Page 1 of 6
NRNP 6566 MIDTERM EXAM LATEST UPDATE 2024\2025
QUESTIONS AND CORRECT ANSWERS| GRADED A+
Describe how aging can affect absorption, distribution, metabolism and excretion
Answer: decreased 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.
• 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
Identify 1st degree heart block Answer: cardiologist consult Order echo to rule out
structural diagnosis, check thyroid levels, medications, electrolytes and identify and
treat cause
Identify 2nd degree heart block Answer: permanent pacemaker, continuous tele
monitoring, possible transcutaneous pacing, determine cause; IV atropine if poor
perfusion s/s every 3-5 minutes with max of 3mg if poor perfusion. No response to
atropine, use dopamine, epinephrine, isoproterenol
Identify 3rd degree heart block/complete heart block Answer: Permanent pacemaker,
telemetry monitoring and transcutaneous pacing if needed, identify cause, IV atropine
if s/s poor perfusion. If no response to atropine, use dopamine, epinephrine and
isoproterenol
Atrial fibrillation Answer: Stable- rate control versus rhythm control strategy
(example: AV nodal blockers, antiarrhythmics, anticoagulation). Ablation may be
needed if no response to medications
Unstable- DCC/ cardioversion
, Page 2 of 6
Atrial Flutter Answer: Cardioversion Rate control not as responsive as Afib
Ventricular fibrillation Answer: Defibrillate and CPR
Ventricular Tachycardia Answer: Stable- betablocker Amiodarone, sotalol,
mexiletine to reduce number of shocks MG if torsades
EPS / ablation
Unstable - CPR, epinephrine vasopressin, amiodarone, lidocaine, magnesium, airway
management
Tachycardia Answer: vagal manuever, adenosine (6 or 12 mg), betablocker or
calcium channel blocker. Know what conditions each class would be used to treat
Dihydropyridine Calcium Channel Blockers Answer: nefedipine, amlodipine
these primarily act on vascular smooth muscles Use this for hypertension
Non-Dihydropyridine Calcium Channel blocker Answer: Diltiazem
< verapamil
Primarily act on the heart
Use these for CP, SVT (verapamil), controlling irregular heart rate and lowering
blood pressure (Diltiazem)
CHADS 2 score Answer: anything 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
Hyperthyroidism Answer: heat intolerance fatigue
anxiety nervousness manic
confusion / restless emotional liability fine tremors diaphoresis
hyperreflexia of deep tendon reflexes resting tachycardia, palpitations, afib exterional
dyspnea
low-grade fever
increased appetite weight loss
fine thin hair exopthalamus Graves
Abnormal labs with hyperthyroidism Answer: elevated 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
NRNP 6566 MIDTERM EXAM LATEST UPDATE 2024\2025
QUESTIONS AND CORRECT ANSWERS| GRADED A+
Describe how aging can affect absorption, distribution, metabolism and excretion
Answer: decreased 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.
• 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
Identify 1st degree heart block Answer: cardiologist consult Order echo to rule out
structural diagnosis, check thyroid levels, medications, electrolytes and identify and
treat cause
Identify 2nd degree heart block Answer: permanent pacemaker, continuous tele
monitoring, possible transcutaneous pacing, determine cause; IV atropine if poor
perfusion s/s every 3-5 minutes with max of 3mg if poor perfusion. No response to
atropine, use dopamine, epinephrine, isoproterenol
Identify 3rd degree heart block/complete heart block Answer: Permanent pacemaker,
telemetry monitoring and transcutaneous pacing if needed, identify cause, IV atropine
if s/s poor perfusion. If no response to atropine, use dopamine, epinephrine and
isoproterenol
Atrial fibrillation Answer: Stable- rate control versus rhythm control strategy
(example: AV nodal blockers, antiarrhythmics, anticoagulation). Ablation may be
needed if no response to medications
Unstable- DCC/ cardioversion
, Page 2 of 6
Atrial Flutter Answer: Cardioversion Rate control not as responsive as Afib
Ventricular fibrillation Answer: Defibrillate and CPR
Ventricular Tachycardia Answer: Stable- betablocker Amiodarone, sotalol,
mexiletine to reduce number of shocks MG if torsades
EPS / ablation
Unstable - CPR, epinephrine vasopressin, amiodarone, lidocaine, magnesium, airway
management
Tachycardia Answer: vagal manuever, adenosine (6 or 12 mg), betablocker or
calcium channel blocker. Know what conditions each class would be used to treat
Dihydropyridine Calcium Channel Blockers Answer: nefedipine, amlodipine
these primarily act on vascular smooth muscles Use this for hypertension
Non-Dihydropyridine Calcium Channel blocker Answer: Diltiazem
< verapamil
Primarily act on the heart
Use these for CP, SVT (verapamil), controlling irregular heart rate and lowering
blood pressure (Diltiazem)
CHADS 2 score Answer: anything 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
Hyperthyroidism Answer: heat intolerance fatigue
anxiety nervousness manic
confusion / restless emotional liability fine tremors diaphoresis
hyperreflexia of deep tendon reflexes resting tachycardia, palpitations, afib exterional
dyspnea
low-grade fever
increased appetite weight loss
fine thin hair exopthalamus Graves
Abnormal labs with hyperthyroidism Answer: elevated 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
