Patho & Pharm PrepU Ch 5
The nurse should caution an older adult client against using diphenhydramine hydrochloride because of what increased risk?
Confusion
The 68-year-old client states, "I have been taking aspirin on occasion for my arthritis for many years but notice that it takes longer for it to start working now." What is the best response by the nurse?
"As you get older, absorption is prolonged and medications may take a little longer to act than normal."
A nurse is conducting an assessment of a client who has recently had several changes made to the drug regimen. What assessment question most directly addresses the safety implications of the client's drug regimen?
"Do you take any herbal supplements or alternative medications?"
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?
"I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."
The nurse educates an older adult about the seven prescribed medications to prevent medication-related reactions and adverse effects. Which client statement indicates the need for further clarification?
"The dietary supplement I used to take before admission to the hospital is all right to restart."
The elderly client has been noncompliant with taking a prescribed medication. The nurse asks the client:
"What is the reason you have not taken the medication?"
What interventions will the nurse use to improve adherence to a medication regimen for the older adult? (Select all that apply.)
-Educate client and family to the medication regimen -Provide easy-to-follow directions -Keep the cost of the medications as low as possible
When should the nurse assess all the client's prescribed medications? (Select all that apply.) -when a medication is discontinued -when the client orders medications from another country -during every visit to a health care facility -when the client transitions from one health care setting to another
-during every visit to a health care facility -when the client transitions from one health care setting to another
The elderly client is taking five prescription and over-the-counter medications. The nurse calculates the client is at risk for two-drug combinations that could interact to produce an adverse effect. The number of these two-drug combinations is:
10 The client is at risk for 10 two-drug combinations that could interact to produce an adverse effect. 1 2 3 4 5 1-----2x----3xx---4xxx--5xxxx- x indicates two-drug combination
The nurse who is caring for an older client sees that the latest laboratory report reveals a decreased creatinine clearance. The nurse anticipates what modification to the client's drug regimen?
A decrease in the dosage of medication
An older adult is concerned because his clothes feel tight though he hasn't gained any weight. The nurse knows that this is because of what physiologic change related to aging?
Aging results in an increase in body fat and a decrease in lean body mass.
Which factor should the nurse take into account when administering medications to older adults on the unit?
As a result of age-related changes, older adults face an increased risk of adverse medication
To reduce older adults' risk of experiencing adverse drug effects or interactions, what action should the nurse prioritize?
Assess clients' use of herbal remedies and over-the-counter (OTC) medications.
A 72-year-old man with pain issues is being given a drug by the intramuscular route. His serum blood level concentrations have been erratic. The nurse suspects that this may be due to
Decreased blood flow to tissues and muscles
What are the most common medical problems seen in older adults? (Select all that apply.) Arthritis Heart disease Ventral hernia Diabetes mellitus
Diabetes mellitus Arthritis Heart disease
A home health nurse is performing a home visit to an elderly client who has early-stage dementia. The nurse observes that some of the client's pill bottles are empty, even though the client is not due for refills for 2 weeks. What nursing diagnosis should the nurse prioritize when planning this client's care?
Ineffective Therapeutic Regimen Management
A 79-year-old woman who takes several medications for a variety of chronic health problems has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has encouraged the woman to take the pill at the same time of day that she takes some of her other medications. What is the most likely rationale for the nurse's advice?
Integrating the new drug into the client's existing schedule promotes adherence.
What intervention can the nurse provide to improve adherence for elderly clients who are taking multiple drugs?
Make drug regimens easy to follow and uncomplicated.
An older adult client calls the health care provider's office and tells the nurse that prescriptions for three medications have run out and the pharmacy will not refill them this close together. A home health referral is made and the client is found to be taking the medication more often than prescribed. What is a priority nursing diagnosis for this client?
Nonadherence to therapeutic medication regimen
A nurse who is working with an older adult who takes eight medications a day wants to promote medication adherence. Which nursing intervention would best promote medication adherence?
Place pills in a daily or weekly pillbox organized according to hours of the day or mealtimes.
The nurse should be aware that many older adults take multiple prescribed and over-the-counter (OTC) drugs. What is taking several drugs simultaneously known as?
