Your FREE FNP Flashcards 2026 – 300+ Cards

Assessment: systematic collection of subjective and objective data (history, physical exam, screening, diagnostics).

Subjective = what the patient reports (symptoms, history). Objective = measurable/observable findings (vital signs, exam, labs).

Symptom history mnemonic: Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity.

Harsh crescendo-decrescendo systolic murmur at the right upper sternal border (2nd intercostal space), radiating to the carotids.

Holosystolic (pansystolic) blowing murmur at the apex, radiating to the left axilla.

High-pitched, blowing, decrescendo diastolic murmur at the left sternal border, heard best leaning forward.

Low-pitched diastolic rumble at the apex with an opening snap, best heard in the left lateral decubitus position.

Early diastolic 'ventricular gallop'; suggests volume overload/heart failure in adults (can be normal in children and young adults).

Late diastolic 'atrial gallop'; reflects a stiff, noncompliant ventricle (e.g., LVH, hypertension, ischemia).

Discontinuous popping lung sounds; suggest fluid in the alveoli (heart failure, pneumonia, pulmonary fibrosis).

Continuous high-pitched musical sounds from narrowed airways; classic in asthma and COPD.

Low-pitched continuous sounds from secretions in larger airways; often clear with coughing.

High-pitched inspiratory sound indicating upper-airway obstruction (croup, epiglottitis, foreign body) — an emergency.

'E' to 'A' change on auscultation; sign of lung consolidation (e.g., pneumonia).

Inspiratory arrest on RUQ palpation; suggests acute cholecystitis.

Tenderness 1/3 of the way from the ASIS to the umbilicus; suggests appendicitis.

RLQ pain elicited by palpating the LLQ; suggests appendicitis.

Calf pain on dorsiflexion; historically associated with DVT but unreliable — use Wells criteria and ultrasound instead.

Sounds heard during BP measurement; phase I onset = systolic, phase V disappearance = diastolic pressure.

Drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing; assess for volume depletion or autonomic dysfunction.

Ankle SBP ÷ arm SBP; <0.90 indicates peripheral arterial disease; >1.40 suggests noncompressible (calcified) vessels.

12–20 breaths per minute.

60–100 beats per minute.

Appears around 2 months of age.

Around 6 months of age.

Around 9 months of age.

Around 12 months (range 9–15 months).

Around 24 months; vocabulary ~50 words.

Closes between 12 and 18 months of age.

Closes by about 2 months of age.

Sexual maturity rating (stages 1–5) describing pubertal development of breasts, genitalia, and pubic hair.

Weight (or weight-for-length) persistently below the 5th percentile or crossing ≥2 major percentile lines downward; evaluate organic vs nonorganic causes.

Use CDC growth charts (2–20 yr) and WHO charts (0–2 yr) to track weight, length/height, and head circumference over time.

Overweight = 85th–94th percentile; obesity = ≥95th percentile for age and sex.

Screen all newborns/infants; an abnormal or absent red reflex may indicate cataract, retinoblastoma, or glaucoma — refer urgently.

Newborn hip exam screening for developmental dysplasia of the hip (DDH).

Function (ADLs/IADLs), cognition, mood, falls, polypharmacy, sensory deficits, nutrition, and social support.

Timed Up and Go: ≥12 seconds suggests increased fall risk in older adults.

Brief cognitive screen: 3-item recall plus clock draw; quick screen for dementia.

Activities of daily living: bathing, dressing, toileting, transferring, continence, feeding.

Instrumental ADLs: shopping, cooking, managing finances, medications, transportation, housekeeping, using the phone.

Recommendation grades indicating high/moderate certainty of net benefit; services that should be offered/provided (covered without cost-sharing under the ACA).

Recommendation against the service (no net benefit or harms outweigh benefits).

Begin at age 45 for average-risk adults (USPSTF); options include colonoscopy q10y or annual FIT.

Biennial screening mammography for women ages 40–74.

