AANP Adult gerontology primary care nurse
practiotioner study guide
Pheochromocytoma - (ANSWERS)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 - (ANSWERS)Palpation in LLQ ilicits pain in RLQ indicates appendicitis
NYHA classes of Heart Failure - (ANSWERS)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 - (ANSWERS)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):
Green Yellow Red Zone: - (ANSWERS)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 - (ANSWERS)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.
,AANP Adult gerontology primary care nurse
practiotioner study guide
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) - (ANSWERS)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 - (ANSWERS)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) - (ANSWERS)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 - (ANSWERS)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.
, AANP Adult gerontology primary care nurse
practiotioner study guide
Spironolactone is rarely used to treat htn in primary care due to adverse effects and higher risk
of certain cancer.
Postassium Sparing Diuretics - (ANSWERS)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 - (ANSWERS)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 - (ANSWERS)**** DO NOT give with ASTHMA, BRONCHIAL CONSTRICTIVE
DISEASE!!!****
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.
Loop Diuretics - (ANSWERS)Examples a. Furosemide (Lasix) b. Bumetanide (Bumex) 2. Loop
diuretics inhibit reabsorption of sodium and chloride at the proximal portion of the ascending
loop of Henle, increasing water excretion. 3. Side effects / nursing care a. Hypokalemia,
hypochloremic alkalosis, hyperuricemia (gout), hyperglycemia b. Teach high potassium foods
practiotioner study guide
Pheochromocytoma - (ANSWERS)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 - (ANSWERS)Palpation in LLQ ilicits pain in RLQ indicates appendicitis
NYHA classes of Heart Failure - (ANSWERS)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 - (ANSWERS)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):
Green Yellow Red Zone: - (ANSWERS)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 - (ANSWERS)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.
,AANP Adult gerontology primary care nurse
practiotioner study guide
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) - (ANSWERS)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 - (ANSWERS)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) - (ANSWERS)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 - (ANSWERS)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.
, AANP Adult gerontology primary care nurse
practiotioner study guide
Spironolactone is rarely used to treat htn in primary care due to adverse effects and higher risk
of certain cancer.
Postassium Sparing Diuretics - (ANSWERS)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 - (ANSWERS)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 - (ANSWERS)**** DO NOT give with ASTHMA, BRONCHIAL CONSTRICTIVE
DISEASE!!!****
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.
Loop Diuretics - (ANSWERS)Examples a. Furosemide (Lasix) b. Bumetanide (Bumex) 2. Loop
diuretics inhibit reabsorption of sodium and chloride at the proximal portion of the ascending
loop of Henle, increasing water excretion. 3. Side effects / nursing care a. Hypokalemia,
hypochloremic alkalosis, hyperuricemia (gout), hyperglycemia b. Teach high potassium foods
