3, 5, 6, 7 Worksheets

The older patient presents to the provider's office for a follow-up visit and also with complaints of sneezing, runny nose, headache, and scratchy eyes after working out in the garden. The patient states he takes digoxin, fluoxetine, and a multivitamin regularly and has started taking diphenhydramine for the current symptoms. What statement by the patient indicates further teaching is needed?

"I cannot work outside anymore because of the digoxin." There is no reason that the patient cannot work outside if he is taking dioxin, and the patient's symptoms are not related to the digoxin. Diphenhydramine can be very sedating in the geriatric population, and there are substitutes that are equally effective with fewer side effects. Fluoxetine, an SSRI, is prescribed for depression. Patients of all ages should be advised not to take each other's medications.

What percentage of nurses abuse drugs and demonstrate impaired practice attributable to that abuse?

10-15%

Clary, 57 years old, presents to the ED. She is unresponsive to verbal and painful stimuli and smells strongly of alcohol. Vital signs: T: 96.8, HR: 104, RR: 6, BP: 90/68, O2 sat: 88% 2. What are the potential complications for alcohol toxicity?

A person with alcohol toxicity can a pirate on vomitus and asphyxiate and develop severe dehydration, seizures, hypothermia, and eventually brain damage and death.

A.M, 4 years old, fell from a tree branch and fractured her forearm. An IV needs to be established and analgesia administered. Discuss the utilization of topical anesthetics before inserting an IV.

A topical anesthetic like a eutecic mixture of local anesthetics (EMLA) or topical lidocaine may be utilized to lessen the pain of establishing an IV. The downside to using these topical aesthetics is that they must be in place 60-90 minutes before the IV can be started for them to be effective.

The 12-year-old patient has been admitted for nausea, vomiting and diarrhea, and the HCP has prescribe several drugs. What concerns will the nurse have regarding drug administration? (Select all that apply) A. Renal tubular function is decreased. B. dehydration may lead to toxicity C. The drugs should not be administered by the oral route D. Rectal administration will promote quick absorption E. Developmental levels must be considered

A, B, C, E In early adolescents, renal tubular function decreases, which may lead to impaired excretion and a higher risk for toxicity. dehydration can also decrease renal unction and may lead to toxicity. Because the patient is nauseated and vomiting, drugs should not be administered orally. When providing care to any patient, developmental levels should be considered.

In older adults, drug dosages are adjusted based on which factors? A. Amount of adipose tissue B. Height C. Nutritional status D. Laboratory results E. Response to drug

A, C, D, E Older adults have more adipose tissue, so a greater amount of lipid-Soluble drug would be absorbed. Protein is required for binding of some drugs, so if a patient is malnourished, there would be less protein available. Laboratory results, specifically those that assess renal and hepatic function, are important to trend, as well as those drug levels (digoxin, INR) needed to measure toxicity. As with any population, it is important to evaluate the patient for responsiveness to the drug.

What class are these drugs? Lisinopril, benazepril, enalapril, quinapril

ACE-I

What class are these drugs? Irbesartan, losartan, valsartan

ARBs

_____ is altered by decreased small bowel surface area, decreased gastric emptying, and reduced gastric blood flow

Absorption

Age-related factors among older adults influence drug _____, _____, _____, and excretion.

Absorption, distribution, metabolism

What are the components of pharmacokinetics?

Absorption, distribution, metabolism, excretion

Risk factors associated with polypharmacy include...

Advanced age, being female, having more than one HCP, having more than one OTC drug, having chronic diseases, use of vitamin and mineral supplements.

The degree and rate of absorption of drugs in a pediatric patient are based on ______, _____ ______, _____, and _____ _____ _____.

Age, health status, weight, route of administration

What to consider when administering drugs to this age group? Preschool

Allow some choice

Electronic cigarettes (are/are not) safer than tobacco products

Are not

The patient has decided to quit smoking. What key points must the nurse include in the teaching plan?

Assess that the patient is motivated to quit. Help the patient identify the cultural context that increases the desire to smoke. Provide the patient with a list of over-the-counter and prescription options for smoking cessation aids.

The nurse is administering an oral drug with a low pH to the 2-week-old infant. What is the impact of this drug? *(select all that apply)* A. Absorption may be slower in this patient B. Absorption may be quicker in this patient C. This drug will be absorbed at the same rate as an older patient D. Oral drugs should not be administered to this age group

B. Absorption may be quicker in this patient. Absorption depends on the drug formulation (basic [alkalotic] or acidic). A low pH environment favors acidic drug absorption, whereas a high pH favors basic drug formulation.