Ages 21–29: Pap cytology every 3 years. Ages 30–65: Pap q3y, HPV testing q5y, or co-testing q5y.

Annual low-dose CT for adults 50–80 with a 20 pack-year history who currently smoke or quit within 15 years.

One-time ultrasound for men ages 65–75 who have ever smoked.

DEXA bone density for women ≥65 (and younger postmenopausal women at increased risk).

USPSTF recommends screening all adults, including pregnant/postpartum women; PHQ-9 is commonly used.

Screen all persons aged 15–65 at least once; screen all pregnant women.

State-mandated heel-stick panel (e.g., PKU, congenital hypothyroidism, sickle cell, CF), plus hearing and critical congenital heart disease (pulse oximetry) screening.

Risk-based or universal blood lead screening at 12 and 24 months per local guidance.

Blood type/Rh and antibody screen, CBC, rubella, hepatitis B, HIV, syphilis (RPR/VDRL), urine culture, and Pap if due.

After ~20 weeks, fundal height in cm approximately equals gestational age in weeks (±2 cm).

Periumbilical (Cullen) or flank (Grey Turner) ecchymosis; suggest retroperitoneal/hemorrhagic pancreatitis.

Annual comprehensive exam including 10-g monofilament testing for protective sensation (peripheral neuropathy).

CN II–XII assessment; e.g., facial droop sparing the forehead suggests a central (UMN) lesion vs peripheral Bell's palsy involving the whole side.

Systolic 130–139 mmHg OR diastolic 80–89 mmHg, on the average of ≥2 readings on ≥2 occasions.

A1c ≥6.5% (confirmed). Prediabetes is 5.7–6.4%.

Score for strep pharyngitis: fever, tonsillar exudate, tender anterior cervical nodes, absence of cough (age-adjusted). Guides testing/treatment.

Systolic 120–129 AND diastolic <80 mmHg.

Systolic ≥140 OR diastolic ≥90 mmHg.

BP >180/120 mmHg. 'Urgency' = no target-organ damage; 'emergency' = acute target-organ damage requiring rapid, controlled lowering.

Systolic <120 AND diastolic <80 mmHg.

FPG ≥126 mg/dL (no caloric intake ≥8 h), confirmed.

2-hour plasma glucose ≥200 mg/dL during a 75-g oral glucose tolerance test diagnoses diabetes.

Random plasma glucose ≥200 mg/dL with classic hyperglycemia symptoms (polyuria, polydipsia, weight loss) diagnoses diabetes.

A1c 5.7–6.4%, FPG 100–125 mg/dL (impaired fasting glucose), or 2-h OGTT 140–199 mg/dL (impaired glucose tolerance).

Type 1 = autoimmune beta-cell destruction, insulin-dependent, often younger, prone to DKA. Type 2 = insulin resistance + relative deficiency, often adult/obese.

Na − (Cl + HCO3); normal 8–12. Elevated gap metabolic acidosis: MUDPILES (e.g., DKA, lactic acidosis, toxins).

Elevated TSH with low free T4 (primary hypothyroidism). Subclinical = high TSH with normal free T4.

Low (suppressed) TSH with elevated free T4 and/or T3.

Microcytic (low MCV), low ferritin, low serum iron, high TIBC. Most common anemia worldwide.

Macrocytic (high MCV) megaloblastic anemia; B12 deficiency may add neurologic deficits.

Normocytic (sometimes microcytic), normal/high ferritin, low TIBC.

High retic = appropriate marrow response (blood loss/hemolysis). Low retic = production problem (deficiency, marrow failure).

Positive nitrites (gram-negative bacteria) and leukocyte esterase support urinary tract infection.

Urine albumin-to-creatinine ratio 30–300 mg/g; early marker of diabetic/hypertensive nephropathy.

CKD staged G1–G5 by eGFR; G3a = 45–59, G3b = 30–44, G4 = 15–29, G5 <15 mL/min/1.73 m². Albuminuria (A1–A3) further stratifies risk.

