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ANCC AGACNP-BC Cheat Sheet

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Core Competencies

  • 24% of exam
  • Pathophysiology Pharmacology Physical Assessment Acid-Base/ABG Older Adult

Clinical Practice

  • 43% of exam
  • Hemodynamics Mechanical Ventilation ACS/STEMI Sepsis Bundle Vasopressors Sedation

Professional Role

  • 33% of exam
  • Evidence-Based Practice Quality Improvement Scope of Practice Healthcare Policy

Quick Facts

  • Exam AGACNP-BC
  • Credential Adult-Gerontology Acute Care NP
  • Questions 175 (150 scored + 25 pretest)
  • Time 3.5 hours
  • Pass Scaled score 350/500
  • Format CBT at Prometric
  • Level Post-master's/DNP APRN
  • Blueprint Mar 2025 (rev Aug)

MUDPILES (High Anion Gap) CO

  • Gap acidosis differential: 8 classic causes
  • Methanol, uremia, DKA Propylene glycol, iron, INH Lactate, ethylene glycol, salicylates

Prerenal AKI vs ATN CO

Prerenal AKI

  • FeNa <1%
  • Low urine sodium
  • Reversible with fluids

ATN

  • FeNa >2%
  • High urine sodium
  • Tubular cell damage
  • FeNa <1 vs >2

Glucose Emergency Picker CO

  • Glucose <70, alert patient → 15-20g oral fast carbs
  • Glucose <70, unconscious patient → Glucagon IM or IV dextrose
  • Glucose >250, ketones, gap → Diagnose DKA
  • K+ <3.3 before insulin → Replete potassium first

Acid-Base & ABG Interpretation CO

  • Normal pH 7.35-7.45
  • Normal PaCO2 35-45 mmHg
  • Normal HCO3 22-26 mEq/L
  • Anion gap formula Na - (Cl+HCO3)
  • Normal anion gap 8-12 mEq/L
  • Winters formula 1.5(HCO3)+8, +-2
  • High-gap acidosis MUDPILES mnemonic causes

Delirium vs Dementia CO

Delirium

  • Acute onset
  • Fluctuating course
  • Often reversible

Dementia

  • Chronic onset
  • Stable consciousness
  • Progressive, irreversible
  • Acute/reversible vs chronic/progressive

High-Yield Pathophysiology CO

  • Aortic dissection BP differential, tearing pain
  • Prerenal AKI FeNa <1%, low UNa
  • ATN FeNa >2%, high UNa
  • Septic shock physiology catecholamine hyporeactivity, vasodilation
  • Hepatic encephalopathy ammonia neurotoxicity
  • Toxic megacolon colon >6cm, colitis

High-Yield Pharmacology CO

  • Warfarin reversal (INR>8.5) oral vitamin K, minor bleed
  • ACEI cough mechanism bradykinin accumulation
  • Apixaban MOA direct factor Xa inhibition
  • HIT treatment argatroban, avoid all heparin
  • Steady state reached in 4-5 half-lives
  • Digoxin toxicity hyperkalemia, visual disturbances

Older-Adult Considerations CO

  • Atypical MI presentation dyspnea/confusion, no chest pain
  • Beers Criteria flags inappropriate drugs, elderly
  • Delirium acute, fluctuating, reversible
  • Dementia chronic, stable, progressive
  • Renal dosing reduced clearance, adjust doses
  • Frailty phenotype weight loss, weakness, exhaustion

SIRS Criteria Mnemonic CL

  • Temp, heart rate, resp rate, WBC
  • Temp >38 or <36C HR >90, RR >20 WBC >12k or <4k

STEMI vs NSTEMI CL

STEMI

  • ST elevation present
  • Transmural infarct
  • Emergent PCI/lytics

NSTEMI

  • ST depression/T inversion
  • Partial-thickness infarct
  • Urgent (non-emergent) cath
  • Elevation = emergent

Shock Type Picker (Hemodynamics) CL

  • Low CO, high SVR, high PCWP → Cardiogenic shock
  • Low CO, high SVR, low PCWP → Hypovolemic shock
  • High CO, low SVR, low PCWP → Septic shock (warm)
  • Low CO, high SVR, PCWP variable → Obstructive shock ( PE, tamponade )
  • Low CO, low SVR, bradycardia → Neurogenic shock

