Safe Medications
The older adult client is prescribed a new atypical antipsychotic medication. What instruction(s) should the nurse provide the caregiver to manage adverse effects of the medication? Select all that apply. "Assist the client from a sitting to standing position slowly." "Be sure to remove any trip or fall hazards from the house." "Notify the health care provider if the client appears to be sleeping more than usual during the day." "It is important to report any signs of confusion and disorientation." "Notify the health care provider if the client develops repetitive movements."
"Assist the client from a sitting to standing position slowly." "Be sure to remove any trip or fall hazards from the house." "Notify the health care provider if the client appears to be sleeping more than usual during the day." Because they were viewed as having a lower risk of adverse effects and greater tolerability, the atypical antipsychotics have largely replaced the conventional/typical agents. Although atypical antipsychotics are thought to be safer than typical antipsychotics, they still have severe side effects, such as drowsiness, confusion and tardive dyskinesia (a serious movement disorder). Falls due to obstacles in the home would not be directly related to use of the medication.
A nurse at a long-term care facility is teaching a group of unlicensed assistive personnel about medications and their use in older adults. Which information would the nurse include when characterizing adverse drug reactions? Select all that apply. "Even when a client stops taking a drug, a reaction can take place after the fact." "Even when a client has been taking a drug for a long time, a drug reaction can still occur." "Most drug reactions are in fact age-related changes that are mistakenly attributed to medications." "Older adults can have signs and symptoms of adverse reactions that are different from those of other older adults." "While older adults are prone to adverse reactions, these reactions tend to resolve more quickly than in younger people."
"Even when a client stops taking a drug, a reaction can take place after the fact." "Even when a client has been taking a drug for a long time, a drug reaction can still "Older adults can have signs and symptoms of adverse reactions that are different from those of other older adults." Explanation: The risk of adverse drug reactions is so high in older adults that nurses should assess for complications with every assessment. An adverse reaction to a drug may be demonstrated even after the drug has been discontinued. Adverse reactions can develop suddenly, even with a drug that has been used over a long period of time without problems. The signs and symptoms of an adverse reaction to a given drug may differ in older adults. Most drug reactions are not age-related changes. Adverse drug reactions do not resolve more quickly in older clients than in younger people.
An older adult client with a history of stroke and congestive heart failure demonstrates left-sided weakness, dysphasia and fatigue. The caregiver shares that that the client often refuses to take medications as prescribed. Which assessment question should the nurse ask to best determine the possible cause of the nonadherence behaviors? "Have you noticed the client having any difficult swallowing?" "When did this reluctance to take the medication start?" "Does the client take frequent naps during the day?" "What have you done to attempt to get the client to take the medications?"
"Have you noticed the client having any difficult swallowing?" Explanation: The client's history of stroke with dysphagia should lead the nurse to the client's swallowing as it can affect he ability to take the oral medication. While the other options are appropriate assessment questions, none address the cause of the behaviors as directly as assessing for a problem swallowing.
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? "How often do you take nonsteroidal anti-inflammatory drugs (NSAIDs) for your arthritis?" "Have you ever been diagnosed with asthma before?" "Do you take any over-the-counter drugs that contain caffeine?" "What type of diet do you generally eat?"
"How often do you take nonsteroidal anti-inflammatory drugs (NSAIDs) for your arthritis?" Explanation: 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.
x The nurse should immediately assess the current medication therapies when the older adult client makes which statement? "I am feeling sleepy all of the time." "I was diagnosed with schizophrenia when I was 19 years old." "I take medication to lower my blood pressure." "The NSAID I take really helps my arthritis pain."
"I am feeling sleepy all of the time." Explanation: 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.
A client has been prescribed warfarin. Which client statement shows an understanding of the interaction between the medication and dietary needs? "I need to have sufficient protein in my diet." "I have switched to low-fat and fat-free dairy products." "I love kale but I know I cannot eat it often." "I have cut back on coffee; just 2 small cups a day."
"I love kale but I know I cannot eat it often." Explanation: 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 statement made by an older adult client indicates to the nurse that the client is no longer experiencing a anticholinergic adverse affect to the antacids being taken regularly? "Spicy food does not cause me heartburn anymore." "My skin rash has been gone for several weeks." "My bowel movements are much more regular now." "I am so pleased that I have not had a headache in several months."
