ATI CHAPTER 5: PHARM

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 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."

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.

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?"

The nurse who is caring for an older client and 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

Older adults are susceptible to what type of infection?

Antibiotic-resistant

A nurse who works in an acute care for elders (ACE) unit recognizes the unique pharmacokinetics and pharmacodynamics that often occur in older adults. 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 effects.

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.

What schedule of medication dosing assists older adults in adhering to a medication regimen?

Begin with a low dose to minimize adverse effects

How is the renal system affected by the aging process? (Select all that apply.)

Decrease in blood flow to the kidneys Decrease in the number of functioning nephrons Decrease in tubular secretion

What are the most common medical problems seen in older adults? (Select all that apply.)

Diabetes mellitus Arthritis Heart disease

A nurse is aware that older adults tend to have a significantly decreased rate of hepatic blood flow compared with younger adults. What effect is this likely to have on pharmacokinetics and pharmacodynamics in an older adult?

Drug clearance is likely to be slower.

Which condition contributes to nonadherence to the medication regimen due to its lack of identifiable symptoms?

Hypertension

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 interventions will the nurse use to improve adherence to a medication regimen for the older adult? (Select all that apply.)

Keep the cost of the medications as low as possible Provide easy-to-follow directions Educate client and family to the medication regimen

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.

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

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?

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.

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?

There is less creatinine overall to be filtered.

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

The ability of older adults to adequately distribute drugs that are ingested is highly dependent on serum levels of what factor?

albumin

An older adult client intends to supplement a prescribed anti-inflammatory with a herbal remedy that a neighbor strongly recommended. What action should the nurse encourage the client to take before initiating that plan?

checking with the care provider before taking the supplement

The nurse should caution an older adult client against using diphenhydramine hydrochloride because of what increased risk?

confusion

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 phenomenon is primarily responsible for the changes in pharmacokinetics that accompany the aging process?

decreased function of vital organs

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.

A 75-year-old client with diabetes had an ankle wound that became infected. An intramuscular injection of a low concentration of ampicillin in saline solution was absorbed very quickly, and the infection was controlled. Which factor was most likely responsible for the quick absorption?

disease

Intravenous diazepam (Valium) is given to clients for an outpatient procedure. The elderly client who may experience effects of the medication for a prolonged period is the client who is:

morbidly obese.

An older adult client has presented with signs and symptoms that are suggestive of a urinary tract infection. Due to the risk of nephrotoxicity among older clients, the nurse practitioner should avoid prescribing which drug?

nitrofurantoin

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 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

A hospital nurse works on a unit specializing in neurological problems and frequently provides care to elderly clients who have undergone spinal surgery. The nurse assesses that the client at highest risk for a medication-related problem:

prescribed metoprolol, pantoprazole, and docusate.

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

A n 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

The elderly client has been taking digoxin for the past several months. To assess the client for toxicity of digoxin, what would the nurse evaluate? (Select all that apply.)

serum digoxin level apical pulse rate reports of yellow halo around lights electrolyte levels