NR 601 Midterm Study Guide – Walden University (Latest 2025 Update) Comprehensive
Review & Exam Prep A+ Guaranteed
Week 1
Chapter Readings – 1, 5-7
Topics: Wellness, Prevention, Cultural Aspects, Prescribing
1. Know the physiologic effects of aging in all body systems
Body Composition: decreased body water (increased chance of dehydration, thirst sensation
is blunted with age, increased body fat
Brain: decrease of 7% of physical weight, anatomy “atrophy” commonly noted
Sleep patterns are reduced in stage 3 & 4, more frequent awakenings,
reduced sleep efficiency
Vision: Lens accommodation reduced after age 40-50 ( reading glasses at 42-50)
Amount of light reaching the retina: diminished by up to 70%
Color perception: Reduced color intensity especially noted in greens and
blues
Hearing: decline begins about age 12 and is steepest in higher frequencies (>5000
hertz cycles/second)
Taste/Smell: number of taste buds: reduced by 70 %
Changes in preferences: increased tolerance for very sweet and very
salty food due to reduced perception
Cardiac Function: maximum heart rate reduced from 195 to 155 bpm
Reduced cardiac output during stress predisposed to heart failure during
sepsis, pneumonia, and surgery
Renal Profusion: decreased by 50%, Reduced renal response to antidiuretic hormone and
often a relative hyporeninemic hypoaldosteronism (sodium wasting and
potassium retention)
Bone Mineral Content: decreased by 10 – 30 %
Prostate Gland: 100% increase in size
Sexual function: Males: reduced intensity, and persistence of erections, decreased
ejaculate and ejaculatory rate
Females: menopause (age 50), reduced lubrication, vaginal atrophy
Other changes: Vestibular sensitivity, reaction time increases, amount of sway increases
beyond age 60, ankle jerk reflexes are decreased or absent in the
absence of detectable musculoskeletal pathology, bone density plateaus
between 20-50 yrs. then gradually declines (more rapid in women),
reduced stamina (cardinal symptom of frailty syndrome),
Frailty: (as the occurrence of three or more of the following)
unintentional weight loss (10 lbs. in past year), self-reported exhaustion,
weakness (reduced grip strength), slow walking speed, and low physical
activity
Metabolism slows, physical activity declines, and absorption of
nutrients becomes problematic because of chronic conditions and
medication-nutrient interactions
This study source was downloaded by 100000899792425 from CourseHero.com on 08-13-2025 22:38:05 GMT -05:00
https://www.coursehero.com/file/250779861/NR601-Midterm-Study-Guidedocx/
, 2. Know the factors that cause disability in the elderly
Immobility: use it or lose it, family attending to every need after illness,
“don’t hurt yourself”, “let me do that for you”, a week in bed in the
hospital is like adding 10 years to your age. Among older persons,
extended immobility is often the end of ambulation.
3. Understand medication classes and their effects on the elderly, particularly riskier classes of
medications such as opioids and sedating agents
↓ First-pass metabolism ↑ Drug serum concentration Oral nitrates, beta-blockers,
calcium channel blockers,
estrogens
↓ Rate of absorption ↓ Clinical effect Furosemide
↓ Lean mass and total body water ↓ Volume of distribution Digoxin, lithium
↑ Fat content ↑ Volume of distribution Diazepam, chlordiazepoxide,
flurazepam, alprazolam
↓ Food intake/catabolic disease states ↓ Serum protein concentration Warfarin, phenytoin
w/↓ binding
↓ Approximately one half of CYP 450 metabolic pathways (Phase I reactions)
↓ Reduction, oxidation, hydroxylation, demethylation →↑ half-life Diazepam, chlordiazepoxide,
flurazepam, alprazolam
↓ Renal elimination ↓ Clearance →↑ half-life Aminoglycosides, vancomycin,
digoxin, salicylates
Medications that require an acidic environment for optimal absorption (e.g., calcium carbonate or
ketoconazole) have reduced absorption in patients with hypochlorhydria (whether physiological or acid
suppressant–induced)
Absorption of topical medications (e.g., creams, ointments, or patches) may fluctuate because of
changes in the skin, such as atrophy and reduced blood flow to the dermal layer.
