NRNP 6566 FINAL EXAM
PREP
ADVANCED CARE OF
ADULTS IN ACUTE
SETTINGS
ANSWERED
2023/2024
,1. What are the main components of the comprehensive geriatric assessment (CGA) and why
is it important for older adults? (5 marks)
- The CGA is a multidimensional, interdisciplinary diagnostic process that evaluates the
medical, functional, psychological, and social aspects of older adults. It is important
because it can identify the strengths and limitations of older adults, guide individualized
care plans, prevent or delay functional decline, improve quality of life, and reduce
hospitalization and institutionalization. (5 marks)
2. What are some common causes and risk factors of delirium in older adults? How can
nurses prevent and manage delirium in this population? (10 marks)
- Some common causes of delirium in older adults are infections, medications, dehydration,
electrolyte imbalances, surgery, pain, sensory impairment, sleep deprivation, and
environmental changes. Some risk factors are dementia, cognitive impairment, frailty,
comorbidity, polypharmacy, and malnutrition. Nurses can prevent and manage delirium
by identifying and treating the underlying cause, avoiding or minimizing the use of
anticholinergic and sedative medications, ensuring adequate hydration and nutrition,
maintaining normal sleep-wake cycles, providing orientation and reassurance, optimizing
sensory input, and creating a safe and familiar environment. (10 marks)
3. What are the differences between pressure ulcers and diabetic foot ulcers in terms of
etiology, pathophysiology, classification, and treatment? (15 marks)
- Pressure ulcers are caused by prolonged pressure or shear forces on the skin and underlying
tissues, especially over bony prominences. Diabetic foot ulcers are caused by
neuropathy, ischemia, or infection in the feet of patients with diabetes mellitus. Pressure
ulcers are classified according to the depth of tissue damage, from stage I (non-
blanchable erythema) to stage IV (full-thickness tissue loss with exposed bone or
muscle). Diabetic foot ulcers are classified according to the presence or absence of
infection and ischemia, from grade 0 (pre-ulcerative lesion) to grade 5 (gangrene of the
whole foot). Treatment of pressure ulcers involves relieving pressure and shear forces,
debridement of necrotic tissue, wound dressing, infection control, nutrition support, and
pain management. Treatment of diabetic foot ulcers involves glycemic control,
debridement of necrotic tissue, wound dressing, infection control, revascularization if
indicated, off-loading pressure from the ulcer site, and education on foot care. (15 marks)
, 4. What are the indications and contraindications of mechanical ventilation in critically ill
patients? What are the modes and settings of mechanical ventilation and how do they
affect the patient's respiratory physiology? (15 marks)
- Mechanical ventilation is indicated for patients who have respiratory failure (hypoxemic or
hypercapnic), respiratory distress (increased work of breathing or dyspnea), or impaired
consciousness (coma or sedation). Mechanical ventilation is contraindicated for patients
who have irreversible brain damage or terminal illness with no chance of recovery. The
modes and settings of mechanical ventilation include volume-controlled ventilation
(VCV), pressure-controlled ventilation (PCV), pressure support ventilation (PSV),
continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP),
tidal volume (VT), respiratory rate (RR), inspiratory time (IT), inspiratory to expiratory
ratio (I:E), fraction of inspired oxygen (FiO2), peak inspiratory pressure (PIP), plateau
pressure (Pplat), mean airway pressure (MAP), trigger sensitivity
1. Describe the cytochrome P450 system. Describe how inducers and inhibitors affect the
cytochrome system and how that affects the half-life of medications.
Cytochromes P450 (CYPs) are a superfamily of enzymes containing heme as a cofactor that
function as monooxygenases. In mammals, these proteins oxidize steroids, fatty acids, and
xenobiotics, and are important for the clearance of various compounds, as well as for hormone
synthesis and breakdown. Cytochrome P450 enzymes can be inhibited or induced by drugs,
resulting in clinically significant drug-drug interactions that can cause unanticipated adverse
reactions or therapeutic failures. Fluoxetine, sertraline, and fluvoxamine are believed to inhibit
cytochrome P450 2C because of observed interactions with phenytoin, diazepam, and other
drugs metabolized by these enzymes. Rifampicin and isoniazid are key drugs used in the
treatment of tuberculosis, while rifampicin is highly effective in inducing hepatic, drug metabolic
P450 enzyme.
The mnemonic SICKFACES.COM can be used to easily remember common cytochrome
P450 inhibitors.
1. Sodium valproate.
2. Isoniazid.
3. Cimetidine.
4. Ketoconazole.
5. Fluconazole.
6. Alcohol & Grapefruit juice.
7. Chloramphenicol.
8. Erythromycin.
2. Describe the affect on low and high albumin levels on active drug levels especially for
drugs that are highly protein bound.