What specific lab values should be monitored in a geriatric patient to assess kidney function?

BUN, creatinine clearance

Mary, 80 years old, presents to her HCP for her annual checkup. She has a medical history of diabetes, insomnia, and hypertension. Vital signs: T: 99, HR: 83, RR: 16, BP: 142/90, blood glucose: 96. During health history, Mary complains of having trouble falling asleep and staying asleep, and having to get up several times per night to go to the bathroom. Mary says her current drugs include hydrochlorothiazide, triazolam, and chamomile tea. "I try to remember to take my drugs, and sometimes I take an extra one, use in case I forgot one," she says. 1. What lab test would the nurse anticipate for this patient?

Because both renal function an hepatic function are important in drug metabolism and excretion, an both decrease with aging, the nurse would anticipate that measurement of liver enzymes, BUN, creatinineand cleatinine clearance would be ordered. Since this patient also has diabetes, blood glucose test would also be done.

What class are these drugs? Acebutolol, atenolol, sotolol

Beta blockers

Distribution of a drug throughout the body is affect by _____ _____ _____, _____ _____, _____-_____ _____, and effectiveness of various barriers to drug transport.

Body fluid composition, tissue composition, protein-binding capability

Which drug would have fewer adverse and toxic effects? A. Fat-soluble, half-life of 50 hours B. Fat-soluble, 90% protein bound C. Half-life of 4 hours, 50% protein bound D. Fat-soluble, 60% protein bound

C. Half-life of 4 hours, 50% protein bound Drugs with a shorter half-life and less protein-binding would have fewer side effects. There are fewer protein binding sites in older adults, resulting in more circulating drug. Because of less effective functioning of both hepatic and renal metabolism, drugs with a shorter half-life are safer.

The 18-month-old child has been prescribed an oral drug that is water-soluble. Based on the nurse's knowledge of drug distribution, how may the dosage need to be modified for the patient in order to reach therapeutic levels? A. Alternate route B. Decreased C. Increased D. No change

C. Increased The dosage for a water-soluble medication may need to be increased in this age group because their bodies are about 70% water up until 2 years. Therefore, there is more water in which the drug will be distributed.

_____ questionnaire can be used to screen for alcohol misuse

CAGE

A.M, 4 years old, fell from a tree branch and fractured her forearm. An IV needs to be established and analgesia administered. How may the caregiver be involved in the patient's care while the IV is established?

Caregivers may be involved in patient care (if they choose to be) by helping to gently restrain the child. The can also provide distraction ("What color sling would you like" or "What should we have to eat tomorrow morning when we get up"). Reassuring the preschooler that she is doing a good job holding still can also be beneficial.

What changes will the nurse recommend to a patient who experiences dizziness when arising from bed?

Change positions slowly.

_____ _____ _____ recognizes and stops negative patterns and enhances self-control

Cognitive behavior therapy

What to consider when administering drugs to this age group? Adolescent

Collaborate regarding plan of care

_____ _____ based on frequent behavior monitoring and removal of rewards for substance use

Contingency management

_____ is defined as a strong desire for the drugs effects

Craving

What is an indicator of the glomerular filtration rate and the normal value for an adult?

Creatinine clearance: 100-125 mL/min

The blood-brain barrier in infants is immature. Which outcome is more likely in infants? A. Increased effect of drug B. More side effects from drug C. Quicker results of drug D. Higher toxicity

D. Higher toxicity risk

The patient presents to the emergency department (ED) under the custody of local law enforcement. The patient reportedly stalled a small balloon full of cocaine. What clinical manifestations would the nurse expect to see if the balloon ruptured?

Dilated pupils and restlessness

_____ is altered by a decline in muscle mass and an increase in fat

Distribution

Clary, 57 years old, presents to the ED. She is unresponsive to verbal and painful stimuli and smells strongly of alcohol. Vital signs: T: 96.8, HR: 104, RR: 6, BP: 90/68, O2 sat: 88% 3. Describe the pharmacokinetics for disulfiram and the side effects if taken with any alcohol.

Disulfiram inhibits aldehyde dehydrogenase, the enzyme needed to metabolize alcohol. Disulfiram keeps patients from ingesting alcohol because of its side effects. It is slowly metabolized by the liver. This side effects can occur up to 2 weeks after cessation of drug therapy. Side effects can occurs within 10 minutes of ingesting alcohol. (Including mouthwash, cough medicine, or foods containing or cooked in alcohol). Side effects include nausea, headache, vomiting, chest pains, dyspnea, rash, drowsiness, impotence, acne, and a metallic aftertaste

Misused drugs typically increase _____ and other _____ in the limbic system of the brain.

