Chapter 11: Drug Therapy in Older Adults (Evolve, Kahoot, PPT)
Which statement about drug use among older adults is true? A. Drug use among older adults is disproportionately high. B. Older adults consume 20% of the nation's prescribed drugs. C. Older patients are less sensitive to drugs than younger adults. D. Older adults experience fewer adverse drug reactions.
A. Drug use among older adults is disproportionately high. Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions.
When preparing a teaching session for residents at an assisted living facility, the nurse will include what? A. The importance of avoiding intentional underdosing B. The importance of using multiple pharmacies for cost-effective savings on prescription drugs C. The importance of taking double amounts of missed doses to maintain therapeutic levels of medications D. The importance of reducing protein intake while taking prescription medications
A. The importance of avoiding intentional underdosing Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. Using multiple pharmacies should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.
An older adult patient is taking a new prescription medication. After reviewing the patient's medical record, the nurse is most concerned about an adverse drug reaction if what is documented? A. The patient is currently taking eight prescription medications. B. The patient's urinary creatinine clearance is 70 mL/min/1.73 m2. C. The patient regularly takes herbal and dietary supplements. D. The patient takes a medication with a high therapeutic index.
Answer: B Rationale: Drug accumulation secondary to reduced renal function in older adults is the most important factor in adverse drug reactions. The best indicator of renal function is urinary creatinine clearance. Urinary creatinine clearance of less than 105 to 110 mL/min/1.73 m2 indicates reduced renal function.
An older adult patient frequently forgets to take an oral medication that has been prescribed to be taken 3 times a day. Which action by the nurse is best? A. Assess the patient's ability to swallow the medication. B. Arrange for a neighbor to call the patient 3 times a day. C. Call the prescriber for a sustained-release form of the drug. D. Give the patient verbal and written instructions about the drug.
Answer: C Rationale: If the patient forgets to take a prescribed medication that is scheduled throughout the day, simplifying the regimen by reducing the number of doses per day may improve adherence. •Enlisting the aid of a friend, relative, or visiting healthcare professional 3 times a day may be helpful, but it is not realistic. •In addition, the patient should retain as much independence as possible in his or her self-care.•Explaining the treatment plan using clear and concise verbal and written instructions will not directly correct the problem of forgetfulness. •Difficulty swallowing may be a reason for nonadherence, but it is not related to the problem of forgetfulness.
The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal function in this patient? A. Serum creatinine B. Blood urea nitrogen C. Urinalysis D. Creatinine clearance
Answer: D Rationale: In older adults, the proper index of renal function is creatinine clearance. Serum creatinine levels do not reflect kidney function in older adults, because the source of serum creatinine—lean muscle mass—declines in parallel with the decline in kidney function. As a result, creatinine levels may be normal even though renal function is greatly reduced.
The nurse will monitor which laboratory result closely when administering medications to an older adult patient while assessing for adverse drug reactions (ADRs)? A. Serum creatinine levels B. Creatinine clearance C. Serum albumin levels D. Liver function tests
B. Creatinine clearance Drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the elderly. Creatinine clearance, not serum creatinine levels, is the proper index of renal function in older adult patients.
What is the Beers list? A. Drugs with a low likelihood of causing adverse effects in older adults B. Drugs with a high likelihood of causing adverse effects in older adults C. Drugs with zero likelihood of causing adverse effects in older adults D. Drugs that are recommended to be used for older adults
B. Drugs with a high likelihood of causing adverse effects in older adults The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults.
Which statement about the percentage of oral drug absorption is true? A. The percentage absorbed increases with age. B. The percentage absorbed decreases with age. C. The percentage absorbed does not usually change with age. D. The percentage absorbed severely declines with age.
C. The percentage absorbed does not usually change with age. As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.
To evaluate kidney function in an elderly pt, which lab result is a priority? Creatinine clearance Serum creatinine Serum blood urea nitrogen (BUN) Renal ultrasound
Creatinine clearance
When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? A. Absorption B. Distribution C. Metabolism D. Excretion
D. Excretion Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of ADRs in the older adult.
Which is not a reason for the decline in hepatic drug metabolism with age? A. Reduced hepatic blood flow B. Reduced liver mass C. Decreased activity of some hepatic enzymes D. Poor diet
D. Poor diet Rates of hepatic drug metabolism tend to decline with age. Principal reasons are reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.
