Prep U 8 Safe Medication Use

An older adult client is prescribed tacrine to help with cognitive functioning. What should the nurse include when teaching the client about this medication? A. take on an empty stomach B. take after eating a full meal C. recline for an hour after taking D. sit upright for 30 minutes after taking

A Reason: Clients should be instructed that tacrine is best taken on an empty stomach. Food interrupts the metabolism of this medication. There is no need to recline or sit upright after taking this medication.

An older adult client is prescribed a diuretic for heart failure. What should the nurse include when teaching this client about ways to avoid hypokalemia? A. avoid foods and beverages with caffeine B. limit the intake of green leafy vegetables C. plan to take the medication before bedtime D. take the medication with coffee every morning

A Reason: A high caffeine intake can heighten the hypokalemic effects of diuretics. Green leafy vegetables will not help prevent hypokalemia. Taking the medication before bedtime will not impact the development of hypokalemia. Coffee contains caffeine and would potentiate the development of hypokalemia.

Which client has the highest risk for developing medication toxicity? A. The 56-year-old client diagnosed with glomerular nephritis B. The 80-year-old client experiencing a cardiac dysrhythmia C. The 61-year-old client receiving intravenous antibiotics D. The 90-year-old client diagnosed with terminal cancer

A Reason: An age-related decline in glomerular filtration rate, which begins in early adulthood and progresses at an annual rate of 1% to 2%, can decrease renal clearance and increase serum levels of medications. While all the clients listed may be experiencing a decrease in glomerular function, the diagnosis of a glomerular-related disorder would place the 56-year-old client at a high risk for drug toxicity.

An older adult is prescribed an antibiotic to be taken three times a day. What is the best schedule for administration of the antibiotic? A. 0600, 1400, 2200 B. 0900, 1700, 0100 C. 0800, 1600, 2400 D. 1000, 1800, 0200

A Reason: Antibiotics should be administered on a regular schedule to maintain a constant blood level. Older adults tend to go to bed early and wake up earlier; therefore, avoiding waking the client up during the night is preferable.

An older adult client taking spironolactone is experiencing an increase in blood pressure. Which action will the nurse take next? A. Check the medication record for use of aspirin. B. Encourage the client to exercise more. C. Recommend the client drink more water. D. Educate the client about a diet low in sodium.

A Reason: Aspirin can decrease the effects of spironolactone, which would cause the client's blood pressure to increase. If the record does not indicate the client is using aspirin, the nurse will educate the client about the other nonpharmacologic ways to lower blood pressure.

An older adult client is prescribed methylcellulose every morning. What should the nurse emphasize when teaching about this medication? A. mix with large amounts of water B. it takes 6 to 10 hours to be effective C. expect to experience abdominal cramps D. it coats fecal material to ease evacuation

A Reason: Bulk formers such as methylcellulose absorb fluid in the intestines and create extra bulk, which distends the intestines and increases peristalsis. Bulk formers need to be mixed with large amounts of water. Stimulants take 6 to 10 hours to be effective. Abdominal cramps can occur with a stimulant. Lubricants coat fecal material to ease evacuation.

A client who is being treated for liver cirrhosis states taking the herbal preparation chaparral. Which is the best response by the nurse? A. "Please discuss this herbal supplement with your health care provider." B. "There are no concerns about you taking this herbal supplement." C. "Please take this supplement with caution." D. "Do not take more than the recommended dosage of this herbal supplement."

A Reason: Chaparral can cause liver damage and should be avoided in the client with liver disease. The nurse should ask the client to refrain from taking this herbal supplement until consulting with the health care provider.

After reviewing the medical record of an older adult client with arthritis, the nurse contacts the health care provider to have a prescription for celecoxib changed. What information did the nurse use to make clinical decision? A. allergy to sulfa B. heart rate 72 beats/min and regular C. systolic blood pressure 150 mm Hg D. urine output 800 ml over the past 4 hours

A Reason: Clients who are allergic to sulfa drugs may have allergic reactions to celecoxib. A regular heart rate, elevated systolic blood pressure, or urine output of 800 ml over 4 hours are not reasons to have the medication celecoxib changed.

The nurse is caring for an older adult client admitted with dehydration. The client's serum albumin level is 2.9 g/dL (29 g/L). What is most important for the nurse to check before administering the client's scheduled medications? A. Dosage level of the medications B. Decreased effectiveness of the drugs C. Excretion of the drugs D. Time of day when administered

A Reason: Conditions such as dehydration and hypoalbuminemia decrease drug distribution and result in higher drug levels in the plasma. When these conditions exist, lower dosage levels may be necessary. The higher levels of drugs would likely increase the effects of the drug. Excretion of medications cannot be assessed until after the drugs are administered. The time of day will not likely affect the distribution of drugs as much as the dosage levels will.

An older client is being treated for heart failure. Which medication should the nurse monitor for potentially adverse effects in this client? A. Digoxin B. Warfarin C. Furosemide D. Metoprolol

A Reason: Decreasing cardiac function contributes to the almost 50% reduction in blood flow to the kidneys. Drugs are not as quickly filtered from the bloodstream and are present in the body longer. Drugs that have a likelihood of accumulating because of an increased biological half-life include digoxin. Warfarin, furosemide, and metoprolol are not identified as medications that have an increased biological half-life.

A home health nurse assesses an older adult client who has been having a difficult time sleeping throughout the night and having incontinence. Which question by the nurse provides the most useful clues to the client's concerns? A. "What beverages do you drink on a regular basis?" B. "What is your normal bedtime routine?" C. "What medications do you take when you need to stay asleep?" D. "What did your health care provider tell you about your medications?"

A Reason: Determining what medications the client has used PRN can be helpful, but an increase in caffeine intake might be making it difficult for the older adult client to sleep. Handling sleep problems by decreasing caffeine intake rather than by giving the older adult client a sleeping medication is the preferable method. Finding out about the client's normal routine for bedtime does not address the problems of insomnia and incontinence. The normal routine shares what usually helps the client to fall asleep and maintain sleep. Asking about what the health care provider told the client assesses the client's knowledge of medications, but it does not address the issues of difficulty sleeping and incontinence.

An older adult client takes diazepam for anxiety. Which drug level should be routinely evaluated for possible toxicity? A. Digoxin B. Glycerin C. Phenytoin D. Docusate sodium

A Reason: Diazepam can increase the effects of digoxin, leading to toxicity. Diazepam does not affect the metabolism of glycerin, phenytoin, or docusate sodium.

An older adult client is prescribed ethacrynic acid to help treat heart failure. Which will be included when teaching the client about this medication? A. Do not take this medication if you cannot urinate. B. Skip any missed doses. C. Continue to take nonsteroidal anti-inflammatory drugs (NSAIDs) as needed. D. Take this medication on a full stomach.

A Reason: Ethacrynic acid is a loop diuretic. This medication inhibits the reabsorption of sodium and chloride at the proximal portion of the ascending loop of Henle. It should not be taken if a client cannot urinate. This medication should be taken before meals. It should not be taken in conjunction with an NSAID. If a dose is missed the client should take the missed dose as soon as remembered. The missed dose should only be skipped if it is almost time for the next scheduled dose.

