Mixed Deck — All ANCC Topics Flashcards

When participating in the development of the Individualized Education Plan (IEP) for a child with mild intellectual disability and IQ of 65, the pediatric nurse should explain that the child should be educated about the:

Answer: 6th grade level

Explanation: When participating in the development of the Individualized Education Plan (IEP) for a child with mild cognitive impairment and an IQ of 65, the pediatric nurse should explain that the child should be educated about the 6th-grade level. The child should be able to master many skills and may, as an adult, be able to work and live independently or with minimal supervision, so this should be an ultimate goal.

During a mental status exam, a patient demonstrates flight of ideas. This finding is most consistent with which condition?

Answer: Manic episode

Flight of ideas — rapidly shifting, loosely connected thoughts — is a hallmark feature of manic episodes.

A nurse leader implementing shared governance is most focused on which goal?

Answer: Empowering bedside nurses to participate in decision-making

Shared governance distributes decision-making authority to frontline nurses, promoting autonomy and professional practice.

A patient with severe refractory cancer pain has inadequate relief from high-dose systemic opioids with intolerable side effects. The palliative team recommends an intrathecal drug delivery system (IDDS). Which statement about IDDS is correct?

Answer: IDDS delivers opioids directly to the intrathecal space achieving equivalent analgesia at approximately 1/300th of the oral morphine dose

Intrathecal delivery bypasses the blood-brain barrier, achieving equivalent analgesia at approximately 1/300th of the oral morphine dose, dramatically reducing systemic side effects.

An intubated ICU patient has partial facial tightening (face 2), fully bent upper limbs with finger flexion (upper limbs 3), and is tolerating the ventilator (compliance 1). What is the BPS total score and what does it indicate?

Answer: Score 6: clinically significant pain requiring intervention

BPS total: face 2 + upper limbs 3 + ventilator compliance 1 = 6. BPS scores at or above 5 indicate significant pain requiring intervention.

A patient with acute pancreatitis is NPO and requesting pain relief. Which analgesic is preferred?

Answer: Hydromorphone IV

Hydromorphone is preferred for pancreatitis pain; meperidine is avoided due to toxic normeperidine metabolites, and morphine may cause sphincter of Oddi spasm.

When counseling a patient about emergency contraception, the nurse practitioner should teach that Plan B (levonorgestrel) is most effective when taken within:

Answer: 72 hours of unprotected intercourse

Plan B is most effective when taken within 72 hours of unprotected sex, though it has some efficacy up to 120 hours.

A patient with PAD reports cramping calf pain after walking two blocks that reliably resolves with rest. This symptom pattern is called:

Answer: Intermittent claudication

Intermittent claudication is reproducible ischemic muscle pain during exercise that reliably resolves with rest, resulting from inadequate arterial flow to meet muscle oxygen demands during exertion.

Which mnemonic is most useful for performing a comprehensive pain assessment?

Answer: OLDCARTS (Onset, Location, Duration, Character, Alleviating/Aggravating factors, Radiation, Timing, Severity)

OLDCARTS is a comprehensive pain assessment mnemonic covering all essential dimensions: Onset, Location, Duration, Character, Alleviating/Aggravating factors, Radiation, Timing, and Severity.

Which of the following is the hallmark symptom that distinguishes bipolar I disorder from bipolar II disorder?

Answer: At least one full manic episode

Bipolar I disorder requires at least one full manic episode, while bipolar II involves hypomania without full mania.

A nurse executive is analyzing a balanced scorecard for the nursing division. Which of the four perspectives does this tool evaluate?

Answer: Financial, customer, internal processes, learning and growth

The balanced scorecard evaluates performance across financial, customer, internal process, and learning/growth perspectives.

A patient with HFrEF (EF 30%) is being discharged. Which medication combination has the strongest evidence for reducing mortality?

Answer: ACE inhibitor or ARNI, beta-blocker, aldosterone antagonist, and SGLT2 inhibitor

The four pillars of HFrEF therapy with mortality benefit are: ACE inhibitor or ARNI (sacubitril/valsartan), beta-blocker, aldosterone antagonist, and SGLT2 inhibitor.

Which chemotherapy agent is classified as an alkylating agent?

Answer: Cyclophosphamide

Cyclophosphamide is an alkylating agent that works by cross-linking DNA strands, preventing cancer cell replication.

In conducting evidence-based research, which of the following types of studies represents one in which those with a condition (such as infection) are compared to those without the condition?

Answer: Case-control study

Explanation: Case-control studies compare those with a condition (cases) to a group without (controls) to determine if the affected group has characteristics that are different. Prospective cohort studies choose a group of patients without the disease, assess risk factors, and then follow the group over time to determine (prospect for) which ones develop the disease. Retrospective cohort studies are initiated after a condition develops and data are collected retrospectively from medical records to evaluate whether members of the cohort selected had exposure and developed disease. Cross-sectional studies assess disease and exposure at the same time in a target population, evaluating the presence of disease at a point in time.

Which preoperative nursing intervention most reduces the risk of surgical site infection (SSI)?

Answer: Administering prophylactic antibiotics within 60 minutes before incision

Evidence-based SSI prevention bundles include prophylactic antibiotics given within 60 minutes before surgical incision.

A patient takes oxycodone 30 mg orally every 12 hours and is switching to IV morphine. What IV morphine dose per 24 hours is approximately equivalent?

Answer: 20 mg IV morphine per 24 hours

Total daily oral oxycodone = 60 mg. Converting to OME: 60 mg x 1.5 = 90 mg oral morphine/24hr. Converting oral to IV (3:1): 90/3 = 30 mg IV morphine/24hr. After 25-30% dose reduction for incomplete cross-tolerance: approximately 20-22 mg IV morphine/24hr.

According to the ANCC Ambulatory Care Nursing scope and standards, telephone nursing practice (telehealth triage) requires the nurse to document which essential element?

Answer: The clinical decision-making process, advice given, and patient response

Thorough documentation of the clinical reasoning, instructions provided, and patient understanding is essential for legal accountability and continuity of care in telephone nursing.

Which developmental milestone is expected in a 4-month-old infant?

Answer: Holds head steady when sitting, follows objects past midline, social smile

At 4 months, expected milestones include head control when supported sitting, tracking objects past midline, cooing, and a well-established social smile.

Which laboratory finding is most consistent with dehydration in an older adult?

Answer: BUN:creatinine ratio greater than 20:1

A BUN:creatinine ratio >20:1 indicates prerenal azotemia, commonly caused by dehydration in older adults.

A patient on chronic opioid therapy develops nausea, vomiting, diarrhea, sweating, and severe anxiety 12 hours after their last dose. This is most consistent with:

Answer: Opioid withdrawal syndrome

Opioid withdrawal presents with autonomic hyperactivity (sweating, tachycardia) and GI symptoms (nausea, vomiting, diarrhea) beginning 8-24 hours after last dose of short-acting opioids.