Chapter 5
Race is a variable that is known to influence what aspect of pharmacokinetics in older adults?
Metabolism
The 68-year-old client states, "I have been taking aspirin on occasion for my arthritis for many years but notice that it takes longer for it to start working now." What is the best response by the nurse?
"As you get older, absorption is prolonged and medications may take a little longer to act than normal."
A nurse is conducting an assessment of a client who has recently had several changes made to the drug regimen. What assessment question most directly addresses the safety implications of the client's drug regimen?
"Do you take any herbal supplements or alternative medications?"
A gerontological nurse is conducting a medication assessment of a new client on a subacute medicine unit. Which of the client's statements should signal to the nurse a need for education?
"I use a lot of herbs and supplements, but I'm careful to make sure that they're all natural."
An older adult client with a history of seasonal allergies, heartburn, and headaches reports falling several times in the last three months. Which assessment question best demonstrates the nurse's understanding of the negative effects of anticholinergic medications on an older adult?
"What over-the-counter (OTC) medication are you taking to manager your pollen allergy?"
The nurse implements strategies to increase medication adherence such as:
- Educating the patient about medication administration and adverse effects, - Providing medication administration aids - EMPLOY STRATEGIES TO MINIMIZE SIDE EFFECTS
The nurse who is caring for an older client sees that the latest laboratory report reveals a decreased creatinine clearance. The nurse anticipates what modification to the client's drug regimen?
A decrease in the dosage of medication
Assess the patient's ____________to the prescribed medications
Adherence
Provide the patient with medication administration aids to increase _________
Adherence
The ability of older adults to adequately distribute drugs that are ingested is highly dependent on serum levels of what factor?
Albumin
To reduce older adults' risk of experiencing adverse drug effects or interactions, what action should the nurse prioritize?
Assess clients' use of herbal remedies and over-the-counter (OTC) medications.
What schedule of medication dosing assists older adults in adhering to a medication regimen?
Begin with a low dose to minimize adverse effects
Assess ________________ to determine the patient's ability to excrete the medications.
Blood urea nitrogen and creatinine clearance levels
The nurse should caution an older adult client against using diphenhydramine hydrochloride because of what increased risk?
Confusion
How is the renal system affected by the aging process? (Select all that apply.)
Decrease in blood flow to the kidneys Decrease in the number of functioning nephrons Decrease in tubular secretion
Decreased or increased: Function of vital organs(liver, kidney, heart)
Decreased
Decreased or increased: In blood flow to the GI tract, a decrease in surface area to support absorption, and diminished gastric emptying limits absorption.
Decreased
A 72-year-old man with pain issues is being given a drug by the intramuscular route. His serum blood level concentrations have been erratic. The nurse suspects that this may be due to
Decreased blood flow to tissues and muscles
A 72-year-old man who is unable to sleep since admission into the hospital is given a hypnotic medication at 9 PM. The nurse finds the patient drowsy and confused at 10 AM the next day. The nurse is aware that this behavior is most likely due to
Decreased hepatic function
An elderly client is being admitted to the hospital for surgery. The nurse is reconciling the client's medications. The client is prescribed digoxin 0.125 mg daily, furosemide 40 mg two times a day, Lanoxin 0.125 mg daily, metoprolol XL 25 mg once a day, and pravastatin (Pravachol) 40 mg at hours of sleep daily. The nurse recognizes a problem when the nurse notes:
Digoxin and Lanoxin are the same medications.
A nurse is aware that older adults tend to have a significantly decreased rate of hepatic blood flow compared with younger adults. What effect is this likely to have on pharmacokinetics and pharmacodynamics in an older adult?
Drug clearance is likely to be slower
The nurse is caring for an older adult client who has been prescribed multiple medications. How can the nurse best work with the care team to prevent polypharmacy-related issues?
Ensure that each of the client's medications is genuinely necessary and discontinue those that are not
The mentoring nurse is orienting a new graduate RN to the geriatric floor. What assessment technique will the new graduate nurse perform to identify an age-related physiological change associated with medication metabolism?
External palpation of the liver
A 76-year-old is brought into the clinic via wheelchair by a family member. The client has end-stage renal disease, hypertension, diabetes mellitus, and two prior myocardial infarctions. What category of elderly is this client considered?
Frail elderly
Educate the patient and family about the __________ of medications to prevent overmedication.
Generic and trade names
Older adults Interactions of medications can lead to ________ complications and _________ mental status.
Greater; Diminished
Which condition contributes to nonadherence to the medication regimen due to its lack of identifiable symptoms?