The nurse instructs the family of a client with cognitive dysfunction on the medication galantamine. Which statement indicates that teaching has been effective? A. "I should give this medication with food." B. "I should give this medication right before bedtime." C. "I should give this medication first thing in the morning." D. "I should make sure my family member lies down after taking this medication."

A Reason: Galantamine is best taken with food. This medication does not need to be taken before bedtime or first thing in the morning. There is no reason for the client to lie down after taking this medication.

An older adult report taking aspirin first thing in the morning, before breakfast. What priority sign or symptom should the nurse assess for in this client? A. Blood in the stool B. Jaundice C. Decreased urinary output D. Joint pain

A Reason: Gastrointestinal (GI) bleeding is one of the most serious side effects of aspirin use. To prevent GI irritation, the nurse should suggest taking the aspirin after eating. Aspirin is not known to decrease kidney function or cause jaundice. Aspirin is commonly taken for joint pain.

An older adult client is suspected of experiencing a hepatic disorder. Which question will the nurse ask to best identify a contributing factor for the dysfunction? A. "How often do you take nonsteroidal anti-inflammatory drugs (NSAIDs) for your arthritis?" B. "Have you ever been diagnosed with asthma before?" C. "Do you take any over-the-counter drugs that contain caffeine?" D. "What type of diet do you generally eat?"

A Reason: Hepatic blood flow declines progressively, beginning around the age of 40 years, and this age-related change can increase serum levels of substances that are metabolized more extensively by the liver. Taking NSAIDs can have a negative impact on liver function. In addition, factors such as diet, smoking, alcohol, genetic variations, and pathologic conditions can affect liver metabolism of substances. There is no substantive link between caffeine intake and liver disease. Diet and asthma medications may or may not have an effect on hepatic function and are not primary risk factors.

After using complementary and alternative approaches, an older adult client continues to experience pain. What should the nurse do at this time? A. provide acetaminophen B. prepare a dose of fentanyl C. ask for a prescription for meperidine D. use another nonpharmacologic approach

A Reason: If nonpharmacological means of pain control are unsuccessful, pharmacological measures should begin with the weakest type and dose of analgesic and gradually increase so that the client's response can be evaluated. Acetaminophen should be provided. Fentanyl is a powerful opioid and should not be used first. Meperidine should be avoided because of the risk of toxic effects in the older adult client. Nonpharmacological approaches have already been tried. The client's comfort needs to be addressed.

During an assessment interview, an older adult client talks about self-medicating with several herbal supplements. The nurse provides information to reduce the risk of the client developing toxicity. What statement by the nurse is best? A. "Aging causes the liver to be less effective at metabolizing these herbs, so toxicity can occur." B. "At your age the effectiveness of an important enzyme called cytochrome P-450 is decreased." C. "As we age, our bodies do not utilize medications and herbs as effectively." D. "Taking several herbal supplements at one time can cause toxicity problems."

A Reason: In advanced age, there may be a reduced secretion of cytochrome P-450 that aids in the metabolism of bioactive substances (e.g., herbs) in addition to medications. When two or more substances that utilize the cytochrome P-450 enzyme system are used concurrently, they compete for the reduced enzymes and are metabolized more slowly, thereby increasing the risk of toxicity. Thus, all the statements are true. The correct option, however, provides sufficient information in terms the client is likely to understand.

The nurse prepares an intramuscular injection for an older client who has paresis in one arm. Which is the best action for the nurse to take? A. Inject the medication in the unaffected arm. B. Inject the medication just under the skin. C. Inject the medication at a 45-degree angle. D. Inject the medication using the Z-track method.

A Reason: Medication should not be injected into an immobile limb, because the inactivity of the limb will reduce the rate of absorption. An intramuscular injection is injected into the muscle at a 90-degree angle. The Z-track method is only used when the medication requires this technique.

Which client, prescribed a anticholinergic medication, may be at high risk for adverse drug reaction? A. A male diagnosed with benign prostatic hyperplasia B. A female diagnosed with asthma C. A female diagnosed with insomnia D. A male with a history of falls

A Reason: Medications can cause serious adverse effects for people with pathologic conditions. For example, anticholinergics may cause urinary retention in men with prostatic hyperplasia. None of the other options are directly affected by the anticholinergic effect.

An older adult client is prescribed nicotinic acid and aspirin to control cholesterol. Which will the nurse include in the client education? A. Aspirin is co-prescribed to help lessen the side effects of nicotinic acid. B. It is best to take the aspirin one hour after taking the nicotinic acid. C. Aspirin works with nicotinic acid to lower cholesterol. D. With nicotinic acid alone, flushing and tingling occur after taking the medication.

A Reason: Nicotinic acid is a B-complex vitamin that can be prescribed at high dosages to lower low-density lipoprotein cholesterol and raise high-density lipoprotein cholesterol. The main side effects of this medication are flushing, itching, tingling, and headache. Pretreatment with aspirin, at least 15 to 30 minutes prior, can reduce many of these symptoms. If taking aspirin, the client should not experience these symptoms.

The nurse should immediately assess the current medication therapies when the older adult client makes which statement? A. "I am feeling sleepy all of the time." B. "I was diagnosed with schizophrenia when I was 19 years old." C. "I take medication to lower my blood pressure." D. "The NSAID I take really helps my arthritis pain."

A Reason: Older adults are at a higher risk for drug interactions. If the client is feeling sleep all of the time that might be an indicator of a problem. Medication benefits or statements of fact are not indications of a potential problem.

An older adult client who is prescribed alendronate reports the medication is taken after dinner each night. The nurse reviews information on this medication. Which pharmacokinetic action is the most important for the nurse to review in this situation? A. Absorption B. Excretion C. Distribution D. Metabolism

A Reason: Pharmacokinetics refers to the absorption, distribution, metabolism, and excretion of drugs. Understanding how the medications affects the body is an important aspect when reviewing medications. Food and beverages (e.g., mineral water, coffee, tea, or juice) will decrease the amount of alendronate absorbed by the body. The client should be advised to take the medication on an empty stomach. Timing does not affect the metabolism, distribution and excretion of the drug.

The nurse completes an assessment of an older adult client. What should the nurse do first when reviewing this client's list of prescribed medications? A. match the medications with Beers criteria B. discuss the prescribed dosages with the pharmacist C. strategize ways to ensure the client takes medications as prescribed D. ask the health care provider to explain rationales for prescribing certain medications

A Reason: The Beers criteria have been widely accepted in geriatric care circles as a means to reduce both adverse drug effects and drug costs. Discussing dosages, ensuring compliance, and providing rationales for specific medications are not identified as actions for the nurse to take when reviewing an older client's medications.

A client is prescribed a potassium supplement. What should the nurse include when teaching the client about this medication? A. Do not take with milk B. Take before eating breakfast C. Limit the intake of fruit juices D. Avoid taking with carbonated beverages

A Reason: The absorption of potassium supplements is decreased by dairy products. Potassium supplements do not have to be taken before eating breakfast. Fruit juice does not need to be limited. Carbonated beverages do not adversely affect potassium supplements.