Hemodynamic Norms (PA Catheter) CL

  • CVP / RAP 2-8 mmHg
  • PA Pressure (sys/dia) 15-30 / 4-12 mmHg
  • PCWP (wedge) 4-12 mmHg
  • Cardiac Output (CO) 4-8 L/min
  • Cardiac Index (CI) 2.5-4.0 L/min/m2
  • SVR 800-1200 dynes.sec.cm-5
  • SvO2 (mixed venous) 60-80%

Sepsis Hour-1 Bundle CL

  • Lactate, cultures, antibiotics, fluids, pressors
  • Measure lactate level Cultures before antibiotics 30 mL/kg fluid bolus Vasopressors if MAP <65

Septic vs Cardiogenic Shock CL

Septic shock

  • Warm extremities
  • Low SVR
  • High cardiac output

Cardiogenic shock

  • Cold extremities
  • High SVR
  • Low cardiac output
  • Warm vasodilated vs cold pump-failure

Vasopressor Selection Logic CL

  • Septic shock, first-line agent → Norepinephrine
  • Persistent hypotension on norepi → Add vasopressin
  • Cardiogenic shock, low CO → Dobutamine or milrinone
  • Anaphylaxis or cardiac arrest → Epinephrine
  • Vasodilatory shock with tachyarrhythmia → Phenylephrine ( no inotropy )

Mechanical Ventilation & ARDS CL

  • Lung-protective Vt 4-8 mL/kg PBW
  • Plateau pressure goal <30 cmH2O
  • Mild ARDS (Berlin) P/F 200-300 mmHg
  • Moderate ARDS (Berlin) P/F 100-200 mmHg
  • Severe ARDS (Berlin) P/F <=100 mmHg
  • RSBI <105 predicts extubation success
  • SBT pass criteria FiO2 <=40%, stable vitals
  • Physiologic PEEP 5 cmH2O baseline

PADIS Sedation Priority CL

  • Treat pain first, then light sedation
  • Analgesia before sedation RASS goal -2 to 0 Avoid benzodiazepine infusions

Sepsis vs Septic Shock CL

Sepsis

  • Infection present
  • Organ dysfunction (SOFA rise)
  • No pressor need

Septic shock

  • Vasopressors required
  • Lactate >2 mmol/L
  • MAP <65 despite fluids
  • Shock needs pressors + lactate

Ventilator Weaning Readiness CL

  • FiO2 <=40%, PEEP <=5-8 → Attempt SBT
  • RSBI <105 on SBT → Predicts extubation success
  • NIF more negative than -25 → Adequate respiratory strength
  • SBT tolerated 30-120 minutes → Extubate
  • Auto-PEEP suspected clinically → Increase expiratory time

ACS / STEMI Essentials CL

  • STEMI ECG >=1mm, 2 contiguous leads
  • V2-V3 cutoff >=2mm men, >=1.5mm women
  • Door-to-balloon goal <=90 minutes (PCI)
  • Door-to-needle goal <=30 minutes (lytics)
  • First med given aspirin 162-325mg chewed
  • Nitro contraindication SBP <90, RV infarct
  • RV infarct leads V4R (right-sided)

Stroke Time Windows CL

  • 3 hours standard, 4.5 extended, 24 thrombectomy
  • tPA: 3h standard window tPA: 4.5h extended window Thrombectomy: up to 24h

tPA Standard vs Extended Window CL

Standard (0-3h)

  • Broader eligibility
  • Fewer exclusions

Extended (3-4.5h)

  • Age <=80 preferred
  • No anticoagulant use
  • No diabetes + prior stroke
  • 3h broad, 4.5h stricter

Acute Chest Pain Triage CL

  • ST elevation, 2 contiguous leads → Activate cath lab ( STEMI )
  • BP differential, tearing pain → CT angiography ( dissection )
  • Pulsatile epigastric mass → Gentle exam, urgent imaging
  • SBP <90, RV infarct → Avoid nitrates, give fluids