"My bowel movements are much more regular now." Explanation: Specific adverse effects commonly associated with anticholinergic medications include falls, constipation, somnolence, urinary retention, dry mouth, and dry eyes. Indication of normal bowel function would indicate the absence of the anticholinergic effect on a prescribed medication. Antacids are often taken to deal with heartburn triggered by spicy foods. Neither skin rashes nor headaches are considered anticholinergic adverse reactions.
During the admission interview, the nurse learns that an older adult frequently experiences constipation. Which response by the nurse would be most appropriate? "I will make sure that a laxative is prescribed for you while you are here in the hospital." "Many older adults find that increasing their activity level and taking a mild laxative daily provides relief." "Constipation is usually a sign of a more serious health problem, so I will pass that information on to your health care provider." "There are measures that I can teach you, such as changing your diet and increasing the amount of fluids you drink."
"There are measures that I can teach you, such as changing your diet and increasing the amount of fluids you drink." Explanation: Non-pharmacological measures for treating and preventing constipation are preferable to laxatives. Constipation is a common problem among older adults and is related to several lifestyle and age-related factors; it is not necessarily a sign of a more serious illness. When a client reports constipation, the nurse should assess the client carefully before suggesting or administering a laxative. Additionally, the nurse should reinforce to older adults and their caregivers that laxatives, although popular, are drugs and can cause side effects and interact with other drugs.
An older adult client with osteoarthritis takes 2 tablets of 650-mg acetaminophen 3 times per day. What should the nurse respond to this client? "Change the number of tablets to 1 for each dose." "Increase the frequency to 2 tablets every 4 hours." "If you have more pain, another dose can be taken." "This is the maximum amount you can take each day."
"This is the maximum amount you can take each day." Explanation: Acetaminophen is a popular analgesic among older adults with mild to moderate pain. It often is recommended for the initial treatment of osteoarthritis. The total daily dose should not exceed 4,000 mg as high doses taken long term can cause irreversible hepatic necrosis. Since the client is taking 3 doses of 1300 mg each or 3900 mg/day, the nurse should explain that this is maximum amount that the client can take each day. Reducing the number of tablets may not control the client's pain. Increasing the frequency to every 4 hours and taking another dose could cause the client to experience liver necrosis and should not be done.
An older adult is prescribed an antibiotic to be taken three times a day. What is the best schedule for administration of the antibiotic? 0600, 1400, 2200 0900, 1700, 0100 0800, 1600, 2400 1000, 1800, 0200
0600, 1400, 2200 Explanation: 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 is scheduled to receive an enteric-coated tablet; however, the client is concerned the tablet is too big to swallow. What is the nurse's best action? Crush the tablet and administer with applesauce Ask the pharmacist if another form of the medication is available Hold this scheduled dose of medication Provide water to assist in swallowing the pill
Ask the pharmacist if another form of the medication is available Explanation: Enteric-coated tablets should not be crushed, so the nurse should consult with pharmacist and health care provider about an alternative form of the medication. The client still needs the medication; so holding a medication that is prescribed is not appropriate, especially without notifying the health care provider. Providing water is helpful, but does not ensure that the client can swallow the pill. The best option is to first check if another form of the drug is available.
The nurse notes that an older adult client takes a monoamine oxidase inhibitor for depression. Which will the nurse emphasize when reviewing this medication with the client? Avoid all alcohol. You should feel effects within 1 week. Expect an increase in salivation. Stop taking the medication if dizziness occurs.
Avoid all alcohol. Explanation: The effects of antidepressants can be increased by alcohol. Alcohol should be avoided. Most antidepressants begin to work in 2 weeks but may take 4 to 6 weeks to be fully effective. Antidepressant medication can cause dry mouth. Although dizziness is a known adverse effect, the client should not abruptly stop taking the medication. Rather, the client should be instructed to rise slowly from a sitting position.
An older adult client with stress incontinence is prescribed an alpha-blocker and experiencing incidences of incontinence. Which action will the nurse take first? Teach the client Kegel's exercises. Contact the health care provider. Implement a toileting routine. Obtain adult briefs.
Contact the health care provider. Explanation: 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.
x A client is prescribed digitalis for a cardiac problem. Which supplement should the nurse instruct the client to avoid while taking this medication? Zinc Calcium Selenium Glucosamine
Calcium Explanation: Calcium supplements increase the risk of digitalis toxicity. Digitalis can cause a zinc deficiency. Digitalis is not identified as interacting with selenium or glucosamine.
