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NRNP 6566 WK1-5 Midterm: Questions and Answers with Rationales, Exams of Nursing

A collection of questions and answers related to the nrnp 6566 wk1-5 midterm exam. It covers various topics in the field of nursing, including hyperthyroidism, atrial fibrillation, creatinine clearance, beers criteria, chads2 score, therapeutic index, cytochrome p450 system, drug absorption, distribution, metabolism, and excretion, hypertension, hypertensive emergency, hypertensive urgency, and heart block. The document also includes detailed explanations and rationales for each answer, making it a valuable resource for students preparing for the exam.

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2024/2025

Available from 03/12/2025

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NRNP 6566 WK1-5 MIDTERM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES VERIFIED ANSWERS
ALREADY GRADED A+
-Abnormal labs with hyperthyroidism - anselevated T3, T4, thyroid resin uptake, and free thyroxine index.
Sometimes T4 is normal but T3 is always high
Elevated sed rate
Elevated antinuclear antibody, without evidence of lupus or autoimmune disorder
Hypercalcemia and low h/h
Atrial fibrillation - ansStable- rate control versus rhythm control strategy (example: AV nodal blockers,
antiarrhythmics, anticoagulation). Ablation may be needed if no response to medications
Unstable- DCC/ cardioversion
Atrial Flutter - ansCardioversion
Rate control not as responsive as Afib
Be able to calculate creatinine clearance using Cockgraft Gault equation: - ansMale = 140-age times weight
in kilograms divided by serum creatinine times 72.
Women = CRCL (male) times 0.85
Be familiar with the beers criteria and how to use it - ansPotentially Inappropriate Medication Use in Older
Adults
to call attention to medications that are most commonly problematic and thus should be avoided in older
adults
CHADS 2 score - ansanything greater than 3 is high risk and start anticoagulant
1 point for each with history of heart failure, hypertension, and diabetes mellitus
Stroke is 2 points
and greater than 75 years old is one point
Define narrow therapeutic index. How would you monitor a patient with a narrow therapeutic index? -
ansTherapeutic index is the dose range of effiency of med is optimized while side effects are minimized
Narrow therapeutic index drugs are defined as those drugs where small differences in dose or blood
concentration may lead to dose and blood concentration dependant, serious therapeutic failures or adverse
drug reactions.
You will need to monitor blood tests to monitor blood concentrations and dose adjustments accordingly.
Describe cytochrome p450 system - ansCytochrome p450 system is a series of enzymes used to
metabolize medications
Describe effect on low and high albumin levels on active drug levels especially for drugs that are highly
protein bound - ansAlbumin is the plasma protein with the greatest capacity for binding drugs. Binding
plasma proteins affect drug distribution into tissues, because only drug that is not bound is available to
penetrate tissues, bind to receptors, and exert activity. As free drug leaves the blood stream, more bound
drug is released from binding sites.
Describe factors that affect absorption - anslow blood state (shock or arrest), contact time with GI tract too
fast (diarrhea = cant absorb), delayed stomach emptying (large meal = delayed absorption)Drug- to drug or
drug to food interactions
Describe factors that affect excretion - ansaffected by abnormal kidney or liver function, age, drug
interactions
Describe how aging can affect absorption, distribution, metabolism and excretion - ansdecreased organ
function, poorly tolerate drugs that require metabolism, lower rates of excretion
decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH, changes in drug
absorption
With age, body fat generally increases and total body water decreases. Increased fat increases the volume
of distribution for highly lipophilic drugs (for example, diazepam and chlordiazepoxide), which may increase
their elimination half-lives.
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Download NRNP 6566 WK1-5 Midterm: Questions and Answers with Rationales and more Exams Nursing in PDF only on Docsity!

QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES VERIFIED ANSWERS

ALREADY GRADED A+

  • Abnormal labs with hyperthyroidism - anselevated T3, T4, thyroid resin uptake, and free thyroxine index. Sometimes T4 is normal but T3 is always high Elevated sed rate Elevated antinuclear antibody, without evidence of lupus or autoimmune disorder Hypercalcemia and low h/h Atrial fibrillation - ansStable- rate control versus rhythm control strategy (example: AV nodal blockers, antiarrhythmics, anticoagulation). Ablation may be needed if no response to medications Unstable- DCC/ cardioversion Atrial Flutter - ansCardioversion Rate control not as responsive as Afib Be able to calculate creatinine clearance using Cockgraft Gault equation: - ansMale = 140-age times weight in kilograms divided by serum creatinine times 72. Women = CRCL (male) times 0.8 5 Be familiar with the beers criteria and how to use it - ansPotentially Inappropriate Medication Use in Older Adults to call attention to medications that are most commonly problematic and thus should be avoided in older adults CHADS 2 score - ansanything greater than 3 is high risk and start anticoagulant 1 point for each with history of heart failure, hypertension, and diabetes mellitus Stroke is 2 points and greater than 75 years old is one point Define narrow therapeutic index. How would you monitor a patient with a narrow therapeutic index? - ansTherapeutic index is the dose range of effiency of med is optimized while side effects are minimized Narrow therapeutic index drugs are defined as those drugs where small differences in dose or blood concentration may lead to dose and blood concentration dependant, serious therapeutic failures or adverse drug reactions. You will need to monitor blood tests to monitor blood concentrations and dose adjustments accordingly. Describe cytochrome p450 system - ansCytochrome p450 system is a series of enzymes used to metabolize medications Describe effect on low and high albumin levels on active drug levels especially for drugs that are highly protein bound - ansAlbumin is the plasma protein with the greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into tissues, because only drug that is not bound is available to penetrate tissues, bind to receptors, and exert activity. As free drug leaves the blood stream, more bound drug is released from binding sites. Describe factors that affect absorption - anslow blood state (shock or arrest), contact time with GI tract too fast (diarrhea = cant absorb), delayed stomach emptying (large meal = delayed absorption)Drug- to drug or drug to food interactions Describe factors that affect excretion - ansaffected by abnormal kidney or liver function, age, drug interactions Describe how aging can affect absorption, distribution, metabolism and excretion - ansdecreased organ function, poorly tolerate drugs that require metabolism, lower rates of excretion decrease in small-bowel surface area, slowed gastric emptying, increase in gastric PH, changes in drug absorption With age, body fat generally increases and total body water decreases. Increased fat increases the volume of distribution for highly lipophilic drugs (for example, diazepam and chlordiazepoxide), which may increase their elimination half-lives.

QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES VERIFIED ANSWERS

ALREADY GRADED A+

Serum albumin decreases and alpha 1 acid glycoprotein increases -- Phenytoin and warfarin are examples of medications with a higher risk of toxic effects when serum albumin increases hepatic metabolism of many drugs through cytochrome P enzyme system decreases with age; decreasing 30 - 40% decreased renal elimination Describe the factors that affect distribution - anslow albumin levels, body composition, cardiac decompensation (heart failure), age Describe the factors that affect metabolism - ansgenetics, age, organ function Describe the ways the hepatic first pass effect- which is metabolism during first pass through the liver - ansAlternative routes include: suppository intravenous intramuscular inhalational aerosol transdermal sublingual These allow drugs to bypass the first-pass effect and be absorbed directly into systemic circulation Describe what determines the frequency of drug administration - anshalf life plasma concentration Dihydropyridine Calcium Channel Blockers - ansnefedipine, amlodipine these primarily act on vascular smooth muscles Use this for hypertension Essential hypertension - ansunknown cause 95% cases; onset 25 years old - 55 Secondary hypertension- related to known cause or disease process. This could be from estrogen uses, renal disease, pregnant, endocrine disorders Isolated systolic blood pressure- hypertension and systolic blood pressure greater than 140 over 90 Effectively treated with diuretics and long-acting calcium channel blockers Signs and symptoms of hypertension: headache in the morning, epitaxis, lightheadedness, visual disturbances, S4 present related to left ventricular hypertrophy, retinal changes, hematuria (which is rare) Highly protein bound drugs can lead to - anstoxicity in patients with low albumin levels, example malnutrition or chronic illness. This is because there are fewer than the normal sites for the drug to bind Hypertension definition - anssustained BP of 140's over 90's for a sustained period of time Stage 1 is 140-159; and 90-99 diastolic Stage 2 is equal or greater than 160 over greater or equal to 100 diastolic Hypertension medications based on history - ansNon-African Americans can take thiazide diuretics, calcium channel blockers, ace inhibitors, ARBs (grade B) African Americans need thiazides, calcium channel blockers (grade b); grade c for patient with diabetes mellitus Adults equal to or greater than the age of 18 with chronic kidney disease- ace inhibitors, ARBS grade b - regardless of race or other comorbidities Hypertensive emergency - ansSeverely elevated blood pressure 180 over 120 can occur with lower blood pressure if impending or progressive target organ dysfunction ( example : encephalopathy, intracranial hemorrhage, acute myocardial infarction, pulmonary edema with acute LV failure, unstable angina, dissecting aortic aneurysm or eclampsia

QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES VERIFIED ANSWERS

ALREADY GRADED A+

TEE should always proceed DCCV to rule out valve disease or thrombus Inducers - ansincrease CYP450 enzyme activity by increasing enzyme synthesis Inhibitors - ansblock metabolic activity from one or more CYP450 enzymes Low albumin levels - ansmalnutrition, chronic illness Non-Dihydropyridine Calcium Channel blocker - ansDiltiazem < verapamil Primarily act on the heart Use these for CP, SVT (verapamil), controlling irregular heart rate and lowering blood pressure (Diltiazem) Tachycardia - ansvagal manuever, adenosine (6 or 12 mg), betablocker or calcium channel blocker. Know what conditions each class would be used to treat Treatment for hyperthyroidism - anspropanolol (inderal) 10mg 4 times a day (up to 80 mg) Metoprolol 25 mg by mouth (Up to 50 mg) every 6*8 hours Antithyroid medications- methimazole (tapazole) initial dose is 30 to 60mg a day in three doses, and then maintenance of 5 to 15 mg daily If intolerant to tapazole, propylthiouracil initial dose is 300 to 600 mg a day in 4 doses, maintenance dosage is 100 to 150 mg daily in three doses Ventricular fibrillation - ansDefibrillate and CPR Ventricular Tachycardia - ansStable- betablocker Amiodarone, sotalol, mexiletine to reduce number of shocks MG if torsades EPS / ablation Unstable - CPR, epinephrine vasopressin, amiodarone, lidocaine, magnesium, airway management