ACNN/AANP Adult-Gerontology
Primary Care Nurse
Practitioner (AGPCNP ) Exam
Questions And Correct Answer
Green Yellow Red Zone: - ANSWER -PEF based on Height Age Gender. Blow hard
using spirometer highest value recorded.
80-100% expected volume Green Zone maintain or reduce meds
50-80% expected volume Yellow Zone increase maintenance therapy. Or Having
exacerbation.
Below 50% expected volume Red Zone call 911 give epinephrine inj.
PPD - ANSWER -Neg- No firm bump forms at the test site, or a bump forms that is
smaller than 5 mm (0.2 in.).
A firm bump that is 5 mm (0.2 in.) in size suggests a TB infection in people who are in a
high-risk group. HIV, immunocompromise, exposed.
A firm bump that is 10 mm (0.4 in.) in size suggests a TB infection in people who are in
a moderate-risk group. healthcare workers, immigrants, homeless.
A firm bump that is 15 mm (0.6 in.) in size suggests a TB infection in people who are in
a low-risk group no risk for tb.
Digoxin (Cardiac Glycosides) - ANSWER -Therapuetic 0.5-2.0
Overdose toxcitity GI upset, arrhythmias, confusion visual changes (yellow/green tinge
vision- scotomas). Tx with digibind. order dig level, electrolytes, creatinine ekg.
Thiazide Diuretics - ANSWER -Pt with both htn and osteoporosis have an extra benefit
,from thiazides. thiazide diuretics decrease calcium excretion by the kidneys and
stimulate osteoclasts formation. Patients with serious sulfa allergies should avoid
thiazide diuretics. Potassium sparing diuretics can be used as alternative.
Chlorthalidone (hygroton), hydrochlororthiazide (esidrix, microzide), indapamide (lozol),
metolazone (zaroxolyn); indicated for decreased fluid volume, inexpensive, effective,
useful in severe hypertension, effective orally, enhances other antihypertensives;
adverse reactions: hypokalemia symptoms, hyperuricemia, glucose tolerance,
hypercholesterolemia, sexual dysfunction; observe for postural hypotension, caution
with renal failure gout and client taking lithium; hypokalemia increases risk for digitalis
toxicity, administer postassium supplements.
Avoid with Gout, Best fist line for elderly w/ systolic htn.
Coumadin (Warfarin) - ANSWER -an anticoagulant administered to prevent blood clots
from forming or growing larger
Prophylaxis and/or treatment of venous thrombosis, pulmonary embolus, a fib, valve
replacement, recurrent MI, stroke; also immobile pt
Afiib target INR 2-3
If INR 5-9 w/o bleeding hold 2-3 days low dose vit k
avoid leafy veg, broccoli, brussels, canola oil, mayo.
Aldosterone Antagonist - ANSWER -causes a decrease in potassium excretion (spares
K) and decreases Na reabsorption. (spironolactone)
Hirsuitism, htn, severe heart failure. exp spironolactone. Adverse effects are
galactorrhea and hyperkalemia.
Spironolactone is rarely used to treat htn in primary care due to adverse effects and
higher risk of certain cancer.
Postassium Sparing Diuretics - ANSWER -compete w/ aldosterone at receptor sites
causing increase na and water excretion while conserving k and h ions
Alt for Sulfa Allergy Pts to tx HTN.
Triameterene (Dyrenium), Amiloride (Midamor). Combo HCTZ. Severe Hyperkalemia,
Avoid renal pts, ace or arbs, do not give potassium supplement or salt subst. Monitor
, serum K+ 3.5-5.
high risk elder, severe ill, dm.
Ace Inhibitors, ACEI/ARBS - ANSWER -ACTION: prevent the conversion of
angiotensin I to angiotensin II in the lungs USES: CHF, HTN , usually end in PRIL
Indicated for DM, HTN, CKD pts w/ HTN.
Cat C & D. dont give in preg. excereted in breast milk.
Dry Cough, angioedema, hyperkalemia. Captopril causes agrunolocytosis monitor cbc.
switch from ace to arb if cough persist.
Beta Blockers - ANSWER -**** DO NOT give with ASTHMA, BRONCHIAL
CONSTRICTIVE DISEASE!!!****
Step-wise Approach to Asthma Diagnosis & Treatment - ANSWER -Step 1- Mild
Intermitten FEV1/PEF > 80% predicted. Symptoms <2 days/week. Albuterol as needed.
Step 2- Mild presistent Asthma (FEV1/PEF > 80% predicted. Symptoms > 2 days/week.
Albuterol as needed. Low dose ICS ex Flovent. Alt cromolyn, montelukast, nedocromil,
theophylline.
Step 3- Mod presistent (FEV1 or PEF 60-80% predicted. Daily Symptoms. SABA plus
low dose ICS or med dose ICS or low dose with leukotriene inhibitor (singulair,
theophylline, zileuton).
Step 4- Severe presistent asthma (FEV1/PEF <60% predicted. Symptoms most of day.
High dose ICS plus long acting B2 agonist plus oral steroid daily (prednisone).
Peak Expiratory Flow Rate (HAG):
HTN, post myocardial infarction(first line), angina, arrhythmias, migraine prophylaxis.
Adjunct tretment-hyperthyroidism/thyrotoxicosis (decrease HR, anxiety). Migrain
prophylaxis -non-cardioselective(blocks beta 1 and beta 2) propanolol, timolol. -Cardio Selective blocks
beta-1 only atenolol, metoprolol.
Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF;
signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)
Adverse effects: ED, Depression, fatigue, bradycardia.
