NR 601 UPDATED EXAMS TEST PAPER
QUESTIONS AND ANSWERS SURE A+
✔✔What are treatment goals for Stage C HFrEF? - ✔✔Control symptoms
Pt education
Prevent hospitalization
Prevent mortality
✔✔What are drugs used in Stage C HFrEF? - ✔✔Diuretics for fluid retention
ACEi or ARB
BB
Aldosterone antagonists
Drugs in selected pts:
Hydralazine/isosorbide dinitrate
ACEi and ARB
Digitalis
Procedures in selected pts:
CRT
ICD
Revascularization/valvular surgery as appropriate
,✔✔What are treatment goals in Stage D HF? - ✔✔Control symptoms
Improve HRQOL
Reduce hospital readmissions
Establish pt's end-of-life goals
✔✔What are options for Stage D HF? - ✔✔Advanced care measures
Heart transplant
Chronic inotropes
Temporary or permanent MCS
Experimental surgery/drugs
Palliative care, hospice
ICD deactivation
✔✔What is the normal BNP level? - ✔✔<100pg/mL (indicates HF is unlikely)
✔✔What is normal BP? - ✔✔<120/80
✔✔What is "elevated" BP? - ✔✔120-129/<80
✔✔What is Stage 1 HTN? - ✔✔130-139 OR 80-89
✔✔What is Stage 2 HTN? - ✔✔>/= 140 or >/= 90
✔✔What is recommended BP for DM? - ✔✔<130/80
✔✔What is recommended BP for CKD? - ✔✔<130/80
✔✔How should HTN be managed? - ✔✔Stage 2 and up should be given consideration
for pharm treatment.
Others can wait for lifestyle modification.
✔✔What is first-line meds for non-black HTN population (including those w/DM)? -
✔✔Thiazide, CCB, ACEi, or ARB, either alone or in combo
✔✔What is the med guideline for ASCVD for those </= 75yo? - ✔✔High-intensity statin
(atorvastatin/Lipitor 40-80mg, rosuvastatin/Crestor 20mg)
✔✔What is the med guideline for ASCVD for those >75yo? - ✔✔Moderate statin
(atorvastatin 10mg, rosuvastatin 5mg, simvastatin/Zocor 20-40mg,
pravastatin/Pravachol 40mg, lovastatin/Mevacor 40mg, fluvastatin 40mg BID)
✔✔What is the guideline for meds for LDL >/= 190? - ✔✔High intensity statin
(atorvastatin/Lipitor 40-80mg, rosuvastatin/Crestor 20mg)
, ✔✔What is the med guideline for ASCVD for 40-75yo w/DM? - ✔✔Their 10yr risk is
>7.5%, so high intensity statin (atorvastatin/Lipitor 40-80mg, rosuvastatin/Crestor 20mg)
✔✔What is the med guideline for LDL 70-189? - ✔✔Their 10yr risk is <7.5%, so
moderate intensity statin (atorvastatin/Lipitor 10mg, rosuvastatin/Crestor 5mg,
simvastatin/Zocor 20-40mg, pravastatin/Pravachol 40mg, lovastatin/Mevacor 40mg,
fluvastatin 40mgBID)
✔✔What is the ASCVD med guideline for 40-75yo w/out ASCVD or DM? - ✔✔Their
10yr risk is >7.5%, so moderate to high intensity statin
✔✔What is the purpose for Beers criteria? - ✔✔The American Geriatrics Society
developed Beers Criteria for use of providers as a guide for medical management of
geriatric pts.
Goal: to improve quality and safety.
Not a sub for individualized care, but should be incorporated into prescribing practices
for elderly.
As an NP, be familiar w/the lists to avoid prescribing potentially inappropriate meds.
✔✔Why do elderly need special prescribing criteria? - ✔✔Age-related changes also
change metabolism.
Pharmacodynamics change.
Pharmacokinetic changes: absorption, distribution, metabolism, elimination.
Half-lives altered, which affects steady state and dosing intervals.
✔✔What are potential risk factors for ADRs in elderly? - ✔✔6 or more chronic dz's.
9 or more Rx or OTC meds.
>12 doses per day
>85yo
BMI <22
Creatinine clearance <50
H/o previous ADR
✔✔What are some 2015 changes in med awareness for elderly? - ✔✔Nitrofurantoin can
be used w/creatinine clearance of 30, but should be avoided long term due to possible
irreversible pulmonary fibrosis, liver tox, peripheral neuropathy.
Non-benzos, benzo receptor agonist hypnotics (eszopiclone, zaleplon, zolpidem) should
be avoided for insomnia regardless of duration due to associated harm.