Which intervention directed toward management of anticholinergic effects is appropriate for a client prescribed an antidepressant medication? A. Increase the amount of fiber in the diet B. Toilet the client frequently C. Provide eye protection when out in the sun D. Increase calorie-dense, nutritious snacks twice daily

A Reason: The anticholinergic effect of antidepressant drugs increases the risk for the development of constipation in the older adult. Fiber added to the diet will help manage this effect. The client should be toileted often but that is not directly focused on anticholinergic effects; in fact, urinary retention is a common problem. Eye protection and a nutritious diet are appropriate, but neither photophobia nor weight loss is relevant to this situation.

The nurse completes a medication history with an older adult client. Which question should the nurse ask when examining each medication that the client takes? A. Why is the drug prescribed? B. What does the drug cost? C. Where is the drug stored? D. How often is the drug taken?

A Reason: The nurse should ask questions when reviewing an older adult client's medications. The question "why is the drug prescribed" should be asked. The questions "how often is the drug taken," "what does the drug cost," and "where is the drug stored" are not questions that should be the focus when examining an older adult client's medications.

An older adult client expresses an interest in taking an over-the-counter fat-soluble vitamin supplement. What information should the nurse provide to help ensure the client's safety? A. "These vitamins are stored in the body longer, which can cause toxicity." B. "Fat-soluble vitamins generally cause gastrointestinal problems." C. "Taking supplements is more effective than eating foods high in fat-soluble vitamins." D. "Fat-soluble vitamins are difficult to get in a low-fat diet."

A Reason: Tissue structure can modify the distribution process of medications. Adipose tissue increases compared with lean body mass in older adults, especially in women; therefore, drugs stored in adipose tissue (i.e., fat-soluble drugs) will have increased tissue concentrations, decreased plasma concentrations, and a longer duration in the body. None of the other statements present accurate information about this issue.

The nurse reviews the medication list provided by an older adult client and notices the client is taking amitriptyline. Which possible side effect will the nurse discuss with the client? A. Constipation B. Heart burn C. High blood pressure D. High blood sugar

A Reason: Tricyclic antidepressants such as amitriptyline can cause constipation. It would not be unusual for the health care provider to prescribe a laxative to prevent constipation. Elevated blood pressure, elevated blood sugar nor heartburn are known side effects of amitriptyline.

An older adult client with a history of gastroesophageal reflux disease is prescribed aspirin 81 mg by mouth every day. What should the nurse suggest when teaching the client about this medication? A. purchase buffered aspirin B. use the type with caffeine C. take on an empty stomach D. expect to experience ear ringing

A Reason: Using buffered or enteric-coated aspirin preparations and avoiding taking aspirin on an empty stomach are helpful measures in preventing gastrointestinal irritation and bleeding. Aspirin products containing caffeine can contribute to insomnia. Ear ringing (tinnitus) is an adverse effect that should be reported.

The nurse is preparing an older adult client's plan of care. The nurse demonstrates an understanding of significant factors that increase the risk for adverse medication effects when including which intervention(s)? Select all that apply. A. Review medication list for possible medication interactions with each new prescription. B. Ask the client to state date and time frequently. C. Monitor renal function for signs of dysfunction. D. Ask the client to identify frequently used coping skills. E. Monitor the client's ability to interact with family and staff appropriately.

ABC Reason: Factors known to have significant affect on causing medication errors resulting in adverse effects include impaired cognition, multiple medication therapies, and impaired renal function. Frequently used coping skills and family interactions are not significant factors that increase the risk for adverse medication effects.

An older adult client shares with the nurse that, "I do not take medications and, besides, everyone has some degree of high blood pressure." What should the nurse focus on when responding to the client's statement? Select all that apply. A. Understanding of the underlying health condition B. Cultural values related to medications C. Related psychosocial values D. Ability to read E. Ability to comprehend instructions

ABC Reason: The client has expressed a lack of seriousness related to the medical condition that has resulted in nonadherence to the medication therapy. The nurse should initially focus on the client's understanding of the health problem, and cultural and psychological influences/values. Ability to read and comprehend instructions are not as likely to need discussion; the problem seems associated with the client's attitude about hypertension.

Which client statement(s) demonstrates an understanding of safe and effective medication administration? Select all that apply. A. "I should start noticing less joint pain in 5 to 10 days." B. "My blood pressure will get high again if I stop taking the medication." C. "I am to take this medication three times a day." D. "I am likely to get an upset stomach if I do not take the medication with food." E. "This medication is covered by my insurance."

ABCD Reason: Medication safety and effectiveness is supported when the client understands how and when the medication should be taken, when expected effects are to occur, and the outcome of nonadherence. Financial considerations are important but do not affect safety or administration of the medication.

A nurse is conducting a medication assessment of an older adult client who will be receiving home care. Which question(s) should the nurse include in this assessment? Select all that apply. A. "Are you a smoker?" B. "Do you drink alcohol?" C. "Do you exercise regularly?" D. "What over-the-counter drugs do you use?" E. "Do you use any herbs or dietary supplements?"

ABDE Reason: Questions relating to smoking, alcohol use, over-the-counter drugs, and herbs and dietary supplements should be included in a medication assessment. Although important for overall health and well-being, a client's exercise habits, however, are not a common focus during a medication assessment.

The nurse reviews the client's medication list prior to educating a client on the use of the herbal remedy St. John's wort. Which medication(s) will the nurse ensure the client is not taking? Select all that apply. A. Warfarin B. Levodopa C. Digoxin D. Phenytoin E. Aspirin

AC Reason: St. John's wort is a potent inducer of both cytochrome P-450 enzymes and intestinal P-glycoprotein. Clinically significant interactions have been documented with St. John's wort and warfarin, digoxin, and benzodiazepines, among others. Phenytoin, aspirin and levodopa do not have the same risk with St. John's wort.

An older adult client has been prescribed a needed medication. Which question(s) should the nurse ask to assess for safe medication administration? Select all that apply. A. "Can you tell me why you are taking this medication?" B. "Will you be able to afford this new medication?" C. "How long should you continue to take this medication?" D. "How will you know if the medication is working as it should?" E. "What should you do if you miss a dose?"

ACDE Reason: Some of the factors affecting safe medication administration include understanding the reason for the medication, what the intended results are, how long the therapy should last, and what to do if a dose is missed. Being able to afford the medication is a factor related to medication therapy adherence.

An older adult client takes mineral oil every day to maintain bowel regularity. Which vitamin deficiency(ies) is this client at risk for developing? Select all that apply. A. A B. C C. D D. E E. K

ACE Reason: Mineral oil decreases the absorption of vitamins A, D, and K. Mineral oil is not identified as affecting the absorption of vitamins C or E.

An older adult client with diabetes reports intermittent hypoglycemia after being prescribed glyburide. Which is the most important action the nurse will take? A. Discuss how to monitor blood glucose. B. Contact the health care provider to discuss a change in medication. C. Review the food diary for high protein snacks. D. Educate the client about symptoms of hypoglycemia.