Dopamine, neurotransmitters

The safest antihypertensive agents for older adults have a low incidence of what side effect?

Electrolyte imbalance Renal function is decreased in older adults, which can cause electrolyte imbalance. Also, decreased renal function can lead to prolonged half-life and elevated drug levels. Certain antihypertensive like ACE-I, potassium-sparing diuretics, and thiazides diuretics can worsen electrolyte imbalance.

The study of environmental influences on genetics is called _____.

Epigenetics

Opioids provide a sense of _____ and _____; methadone _____ these feelings.

Euphoria, tranquility, blocks

Clary, 57 years old, presents to the ED. She is unresponsive to verbal and painful stimuli and smells strongly of alcohol. Vital signs: T: 96.8, HR: 104, RR: 6, BP: 90/68, O2 sat: 88% 1. What is the initial treatment for Clary?

Even though the patient appears to be intoxicated, other causes of her unresponsiveness need to be evaluated. There is no antidote for alcohol intoxication other than supportive care. The patient's RR is insufficient an d his respiration's must be assisted. Treatment should be aimed toward airways management and supplemental oxygenation, supportive care, and IV hydration.

Polypharmacy increases the risk of _____ among older adults

Falls

Infants have _____ protein sites than adults, resulting in _____ risk of toxicity

Fewer, increased

Benzodiazepines are FDA approved to treat addiction to _____.

GHB

_____ _____ is a diminished ability to control the use of a drug in terms of onset, level, or termination.

Impaired control

Disulfiram _____ the enzyme involved in metabolizing alcohol.

Inhibits

What to consider when administering drugs to this age group? School-age

Involve in administration process

Dehydroepiandrosterone (DHEA) is found in many dietary supplements and (is/is not) proven to slow aging

Is not

The nurse is teaching a group of parents how to administer drugs to their children. Which elements of drug administration will be included in the teaching?

Lightly restrain the child as needed. Praise the child after successful administration. Never threaten the child into taking the drug Herbal preparations should not, in general, be given to children.

Drugs for older adults are prescribed at _____ dosages and _____ increase in dosage based on therapeutic _____.

Low, gradually, response

Discrepancies in controlled-drug handling and records among health care professionals (may/may not) indicate drug diversion.

May

Clary, 57 years old, presents to the ED. She is unresponsive to verbal and painful stimuli and smells strongly of alcohol. Vital signs: T: 96.8, HR: 104, RR: 6, BP: 90/68, O2 sat: 88% 4. Identify the drug-drug interactions that can occur when taken concomitantly with disulfiram

Metronidazole, an antimicrobial, and paraldehyde, a sedative, when taken concomitantly with disulfiram can produce the same side effects as if the person had been ingesting alcohol.

_____ _____ _____ develops motivation internally to commit to a specific plan

Motivational enhancement therapy

An older adult patient is to take newly prescribed drugs at different times. What will the nurse suggest so that the patient can comply with the drug regimen?

Obtain a weekly pill container with multiple time slots from the drugstore and fill the container the day or week before with the drugs

The patient, who is 75 years old, reports feeling dizzy every morning when he gets out of bed. What effect does the nurse recognize the patient is probably experiencing?

Orthostatic hypotension Dizziness when going from a supine to a standing position is referred to as orthostatic hypotension. Although bradycardia may cause dizziness, this is not the most likely cause.

Substance use disorder amount nurses can be recognized by changes in _____, _____, _____ _____, and _____ _____.

Personality, behavior, job performance, job attendance

The older adult patient states he has difficulties opening his bottle of celecoxib. What is the nurse's best response?

Please ask your pharmacist to place your drug in a bottle with a non-childproof cap

A.M, 4 years old, fell from a tree branch and fractured her forearm. An IV needs to be established and analgesia administered. 1. What strategies may the nurse implement to provide developmentally appropriate care for this patient?

Preschoolers may respond to age-appropriate explanations. They may also benefit from a familiar toy or studded animal as support. Allow the child to verbalize being scared or upset. Whenever possible, allow the child options and control. Do not argue with the child or tell the child that she is being punished for falling from the tree. Tell the child what you are going to do before you do it. Do not just surprise the child.

What to consider when administering drugs to this age group? Toddler

Provide simple explanation

What class are these drugs? Lithium, gabapentin, duloxetine, bupropion, benlafaxine, pregablin

Psychotropics

Pharmacodynamic response to drugs are altered with aging as a result of changes in the number of _____ sites, which affects the _____ of certain drugs.