The nurse is caring for a group of older adult patients who are all receiving multiple medications. The nurse understands that it is essential to individualize each patient's therapy. Which is the best rationale for this practice? A. The percentage of drug absorbed often is decreased in older adults. B. Most older adults have decreased body fat and increased lean mass. C. Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels. D. Renal function declines with age, leading to decreased drug excretion.
D. Renal function declines with age, leading to decreased drug excretion. Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.
An 83-year-old patient is being discharged to home after a stay in the acute care facility for heart failure and atrial fibrillation. The discharge orders include furosemide [Lasix], digoxin [Lanoxin], and warfarin [Coumadin]. Should the nurse include any specific instructions regarding warfarin [Coumadin] therapy?
In addition to routine patient teaching regarding warfarin [Coumadin], the nurse should stress the importance of taking the medication as prescribed in adherence with laboratory test results. Older patients usually have less albumin, which is a protein. Warfarin [Coumadin] is a protein-bound drug. The free warfarin [Coumadin] could increase the older patient's risk of bleeding.
An 83-year-old patient is being discharged to home after a stay in the acute care facility for heart failure and atrial fibrillation. The discharge orders include furosemide [Lasix], digoxin [Lanoxin], and warfarin [Coumadin].Is there any specific information that the nurse should include in the patient education regarding furosemide [Lasix]?
In addition to the standard patient teaching regarding the medication regimen for furosemide [Lasix] therapy, the nurse should also teach the patient to be aware of how to prevent orthostatic hypotension. Older patients have a greater chance of developing a drop in blood pressure when rising from a sitting or lying position to a standing position and thus should be cautioned to rise slowly to avoid falling.
An 83-year-old patient is being discharged to home after a stay in the acute care facility for heart failure and atrial fibrillation. The discharge orders include furosemide [Lasix], digoxin [Lanoxin], and warfarin [Coumadin]. Is there any specific information that the nurse should teach the patient regarding digoxin [Lanoxin] therapy?
The nurse should be sure to provide information about signs and symptoms of toxicity to the medication, because the half-life of digitalis [Lanoxin] is doubled in patients who are more than 80 years old. The patient should be reminded of the importance of taking the medication as prescribed and keeping follow-up appointments with the healthcare provider.
An older adult with liver disease on meds that are normally highly protein bound with an albumin level of 2.8 (normal level: 3.5-5) should be assessed for: excessive action of the drugs inadequate action of the drugs
excessive action of the drugs
Which anticholinergic effect is a priority to report to provider as an AE in elderly pt? has not voided in 16 hours no bowel movement for 48 hours dry mouth blurred vision
has not voided in 16 hours
Which of the following is NOT an underlying factor for the increase in adverse reactions in elder population? polypharmacy increased renal function increased individual variation comorbidities
increased renal function
The most important cause of adverse drug reactions in the older adult is: decreased lean muscle mass reduced hepatic function decreased absorption reduced renal function
reduced renal function
Which sign/symptom would warrant the nurse to hold/call provider if prepping to give ketorolac to an 83 yr old? difficulty waking up in the morning Constipation tarry stools dizziness when changing from a prone to upright position
tarry stools
Which factors may contribute to unintentional nonadherence? (Select all that apply.) A. Forgetfulness B. Failure to comprehend instructions C. Unpleasant side effects D. Inability to pay for medications E. Belief that the drug is not needed
A. Forgetfulness B. Failure to comprehend instructions D. Inability to pay for medications Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.
Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? (Select all that apply.) A. Taking a thorough drug history, including over-the-counter (OTC) medications B. Monitoring clinical response and laboratory results to help determine proper dosage C. Using as many drugs as possible to reduce symptoms and improve outcome D. Regularly monitoring patients for drug-drug and drug-nutrient interactions E. Helping patients to avoid prescriptions for drugs on the Beers list
A. Taking a thorough drug history, including over-the-counter (OTC) medications B. Monitoring clinical response and laboratory results to help determine proper dosage D. Regularly monitoring patients for drug-drug and drug-nutrient interactions Correct E. Helping patients to avoid prescriptions for drugs on the Beers list Correct A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly.