Sepsis & SSC Hour-1 Bundle CL

  • Hour-1 bundle order cultures before antibiotics
  • Fluid bolus 30 mL/kg crystalloid
  • MAP goal >=65mmHg; 60-65 if elderly
  • Lactate trigger >2 mmol/L, remeasure serially
  • Septic shock defined pressors + lactate >2
  • qSOFA criteria RR>=22, SBP<=100, altered mentation
  • First-line pressor norepinephrine

Norepinephrine vs Phenylephrine CL

Norepinephrine

  • Alpha-1 + beta-1
  • Adds inotropy

Phenylephrine

  • Pure alpha-1 only
  • No inotropy
  • Reflex bradycardia risk
  • Need inotropy vs pure vasoconstriction

DKA Management CL

  • DKA diagnosis glucose >250, pH <7.3
  • DKA diagnosis (gap) bicarb <18, anion gap >12
  • Insulin infusion rate 0.1 units/kg/hr
  • Hold insulin bolus if K+ <3.3
  • Add dextrose glucose <200-250 mg/dL
  • DKA resolution gap closed, pH >7.3

Acute Stroke & tPA CL

  • Standard tPA window 3 hours
  • Extended tPA window up to 4.5 hours
  • Pre-tPA BP limit <185/110 mmHg
  • Post-tPA BP goal <180/105 mmHg, 24h
  • Thrombectomy window (LVO) up to 24 hours
  • NIHSS severe score 21-42

Vasopressors & Inotropes CL

  • Norepinephrine alpha-1+beta-1, first-line septic
  • Epinephrine alpha+beta, arrest/anaphylaxis
  • Vasopressin fixed 0.03 units/min, adjunct
  • Dobutamine beta-1 inotrope, can hypotend
  • Phenylephrine pure alpha-1, no inotropy
  • Milrinone PDE-3 inhibitor, inodilator

Sedation & Analgesia CL

  • RASS goal -2 to 0
  • Analgosedation treat pain before sedation
  • Propofol risk PRIS, hypertriglyceridemia
  • Dexmedetomidine alpha-2, no respiratory depression
  • Avoid benzodiazepines higher delirium risk
  • Daily SAT/SBT pairing reduces ventilator days

EBP & Quality Improvement PR

  • Strongest evidence RCT, Level I
  • PDSA - Do phase small-scale test implementation
  • RCA method "5 Whys" technique
  • RCA focus systems, not individual blame
  • Power (1-beta) detects true difference
  • Accreditor Joint Commission (TJC)

Scope, Legal & Ethics PR

  • APRN Consensus 4 roles NP, CNS, CRNA, CNM
  • Mandatory reporting suspected abuse, immediately
  • Patient autonomy competent refusal honored
  • AGACNP scope acutely/critically ill adults
  • HIPAA rights record access + amendment
  • Teach-back method verifies low-literacy education

Common Traps

Cardiogenic Shock ≠ Septic Shock

  • Cold, high SVR ≠ Warm, low SVR

SIRS ≠ Sepsis

  • Vital-sign criteria only ≠ Infection + organ dysfunction

Delirium ≠ Dementia

  • Acute, fluctuating, reversible ≠ Chronic, progressive, stable

Prerenal AKI ≠ ATN

  • FeNa <1%, reversible ≠ FeNa >2%, tubular damage

Norepinephrine ≠ Phenylephrine

  • Alpha + beta, inotropy ≠ Pure alpha, no inotropy

STEMI ≠ NSTEMI

  • ST elevation, emergent PCI ≠ ST depression, urgent cath

Dexmedetomidine ≠ Midazolam

  • Alpha-2, less delirium ≠ Benzodiazepine, more delirium risk

Last Minute

  • 1. Weights: Core 24, Clinical 43%
  • 2. Professional Role weight: 33%
  • 3. 175 questions, 150 scored, 3.5h
  • 4. Passing scaled score: 350/500
  • 5. Aspirin first in suspected STEMI
  • 6. Cultures before antibiotics in sepsis
  • 7. MAP 65 (60-65 if elderly)
  • 8. Hold insulin bolus if K+<3.3
  • 9. tPA: 3h standard, 4.5h extended
  • 10. RASS goal: -2 to 0
  • 11. Norepinephrine first-line in septic shock
  • 12. RSBI <105 predicts extubation success
  • 13. FeNa <1% points to prerenal

ANCC-AGACNP-BC

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