Older Adults
A
A 72-year-old has been taking disopyramide (Norpace) for cardiac dysrhythmias. What assessment by the nurse indicates complications from this medication? A) crackles, dyspnea, orthopnea B) nausea, vomiting, and diarrhea C) oliguria, dry skin, and uremia D) confusion, lethargy, and constipation
A
A 73-year-old client has been given metoclopramine to take before meals. The client tells the nurse that the client has noticed tremors of the hands and the head has been shaking. What does the nurse understand may be occurring? A) parkinsonian effects from the metoclopramide B) Parkinson's disease C) a high level of anxiety D) an allergic reaction to the metoclopramide
C
A 76-year-old client with congestive heart failure is being admitted to the hospital. The client states only taking medications that the physician prescribes, but when the nurse assesses the medications, three over-the-counter laxatives are in the client's bag of medications. What concerns does the nurse have about this omission? A) The nurse feels as though the client is not being truthful. B) The client is nonadherent and is taking too many prescription medications. C) The laxatives can interact with and complicate prescribed drug therapy. D) The client is noncompliant with the therapeutic drug regimen.
A
A 76-year-old is brought into the clinic via wheelchair by a family member. The client has end-stage renal disease, hypertension, diabetes mellitus, and two prior myocardial infarctions. What category of elderly is this client considered? A) frail elderly B) old-old C) young elderly D) middle-old
D
A gerontological nurse is conducting a medication assessment of a new client on a subacute medicine unit. Which of the client's statements should signal to the nurse a need for education? A) "Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy." B) "I've made a reminder system for myself so that I don't miss any of my pills during the day." C) "My family doctor has me on so many different pills now, so I want to talk with her about whether they're all necessary." D) "I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."
A, C, E
A medical-surgical nurse works is admitting an elderly client to the unit. When does the nurse perform this client's medication reconciliation? (Select all that apply.) A) when the client is transferred to the intensive care unit B)at the end of the nurse's shift C) upon admission to the hospital D) when the client goes to radiology for a chest x-ray E) prior to discharge to a skilled nursing facility
A
A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care facility. When appraising the woman's medication regimen in light of the Beers Criteria, the nurse will look for A) Drugs that are known to cause adverse effects in older adults. B) Drugs for which generic equivalents are available at lower cost. C) Drugs that have been found to be ineffective in older adults. D) Drugs that are known to exacerbate the aging process.
A
A nurse who provides care for older adults is aware of the decreased rate of drug distribution among this population. The ability of older adults to adequately distribute drugs that are ingested is highly dependent on serum levels of A) Albumin B) Creatinine C) Blood urea nitrogen D) Sodium
B
An 82-year-old is suffering from acute anxiety and is prescribed alprazolam (Xanax) by the physician. What steps can the physician take to ensure that the client will be at a decreased risk for injury? A) Total daily dose should exceed the suggested maximum dose. B) Prescribe a smaller dose. C) Substitute the Xanax with a different benzodiazepine. D) This drug has a short half-life and should be prescribed more frequently.
A
An elderly client comes into the clinic with a family member. The client reports back pain. The physician prescribes cyclobenzaprine (Flexaril) for the client. What type of adverse effects should the nurse educate the client and family about? A) anti-cholinergic side effects such as sedation and weakness B) increased agitation and irritability C) asymptomatic gastrointestinal pathology D) may cause delirium and hallucinations
A, B, C, E
An elderly client has received gentamicin intravenously for several days. To assess for toxicity of gentamicin, the nurse evaluates: A) BUN and creatinine levels. B) for any tinnitus or hearing loss. C) daily weight of the client. D) complete blood counts. E) gentamicin peak and trough levels.
A, B, C, E
An elderly client has received intravenous vancomycin for several days. To assess for toxicity of vancomycin, what should the nurse evaluate? (Select all that apply.) A) peak and trough drug levels B) BUN and creatinine C) color of the urine D) liver function tests E) intake and output ratios
B
An elderly client is being admitted to the hospital for surgery. The nurse is reconciling the client's medications. The client is prescribed digoxin 0.125 mg daily, furosemide 40 mg two times a day, Lanoxin 0.125 mg daily, metoprolol XL 25 mg once a day, and pravastatin (Pravachol) 40 mg at hours of sleep daily. The nurse recognizes a problem when the nurse notes: A) furosemide is not recommended to be given two times a day. B) digoxin and Lanoxin are the same medications. C) the dose of metoprolol XL is too small for an extended-release medication. D) pravastatin should be taken in the morning and not the evening.