Although some medications may have reduced absorption, this is frequently counterbalanced by a
decreased the first-pass effect. For medications that have a low bioavailability in average adults, such as
propranolol or morphine, a small decrease in the initial first-pass effect may drastically impact drug
serum concentrations.
lipophilic medications have a larger volume of distribution. This leads to longer elimination
phase and prolonged therapeutic or toxic effect because drugs are typically not efficiently eliminated
from the lipid compartment. Examples of lipophilic medications include phenytoin, valproic acid,
This study source was downloaded by 100000899792425 from CourseHero.com on 08-13-2025 22:38:05 GMT -05:00
https://www.coursehero.com/file/250779861/NR601-Midterm-Study-Guidedocx/
Review & Exam Prep A+ Guaranteed
Week 1
Chapter Readings – 1, 5-7
Topics: Wellness, Prevention, Cultural Aspects, Prescribing
1. Know the physiologic effects of aging in all body systems
Body Composition: decreased body water (increased chance of dehydration, thirst sensation
is blunted with age, increased body fat
Brain: decrease of 7% of physical weight, anatomy “atrophy” commonly noted
Sleep patterns are reduced in stage 3 & 4, more frequent awakenings,
reduced sleep efficiency
Vision: Lens accommodation reduced after age 40-50 ( reading glasses at 42-50)
Amount of light reaching the retina: diminished by up to 70%
Color perception: Reduced color intensity especially noted in greens and
blues
Hearing: decline begins about age 12 and is steepest in higher frequencies (>5000
hertz cycles/second)
Taste/Smell: number of taste buds: reduced by 70 %
Changes in preferences: increased tolerance for very sweet and very
salty food due to reduced perception
Cardiac Function: maximum heart rate reduced from 195 to 155 bpm
Reduced cardiac output during stress predisposed to heart failure during
sepsis, pneumonia, and surgery
Renal Profusion: decreased by 50%, Reduced renal response to antidiuretic hormone and
often a relative hyporeninemic hypoaldosteronism (sodium wasting and
potassium retention)
Bone Mineral Content: decreased by 10 – 30 %
Prostate Gland: 100% increase in size
Sexual function: Males: reduced intensity, and persistence of erections, decreased
ejaculate and ejaculatory rate
Females: menopause (age 50), reduced lubrication, vaginal atrophy
Other changes: Vestibular sensitivity, reaction time increases, amount of sway increases
beyond age 60, ankle jerk reflexes are decreased or absent in the
absence of detectable musculoskeletal pathology, bone density plateaus
between 20-50 yrs. then gradually declines (more rapid in women),
reduced stamina (cardinal symptom of frailty syndrome),
Frailty: (as the occurrence of three or more of the following)
unintentional weight loss (10 lbs. in past year), self-reported exhaustion,
weakness (reduced grip strength), slow walking speed, and low physical
activity
Metabolism slows, physical activity declines, and absorption of
nutrients becomes problematic because of chronic conditions and
medication-nutrient interactions
This study source was downloaded by 100000899792425 from CourseHero.com on 08-13-2025 22:38:05 GMT -05:00
https://www.coursehero.com/file/250779861/NR601-Midterm-Study-Guidedocx/
, 2. Know the factors that cause disability in the elderly
Immobility: use it or lose it, family attending to every need after illness,
“don’t hurt yourself”, “let me do that for you”, a week in bed in the
hospital is like adding 10 years to your age. Among older persons,
extended immobility is often the end of ambulation.
3. Understand medication classes and their effects on the elderly, particularly riskier classes of
medications such as opioids and sedating agents
↓ First-pass metabolism ↑ Drug serum concentration Oral nitrates, beta-blockers,
calcium channel blockers,
estrogens
↓ Rate of absorption ↓ Clinical effect Furosemide
↓ Lean mass and total body water ↓ Volume of distribution Digoxin, lithium
↑ Fat content ↑ Volume of distribution Diazepam, chlordiazepoxide,
flurazepam, alprazolam
↓ Food intake/catabolic disease states ↓ Serum protein concentration Warfarin, phenytoin
w/↓ binding
↓ Approximately one half of CYP 450 metabolic pathways (Phase I reactions)
↓ Reduction, oxidation, hydroxylation, demethylation →↑ half-life Diazepam, chlordiazepoxide,
flurazepam, alprazolam
↓ Renal elimination ↓ Clearance →↑ half-life Aminoglycosides, vancomycin,
digoxin, salicylates
Medications that require an acidic environment for optimal absorption (e.g., calcium carbonate or
ketoconazole) have reduced absorption in patients with hypochlorhydria (whether physiological or acid
suppressant–induced)
Absorption of topical medications (e.g., creams, ointments, or patches) may fluctuate because of
changes in the skin, such as atrophy and reduced blood flow to the dermal layer.
Although some medications may have reduced absorption, this is frequently counterbalanced by a
decreased the first-pass effect. For medications that have a low bioavailability in average adults, such as
propranolol or morphine, a small decrease in the initial first-pass effect may drastically impact drug
serum concentrations.
lipophilic medications have a larger volume of distribution. This leads to longer elimination
phase and prolonged therapeutic or toxic effect because drugs are typically not efficiently eliminated
from the lipid compartment. Examples of lipophilic medications include phenytoin, valproic acid,
This study source was downloaded by 100000899792425 from CourseHero.com on 08-13-2025 22:38:05 GMT -05:00
https://www.coursehero.com/file/250779861/NR601-Midterm-Study-Guidedocx/