Primary Care Nurse
Practitioner (AGPCNP ) Exam
Questions And Correct Answer
Green Yellow Red Zone: - ANSWER -PEF based on Height Age Gender. Blow hard
using spirometer highest value recorded.
80-100% expected volume Green Zone maintain or reduce meds
50-80% expected volume Yellow Zone increase maintenance therapy. Or Having
exacerbation.
Below 50% expected volume Red Zone call 911 give epinephrine inj.
PPD - ANSWER -Neg- No firm bump forms at the test site, or a bump forms that is
smaller than 5 mm (0.2 in.).
A firm bump that is 5 mm (0.2 in.) in size suggests a TB infection in people who are in a
high-risk group. HIV, immunocompromise, exposed.
A firm bump that is 10 mm (0.4 in.) in size suggests a TB infection in people who are in
a moderate-risk group. healthcare workers, immigrants, homeless.
A firm bump that is 15 mm (0.6 in.) in size suggests a TB infection in people who are in
a low-risk group no risk for tb.
Digoxin (Cardiac Glycosides) - ANSWER -Therapuetic 0.5-2.0
Overdose toxcitity GI upset, arrhythmias, confusion visual changes (yellow/green tinge
vision- scotomas). Tx with digibind. order dig level, electrolytes, creatinine ekg.
Thiazide Diuretics - ANSWER -Pt with both htn and osteoporosis have an extra benefit
,from thiazides. thiazide diuretics decrease calcium excretion by the kidneys and
stimulate osteoclasts formation. Patients with serious sulfa allergies should avoid
thiazide diuretics. Potassium sparing diuretics can be used as alternative.
Chlorthalidone (hygroton), hydrochlororthiazide (esidrix, microzide), indapamide (lozol),
metolazone (zaroxolyn); indicated for decreased fluid volume, inexpensive, effective,
useful in severe hypertension, effective orally, enhances other antihypertensives;
adverse reactions: hypokalemia symptoms, hyperuricemia, glucose tolerance,
hypercholesterolemia, sexual dysfunction; observe for postural hypotension, caution
with renal failure gout and client taking lithium; hypokalemia increases risk for digitalis
toxicity, administer postassium supplements.
Avoid with Gout, Best fist line for elderly w/ systolic htn.
Coumadin (Warfarin) - ANSWER -an anticoagulant administered to prevent blood clots
from forming or growing larger
Prophylaxis and/or treatment of venous thrombosis, pulmonary embolus, a fib, valve
replacement, recurrent MI, stroke; also immobile pt
Afiib target INR 2-3
If INR 5-9 w/o bleeding hold 2-3 days low dose vit k
avoid leafy veg, broccoli, brussels, canola oil, mayo.
Aldosterone Antagonist - ANSWER -causes a decrease in potassium excretion (spares
K) and decreases Na reabsorption. (spironolactone)
Hirsuitism, htn, severe heart failure. exp spironolactone. Adverse effects are
galactorrhea and hyperkalemia.
Spironolactone is rarely used to treat htn in primary care due to adverse effects and
higher risk of certain cancer.
Postassium Sparing Diuretics - ANSWER -compete w/ aldosterone at receptor sites
causing increase na and water excretion while conserving k and h ions
Alt for Sulfa Allergy Pts to tx HTN.
Triameterene (Dyrenium), Amiloride (Midamor). Combo HCTZ. Severe Hyperkalemia,
Avoid renal pts, ace or arbs, do not give potassium supplement or salt subst. Monitor
, serum K+ 3.5-5.
high risk elder, severe ill, dm.
Ace Inhibitors, ACEI/ARBS - ANSWER -ACTION: prevent the conversion of
angiotensin I to angiotensin II in the lungs USES: CHF, HTN , usually end in PRIL
Indicated for DM, HTN, CKD pts w/ HTN.
Cat C & D. dont give in preg. excereted in breast milk.
Dry Cough, angioedema, hyperkalemia. Captopril causes agrunolocytosis monitor cbc.
switch from ace to arb if cough persist.
Beta Blockers - ANSWER -**** DO NOT give with ASTHMA, BRONCHIAL
CONSTRICTIVE DISEASE!!!****
Step-wise Approach to Asthma Diagnosis & Treatment - ANSWER -Step 1- Mild
Intermitten FEV1/PEF > 80% predicted. Symptoms <2 days/week. Albuterol as needed.
Step 2- Mild presistent Asthma (FEV1/PEF > 80% predicted. Symptoms > 2 days/week.
Albuterol as needed. Low dose ICS ex Flovent. Alt cromolyn, montelukast, nedocromil,
theophylline.
Step 3- Mod presistent (FEV1 or PEF 60-80% predicted. Daily Symptoms. SABA plus
low dose ICS or med dose ICS or low dose with leukotriene inhibitor (singulair,
theophylline, zileuton).
Step 4- Severe presistent asthma (FEV1/PEF <60% predicted. Symptoms most of day.
High dose ICS plus long acting B2 agonist plus oral steroid daily (prednisone).
Peak Expiratory Flow Rate (HAG):
HTN, post myocardial infarction(first line), angina, arrhythmias, migraine prophylaxis.
Adjunct tretment-hyperthyroidism/thyrotoxicosis (decrease HR, anxiety). Migrain
prophylaxis -non-cardioselective(blocks beta 1 and beta 2) propanolol, timolol. -Cardio Selective blocks
beta-1 only atenolol, metoprolol.
Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF;
signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)
Adverse effects: ED, Depression, fatigue, bradycardia.
