NRNP 6566 WK1-5 Midterm Exam 2026
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Describe effect on low and high albumin levels on active drug levels especially for drugs
that are highly protein bound - ANSWERS-Albumin is the plasma protein with the
greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into
tissues, because only drug that is not bound is available to penetrate tissues, bind to
receptors, and exert activity. As free drug leaves the blood stream, more bound drug is
released from binding sites.
Describe cytochrome p450 system - ANSWERS-Cytochrome p450 system is a series of
enzymes used to metabolize medications
Inhibitors - ANSWERS-block metabolic activity from one or more CYP450 enzymes
Inducers - ANSWERS-increase CYP450 enzyme activity by increasing enzyme
synthesis
Describe how aging can affect absorption, distribution, metabolism and excretion -
ANSWERS-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 - ANSWERS-cardiologist consult Order echo to rule out
structural diagnosis, check thyroid levels, medications, electrolytes and identify and
treat cause
Identify 2nd degree heart block - ANSWERS-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 - ANSWERS-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 - ANSWERS-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
Atrial Flutter - ANSWERS-Cardioversion
Rate control not as responsive as Afib
Ventricular fibrillation - ANSWERS-Defibrillate and CPR
MOST Recent Tested,Actual Exam
Questions (2026)WITH Recent Newest
Verified And Well Analyzed Exam
Questions (Actual Exam 2026-2027)
Correct Detailed & Verified ANSWERS
(100% Accurate Solutions) ||ALREADY
GRADED A+||Exam Guarantee Pass!!
Describe effect on low and high albumin levels on active drug levels especially for drugs
that are highly protein bound - ANSWERS-Albumin is the plasma protein with the
greatest capacity for binding drugs. Binding plasma proteins affect drug distribution into
tissues, because only drug that is not bound is available to penetrate tissues, bind to
receptors, and exert activity. As free drug leaves the blood stream, more bound drug is
released from binding sites.
Describe cytochrome p450 system - ANSWERS-Cytochrome p450 system is a series of
enzymes used to metabolize medications
Inhibitors - ANSWERS-block metabolic activity from one or more CYP450 enzymes
Inducers - ANSWERS-increase CYP450 enzyme activity by increasing enzyme
synthesis
Describe how aging can affect absorption, distribution, metabolism and excretion -
ANSWERS-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 - ANSWERS-cardiologist consult Order echo to rule out
structural diagnosis, check thyroid levels, medications, electrolytes and identify and
treat cause
Identify 2nd degree heart block - ANSWERS-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 - ANSWERS-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 - ANSWERS-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
Atrial Flutter - ANSWERS-Cardioversion
Rate control not as responsive as Afib
Ventricular fibrillation - ANSWERS-Defibrillate and CPR