Elevated natriuretic peptides support heart failure; useful to rule out HF when low in dyspneic patients.

Cardiac-specific marker; elevation indicates myocardial injury (e.g., acute coronary syndrome).

Sensitive but nonspecific; a negative D-dimer in a low-probability patient helps rule out PE/DVT.

Clinical probability score for DVT/PE to guide D-dimer vs imaging decisions.

Obstructive pattern (reduced FEV1/FVC) with ≥12% and ≥200 mL improvement in FEV1 after bronchodilator (reversibility).

Post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation (not fully reversible).

Rapid antigen detection test; in children a negative rapid test is backed up by throat culture.

EBV; fatigue, posterior cervical lymphadenopathy, splenomegaly; positive monospot (heterophile antibody); avoid contact sports.

Pneumonia severity score: Confusion, Urea >19 mg/dL, RR ≥30, BP <90/60, age ≥65; guides outpatient vs inpatient care.

Cough, fever, dyspnea with focal exam findings and an infiltrate on chest x-ray.

Bulging tympanic membrane with impaired mobility plus signs of acute inflammation/middle-ear effusion.

Suspect bacterial if symptoms persist ≥10 days, are severe (≥3–4 days fever ≥39°C/purulence), or worsen after initial improvement ('double sickening').

Cystitis = dysuria/frequency/urgency without systemic signs. Pyelonephritis adds fever, flank pain, and CVA tenderness.

≥5 symptoms ≥2 weeks including depressed mood or anhedonia: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.

Excessive worry more days than not for ≥6 months plus ≥3 physical symptoms; GAD-7 screens.

≥3 of: waist circumference (central obesity), triglycerides ≥150, HDL low, BP ≥130/85, fasting glucose ≥100.

Acute monoarthritis (classically first MTP joint); definitive = negative birefringent needle-shaped monosodium urate crystals on synovial fluid.

A prioritized list of possible conditions explaining the findings; refine with history, exam, and targeted testing.

Likelihood of disease before testing; combined with sensitivity/specificity to interpret results (Bayesian reasoning).

Sensitivity = true-positive rate (rule OUT when negative, SnNout). Specificity = true-negative rate (rule IN when positive, SpPin).

Probability that a positive test reflects true disease; rises with higher disease prevalence.

How much a test result changes the odds of disease; LR >10 strongly rules in, LR <0.1 strongly rules out.

Painful unilateral vesicular rash in a dermatomal distribution; antivirals within 72 h reduce postherpetic neuralgia.

Cellulitis = spreading erythema, warmth, tenderness without fluctuance. Abscess = fluctuant, walled-off collection needing incision and drainage.

Dermatophyte; annular scaly plaques with central clearing; KOH prep shows hyphae; topical antifungals (oral for scalp/nails).

Pruritic, erythematous, sometimes vesicular eruption in the pattern of allergen/irritant exposure.

Peaked T waves → widened QRS → loss of P waves → sine wave; an emergency requiring stabilization with calcium.

Headache, nausea, confusion, lethargy, and (severe) seizures; correct slowly to avoid osmotic demyelination.

TSH is the most sensitive first-line screen for thyroid dysfunction; reflex to free T4 if abnormal.

Assess LDL, HDL, triglycerides, total cholesterol; combine with 10-year ASCVD risk to guide statin therapy.

Average glycemia over the prior ~2–3 months; unreliable with hemoglobinopathies, anemia, or recent transfusion.

Metformin (biguanide); reduces hepatic glucose output and improves insulin sensitivity. Hold for eGFR <30 and around iodinated contrast.

Inhaled corticosteroid (ICS); a short-acting beta-agonist (SABA) is the rescue medication.

Thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker (CCB) for most adults.

ACE inhibitor or ARB (renal protection, especially with albuminuria) — do not combine ACEi + ARB.

Thiazide diuretic or calcium channel blocker is preferred initial therapy.

Dry cough from bradykinin accumulation; switch to an ARB, which does not cause cough.