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? Aspirin Cinacalcet Cimetidine Acetaminophen
Cimetidine Explanation: 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.
The nurse reviews an older adult client's medication list and immediately assesses the client's cognitive function. Which medication caused the nurse to make this clinical determination? Aspirin Codeine Verapamil Colchicine
Codeine Explanation: Varying degrees of mental dysfunction often are early symptoms of adverse reactions to commonly prescribed medications for older adults, such as codeine. Mental dysfunction is not identified as being associated with aspirin, verapamil, or colchicine. Reference:
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? Take another dose of the medication. Time rest breaks to when medication wears off. Take an over-the-counter medication between doses. Discuss the situation with the health care provider.
Discuss the situation with the health care provider. Explanation: 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.
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? Dosage level of the medications Decreased effectiveness of the drugs Excretion of the drugs Time of day when administered
Dosage level of the medications Explanation: 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.
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? Add more protein to the diet. Eat more green leafy vegetables. Include less whole grains in the diet. Eat less cruciferous vegetables.
Eat more green leafy vegetables. Explanation: 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 has been prescribed a potassium-sparing diuretic and a beta blocker for hypertension. Which action should be a priority for the nurse? Monitoring the client for tachycardia Closely monitoring the client's electrolyte levels Ensuring the client does not change position quickly Assessing the client for changes in level of consciousness
Ensuring the client does not change position quickly Explanation: Antihypertensive therapy, especially when first initiated or changed, carries a risk of orthostatic hypotension and subsequent falls. This is especially true when diuretics and β-beta-blockers are prescribed together. Although electrolytes would be monitored, the potassium-sparing nature of the diuretic makes this less urgent than ensuring safety. Cognitive changes and changes in level of consciousness are less likely side effects of diuretic and β-blocker therapy. Beta blockers tend to slow the heart rate down, not increase it.
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? Hops are known to increase pulse rate. Garlic is known to lower blood pressure. Ginseng is known to raise blood pressure. Mistletoe is known to lower pulse rate.
Ginseng is known to raise blood pressure. Explanation: 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 recently prescribed a diuretic is experiencing an irregular heartbeat. What action(s) will the nurse take? Select all that apply. Encourage intake of foods low in calcium. Instruct the client on the use of magnesium replacement supplements. Place the client on a cardiac monitor. Administer IV fluids. Limit oral fluids.
Instruct the client on the use of magnesium replacement supplements. Place the client on a cardiac monitor. Administer IV fluids. Explanation: Electrolyte imbalances are a common adverse effect of diuretic use. Hypomagnesemia is often associated with increased renal losses of magnesium (for example, use of diuretics). The nurse will administer fluids, place the client on cardiac monitor, monitor fluid intake and output and instruct the client on the use of magnesium supplements. Oral fluids would be encouraged. Hypercalcemia is not associated with the use of diuretics.
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? Hemoglobin and hematocrit Liver function tests Electrolyte panel Coagulation studies
Liver function tests Explanation: 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.
An older adult is brought to the emergency department experiencing confusion. After ensuring the client's safety, which action should the emergency department staff take next? Prescribe an electrocardiogram Administer a stimulant Review the client's current medication regimen Check serum electrolyte levels
Review the client's current medication regimen Explanation: Varying degrees of mental dysfunction often are early symptoms of adverse reactions to commonly prescribed medications for older adults. Even the most subtle changes in mental status could be linked to a medication and should be reviewed as a priority. If the client or an accompanying person knows what drugs are being taken and the dosages, the cause of the dysfunction may be immediately apparent. No stimulant should be given until that information is available, as it might cause an interaction with adverse results. Serum electrolyte levels and an electrocardiogram may be needed but only after the drug information is known.
An older adult client is experiencing high levels of anxiety and is prescribed lorazepam. Which information will the nurse include in the client teaching? Select all that apply. Take medication as prescribed; do not skip or double doses. Try nonpharmacologic methods to relieve anxiety. This medication may cause increased wakefulness. This medication is usually prescribed for short-term use and does not cure the underlying problem. Do not use alcohol or other central nervous system (CNS) depressants while taking this medication.