Albumin is the plasma protein with the greatest capacity for binding drugs. Binding to plasma
proteins affects drug distribution into tissues, because only drug that is not bound is available to
PREP
ADVANCED CARE OF
ADULTS IN ACUTE
SETTINGS
ANSWERED
2023/2024
,1. What are the main components of the comprehensive geriatric assessment (CGA) and why
is it important for older adults? (5 marks)
- The CGA is a multidimensional, interdisciplinary diagnostic process that evaluates the
medical, functional, psychological, and social aspects of older adults. It is important
because it can identify the strengths and limitations of older adults, guide individualized
care plans, prevent or delay functional decline, improve quality of life, and reduce
hospitalization and institutionalization. (5 marks)
2. What are some common causes and risk factors of delirium in older adults? How can
nurses prevent and manage delirium in this population? (10 marks)
- Some common causes of delirium in older adults are infections, medications, dehydration,
electrolyte imbalances, surgery, pain, sensory impairment, sleep deprivation, and
environmental changes. Some risk factors are dementia, cognitive impairment, frailty,
comorbidity, polypharmacy, and malnutrition. Nurses can prevent and manage delirium
by identifying and treating the underlying cause, avoiding or minimizing the use of
anticholinergic and sedative medications, ensuring adequate hydration and nutrition,
maintaining normal sleep-wake cycles, providing orientation and reassurance, optimizing
sensory input, and creating a safe and familiar environment. (10 marks)
3. What are the differences between pressure ulcers and diabetic foot ulcers in terms of
etiology, pathophysiology, classification, and treatment? (15 marks)
- Pressure ulcers are caused by prolonged pressure or shear forces on the skin and underlying
tissues, especially over bony prominences. Diabetic foot ulcers are caused by
neuropathy, ischemia, or infection in the feet of patients with diabetes mellitus. Pressure
ulcers are classified according to the depth of tissue damage, from stage I (non-
blanchable erythema) to stage IV (full-thickness tissue loss with exposed bone or
muscle). Diabetic foot ulcers are classified according to the presence or absence of
infection and ischemia, from grade 0 (pre-ulcerative lesion) to grade 5 (gangrene of the
whole foot). Treatment of pressure ulcers involves relieving pressure and shear forces,
debridement of necrotic tissue, wound dressing, infection control, nutrition support, and
pain management. Treatment of diabetic foot ulcers involves glycemic control,
debridement of necrotic tissue, wound dressing, infection control, revascularization if
indicated, off-loading pressure from the ulcer site, and education on foot care. (15 marks)
, 4. What are the indications and contraindications of mechanical ventilation in critically ill
patients? What are the modes and settings of mechanical ventilation and how do they
affect the patient's respiratory physiology? (15 marks)
- Mechanical ventilation is indicated for patients who have respiratory failure (hypoxemic or
hypercapnic), respiratory distress (increased work of breathing or dyspnea), or impaired
consciousness (coma or sedation). Mechanical ventilation is contraindicated for patients
who have irreversible brain damage or terminal illness with no chance of recovery. The
modes and settings of mechanical ventilation include volume-controlled ventilation
(VCV), pressure-controlled ventilation (PCV), pressure support ventilation (PSV),
continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP),
tidal volume (VT), respiratory rate (RR), inspiratory time (IT), inspiratory to expiratory
ratio (I:E), fraction of inspired oxygen (FiO2), peak inspiratory pressure (PIP), plateau
pressure (Pplat), mean airway pressure (MAP), trigger sensitivity
1. Describe the cytochrome P450 system. Describe how inducers and inhibitors affect the
cytochrome system and how that affects the half-life of medications.
Cytochromes P450 (CYPs) are a superfamily of enzymes containing heme as a cofactor that
function as monooxygenases. In mammals, these proteins oxidize steroids, fatty acids, and
xenobiotics, and are important for the clearance of various compounds, as well as for hormone
synthesis and breakdown. Cytochrome P450 enzymes can be inhibited or induced by drugs,
resulting in clinically significant drug-drug interactions that can cause unanticipated adverse
reactions or therapeutic failures. Fluoxetine, sertraline, and fluvoxamine are believed to inhibit
cytochrome P450 2C because of observed interactions with phenytoin, diazepam, and other
drugs metabolized by these enzymes. Rifampicin and isoniazid are key drugs used in the
treatment of tuberculosis, while rifampicin is highly effective in inducing hepatic, drug metabolic
P450 enzyme.
The mnemonic SICKFACES.COM can be used to easily remember common cytochrome
P450 inhibitors.
1. Sodium valproate.
2. Isoniazid.
3. Cimetidine.
4. Ketoconazole.
5. Fluconazole.
6. Alcohol & Grapefruit juice.
7. Chloramphenicol.
8. Erythromycin.
2. Describe the affect on low and high albumin levels on active drug levels especially for
drugs that are highly protein bound.
Albumin is the plasma protein with the greatest capacity for binding drugs. Binding to plasma
proteins affects drug distribution into tissues, because only drug that is not bound is available to