Check potassium and serum creatinine within 1–2 weeks of starting or dose increase; expect a small Cr rise (≤30% acceptable).

Contraindicated (teratogenic — fetal renal and skeletal injury). Use labetalol, nifedipine, or methyldopa instead.

Hypokalemia, hyponatremia, hyperglycemia, hyperuricemia (gout), and hypercalcemia.

Not first-line for uncomplicated HTN; preferred with compelling indications (post-MI, heart failure, certain arrhythmias).

Generally <130/80 mmHg for most adults per ACC/AHA, individualized by risk and tolerance.

Generally <7% for most nonpregnant adults; individualize (looser for limited life expectancy/hypoglycemia risk).

Hold for eGFR <30 (avoid initiating <45) and around iodinated contrast; risk of lactic acidosis; GI side effects and B12 deficiency.

Preferred add-on with heart failure, CKD, or ASCVD; cardiorenal benefit; watch for genital infections, euglycemic DKA, volume depletion.

Preferred with ASCVD/obesity; promote weight loss and lower CV risk; GI side effects; avoid with personal/family history of medullary thyroid cancer or MEN2.

Basal (long-acting) controls fasting glucose; bolus (rapid-acting) covers meals; hypoglycemia is the key adverse effect.

High-intensity (atorvastatin 40–80, rosuvastatin 20–40) lowers LDL ≥50%; moderate-intensity lowers LDL 30–49%.

Clinical ASCVD; LDL ≥190; diabetes age 40–75; or elevated 10-year ASCVD risk after risk discussion.

Baseline lipid panel and ALT; recheck lipids 4–12 weeks after starting; counsel on myalgia/rhabdomyolysis.

Step up with persistent symptoms; ICS (± LABA) is controller; reassess control and step down when stable.

SABA monotherapy is no longer recommended for persistent asthma; even mild asthma benefits from ICS-containing therapy.

Long-acting bronchodilators (LAMA/LABA); add ICS for frequent exacerbations/eosinophilia; smoking cessation is the most important intervention.

Replace with levothyroxine (T4); take on an empty stomach; recheck TSH in 6–8 weeks after dose changes.

Penicillin V or amoxicillin first-line; cephalexin/azithromycin/clindamycin for penicillin allergy.

Nitrofurantoin, TMP-SMX, or fosfomycin first-line (per local resistance).

Avoid with eGFR <30 (ineffective) and in pyelonephritis (doesn't reach tissue); avoid near term in pregnancy.

High-dose amoxicillin first-line; amoxicillin-clavulanate if recent antibiotics/treatment failure; observation option in select older children.

Healthy adult: amoxicillin or doxycycline (or a macrolide where resistance is low); comorbidities: respiratory fluoroquinolone or beta-lactam + macrolide.

Most are viral — supportive care; if bacterial, amoxicillin-clavulanate first-line.

400–800 mcg daily for all women of childbearing potential to prevent neural tube defects; higher doses for prior NTD-affected pregnancy.

Estrogen + progestin; contraindicated with migraine with aura, age ≥35 + smoking, history of VTE, or uncontrolled hypertension.

Long-acting reversible contraception (IUDs, implant) — most effective reversible methods; first-line for most including adolescents.

Levonorgestrel (within 72 h), ulipristal acetate (within 120 h), or a copper IUD (most effective, up to 5 days).

Oral ferrous sulfate with vitamin C; identify and treat the source of blood loss.

Lifestyle changes plus a proton pump inhibitor; evaluate for alarm features (dysphagia, weight loss, bleeding, anemia).

NSAIDs, colchicine, or corticosteroids for the flare; do not start/stop urate-lowering therapy during an acute attack.

Xanthine oxidase inhibitor for chronic urate lowering; target uric acid <6 mg/dL; titrate gradually.

Use the narrowest effective agent for the shortest effective duration; avoid antibiotics for viral illness to limit resistance.