B Reason: Glyburide is not a drug of choice for older adults because it has a long half-life and increases the risk of serious hypoglycemia. The nurse should contact the health care provider to discuss a change in medication, or the hypoglycemia will continue. In the meanwhile, the nurse will educate the client on measuring blood glucose, healthy snacks to maintain glucose and how to observe for further symptoms.

The nurse provides education for a client with renal disease regarding the effects of medication therapy. Which statement made by the client demonstrates the teaching was effective? A. "I have cut back on my daily intake of caffeine." B. "I limit the daily amounts of acetaminophen I take for my arthritis." C. "My liver disease means I need higher doses of prescribed medications." D. "I need more warfarin daily than I did before my liver problems occurred."

B Reason: A client with renal disease has a high risk of serious side effects when using acetaminophen, because clearance of the medication is decreased. This decrease in clearance places the client at risk for medication toxicity. The amount of acetaminophen taken daily should be limited. It is not typical to need to decrease caffeine intake related to medications. As the client's condition progresses, there may be a need to limit caffeine because it has a diuretic effect and can increase dehydration. This client has renal disease, which does not involve the liver; however, clients with decreased liver function often need lower dosages of medication to prevent overdosages. Warfarin requirements must be monitored carefully and may be decreased due to reduction of liver synthesis of clotting factors and consequently prolonged prothrombin time (PT) or an increased international normalized ratio (INR).

An older adult client with stress incontinence is prescribed an alpha-blocker and experiencing incidences of incontinence. Which action will the nurse take first? A. Teach the client Kegel's exercises. B. Contact the health care provider. C. Implement a toileting routine. D. Obtain adult briefs.

B Reason: A high potential for exacerbation of incontinence exist in clients with stress incontinence who are taking an alpha-blocker. First, the nurse should contact the health care provider, as there may be alternative medications without this effect. If the symptoms continue, the nurse may implement the other interventions.

A nurse administers medications to a group of older adults in a residential facility. Which client is most likely to experience adverse effects? A. an 82-year-old woman with constipation B. a 77-year-old man with a creatinine of 3.6 mg/dl (274.50 µmol/l) C. a 78-year-old man with a body mass index of 35 D. an 84-year-old woman with a hemoglobin of 98 g/dl (980 g/l)

B Reason: Although age-related changes can influence skills related to taking medications, risk factors that commonly occur in older adults exert a stronger influence. A creatinine of 3.6 mg/dl (274.50 µmol/l) reflects renal failure, which will lead to an increase in serum levels of medications. Iron deficiency anemia, obesity, and constipation exhibit no impacts to the risk of adverse and altered effects.

An older adult client has reported being nonadherent to the prescribed medication therapy for a peptic ulcer. Which statement made by the client suggests the best possible explanation for the behavior? A. "My sister took that medication for years." B. "I only read at the third grade level." C. "I take several different medications." D. "I go to bed really early so I can get up early."

B Reason: Although there are numerous reasons for medication nonadherence, the client's statement regarding the level of education suggests a reading deficiency that could lead to inappropriate medication dosing and timing. The fact that the client's sister took this medication and that the client takes other medications are not reasons for medication noncompliance. If the client indicated adverse reactions experienced by the sister or to other medications, that would be cause for concern. The time a client goes to bed and wakes has no relevant tie to taking medications. It could affect the time a client takes a medication, however.

A client develops anorexia, diarrhea, abdominal pain, and agitation while taking a digitalis preparation. Which data should the nurse review first? A. Potassium level B. Digoxin level C. Thyroid stimulating hormone level D. Carotid pulse rate

B Reason: Anorexia, abdominal pain, diarrhea, and agitation are signs of digitalis toxicity, so the digoxin level should be reviewed first since digoxin toxicity is the most likely cause of the client's symptoms. The nurse should assess the client's apical heart rate. Potassium levels should be assessed as well, but digoxin levels are the most likely cause, and the resulting priority.

A client is prescribed digitalis for a cardiac problem. Which supplement should the nurse instruct the client to avoid while taking this medication? A. Zinc B. Calcium C. Selenium D. Glucosamine

B Reason: Calcium supplements increase the risk of digitalis toxicity. Digitalis can cause a zinc deficiency. Digitalis is not identified as interacting with selenium or glucosamine.

The nurse is reviewing the medications taken by a client with diabetes who is also managing rheumatoid arthritis by taking aspirin. Which information will the nurse include in the education plan? A. Do not take aspirin with antidiabetic medications. B. Aspirin can lower your blood glucose. C. Aspirin is not recommended for rheumatoid arthritis. D. Do not take aspirin with insulin.

B Reason: Conditions such as diabetes mellitus can affect the absorption of drugs and result in changes in blood sugar levels. Aspirin, which is recommended in the treatment of rheumatoid arthritis, can lower blood sugar. Aspirin can be used safely with antidiabetic medications, as long as the client keeps in mind that the blood sugar may be lowered while calculating the best dosage of insulin.

An older adult client is prescribed an antipsychotic medication. Which type of food should the nurse include in this client's plan of care? A. Low fat B. High fiber C. High protein D. Low carbohydrate

B Reason: Constipation is a common side effect of antipsychotics. Clients should ingest foods high in fiber to promote regular bowel movements and monitor bowel elimination. The client does not need to ingest low-fat, high-protein, or low-carbohydrate foods when taking antipsychotic medications.

An older adult client asks what can be done to reduce blood pressure besides taking medication. Which response will the nurse make to this client? A. "High blood pressure is best treated with medication." B. "Reducing the intake of salt will help." C. "A small glass of wine every evening is helpful to reduce blood pressure." D. "Weightlifting is a good exercise to lower blood pressure."

B Reason: Lifestyle modifications that help reduce blood pressure include weight reduction and limiting the intake of sodium. Although medication is an option to treat high blood pressure, lifestyle modification must occur in tandem. Alcohol should be avoided in individuals with high blood pressure. Exercise should be encouraged to help reduce blood pressure, but weightlifting is not recommended for older adults and not specifically known to lower blood pressure.

The nurse decides to notify the health care provider after assessing a client taking an anticholesterol medication. Which finding caused the nurse to take this action? A. rise in blood pressure B. new onset of muscle pain C. hyperactive bowel sounds D. bronchovesicular breath sounds

B Reason: Muscle pain is an important symptom to note in clients prescribed statins, as these drugs can cause myopathy and the breakdown of skeletal muscle, which can precipitate renal failure. It is unlikely that an anticholesterol medication would cause a rise in blood pressure. There is no reason for the nurse to report hyperactive bowel sounds. Bronchovesicular breath sounds are considered normal.

An older adult client takes gentamicin for a wound infection. On what should the nurse focus when assessing this client for adverse effects? A. Heart rate B. Urine output C. Blood pressure D. Respiratory rate

B Reason: Parenteral aminoglycosides such as gentamicin require close monitoring due to the risk of causing renal failure. The client's urine output should be closely monitored. This antibiotic does not affect heart rate, blood pressure, or respiratory rate.

An older adult client taking sodium bicarbonate is prescribed a sodium-restricted diet. Which action will the nurse take next? A. Encourage the client to drink more fluids. B. Contact the health care provider. C. Observe the client for indigestion. D. Minimize sun exposure.

