prep u ch 5

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."

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?"

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) "My family doctor has me on so many different pills now, so I want to talk with her about whether they're all necessary." b) "I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural." c) "I've made a reminder system for myself so that I don't miss any of my pills during the day." d) "Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy." Submit your answer

"I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."

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 Correct

n 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? a) As adults age, their limited vision distorts their ability to read the scale. b) Aging results in an increase in body fat and a decrease in lean body mass. c) Many of the medications that are taken by older adults result in truncal obesity. d) It is normal for older adults to develop edema.

Aging results in an increase in body fat and a decrease in lean body mass.

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? a) Older adults tend to need either higher doses or more frequent doses of a drug to achieve therapeutic effect. b) As a result of age-related changes, older adults face an increased risk of adverse medication effects. c) Older adults tend to achieve clearance of medication faster than younger clients. d) Drug metabolism shifts from the liver to the kidneys as individuals age.

As a result of age-related changes, older adults face an increased risk of adverse medication effects.

In order to reduce an older adult's risk of experiencing adverse drug effects or interactions, what action should the nurse prioritize? a) Encourage patients to seek a second opinion whenever prescribed a new drug. b) Assess the degree to which patients understand the indications for their medications. c) Encourage patients to taper down their dosages until they sense the reemergence of symptoms. d) Assess the patient's use of herbal remedies and OTC medications. Submit your answer

Assess the patient's use of herbal remedies and OTC medications

How is the renal system affected by the aging process? (Select all that apply.) a) Decrease in the number of functioning nephrons b) Increased creatinine clearance c) Decrease in blood flow to the kidneys d) Increased glomerular filtration rate e) Decrease in tubular secretion

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

What are the most common medical problems seen in older adults? (Select all that apply.) a) Diabetes mellitus b) Heart disease c) Ventral hernia d) Systemic lupus erythematosus e) Arthritis

Diabetes mellitus • Heart disease • Arthritis

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? a) "Which pharmacy do you use to fill your prescriptions?" b) "What effect are you expecting that these medications will have on your health?" c) "Do you prefer to take liquid medications or are you fine with taking pills?" d) "Do you take any herbal supplements or alternative medications?"

Do you take any herbal supplements or alternative medications?"

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? a) Drug clearance is likely to be slower. b) The kidneys will likely compensate for decreased hepatic capacity. c) Multiple bioactive substances will be needed for therapeutic effect. d) Elimination half-time is likely to be faster. Submit your answer

Drug clearance is likely to be slower.

A 70-year-old preparing for discharge from the hospital tells the nurse that she must take bisacodyl (Dulcolax) every day or she will not have a bowel movement daily. What would the nurse include in the discharge teaching? a) Call the physician for a prescription for Dulcolax suppositories because they have less of an addictive quality. b) Educate the client on natural ways to stimulate bowel evacuation such as increasing the fiber in her diet. c) Inform the client that she will probably need a stronger laxative soon because the Dulcolax will stop working. d) Alert the client that she is addicted to laxatives and will have to continue using them or will be unable to defecate.

Educate the client on natural ways to stimulate bowel evacuation such as increasing the fiber in her diet.

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? a) Rapid drug clearance fostered when a client is able to minimize the number of drug administration times. b) Combining a new drug with one or more existing drugs mitigates the risk of adverse effects. c) Integrating the new drug into the client's existing schedule promotes adherence. d) Taking several drugs at one time maximizes recovery time for the liver and kidneys. Submit your answer

Integrating the new drug into the client's existing schedule promotes adherence. Correct

An elderly client calls the physician'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? a) Take prescribed medication as needed. b) Ask for child-proof caps for all medication bottles. c) Place pills in a daily or weekly pillbox organized according to hours of the day or mealtimes. d) Refill prescription medication when the last dose is taken. Submit your answer

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? a) Pharmacotherapeutic drug use b) Polypharmacy c) Elderly pharmacology abuse d) Multiple drug use

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? a) Order an ECG. b) Review the drugs being taken. c) Administer a stimulant. d) Check serum electrolyte levels.

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 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 client is noncompliant with the therapeutic drug regimen. b) The client is nonadherent and is taking too many prescription medications. c) The nurse feels as though the client is not being truthful. d) The laxatives can interact with and complicate prescribed drug therapy. Submit your answer

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? a) The older adult is having transient ischemic attacks. b) The older adult has an overwhelming infection. c) The older adult has an electrolyte imbalance, leading to delirium. d) The older adult is experiencing mental changes as an adverse drug effect.

The older adult is experiencing mental changes as an adverse drug effect.

A 79-year-old patient has been diagnosed with sepsis and the care team is deciding on the most appropriate course of antibiotic therapy. 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? a) The patient may require lower-than-normal doses of a drug. b) The patient may require higher doses to achieve therapeutic effect. c) The patient may require small, frequent doses of a drug. d) The patient may require oral, rather than IV, drug administration.

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? a) To determine if the client needs another medication added to the present drug profile b) To determine if the client is able to take the medication as prescribed c) To determine if the client is noncompliant with medication regimen d) To determine any new signs and symptoms in the client that could be related to drug therapy

To determine any new signs and symptoms in the client that could be related to drug therapy Correct

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 a) altered gastric pH levels. b) decreased gastrointestinal motility. c) decreased blood flow to tissues and muscles. d) increased levels of plasma albumin.

decreased blood flow to tissues and muscles.

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) the dose of metoprolol XL is too small for an extended-release medication. c) digoxin and Lanoxin are the same medications. d) pravastatin should be taken in the morning and not the eveni

digoxin and Lanoxin are the same medications.

What is the relation between the activity level of older adults and the response to medication? a) There is no relation between activity level and medication response. b) The more active the older adult, the greater the chance for adverse effects to prescribed drugs. c) The older adult who is more physically active is less likely to have an adverse drug effect. d) The less physical activity an older adult engages in, the less chance there is for an altered response to a medication.

he older adult who is more physically active is less likely to have an adverse drug effect.

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

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: a) polypharmacy decreasing the number of available protein-binding sites. b) the normally low protein-binding properties of Dilantin. c) increased efficiency of the blood-brain barrier. d) an increase in creatinine to be filtered.

polypharmacy decreasing the number of available protein-binding sites. Correct

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.

What interventions will the nurse use to improve adherence to a medication regimen for the older adult? (Select all that apply.) a) Educate client and family to the medication regimen b) Provide easy-to-follow directions c) Use brand name drugs d) Keep the cost of the medications as low as possible e) Plan medication administration every 2 hours

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