Receptor, affinity

The _____ _____ is a structure within the brain that regulate the body's ability to feel pleasure.

Reward circuit

Some of the characteristic in older adults that increase the risk or problems related to drugs include _____ and _____ changes associated with _____.

Sensory, physical, aging

Drugs that nurses should avoid administering to older adults with 4 or 5 chronic kidney disease

Sotolol, all NSAIDs, meperidine, glyburide, metformin, exenatide, potassium-sparing diuretics, thiazides diuretics, olmesartan, new anticoagulants

A mother brings her 13 year old daughter to the ED because she is "acting strange." The mother states she found a package of "bath salts" in her daughters bedroom. "Bath salts" are classified as which type of drug?

Synthetic cathinone

The 3-year-old patient requires a topical drug. What does the nurse know about the rate of absorption for topical drugs in this age group?

The drug will absorb faster because the skin is thinner

Mary, 80 years old, presents to her HCP for her annual checkup. She has a medical history of diabetes, insomnia, and hypertension. Vital signs: T: 99, HR: 83, RR: 16, BP: 142/90, blood glucose: 96. During health history, Mary complains of having trouble falling asleep and staying asleep, and having to get up several times per night to go to the bathroom. Mary says her current drugs include hydrochlorothiazide, triazolam, and chamomile tea. "I try to remember to take my drugs, and sometimes I take an extra one, use in case I forgot one," she says. 3. What further teaching will the nurse provide to the patient to the patient about her drug regimen?

The nurse should recognize and support the patient's desire to be compliant with her drug regimen; however, the patient does need further education about "doubling up" on medications. A verisimilitude of methods can be used to help the patient remember to take her drug. These can include using commercial pill dispensers, making a list, keeping a calendar, or setting an alarm.

Mary, 80 years old, presents to her HCP for her annual checkup. She has a medical history of diabetes, insomnia, and hypertension. Vital signs: T: 99, HR: 83, RR: 16, BP: 142/90, blood glucose: 96. During health history, Mary complains of having trouble falling asleep and staying asleep, and having to get up several times per night to go to the bathroom. Mary says her current drugs include hydrochlorothiazide, triazolam, and chamomile tea. "I try to remember to take my drugs, and sometimes I take an extra one, use in case I forgot one," she says. 2. What suggestions can the nurse make to help with Mary's sleeping difficulties?

There are a variety of sleep aids besides triazolam that could be utilize. Because this patient is also taking a diuretic, it would be important to suggest the patient take her diuretic in the morning to prevent frequent awakenings during the night to go to the bathroom. Some nonpharmacologic measures include taking warm baths, decreasing stimulation in the evening, and eliminating caffeine intake late in the day. The patient also states that she like chamomile tea, which may help induce sleep. A light bedtime snack will help maintain blood sugar levels throughout the night.

_____ is requiring a significantly increased amount of a drug to achieve the desired effect.

Tolerance

Until about the age _____ _____, the pediatric patient requires a _____ dose of water-soluble drugs to achieve therapeutic levels.

Two years, higher

Gastric pH does not reach adult acidity until between _____ and _____ years of age.

Two, three

What to consider when administering drugs to this age group? Infant

Use minimum restraint necessary

Before administering drugs to the older adult, what should the nurse know?

Whether the drug is highly protein bound Half-life of the drug Serum levels of drugs with a narrow therapeutic range Baseline vital signs Older patients have less protein available for binding, so its important to know if a drug is highly protein bound. Drugs with a short half-life are less likely to cause problems for the patient. Certain drugs (some antibiotics, digoxin, warfarin) have a very narrow therapeutic range, so they must be monitored closely. Vital signs may vary as a patient ages; therefore, it is important to obtain baseline vital signs to know the patient's norm.

_____ _____ is a group of signs and symptoms of physiologic disturbance upon cessation or reduction of a drug.

Withdrawal syndrome

Following hospitalization, the older adult patient receives a home visit from the nurse. The patient asks if she should continue to take the drugs she took before hospitalization. What is the most appropriate response?

You should take only the drugs that have been prescribed on discharge and not drugs you took prior to hospitalization unless otherwise indication.

_____ is altered by the decline in hepatic circulation, liver atrophy, and a reduction in hepatic enzyme activity

____ is altered by the decline in renal function

Which drug can be given to aid a patient with opioid withdrawal?

methadone

Heroin addiction may be treated with _____ or _____

methadone, buprenorphine