B Reason: Sodium bicarbonate can cause hypernatremia and should be avoided by clients prescribed a low-sodium diet. Therefore, the nurse should contact the health care provider regarding the prescription before administration. Sodium bicarbonate is not known to cause indigestion or interact with sun exposure. While drinking more fluids is always a sound recommendation, more fluids will not offset this client's need for less sodium.

An older adult client has been prescribed atorvastatin to reduce cholesterol. Before administering the first dose, it is most important for the nurse to review which laboratory results? A. Hemoglobin and hematocrit B. Liver function tests C. Electrolyte panel D. Coagulation studies

B Reason: Statin medications prescribed to reduce cholesterol can impair liver function. Liver function tests should be checked prior to starting therapy and at regular intervals thereafter. Hemoglobin, hematocrit, electrolytes, and coagulation are not as adversely affected by statins as liver function.

A home care nurse admits an older adult with macular degeneration. Which assessment question is appropriate? A. "What medications do you take each day?" B. "How do you organize your medications?" C. "How many medications do you take each day?" D. "Do you have difficulty opening your medication bottles?"

B Reason: The client with macular degeneration will have limited sight; therefore, a question about assuring that this client takes the correct medications at the correct time is appropriate. There is no indication that this client would have difficulty in opening bottles. Asking how many medications taken each day is not helpful nor does it use therapeutic communication. The nurse will want to know what medications the client takes; however, this question is limiting. It does not include PRN, herbs, or even medications a client may take weekly. Nurses should ask additional questions about the client's ability to take medications as prescribed based on specific observations.

The nurse is concerned that an older adult client's infection is not improving despite taking ampicillin as prescribed. Which concomitant medication should the nurse consider as the reason for this outcome? A. Aspirin B. Antacids C. Anticoagulant D. Antihypertensive

B Reason: The effects of ampicillin can be decreased by antacids. Aspirin, anticoagulants, and antihypertensives are not identified as affecting ampicillin.

An older adult client reports taking the antihypertensive as prescribed; however, the most recent blood pressure measurement is 170/90 mm Hg. What should the nurse consider as interfering with the effects of the antihypertensive medication? A. Insulin B. Antacid C. Digoxin D. Thiazide diuretics

B Reason: The effects of antihypertensives can be decreased by antacids. Antihypertensive drugs can increase the effects of insulin and thiazide diuretics. Digoxin is not identified as being affected by antihypertensive medications.

An older adult client reports not taking a prescribed diuretic because of the need to void throughout the night. Which should the nurse instruct this client? A. "Elevate your legs at night." B. "Take the medication in the morning." C. "Restrict the intake of fluids after 6 pm." D. "Eat something salty before bedtime."

B Reason: The nurse should plan an administration schedule that interferes least with the client's schedule. Morning administration is usually preferable. The client should elevate the legs during the day to mobilize the fluid in the tissue and make its way back to the bladder during the day hours. This prevents excessive trips to the bathroom at night. Restricting the intake of fluids should not be encouraged, because this could lead to dehydration in the older client taking a diuretic. Eating something salty at night may cause the body to retain fluid but would also interfere with the client's treatment.

The health care provider has prescribed an antacid for an older adult client. What teaching will the nurse provide about taking this medication? A. Check your apical pulse before taking this medication. B. Avoid taking other medications within 2 hours of taking this one. C. Limit fluid intake before and after taking this medication. D. Take this medication on a full stomach.

B Reason: The nurse will advise the client to avoid taking other medications within 2 hours of taking the antacid. The client does not need to check their apical pulse; this action is indicated before taking digoxin. The client does not need to take the antacid on a full stomach, nor does the client need to limit fluid intake.

An older adult client diagnosed with renal failure has been prescribed a loop diuretic for hypertension and is experiencing excess thirst. Which action will the nurse take first? A. Notify the health care provider. B. Assess the client for toxicity. C. Limit fluid intake. D. Monitor intake and output.

B Reason: The renal system is primarily responsible for the body's excretory functions, and among its activities is the excretion of drugs. Renal failure causes the glomerular filtration rate and tubular reabsorption to be reduced. Drugs are not as quickly filtered from the bloodstream and are present in the body longer. For this reason, the nurse should observe for signs of signs of toxicity such as excess thirst that can be a sign of dehydration. If suspected, the nurse should perform a physical assessment and then report the findings to the health care provider. The nurse will continue to limit fluids, while closely monitoring intake and output.

The nurse reviews the use of warfarin with an older adult client. The client's international normalized ratio (INR) has been unexpectedly elevated. Which recommendation will the nurse make based on this laboratory finding? A. Add more protein to the diet. B. Eat more green leafy vegetables. C. Include less whole grains in the diet. D. Eat less cruciferous vegetables.

B Reason: Warfarin is prescribed as blood thinner and an elevated INR can cause unexplained bleeding. The nurse would recommend the client eat more green leafy vegetables until the INR results return to a therapeutic level. This would help prevent bleeding. Protein intake does not have an effect on the INR nor does whole grains or cruciferous vegetables such as broccoli and cauliflower.

An older adult client is prescribed thioridazine. What should the nurse add to this client's plan of care? A. limited oral fluid intake B. fall prevention strategies C. actions to reduce diarrhea D. vital signs assessment every 2 hours

B Reason: Clients taking antipsychotics are at high risk for falls due to the hypotensive and sedative effects. Nurses should implement fall prevention measures for these individuals. There is no need to limit oral fluid intake with this medication. This medication can cause constipation. There is no need to assess vital signs every 2 hours with this medication.

A nurse assesses the eating habits of an older adult client who takes iron supplements. Which statement(s) indicate client understanding? Select all that apply. A. "I prefer coffee to take my pills." B. "I drink orange juice with my iron." C. "I take my iron in between my meals." D. "I take all my pills with a glass of warm water." E. "I may have light green stools when I have a bowel movement."

BCD Reason: Foods that change the pH of the gastrointestinal (GI) system interfere with the absorption of iron. The preferable method is to take iron on an empty stomach, but if it causes GI upset, it can be taken with orange juice, which helps absorption. Caffeine and some foods interfere with iron absorption. The temperature of the water should not affect the medication absorption. Stools will be dark in color and normal consistency; however, the client can become constipated with the iron.

A client reports drinking 4 to 6 cups of caffeinated coffee each day. Which prescribed medication should the nurse expect to be affected by this client's intake of caffeine? A. Aspirin B. Cinacalcet C. Cimetidine D. Acetaminophen

C Reason: A high caffeine intake can decrease the effects of cimetidine, a stomach acid reducer. Caffeine intake is not identified as affecting aspirin, cinacalcet, or acetaminophen.

An older adult client diagnosed with heart failure reports an irregular heartbeat. Which medication will the nurse discuss with the health care provider before giving to this client? A. Aspirin B. Clozapine C. Disopyramide D. Metoclopramide

C Reason: A high potential for adverse reactions exists in clients with heart failure who are prescribed disopyramide. Aspirin, clozapine, and metoclopramide are not identified as causing adverse reactions in a client with heart failure.