Polypharmacy
An 82-year-old is suffering from acute anxiety and is prescribed alprazolam (Xanax) by the health care provider. What steps can the provider take to ensure that the client will be at a decreased risk for injury?
Prescribe a smaller dose
Mental dysfunction in an older adult 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 older adult with a mental dysfunction such as extreme confusion?
Review the drugs being taken.
A 76-year-old client with congestive heart failure is being admitted to the hospital. The client states only taking medications that the health care provider 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?
The laxatives can interact with and complicate prescribed drug therapy.
A healthy 70-year-old man has been having trouble sleeping at night. Additionally, he has been having difficulties with gastroesophageal reflux. He buys generic Benadryl to help him sleep and buys generic Tagamet for his reflux. After 7 days of taking these over-the-counter medications, he exhibits signs of confusion and disorientation. His wife calls the primary care facility to speak with the nurse. What should the nurse suspect first?
The older adult is experiencing mental changes as an adverse drug effect.
What is the relation between the activity level of older adults and the response to medication?
The older adult who is more physically active is less likely to have an adverse drug effect.
The patient's admission blood work indicates a low creatinine clearance rate (CrCl). A low CrCl may have what implication for the patient's pharmacotherapy?
The patient may require lower-than-normal doses of a drug.
Why is it important for the nurse to obtain baseline information from a client, such as a drug profile, an accurate history of the client's usual abilities, and changes in abilities or health status?
To determine any new signs and symptoms in the client that could be related to drug therapy
An elderly client comes into the clinic with a family member. The client reports back pain. The health care provider prescribes cyclobenzaprine (Flexaril) for the client. What type of adverse effects should the nurse educate the client and family about?
anti-cholinergic side effects such as sedation and weakness
Ethnicity is a variable that is known to affect what aspect of pharmacokinetics in older adults?
metabolism
What phenomenon is primarily responsible for the changes in pharmacokinetics that accompany the aging process?
decreased function of vital organs
A 72-year-old man who is unable to sleep since admission into the hospital is given a hypnotic medication at 9 PM. The nurse finds the patient drowsy and confused at 10 AM the next day. The nurse is aware that this behavior is most likely due to
decreased hepatic function.
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:
digoxin and Lanoxin are the same medications.
The mentoring nurse is orienting a new graduate RN to the geriatric floor. What assessment technique will the new graduate nurse perform to identify an age-related physiological change associated with medication metabolism?
external palpation of the liver
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?
frail elderly
A 92-year-old woman is beginning to take a new medication. What may affect drug absorption in this client? (Select all that apply.) increased gastric acidity increased gastric pH decreased blood flow to the stomach diminished gastric emptying
increased gastric pH decreased blood flow to the stomach diminished gastric emptying
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?
medication reconciliation
A nurse is caring for an 81-year-old client in a long-term care facility who takes nine different medications each day. The client has a recent diagnosis of seizure disorder and has begun treatment with phenytoin (Dilantin), a highly protein-bound drug. After 1 month of Dilantin therapy, the client is still extremely drowsy and sluggish. The nurse determines that the prolonged adverse effect is likely due to:
polypharmacy decreasing the number of available protein-binding sites.
A client will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During client education about drug regimen, the nurse should prioritize teaching about:
potential adverse effects of the drugs that the client will be taking.
A client has been diagnosed with cardiovascular disorder. The client is age 68; suffers from intermittent joint pain and is under drug therapy; eats meat, salads, and fruits; prefers alternative herb medications along with drug therapy; sometimes smokes; he lives alone and is looked after by a caregiver. Which item of information has the greatest implication for planning his drug therapy?
prefers alternative herb medications
The nurse knows that when caring for the older adult, there are several normal aging processes that put the client at risk for toxicity. What factor puts such clients at increased risk for drug toxicity?
reduced efficiency of renal function
An older adult client has had two falls in the period of a week. The care provider's willingness to consider discontinuation of the medication demonstrates a consideration of what safety-related action?
risk-to-benefit ratio
A nurse is caring for a 92-year-old who is taking multiple drugs and displaying increased cognitive impairment and memory loss. The initial action of the nurse would be to:
try to distinguish between normal signs of aging and the adverse drug effects.
A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. The client has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the client's drug therapy?
vascular impairment