Nicotine replacement, varenicline, or bupropion combined with counseling improves quit rates.

Annual inactivated influenza vaccine for everyone ≥6 months.

Tdap once (substituting for a Td), then Td or Tdap booster every 10 years; Tdap in each pregnancy (27–36 weeks).

Recommended for adults ≥65 and younger adults with risk conditions (PCV15/PCV20 ± PPSV23 per current ACIP guidance).

Recombinant zoster vaccine (RZV), 2 doses, for adults ≥50.

Routine at ages 11–12 (can start at 9); catch-up through age 26; shared decision-making 27–45.

DTaP, IPV, Hib, PCV, rotavirus, and hepatitis B (per ACIP schedule).

First doses at 12–15 months; second doses at 4–6 years.

Avoid live vaccines (MMR, varicella, LAIV) in pregnancy and significant immunocompromise.

Give the first hepatitis B vaccine dose within 24 hours of birth.

Use CHA2DS2-VASc to decide; anticoagulate (DOAC preferred over warfarin for most) when score warrants.

Monitor INR; target 2–3 for most indications; many food (vitamin K) and drug interactions.

Use lowest effective dose/duration, screen risk, check the PDMP, and offer naloxone; nonopioid options first for most acute pain.

AGS list of potentially inappropriate medications in older adults (e.g., benzodiazepines, anticholinergics, long-acting sulfonylureas) — raise fall and delirium risk.

Geriatric prescribing principle: begin medications at low doses and titrate slowly due to altered pharmacokinetics and polypharmacy risk.

Patient-centered goals that are Specific, Measurable, Achievable, Relevant, and Time-bound.

Collaborative process where clinician and patient weigh options, evidence, and patient values to choose a plan.

Ask the patient to restate instructions in their own words to confirm understanding and improve adherence.

Aspirin (selected ASCVD prevention), tamoxifen/raloxifene (high breast-cancer risk), statins, PrEP for HIV prevention.

Carrying out the plan: prescribing/treatments, education, counseling, referrals, and coordinating care.

DASH diet, sodium reduction (<1500–2300 mg/day), weight loss, physical activity, limited alcohol — each lowers BP measurably.

BP above goal on 3 drugs (including a diuretic) at optimal doses; add an aldosterone antagonist (spironolactone) and evaluate for secondary causes.

Young age, abrupt onset, resistant HTN, hypokalemia (hyperaldosteronism), or episodic symptoms (pheochromocytoma) prompt workup.

Teach glucose monitoring, hypoglycemia recognition/treatment, foot care, sick-day rules, and carbohydrate awareness.

Rule of 15: 15 g fast carbohydrate, recheck in 15 minutes, repeat if still <70 mg/dL; glucagon if unable to take orally.

Annual dilated eye exam, urine albumin-to-creatinine ratio, comprehensive foot exam, and lipid panel.

Hyperglycemia, anion-gap metabolic acidosis, ketones, dehydration; refer/admit for IV fluids, insulin, and electrolyte correction.

Written green/yellow/red zone plan based on symptoms and peak flow to guide self-management and escalation.

Oxygen, repeated SABA (± ipratropium), systemic corticosteroids; assess response and need for higher care.

Short-acting bronchodilators, systemic steroids, antibiotics if increased purulence/volume; oxygen targeting 88–92% saturation.

Guideline-directed therapy: ARNI/ACEi/ARB, beta-blocker, MRA, and SGLT2 inhibitor for HFrEF; diuretics for congestion; sodium/fluid counseling.

BP and glucose control, ACEi/ARB for albuminuria, SGLT2 inhibitor, avoid nephrotoxins, adjust drug doses, and refer to nephrology in advanced stages.

After starting/adjusting levothyroxine, recheck TSH in 6–8 weeks and titrate to target.

Order CBC with indices, reticulocyte count, iron studies, B12/folate; treat the underlying cause.

MONA-B context: aspirin, nitroglycerin, oxygen if hypoxic, and emergent transfer; obtain ECG within 10 minutes of presentation.