A
An elderly client is prescribed a medication to take twice a day at breakfast and dinner. The client is now prescribed a second medication to take once a day. The nurse tells the client to take the medication: A) with breakfast. B) at 0900 each day. C) at hour of sleep. D) two hours after the other medication.
C
An elderly client who is supposed to take a large calcium tablet every day objects because it is difficult to swallow the tablet without choking. What is the most helpful action an attending nurse can take in this situation? A) Substitute a glass of milk for the tablet. B) Have the client take the tablet along with food or drink. C) Find the most concentrated form of the same dose. D) Ask the physician if it can be discontinued.
B
An older adult's most recent blood work reveals that his serum albumin level is 21 g/L (low). This will most influence what aspect of pharmacokinetics? A) Absorption B) Distribution C) Metabolism D) Excretion
A
In order to reduce an older adult's risk of experiencing adverse drug effects or interactions, what action should the nurse prioritize? A) Assess the patient's use of herbal remedies and OTC medications. B) Encourage patients to seek a second opinion whenever prescribed a new drug. C) Encourage patients to taper down their dosages until they sense the reemergence of symptoms. D) Assess the degree to which patients understand the indications for their medications.
C
Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse indicates that his liver function has been gradually decreasing over the last several years. How will this age-related physiological change influence drug metabolism? A) The patient will metabolize drugs more quickly but derive less of a therapeutic benefit from them. B) The liver will sequester drug molecules in the hepatocytes, and they will be released at unpredictable times. C) Many of the patient's medications will remain in his body for a longer time. D) The patient's kidneys will be forced to metabolize a disproportionate quantity of medications.
B
Mental dysfunction in an elderly person may seem like a normal part of aging, but it can result from disease or another cause. What should the ER staff do first for a presenting elderly person with a mental dysfunction such as extreme confusion? A) Order an ECG. B) Review the drugs being taken. C) Check serum electrolyte levels. D) Administer a stimulant.
A, B, E
The elderly client is being triaged in the emergency department for a report of dizziness. What should the nurse assess? (Select all that apply.) A) blood pressure and pulse B) the client's list of medications C) drug levels in the urine D) serum potassium E) a history of renal or hepatic disease
C
The nurse is caring for an older female who has decreased urinary output. The nurse realizes this is a sign of decreased renal function. The patient's serum creatinine level is normal. What factor should the nurse understand as the reason for this? A) There is absence of renal dysfunction. B) There is high effectiveness of the prescribed drug. C) There is less creatinine overall to be filtered. D) There is slower drug excretion and altered drug half-life.
C
The nurse is obtaining a list of the medications that an elderly client is taking. The client is known to be taking 14 different medications. What concern does the nurse have? A) The client has an increased opportunity to take a drug overdose. B) The client may be noncompliant with the drug regimen. C) The client has an increased risk for morbidity and mortality. D) The physician probably is not aware that the client is taking all this medication.
B
The nurse is reviewing medications with an elderly client who has a history of spinal cord injury. The client reports taking bisacodyl (Dulcolax) every day. When providing client education, the nurse states A) "Bisacodyl is recommended for you on a long-term basis to ensure daily bowel movements." B) "Let me explore other alternative methods with you to assist in having bowel movements." C) "You should increase the fat content in your diet when taking bisacodyl." D) "You can switch to the suppository form of bisacodyl if you experience vomiting."
C
The nurse understands that several physiologic changes are related to normal aging. Which change is the least affected by the pharmacokinetic process during aging? A) Metabolism B) Distribution C) Absorption D) Excretion
A)
What intervention by the nurse will help to rectify inappropriate drug prescriptions, prevent drug interactions, and correct accidental overuse of a prescribed drug in the older client? A) medication reconciliation B) medication compliance C) medication adherence D) medication distribution
C
What intervention can the nurse provide to improve adherence for elderly clients who are taking multiple drugs? A) Have the client come in weekly and put all medication in a drug dispenser. B) Have the physician decrease the amount of medication the client is taking. C) Make drug regimens easy to follow and uncomplicated. D) Have a family member administer all medications.