An older adult client is scheduled to receive several medications at bedtime. Which medication should the nurse question before administration? A. Nonsteroidal anti-inflammatory drug for arthritis B. Penicillin orally to treat infection C. Diphenhydramine for sleep D. Insulin for diabetes mellitus

C Reason: According to the Beers Criteria, first generation antihistamines such as diphenhydramine are inappropriate drugs to use in older adults due to the risk of adverse effects. Nonsteroidal anti-inflammatory drugs, penicillin, and insulin are all safe to administer in appropriate doses.

The nurse reviews the purpose of a diuretic to treat an older adult client's hypertension. Which client statement indicates that teaching has been effective? A. "This pill slows my kidney processes." B. "This pill blocks the effect of salt on my blood vessels." C. "This pill causes blood vessels to enlarge and remove water from my body." D. "This pill makes my heart beat faster to eliminate more water from by body."

C Reason: Diuretics cause blood vessels to dilate and help the kidneys eliminate salt and water, thereby decreasing fluid volume throughout the body and lowering blood pressure. Diuretics do not "slow the kidney processes." Rather, they increase the production of urine. Diuretics do not "block the effects of salt on blood vessels" or increase heart rate.

A nurse has administered metoprolol intravenously to a critically-ill older adult client with a blood pressure of 191/118 mm Hg. When should the nurse initially reassess the client's blood pressure? A. Within 1 hour B. In 30 minutes C. In 5 minutes D. With next routine vital sign check

C Reason: Drugs given intravenously are absorbed and take action very quickly. Most oral medications take at least 30 minutes or longer to take effect. Waiting until the next vital sign could prove dangerous for the client if the medication is not effective and the blood pressure continues to rise.

While reviewing laboratory data for an older adult client taking furosemide, the nurse identifies hypokalemia. Which discussion with the nurse initiate with the health care provider? A. sodium replacement B. Calcium replacement C. Potassium replacement D. Chloride replacement

C Reason: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and chloride and is depleting of potassium (hypokalemia). The nurse will discuss potassium replacement with the health care provider. Monitoring the client's potassium level is essential because of the severe consequences of hypokalemia. Sodium, calcium and chloride replacement would not be necessary when taking furosemide. These electrolytes are associated with cardiac disorders.

A nurse is conducting a medication assessment of an older adult. Which statement by the client indicates a need for further education? A. "I have made a reminder system for myself so that I do not miss any of my pills during the day." B. "Overall, I much prefer to prevent getting sick than having to rely on different drugs to stay healthy." C. "I use a lot of herbs and supplements, but I am careful to make sure that they are all natural." D. "My family provider has me on so many different pills now, so I want to talk about whether they are all necessary."

C Reason: It is a common misconception that because herbs are natural, they have no potential for harm; the nurse should teach the client about the potential risks of herbal supplements. It is proactive to act in a manner that will prevent illness. Implementing a reminder system for drugs is prudent. Similarly, wanting to discuss the potential for polypharmacy with a care provider shows appropriate assertiveness and ownership of health.

An older adult client reports nightmares after a sedative for sleep was discontinued. What should the nurse respond to this client? A. "This is an adverse effect that needs to be evaluated." B. "This means that you need a larger dose of the medication." C. "This is expected after a sedative is no longer used for sleep." D. "This means that you need to continue to take the medication."

C Reason: It is not unusual for nightmares to occur after sedatives are discontinued. Experiencing nightmares is not an adverse effect. A larger dose of the medication is not needed. Experiencing nightmares does not mean that the client needs to continue to take the medication.

An older adult admitted to a long-term care facility is diagnosed with type 2 diabetes and coronary artery disease. The client takes glipizide and isosorbide mononitrate. The medical history states that the client drank 8 ounces (240 mL) of whiskey per day for many years. Which action should be a priority for the admitting nurse? A. Evaluate the client for renal failure. B. Assess and observe the client for depression. C. Assess the client for hypoglycemia and hypotension. Evaluate the client's blood work for changes in electrolytes

C Reason: Older adults are more susceptible to developing medication-alcohol interactions. Age-related changes in body composition can cause higher levels of alcohol to be absorbed into the bloodstream. Alcohol enhances vasodilation when an individual takes a nitrate, and there is potentiation of oral hypoglycemics by alcohol. Central nervous system depression occurs when alcohol interacts with barbiturates and meprobamate, which this client is not taking. There is no need to evaluate for renal failure or changes in electrolytes; these are not known medication-alcohol interactions.

An older adult client with heart failure has a low serum albumin level. Which medication should the nurse expect to be less effective in this client? A. Isoniazid B. Aldactone C. Furosemide D. Indomethacin

C Reason: Reduced serum albumin levels can be problematic if several protein-bound drugs are consumed and compete for the same protein molecules; the unbound drug concentrations increase and the effectiveness of the drugs will be threatened. Highly protein-bound drugs that may compete at protein-binding sites and displace each other include furosemide. Isoniazid, Aldactone, and indomethacin are not identified as being protein-bound drugs.

A client is prescribed spironolactone. Which electrolyte should the nurse monitor closely in this client? A. Sodium B. Calcium C. Potassium D. Magnesium

C Reason: Spironolactone decreases the excretion of potassium which can lead to potassium toxicity. Spironolactone does not affect sodium, calcium, or magnesium balance.

During a home visit the nurse suspects that an older adult client may not be taking medications as prescribed. What finding caused the nurse to make this clinical decision? A. sleeps in a reclining chair B. receives Meals on Wheels C. fingers swollen and painful D. uses a walker for ambulation

C Reason: Swollen and painful fingers could hinder the client's ability to open medication containers. There is no reason to question the client's ability to take medications because of using a recliner to sleep. Receiving Meals on Wheels ensures the client receives a hot meal each day. Using a walker for ambulation would not hinder the client's ability to take prescribed medications.

The nurse is reviewing the medication record of an older adult client who is prescribed warfarin and colchicine. Which change in this client's laboratory values will the nurse expect? A. elevated white blood cells B. elevated blood urea nitrogen (BUN) C. elevated PT/international normalized ratio (INR) D. elevated total cholesterol

C Reason: The effects of anticoagulants can be increased by colchicine, causing the INR to elevate. Elevated white blood cells, BUN, or total cholesterol are not known drug interactions between warfarin and colchicine.

The nurse notes than an older adult client has abnormal liver function test results. Which medication should the nurse question before administering to this client? A. Warfarin B. Ibuprofen C. Meperidine D. Furosemide

C Reason: The liver decreases in size and function with age, and hepatic blood flow declines by 45% between the ages of 25 and 65 years. This could affect the metabolism of some drugs, such as meperidine. Warfarin, ibuprofen, and furosemide are not identified as medications with altered metabolism because of liver function.

A client with hypertension reports adding hops, garlic, ginseng, and mistletoe supplements to the daily regimen. Which warning will the nurse provide about these herbal supplements? A. Hops are known to increase pulse rate. B. Garlic is known to lower blood pressure. C. Ginseng is known to raise blood pressure. D. Mistletoe is known to lower pulse rate.