Balance, Eyes, Face, Arm, Speech, Time — activate emergency response; time-sensitive thrombolysis/thrombectomy window.

Intramuscular epinephrine (anterolateral thigh) is first-line; supine positioning, oxygen, IV fluids; antihistamines/steroids are adjuncts.

Acetaminophen or ibuprofen for analgesia regardless of antibiotic decision.

Most viral/allergic — supportive care; bacterial gets topical antibiotics; refer for vision loss, severe pain, or contact-lens-related keratitis.

Reassurance, stay active, NSAIDs/acetaminophen; imaging only with red flags (neuro deficit, cancer, infection, cauda equina).

Red-flag emergency: saddle anesthesia, urinary retention/incontinence, bilateral leg weakness — urgent imaging and surgery.

Abortive triptans/NSAIDs; prophylaxis (e.g., beta-blockers, topiramate, CGRP antagonists) when frequent; lifestyle/trigger counseling.

SSRIs first-line plus psychotherapy; reassess in 1–2 weeks for safety and 4–6 weeks for response; all antidepressants carry the <25 suicidality warning.

Treat with labetalol, nifedipine, or methyldopa; evaluate for preeclampsia (BP ≥140/90 after 20 weeks with proteinuria/end-organ signs).

Severe headache, visual changes, RUQ pain, BP ≥160/110 — urgent evaluation; magnesium sulfate for seizure prophylaxis.

Growth/development surveillance, immunizations, anticipatory guidance, screening (vision, hearing, lead, autism), and safety counseling.

M-CHAT-R/F at 18 and 24 months; refer for early intervention if positive.

Psychosocial interview (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide, Safety) conducted confidentially when appropriate.

Complete the full antibiotic course for strep; return-to-school after 12–24 h of antibiotics and afebrile.

Adequate hydration, postcoital voiding; consider prophylaxis for recurrent UTIs; vaginal estrogen for postmenopausal women.

Comprehensive lifestyle intervention; pharmacotherapy (e.g., GLP-1 agonists) for BMI ≥30 or ≥27 with comorbidity; bariatric surgery for severe obesity.

Heart-healthy diet, physical activity, weight management, and smoking cessation alongside statin therapy.

Ask, Advise, Assess, Assist, Arrange — the brief intervention framework at every visit.

Patient-centered counseling using OARS (open questions, affirmations, reflective listening, summaries) to strengthen motivation for change.

Use AUDIT-C or single-item screen; brief intervention and referral to treatment (SBIRT) for risky use.

Record vaccine, dose, date, site, lot number, and provide the Vaccine Information Statement (VIS).

Daily emtricitabine/tenofovir for high-risk individuals; baseline and periodic HIV, renal, and STI testing.

Ceftriaxone IM; treat for chlamydia co-infection if not excluded; partner treatment and reporting.

Doxycycline (preferred) or azithromycin; partner therapy; retest in 3 months.

Report suspected child abuse, elder abuse, and certain communicable diseases per state law.

Defined by state nurse practice acts; NP authority ranges from full to reduced to restricted practice.

State licensure allows NPs to evaluate, diagnose, order/interpret tests, and prescribe independently under the board of nursing.

State law limits ≥1 element of NP practice and may require a collaborative or supervisory agreement with a physician.

NPs prescribe per state authority; a DEA registration is required to prescribe controlled substances.

Schedule II (high abuse, no refills) through V; opioids and stimulants are commonly Schedule II.

Process requiring capacity, disclosure of risks/benefits/alternatives, understanding, and voluntariness — not merely a signature.

Capacity is a clinical, decision-specific judgment a clinician makes; competency is a global legal determination only a court makes.

Protects PHI while permitting use for treatment, payment, and operations; disclose only the minimum necessary.

Disclosure allowed for mandatory reporting, serious threats to safety, public health, and court orders.

Autonomy, beneficence, nonmaleficence, and justice.