Take medication as prescribed; do not skip or double doses. Try nonpharmacologic methods to relieve anxiety. This medication is usually prescribed for short-term use and does not cure the underlying problem. Do not use alcohol or other central nervous system (CNS) depressants while taking this medication. Explanation Lorazepam is an example of a benzodiazepine and is commonly used in older adults. The medication is usually prescribed for short-term use and does not cure the underlying condition. Nonpharmacologic methods to decrease anxiety should be used, in addition to counseling to deal with the underlying problem. The medication can cause dizziness and drowsiness and should not be taken with alcohol or other CNS depressants. Doses should not be skipped or doubled.
Which client has the highest risk for developing medication toxicity? The 56-year-old client diagnosed with glomerular nephritis The 80-year-old client experiencing a cardiac dysrhythmia The 61-year-old client receiving intravenous antibiotics The 90-year-old client diagnosed with terminal cancer
The 56-year-old client diagnosed with glomerular nephritis Explanation: 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 client experiences arthritis pain. Which medication should the nurse identify as being the safest for this client? etodolac ibuprofen diclofenac acetaminophen
acetaminophen Explanation: 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.
The nurse notes that an older adult client who takes a sedative for sleep is drowsy during an afternoon visit in the home. Which assessment(s) should the nurse make? Select all that apply. alcohol intake food intake medication regimen amount of fluid intake sleeping pattern
alcohol intake medication regimen sleeping pattern Explanation: The effects of sedatives can be increased by alcohol. The nurse should ask if the client is ingesting alcohol while taking this medication. The sedative is not affected by food or fluid intake. The nurse should assess the client's other medications for possible drug interactions and the client's current sleeping pattern for opportunities to improve it.
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? avoid foods and beverages with caffeine limit the intake of green leafy vegetables plan to take the medication before bedtime take the medication with coffee every morning
avoid foods and beverages with caffeine Explanation: 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.
An older adult client is prescribed a beta blocker. Before administration, the nurse will question the prescription if the client has which health problem? osteoarthritis lymphedema benign prostatic hypertrophy chronic obstructive pulmonary disease
chronic obstructive pulmonary disease Explanation: 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.
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? elevated white blood cells elevated blood urea nitrogen (BUN) elevated PT/international normalized ratio (INR) elevated total cholesterol
elevated PT/international normalized ratio (INR) Explanation: 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 administers oral medications to an older adult client. What should the nurse do to ensure that the client swallows the medication? crush the medication dissolve the medication in water examine the mouth after administering encourage the client to chew the medication
examine the mouth after administering Explanation: Although oral administration is simple, certain problems can interfere with the process. Examining the oral cavity after administration will ensure that the client receives the full benefit of the medicine. Not all oral medications can be safely crushed. It is not recommended to dissolve oral medications in water. Not all oral medication can be safely chewed.
An older adult client is prescribed thioridazine. What should the nurse add to this client's plan of care? limited oral fluid intake fall prevention strategies actions to reduce diarrhea vital signs assessment every 2 hours
fall prevention strategies Explanation: 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.
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? isoniazid Aldactone furosemide indomethacin
furosemide Explanation: 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.
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? match the medications with Beers criteria discuss the prescribed dosages with the pharmacist strategize ways to ensure the client takes medications as prescribed ask the health care provider to explain rationales for prescribing certain medications
match the medications with Beers criteria Explanation: 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.
An older adult client demonstrates changes in cognition over the last few days. On what should the nurse focus first when assessing this client? fluid intake activity status dietary changes medication record
medication record Explanation: Even the subtlest changes in mental status could be linked to a medication and should be reviewed with a health care provider. Older adults easily may become victims of drug-induced cognitive dysfunction. Fluid intake, activity status, and dietary changes are not identified as key areas to assess with a new onset of cognitive changes in an older adult client.
After using complementary and alternative approaches, an older adult client continues to experience pain. What should the nurse do at this time? provide acetaminophen prepare a dose of fentanyl ask for a prescription for meperidine use another nonpharmacologic approach
provide acetaminophen Explanation: 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.
A gerontological nurse is caring for an older adult client receiving various medications in an acute care facility. Which will the nurse use to evaluate the appropriateness of a medication prescription? changes in gastrointestinal (GI) motility body-composition factors preexisting chronic conditions renal and liver function
renal and liver function Explanation: Changes in renal and liver function contribute significantly to the changes in pharmacokinetics that are common in older adults. Consequently, drugs can accumulate to toxic levels and cause serious adverse reactions. While changes in GI motility, drug distribution, and preexisting conditions may be true for many clients, these factors are inconsistent.
