappropriate medications for older adults (e.g., certain benzodiazepines, anticholinergics) that carry a higher risk of adverse effects, guiding safer prescribing.

Delirium: acute onset, fluctuating course, often reversible with an underlying cause treated. Dementia: chronic onset, progressive, generally stable level of consciousness. A patient can have both at once.

4-12 mmHg. Elevated PCWP suggests left ventricular failure or volume overload; a low PCWP suggests hypovolemia.

2.5-4.0 L/min/m2. CI is cardiac output indexed to body surface area, allowing comparison of pump function across patients of different body sizes.

Cardiogenic shock - the failing heart cannot generate adequate output, triggering compensatory vasoconstriction (high SVR) while blood backs up into the pulmonary circulation (high PCWP).

4-8 mL/kg of predicted body weight (PBW), targeting a plateau pressure below 30 cmH2O to minimize ventilator-induced lung injury.

PaO2/FiO2 (P/F) ratio of 100-200 mmHg with PEEP at least 5 cmH2O. Mild ARDS is P/F 200-300 mmHg; severe ARDS is P/F 100 mmHg or less.

RSBI below 105 (respiratory rate divided by tidal volume in liters) during a spontaneous breathing trial predicts a good chance of extubation success.

ST-segment elevation of at least 1 mm in two or more contiguous leads. V2-V3 have higher cutoffs: at least 2 mm in men and at least 1.5 mm in women.

Door-to-balloon (primary PCI): 90 minutes or less. Door-to-needle (fibrinolytics, when timely PCI isn't available): 30 minutes or less.

RV infarct patients are preload-dependent; nitrates cause venodilation that drops preload and can precipitate profound hypotension. Give fluids instead and check right-sided lead V4R to confirm RV involvement.

Blood cultures should be drawn before antibiotics are started (when this doesn't unduly delay treatment), so the causative organism can still be identified after therapy begins.

Septic shock is sepsis plus persistent hypotension requiring vasopressors to maintain a MAP of 65 mmHg or higher, plus a serum lactate above 2 mmol/L despite adequate fluid resuscitation.

Norepinephrine is first-line. The target MAP is 65 mmHg or higher (60-65 mmHg may be acceptable in select elderly patients to avoid excessive vasoconstriction).

Glucose above 250 mg/dL, arterial pH below 7.3, serum bicarbonate below 18 mEq/L, and an elevated anion gap (above 12 mEq/L) with ketonemia/ketonuria.

Insulin drives potassium intracellularly and can precipitate life-threatening hypokalemia. If potassium is below 3.3 mEq/L, hold insulin and replete potassium first.

Standard window: within 3 hours of symptom onset. An extended window up to 4.5 hours applies to a stricter subset of patients (age 80 or younger preferred, no anticoagulant use, no combined diabetes plus prior stroke history).

Pre-tPA: BP must be below 185/110 mmHg. Post-tPA: BP must be kept below 180/105 mmHg for the first 24 hours to reduce the risk of hemorrhagic transformation.

Up to 24 hours from last known well in appropriately selected patients based on perfusion imaging - far longer than the standard tPA window.

Alpha-1 (vasoconstriction) and beta-1 (increased contractility/inotropy). This combination raises blood pressure while supporting cardiac output, making it the first-line septic shock pressor.

Phenylephrine is a pure alpha-1 agonist with no beta (inotropic) activity - it raises blood pressure through vasoconstriction alone and can cause reflex bradycardia, unlike norepinephrine, which also adds inotropic support.

It is added as a fixed-dose adjunct (0.03 units/min) when hypotension persists despite norepinephrine, to help reduce the norepinephrine dose requirement rather than as a first-line agent.

-2 to 0 - light sedation that keeps the patient calm and cooperative while minimizing oversedation, which is linked to longer ventilator days and worse outcomes.

Dexmedetomidine is an alpha-2 agonist that provides sedation with minimal respiratory depression and is associated with lower delirium rates than benzodiazepine infusions.

The randomized controlled trial (RCT), classified as Level I evidence, because randomization minimizes selection bias and confounding compared to observational designs.

The team carries out a small-scale test of the planned change and collects data on its effects, before deciding in the Study/Act phases whether to adopt, adapt, or abandon it.

A root cause analysis (RCA) method that repeatedly asks 'why' to drill down from a symptom to its underlying systemic cause, rather than stopping at a superficial explanation.

Systems, not individual blame. RCA identifies process and system failures that allowed an error to occur, supporting a just-culture approach to safety improvement.

The probability that a study will detect a true difference or effect if one actually exists. Underpowered studies risk a false-negative (Type II error) conclusion.

The Joint Commission (TJC). Accreditation requires meeting patient-safety and quality-of-care standards that acute-care NPs help implement and monitor.

It verifies patient understanding - especially important for patients with low health literacy - by having them restate instructions in their own words rather than simply asking 'do you understand?'

Complex problems such as reducing central-line infections or ventilator days require coordinated input from nursing, medicine, pharmacy, and respiratory therapy; single-discipline QI efforts often miss systemic contributors.

Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse-Midwife (CNM).

Management of acutely, critically, and chronically ill adolescents through older adults in acute-care settings such as ICUs, emergency departments, and specialty units - distinct from the primary-care-focused AGPCNP role.

Report immediately as a mandatory reporter under state law - clinicians should not delay reporting to gather more certainty once reasonable suspicion exists.

Autonomy - a competent adult has the right to refuse any treatment, even against clinical team recommendations, as long as they understand the risks of refusal.

The right to access their own records and the right to request amendment of inaccurate or incomplete information, among other privacy protections over their protected health information.

The 'reasonably prudent NP' standard - whether another competently trained nurse practitioner, acting under similar circumstances, would have made the same clinical decisions.

Full Practice Authority (NPs practice and prescribe independently), Reduced Practice (a collaborative agreement is required for some elements of care), and Restricted Practice (physician supervision is required for clinical practice).

It demonstrates that the patient (or authorized surrogate) understood the risks, benefits, and alternatives before agreeing to the intervention, protecting patient autonomy and providing legal protection for the clinician.