Living will and durable power of attorney for healthcare document patient wishes and surrogate decision-makers.

Delegate the right task to the right person with the right direction and supervision; the NP retains accountability.

Organizing patient care across providers and settings to improve outcomes and reduce fragmentation/duplication.

Refer when the condition exceeds scope, requires specialized testing/procedures, or fails to respond to appropriate management.

Lifelong self-reflection and respect for patients' cultural beliefs; use a professional interpreter (never a family member) for language barriers.

Conditions where people live, work, and age (income, housing, education, food access) that strongly shape health outcomes.

A patient's ability to obtain and understand health information; use plain language and teach-back to improve outcomes.

Continue insulin, monitor glucose/ketones frequently, stay hydrated, and seek care for persistent vomiting or high ketones.

Clean, assess for infection, moisture balance, and tetanus status; refer chronic/nonhealing wounds.

For dirty wounds: Tdap/Td if last dose >5 years; add tetanus immune globulin if unvaccinated/uncertain.

Simplify regimens (once-daily, combination pills), address cost and side effects, and use home BP monitoring.

Perform medication reconciliation, deprescribe when appropriate, and screen with Beers/STOPP criteria in older adults.

Review medications, vision, gait/balance, home hazards, and vitamin D; recommend strength/balance exercise.

Reposition regularly, manage moisture, optimize nutrition, and use support surfaces in at-risk patients.

Assess with a validated scale; use the analgesic ladder, multimodal/nonopioid strategies, and function-based goals.

Palliative care = symptom-focused care at any stage alongside curative treatment; hospice = comfort care when prognosis is ≤6 months.

Verify licensure for the patient's location, ensure privacy/consent, and document as for in-person care.

Plan-Do-Study-Act cycle: test small changes, measure results, and refine to improve care processes.

Integrating best research evidence with clinical expertise and patient values to guide decisions.

Systematic reviews/meta-analyses of RCTs rank highest; expert opinion lowest.

An unexpected occurrence involving death or serious harm; triggers root-cause analysis and reporting.

A safety culture balancing accountability and learning — focuses on system errors rather than individual blame.

Compare a patient's medication orders to all medications they are taking at every transition of care to prevent errors.

Age-appropriate counseling on safety, nutrition, development, and behavior at well visits.

Rear-facing as long as possible (at least to age 2), then forward-facing with harness, then booster per height/weight.

Back to sleep, firm flat surface, no soft bedding, room-share without bed-share to reduce SIDS risk.

Fluoride varnish for young children; establish a dental home by age 1.

Breastfed infants generally need iron supplementation starting around 4 months until iron-rich foods are introduced.

Screen with the Edinburgh Postnatal Depression Scale; treat with therapy and/or SSRIs; ensure safety.

Lifestyle measures; hormone therapy for moderate-severe vasomotor symptoms in appropriate candidates (weigh CV/breast risks).

Identify and reduce triggers (allergens, smoke, exercise, infections) as part of comprehensive management.

Smoking cessation, pulmonary rehab, vaccinations, and oxygen therapy for chronic hypoxemia (improves survival).

Assess CK if severe; consider dose reduction, switching statins, or alternate-day dosing; rule out rhabdomyolysis.

Oral rehydration and supportive care; antibiotics only for specific bacterial/parasitic causes; avoid antimotility agents in bloody diarrhea.

Increase fiber/fluids/activity; osmotic laxatives first-line; evaluate alarm features and secondary causes.

Intranasal corticosteroids are most effective; antihistamines and allergen avoidance as adjuncts.

Determining whether outcomes/goals were met; revise assessment, diagnosis, or plan as needed (the cycle continues).

Recheck BP and adjust therapy monthly until controlled, then every 3–6 months; reinforce adherence and lifestyle.

Check A1c every 3 months until at goal and stable, then at least twice yearly.

Recheck lipid panel 4–12 weeks after initiation/dose change, then every 3–12 months.

Recheck TSH 6–8 weeks after each dose change; adjust to keep TSH in the target range.