QUESTIONS AND ANSWERS SURE A+
✔✔What are treatment goals for Stage C HFrEF? - ✔✔Control symptoms
Pt education
Prevent hospitalization
Prevent mortality
✔✔What are drugs used in Stage C HFrEF? - ✔✔Diuretics for fluid retention
ACEi or ARB
BB
Aldosterone antagonists
Drugs in selected pts:
Hydralazine/isosorbide dinitrate
ACEi and ARB
Digitalis
Procedures in selected pts:
CRT
ICD
Revascularization/valvular surgery as appropriate
,✔✔What are treatment goals in Stage D HF? - ✔✔Control symptoms
Improve HRQOL
Reduce hospital readmissions
Establish pt's end-of-life goals
✔✔What are options for Stage D HF? - ✔✔Advanced care measures
Heart transplant
Chronic inotropes
Temporary or permanent MCS
Experimental surgery/drugs
Palliative care, hospice
ICD deactivation
✔✔What is the normal BNP level? - ✔✔<100pg/mL (indicates HF is unlikely)
✔✔What is normal BP? - ✔✔<120/80
✔✔What is "elevated" BP? - ✔✔120-129/<80
✔✔What is Stage 1 HTN? - ✔✔130-139 OR 80-89
✔✔What is Stage 2 HTN? - ✔✔>/= 140 or >/= 90
✔✔What is recommended BP for DM? - ✔✔<130/80
✔✔What is recommended BP for CKD? - ✔✔<130/80
✔✔How should HTN be managed? - ✔✔Stage 2 and up should be given consideration
for pharm treatment.
Others can wait for lifestyle modification.
✔✔What is first-line meds for non-black HTN population (including those w/DM)? -
✔✔Thiazide, CCB, ACEi, or ARB, either alone or in combo
✔✔What is the med guideline for ASCVD for those </= 75yo? - ✔✔High-intensity statin
(atorvastatin/Lipitor 40-80mg, rosuvastatin/Crestor 20mg)
✔✔What is the med guideline for ASCVD for those >75yo? - ✔✔Moderate statin
(atorvastatin 10mg, rosuvastatin 5mg, simvastatin/Zocor 20-40mg,
pravastatin/Pravachol 40mg, lovastatin/Mevacor 40mg, fluvastatin 40mg BID)
✔✔What is the guideline for meds for LDL >/= 190? - ✔✔High intensity statin
(atorvastatin/Lipitor 40-80mg, rosuvastatin/Crestor 20mg)
, ✔✔What is the med guideline for ASCVD for 40-75yo w/DM? - ✔✔Their 10yr risk is
>7.5%, so high intensity statin (atorvastatin/Lipitor 40-80mg, rosuvastatin/Crestor 20mg)
✔✔What is the med guideline for LDL 70-189? - ✔✔Their 10yr risk is <7.5%, so
moderate intensity statin (atorvastatin/Lipitor 10mg, rosuvastatin/Crestor 5mg,
simvastatin/Zocor 20-40mg, pravastatin/Pravachol 40mg, lovastatin/Mevacor 40mg,
fluvastatin 40mgBID)
✔✔What is the ASCVD med guideline for 40-75yo w/out ASCVD or DM? - ✔✔Their
10yr risk is >7.5%, so moderate to high intensity statin
✔✔What is the purpose for Beers criteria? - ✔✔The American Geriatrics Society
developed Beers Criteria for use of providers as a guide for medical management of
geriatric pts.
Goal: to improve quality and safety.
Not a sub for individualized care, but should be incorporated into prescribing practices
for elderly.
As an NP, be familiar w/the lists to avoid prescribing potentially inappropriate meds.
✔✔Why do elderly need special prescribing criteria? - ✔✔Age-related changes also
change metabolism.
Pharmacodynamics change.
Pharmacokinetic changes: absorption, distribution, metabolism, elimination.
Half-lives altered, which affects steady state and dosing intervals.
✔✔What are potential risk factors for ADRs in elderly? - ✔✔6 or more chronic dz's.
9 or more Rx or OTC meds.
>12 doses per day
>85yo
BMI <22
Creatinine clearance <50
H/o previous ADR
✔✔What are some 2015 changes in med awareness for elderly? - ✔✔Nitrofurantoin can
be used w/creatinine clearance of 30, but should be avoided long term due to possible
irreversible pulmonary fibrosis, liver tox, peripheral neuropathy.
Non-benzos, benzo receptor agonist hypnotics (eszopiclone, zaleplon, zolpidem) should
be avoided for insomnia regardless of duration due to associated harm.