C Reason: The nurse should caution the client that ginseng causes an elevation in blood pressure. Garlic decreases blood pressure. Hops and mistletoe have no effect on blood pressure or pulse.

An older adult client is prescribed gabapentin for neuropathic pain. Which existing client health problem should the nurse monitor for changes? A. Emphysema B. Diverticular disease C. Benign prostatic hypertrophy D. Gastroesophageal reflux disease

C Reason: The nurse should closely monitor the client with prostate disease since anticonvulsants can aggravate this condition. Gabapentin is not identified as adversely affecting emphysema, diverticular disease, or gastroesophageal reflux disease.

An older adult client is prescribed digitalis. Which measurement will the nurse teach the client to take before ingesting this medication? A. international normalized ratio (INR) B. blood pressure C. Pulse D. blood sugar

C Reason: The nurse will educate the client to measure the pulse before taking the medication. Digitalis is prescribed to slow and strengthen the heart. If the pulse is below the recommendation of the health care provider, the client will hold the medication and prevent the pulse rate from falling too low. Blood pressure, INR and blood sugar are not related to the administration of digitalis.

The nurse learns that an older client has been taking meprobamate for several months to help reduce anxiety after the death of a spouse. Which action will the nurse take next? A. Acknowledge the client needs to review the loss experience. B. Refer the client to grief support. C. Assess the current mental health of the client. D. Discuss gradual reduction in doses before discontinuing the medication.

C Reason: The nurse will first want to assess the client's current mental health status to determine the progress the client has made since the loss. If the client is at a point where the mental state is improving the health care provider may consider a medication change. Clients who have used meprobamate for a long period of time can become physically and psychologically dependent on the drug and need to be weaned from it slowly. The medication should not be abruptly discontinued. Once mental health status has been assessed and medication dosage has been titrated, the will acknowledge the client's need to review the loss experience and refer to any support group or agencies as needed.

The nurse notes that an older adult client takes American ginseng every day. For which adverse effect should the nurse monitor this client? A. agitation and anxiety B. ecchymosis C. peripheral edema D. elevated blood pressure

D Reason: American ginseng can cause an increase in blood pressure, tachycardia, arrhythmia, and palpitations. American ginseng is not known to cause bruising, peripheral edema, nor agitation and anxiety.

A client has been prescribed warfarin. Which client statement shows an understanding of the interaction between the medication and dietary needs? A. "I need to have sufficient protein in my diet." B. "I have switched to low-fat and fat-free dairy products." C. "I love kale but I know I cannot eat it often." D. "I have cut back on coffee; just 2 small cups a day."

C Reason: Vitamin K decreases the effectiveness of warfarin. Green leafy vegetables, such as kale, spinach, turnip greens, collards, Swiss chard, mustard greens, parsley, romaine, and green leaf lettuce are high in vitamin K. None of the other foods/beverages mentioned have a negative effect on warfarin effectiveness.

Which factor in an older adult client's history is most likely a contraindication to taking bulk-forming laxatives? A. Bowel distention B. Decrease peristalsis C. Abdominal cramping D. Intestinal obstruction

D Reason: Bulk formers absorb fluid in the intestines and create extra bulk, which distends the intestines and increases peristalsis. These compounds should not be used when there is any indication of intestinal obstruction. Decreased peristalsis, bowel distention, and abdominal cramping can all be indicators for taking laxatives, not contraindications.

An older adult client taking digoxin is experiencing bradycardia and diarrhea. What should the nurse evaluate as the potential reason for this drug reaction? A. fluid intake B. oxygen level C. body weight D. potassium level

D Reason: Signs of digoxin toxicity include bradycardia and diarrhea. Hypokalemia increases a client's risk of developing toxicity. Because of this, the potassium level should be evaluated. Fluid intake, oxygen level, and body weight have no effect on the metabolism of digoxin.

A nurse reviews the medication list of an older adult upon transfer from an acute care to a long-term care facility. Which method is appropriate to reduce the occurrence of adverse effects? A. Stop the administration of gastrointestinal (GI) and opioid pain medications. B. Administer medications at the same time every day with meals. C. Request that the client's medications be held and restarted one at a time. D. Compare the list to the Beers' criteria and notify the health care provider of any on the list.

D Reason: An important theme of the Beer's criteria and other guidelines is that medications are determined to be appropriate or inappropriate in relation to the client's condition. Some medications are given with meals, while others are not. There is no need to stop all medications at this time nor should specific GI and pain medications be stopped.

An older adult client experiences arthritis pain. Which medication should the nurse identify as being the safest for this client? A. Etodolac B. Ibuprofen C. Diclofenac D. Acetaminophen

D Reason: The analgesics with a high risk of adverse reactions in older clients include etodolac, ibuprofen, and diclofenac. Acetaminophen would be the safest medication for this client to take.

An older adult client is prescribed a beta blocker. Before administration, the nurse will question the prescription if the client has which health problem? A. Osteoarthritis B. Lymphedema C. benign prostatic hypertrophy D. chronic obstructive pulmonary disease

D Reason: A client with chronic obstructive pulmonary disease is at high risk for adverse effects if prescribed a beta blocker. A beta blocker does not cause adverse effects in the client with osteoarthritis, lymphedema, or benign prostatic hypertrophy.

An older adult client has recently been diagnosed with a gastric ulcer and asks the nurse what over-the-counter medication they can take for a headache. What medication will the nurse suggest? A. Licorice B. Aspirin C. Ibuprofen D. Acetaminophen

D Reason: Acetaminophen is the safest over-the-counter medication for the client to take. It will not aggravate the client's gastric ulcer. Licorice is a complementary medicine that is indicated for anti-ulcer uses; however, it will possibly increase the intensity of the client's headache. Ibuprofen and aspirin are contraindicated with a gastric or duodenal ulcer.

The nurse reviews the medications that an older adult client currently takes. Which medication will the nurse question because of a high risk for adverse effects in an older adult client? A. Verapamil B. Metoprolol C. Acetaminophen D. Diphenhydramine

D Reason: Diphenhydramine is identified as a first-generation antihistamine that has a high risk for adverse effects in an older adult client. Verapamil relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Metoprolol works by affecting the response to nerve impulses in the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart. Acetaminophen is used to treat minor aches and pains and to reduce fever. Verapamil, metoprolol, and acetaminophen have not been found to commonly cause adverse effects in older adult clients.

An older adult client taking an antidepressant has severely dry mucous membranes. What should the nurse recommend to this client to treat this adverse effect? A. Hot tea B. Lemon water C. Toast with jam D. Sugarless mints

D Reason: Dryness of the mouth can be an uncomfortable side effect of antidepression medications. The nurse should advise the client to use sugarless mints, ice chips, or a saliva substitute to improve this symptom. The client also should monitor oral health closely because dry mouth increases the risk of dental disease. Hot tea, lemon water, and toast with jam are not recommendations to reduce a dry mouth.

Ceftriaxone has been prescribed to be given intramuscularly to an older adult client with disuse syndrome of the left arm due to a stroke. Which action related to intramuscular injections should the nurse utilize with this client? A. Inject the medication in an area with decreased sensation. B. Avoid pressure dressings on the site after injection. C. Administer the medication into the affected limb. D. Monitor for bleeding at the injection site.