Reassess in 1–2 weeks for safety/side effects and at 4–6 weeks for response; full effect may take 6–8 weeks.

Monitor INR frequently after initiation/dose change, then at least every 4 weeks when stable.

Use symptom frequency, rescue-inhaler use, nighttime awakenings, and (optionally) the ACT/peak flow to gauge control and step therapy.

Monitor eGFR and urine albumin-to-creatinine ratio at a frequency based on CKD stage and risk.

Compare results to the goals set during planning; document whether goals were met, partially met, or unmet.

Consider stepping down after ≥3 months of well-controlled asthma to find the lowest effective controller dose.

Reassess diagnosis, adherence, dosing, and barriers before escalating therapy or referring.

Ask nonjudgmentally, review refill data, and address barriers (cost, side effects, complexity, beliefs).

If the patient doesn't respond as expected, broaden or revisit the differential diagnosis.

Screening detects disease in asymptomatic people; surveillance monitors a known condition for change/progression.

Method to measure progress toward individualized patient goals over time.

Transitional-care visit within ~7 days reduces readmissions; reconcile medications and reinforce the plan.

Record outcomes, patient response, plan modifications, and the next follow-up interval.

Repeat the PHQ-9 to monitor treatment response; a ≥50% score reduction suggests adequate response.

Re-evaluate pain after intervention using the same scale and assess functional improvement, not just the number.

If BP remains above goal, verify technique/adherence, intensify lifestyle, and add or up-titrate medication.

Intensify therapy (add agent/insulin), reinforce education, and address adherence and lifestyle barriers.

Check titers when documentation is unavailable or response is uncertain (e.g., hepatitis B in healthcare workers).

Communicate results, arrange appropriate follow-up for abnormal findings, and document recall intervals.

Manage per ASCCP risk-based guidelines — repeat testing, colposcopy, or treatment depending on cytology/HPV results.

Conduct a full diagnostic assessment, evaluate suicide risk, and initiate or refer for treatment.

Rising urine albumin-to-creatinine ratio signals progressing nephropathy; intensify ACEi/ARB and risk-factor control.

Check levels for narrow-index drugs (lithium, warfarin/INR, digoxin, certain antiepileptics) to ensure efficacy and avoid toxicity.

Confirm understanding with teach-back and assess whether behavior change/self-management goals were achieved.

Define the next screening based on results and guidelines (e.g., normal colonoscopy → 10 years; normal co-test → 5 years).

Evaluate symptom resolution; persistent or worsening symptoms prompt reassessment for resistance, complications, or wrong diagnosis.

Schedule labs/visits to detect adverse effects (e.g., potassium with ACEi, LFTs with certain drugs).

If A1c and glucose logs disagree, suspect a hemoglobin variant, anemia, or measurement issue and use alternative markers.

Modify diagnoses, goals, or interventions based on evaluation findings — the nursing process is cyclical.

Use validated questionnaires to capture symptoms, function, and quality of life from the patient's perspective.

Reassess fall risk and home safety periodically; adjust interventions after any new fall.

Population-health tool to track and recall patients due for monitoring or overdue for goals.

Confirm the consult occurred, review recommendations, and integrate them into the care plan.

Review the record at each visit and administer due/overdue vaccines (every visit is an opportunity).

Periodically re-evaluate ADLs/IADLs, cognition, and mobility to detect decline early.

Once control is sustained, consider reducing therapy to the lowest effective regimen and monitor for relapse.

Track measures (BP control, A1c <7%, screening rates) to assess and improve practice performance.

Reassess bleeding/clotting risk over time (e.g., HAS-BLED, CHA2DS2-VASc) and adjust therapy accordingly.

Re-evaluate efficacy and tolerability at an appropriate interval after each medication change.

Accurate, timely documentation supports continuity, legal protection, and outcome evaluation.

Consider adherence, diagnosis accuracy, dosing, comorbidity, and social barriers before concluding treatment failure.