Hypertension
Decreased or increased: In gastric pH
Increased
A home health nurse is performing a home visit to an elderly client who has early-stage dementia. The nurse observes that some of the client's pill bottles are empty, even though the client is not due for refills for 2 weeks. What nursing diagnosis should the nurse prioritize when planning this client's care?
Ineffective Therapeutic Regimen Management
In older adults, physiologic changes alter the ability for the ______ to provide the desired effect for which it is intended.
Medication
An older adult client is prescribed an atypical antipsychotic medication in an appropriate dose after recently demonstrating signs of postoperative delirium. What action should the nurse take to best assure the client's immediate safety?
Monitor the client closely for signs/symptoms of gastrointestinal distress.
The ______ physically active older adults are, the _____ likely they will experience altered drug responses
More; Less
An older adult reports taking a long time to digest meals. Which results of the slowed digestion would affect the absorption of medications? (Select all that apply.)
Nausea and vomiting Dehydration
An older adult client calls the health care provider's office and tells the nurse that prescriptions for three medications have run out and the pharmacy will not refill them this close together. A home health referral is made and the client is found to be taking the medication more often than prescribed. What is a priority nursing diagnosis for this client?
Nonadherence to therapeutic medication regimen
An older adult client has been prescribed meperidine hydrochloride for pain management. According to Beers criteria, what assessment should the nurse conduct regularly to best assure the safety of this client?
Orientation to person, place, and time
Older adult
Person who is 65 years of age or older
Adult
Person who ranges in age from 19 to 64 years
Educate the patient and family to have all prescriptions filled at one
Pharmacy
Age-related changes
Physiologic events due to increasing age, which affect drug responses
A nurse is caring for an 81-year-old client in a long-term care facility who takes nine different medications each day. The client has a recent diagnosis of seizure disorder and has begun treatment with phenytoin (Dilantin), a highly protein-bound drug. After 1 month of Dilantin therapy, the client is still extremely drowsy and sluggish. The nurse determines that the prolonged adverse effect is likely due to:
Polypharmacy decreasing the number of available protein-binding sites
Risk-to-benefit ratio
Poor outcome (adverse effects of medications) in relation to good outcome (desired medication effects); increases with increasing age
A nurse is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the nurse will also be careful to observe for
Possible drug toxicity
A client will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During client education about drug regimen, the nurse should prioritize teaching about:
Potential adverse effects of the drugs that the client will be taking
A client has been diagnosed with cardiovascular disorder. The client is age 68; suffers from intermittent joint pain and is under drug therapy; eats meat, salads, and fruits; prefers alternative herb medications along with drug therapy; sometimes smokes; he lives alone and is looked after by a caregiver. Which item of information has the greatest implication for planning his drug therapy?
Prefers alternative herb medications
An 82-year-old is suffering from acute anxiety and is prescribed alprazolam (Xanax) by the health care provider. What steps can the provider take to ensure that the client will be at a decreased risk for injury?
Prescribe a smaller dose
Educate the patient and family to use one ________ who prescribes medications in consultation with other health care specialists.
Primary care provider
An older client is recovering from a 5-hour surgery requiring intravenous anesthetic. When considering age-related changes and their effect on medication distribution, the recovery room nurse will give which assessment priority when monitoring this client?
Respiratory rate
Knowing that an older adult has received a lipid-soluble anesthetic, the postanesthesia unit nurse will be particularly attentive to which of the client's assessment data?
Respiratory rate
A healthy 70-year-old man has been having trouble sleeping at night. Additionally, he has been having difficulties with gastresophageal reflux. He buys generic Benadryl to help him sleep and buys generic Tagamet for his reflux. After 7 days of taking these over-the-counter medications, he exhibits signs of confusion and disorientation. His wife calls the primary care facility to speak with the nurse. What should the nurse suspect first?
The older adult is experiencing mental changes as an adverse drug effect.
A nurse is caring for a 92-year-old who is taking multiple drugs and displaying increased cognitive impairment and memory loss. The initial action of the nurse would be to:
Try to distinguish between normal signs of aging and the adverse drug effects.
Assess __________ as ordered by the prescriber to determine the medication effectiveness and prevention of toxicity.
Therapeutic drug levels
Polypharmacy
Use of several drugs during the same period
Assess the ratio of alanine _________ to aspartate __________ to determine the patient's liver function and ability to metabolize drugs.
aminotransferase
Educate the patient and family about all medications and possible _______________ interactions.
drug-drug, drug-herb, and drug-diet
What interventions will the nurse use to improve adherence to a medication regimen for the older adult? (Select all that apply.)
• Keep the cost of the medications as low as possible • Provide easy-to-follow directions • Educate client and family to the medication regimen