D Reason: Frequently, the older adult will bleed or ooze after the injection because of decreased tissue elasticity; a small pressure bandage may be helpful. Injecting medications into an inactive limb will reduce the rate of absorption. Injecting the medications into a site with decreased sensation will prevent the client from feeling and reporting any complications at the site.

An older adult client taking ginkgo biloba, valsartan, and hydrochlorothiazide experiences unexpected bruising. What action will the nurse take next? A. Assess level of orientation. B. Question the client about unexpected bleeding. C. Notify the health care provider. D. Instruct the client to stop taking the ginkgo biloba.

D Reason: Gingko biloba has the ability to potentiate the blood thinning effect of valsartan. The nurse will direct the client to stop the herbal supplement. In addition, the nurse will notify the health care provider, question the client about unexpected bleeding, and assess the level of orientation.

Which client statement demonstrates to the nurse appropriate motivation for adherence to prescribed medication therapy? A. "My adult child says I have to take the medication." B. "The medication does not cost very much so I have no reason not to take it." C. "The medication is supposed to get my blood pressure down to the normal range." D. "I do not want high blood pressure to end my life early."

D Reason: Motivation is the desire to do things. It is the crucial element in setting and attaining goals. The client's statement regarding living is an example of motivation related to taking the prescribed medication. It does not indicate personal buy-in by the client if an adult child says the medication must be taken. The cost and reason for taking medication, without personal motivation, do not necessarily lead to adherence.

The nurse discovers an older adult client is not taking medications as prescribed. The client states, "I do not know when to take the medication or how much to take. I do not understand what the bottle has on it." What limitation does the nurse suspect this client needs assistance with? A. Hearing B. Cognitive C. Functional D. Educational

D Reason: Persons with limited education may have difficulty reading and understanding instructions and labels. Hearing impairment could indeed be a barrier to understanding prescribed dosages; however, the nurse needs to consider that while teaching. Older adult clients could have impairments that prevent them from remembering to take the medications, make them forget that they did take the medication and retake them, and cause them to confuse medications, dosage, or schedule. Impairments in the person's ability to perform activities of daily living or instrumental activities of daily living could create challenges in the ability to administer medications.

The home care nurse is performing a medication reconciliation on an 83-year-old female client with heart failure, type 1 diabetes, and gastroesophageal reflux disease (GERD). Click to highlight the findings that increase the risk for polypharmacy and require follow-up. A. The client has seven medications prescribed by a cardiologist, primary care provider, and gastroenterologist. B. The client reports not using herbal remedies or supplements. C. The client uses a pill organizer for laying out medications that the client's adult child fills for the week. D. The client fills prescriptions at the pharmacy that has the lowest price for each drug.

D Reason: Polypharmacy occurs when the client takes five or more medications or uses more medications than clinically necessary, increasing the risk for drug interactions and adverse effects. Because polypharmacy occurs when the client takes more than five medications, this client is at risk because they take seven medications. Polypharmacy can occur when the client uses multiple health care providers who may not communicate with each other about the client's care. For example, the client may be taking duplicate medications under more than one name for the same condition. This client has an increased risk for polypharmacy because prescriptions are written by three providers. The risk for polypharmacy occurs when a client uses multiple pharmacies to obtain drugs. If there is no communication between pharmacies, the client may receive duplicate or similar medications under more than one name. Using one pharmacy allows the pharmacist to check for drug interactions and duplicate prescriptions. Although this client does not take herbal remedies or supplements, their use would increase the risk for polypharmacy. The use of a pill box reminds the client of the need to take medications but does not increase the risk for polypharmacy. Having the adult child set out pills for the client for the week increases safe medication administration but does not affect polypharmacy.

An older adult client is experiencing moderate pain after joint replacement surgery. Which medication will the nurse expect to administer to this client on as needed basis per health care provider prescription? A. Ketorolac B. tramadol XR C. acetaminophen D. hydrocodone and acetaminophen

D Reason: Short-acting opioids such as hydrocodone and acetaminophen are used on an as needed basis after joint replacement surgery. Extended-release drugs such as tramadol XR and ketorolac would not be prescribed on an as needed basis. Acetaminophen would not be indicated for postoperative moderate pain.

An older adult client has an infected leg wound. Which medication should the nurse question before providing to this client? A. Penicillin B. Ampicillin C. Gentamycin D. Nitrofurantoin

D Reason: The anti-infective medication nitrofurantoin is identified as having a high risk of adverse reactions in older adults. Penicillin, ampicillin, and gentamycin are not identified as having a high risk of adverse reactions in older adults.

The nurse is performing a home visit to an older adult, who has a history of obesity and poorly controlled hypertension. Which assessment finding would alert the nurse of a potential adverse reaction? A. The client has increased the intake of green tea to obtain more antioxidants. B. The client has begun taking low-dose aspirin for the prevention of cardiac disease. C. The client takes insulin injections three times daily for the treatment of type 1 diabetes. D. The client has started taking St. John's wort to increase stamina and concentration.

D Reason: The client has a history of poorly controlled hypertension. Herbal agents, such as ginseng and St. John's wort can exacerbate hypertension. Green tea, low-dose aspirin, and insulin will not affect the client's blood pressure.

The nurse instructs an older adult client on medication safety. Which client statement indicates that additional teaching is required? A. "I should make a list of all of my medications." B. "I should limit the number of medications I take." C. "I should write down the doses of my medications." D. "I should take two doses today if I forgot to take one yesterday."

D Reason: The client should keep a current list of all medications. The client should try to manage new symptoms naturally rather than with drugs. The client should write down the dosage of all medications. Medications should not be doubled up because of a skipped dose.

An older adult client who has been taking the same medication for months reports developing diarrhea and a headache over the past several days. The client states no other concerns. Upon review, the nurse notes a temperature of 98.2°F (36.8°C), pulse rate 75 beats/min, and respiratory rate 18 breaths/min. What will the nurse consider first when assessing this client further? A. medication overdose B. symptom of a former illness C. electrolyte imbalance D. development of a new adverse effect

D Reason: The nurse should be aware that an older adult client can develop adverse effects to drugs that they have been taking for years without problems. The nurse would first address potential adverse effects from the client's current medication by reviewing the medications and possible effects. There are no specific signs of a medication overdose, so this would not be assessed first. A former illness that has been resolved should not return. The client may have a new illness, and the nurse should assess to determine if an adverse reaction to medications is the cause. An electrolyte imbalance could occur if the client continues to experience diarrhea. However, at this time, the assessment data are within normal limits, indicating this is not the most likely cause.

The client taking ibuprofen for pain reports the effects of the medication starting to wear off in about 3 hours. Which recommendation will the nurse make to the client? A. Take another dose of the medication. B. Time rest breaks to when medication wears off. C. Take an over-the-counter medication between doses. D. Discuss the situation with the health care provider.

D Reason: The nurse will recommend the client discuss the medication effectiveness with the health care provider. Taking another dose of the medication and taking over-the-counter medications will require direction from the health care provider. Taking rest breaks is not a sustainable solution.