2
AANP Adult gerontology primary care nurse practitioner study guide
|| || || || || || || ||
questions with verified detailed answers
|| || || || ||
Pheochromocytoma - ✔✔small vascular tumor of the adrenal medulla, causing irregular || || || || || || || || || || ||
secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure,
|| || || || || || || || || || || ||
palpitations, and headache. Tx with Alpha blockers || || || || || ||
Rovsing's Sign - ✔✔Palpation in LLQ ilicits pain in RLQ indicates appendicitis
|| || || || || || || || || || ||
NYHA classes of Heart Failure - ✔✔I No limitation of physical activity. Ordinary physical
|| || || || || || || || || || || || || ||
activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
|| || || || || || || || || ||
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results
|| || || || || || || || || || || ||
in fatigue, palpitation, dyspnea (shortness of breath).
|| || || || || || ||
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity
|| || || || || || || || || || || || ||
causes fatigue, palpitation, or dyspnea.
|| || || ||
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at
|| || || || || || || || || || || || || ||
rest. If any physical activity is undertaken, discomfort increases.
|| || || || || || || || ||
Step-wise Approach to Asthma Diagnosis & Treatment - ✔✔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).
|| || || || || || || || || || ||
,2
Peak Expiratory Flow Rate (HAG):
|| || || ||
Green Yellow Red Zone: - ✔✔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 - ✔✔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) - ✔✔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.
|| || || || || || || || || ||
, 2
Thiazide Diuretics - ✔✔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) - ✔✔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 - ✔✔causes a decrease in potassium excretion (spares K) and
|| || || || || || || || || || || ||
decreases Na reabsorption. (spironolactone) || || ||
AANP Adult gerontology primary care nurse practitioner study guide
|| || || || || || || ||
questions with verified detailed answers
|| || || || ||
Pheochromocytoma - ✔✔small vascular tumor of the adrenal medulla, causing irregular || || || || || || || || || || ||
secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure,
|| || || || || || || || || || || ||
palpitations, and headache. Tx with Alpha blockers || || || || || ||
Rovsing's Sign - ✔✔Palpation in LLQ ilicits pain in RLQ indicates appendicitis
|| || || || || || || || || || ||
NYHA classes of Heart Failure - ✔✔I No limitation of physical activity. Ordinary physical
|| || || || || || || || || || || || || ||
activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
|| || || || || || || || || ||
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results
|| || || || || || || || || || || ||
in fatigue, palpitation, dyspnea (shortness of breath).
|| || || || || || ||
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity
|| || || || || || || || || || || || ||
causes fatigue, palpitation, or dyspnea.
|| || || ||
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at
|| || || || || || || || || || || || || ||
rest. If any physical activity is undertaken, discomfort increases.
|| || || || || || || || ||
Step-wise Approach to Asthma Diagnosis & Treatment - ✔✔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).
|| || || || || || || || || || ||
,2
Peak Expiratory Flow Rate (HAG):
|| || || ||
Green Yellow Red Zone: - ✔✔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 - ✔✔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) - ✔✔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.
|| || || || || || || || || ||
, 2
Thiazide Diuretics - ✔✔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) - ✔✔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 - ✔✔causes a decrease in potassium excretion (spares K) and
|| || || || || || || || || || || ||
decreases Na reabsorption. (spironolactone) || || ||
