Older Adult Ch. 9 Geropharmacology

Which pharmacokinetic/ pharmacodynamic parameter is least affected by the aging process? a. Absorption b. Distribution c. Metabolism d. Excretion

Absorption There is no conclusive evidence that the absorptive process is changed appreciably in older adults.

The nurse's first response when told by a client during an assessment interview that they "can't take furosemide (Lasix)" is to ask: a. "Is your healthcare provider aware that you are allergic to Lasix?" b. "Can you describe what happened when you took Lasix?" c. "When was the last time you took Lasix?" d. "Have you any question regarding your reaction to Lasix?"

"Can you describe what happened when you took Lasix?" It is important to document the type of allergic reaction, when the patient had it, how long it lasted, and how it was treated.

When discussing pharmacological considerations a 68-year-old client asks, "Why do medications seem to act differently than they did when I was younger?" The nurse bases the response on the concept that: a. Age-related changes affect the way drugs are metabolized by older adults b. Over-the-counter (OTC) drugs have standardized dosages that are appropriate all ages c. Older adults may need larger doses of medication to bring about the desired effects d. Adverse drug reactions occur with similar frequency in older adults as the general population

Age-related changes affect the way drugs are metabolized by older adults Age-related pharmacokinetic and pharmacodynamic changes explain why older adults react differently to medications

In order to best assure client safety and affective medication therapy, the nurse suggests that the son who will be a administering his parent's medications via PEG (percutaneous enteral gastrostomy) tube: a. Ask the pharmacist to provide the medications in liquid form when available b. Crush all medications and add them to the tube feeding c. Medications that can not be crushed should be given orally d. Medications should be administered via the PEG all at once, one time daily

Ask the pharmacist to provide the medications in liquid form when available Administration of medications in liquid form is preferable and easier with a PEG; many medications are available in liquid format. Crushing and adding medications to food is not done unless specified by the pharmacist because food may interfere with medication effectiveness.

What factor is an important contribution to polypharmacy in older adults? a. Inadequate communication among medical care providers b. Implementation of Medicare Part D prescription drug benefit c. Use of generic medications d. Increasing popularity of dietary and herbal supplements

Inadequate communication among medical care providers Polypharmacy is often the result of inadequate communication among specialists or between specialists and primary care providers.

An 81-year-old patient is being discharged from the hospital to home. She is on seven different medications, which are to be taken at four different times during the day. What would be most useful in helping this patient manage her medications? The nurse makes the greatest impact on the safe management of an 81-year-old client's medication administration when included in discharge education is: a. the package inserts from all of the medications for the client to read b. a pillbox with compartments for each day and each of the doses c. a written list of all the client's medications and administration routine d. a suggestion that the client's daughter administer the medications

a pillbox with compartments for each day and each of the doses Providing a pillbox is an effective method to reinforce which medications are to be given at what times. It also serves as an effective method to remind patients when they have missed a dose.

An older client prescribed a transdermal morphine patch for severe chronic pain is being educated on the appropriate administration of the medication. The nurse shows an understanding of essential information regarding this route of drug administration when stating: Select all that apply. a. "Aging increases the risk of having an allergic reaction to medication delivered by patch." b. "Since you have problems with digestion, this is a good way to take your medication." c. "Please show me how you would apply your patch." d. "Be careful to put the patch only on your chest but change locations with each application." e. "Be sure to avoid placing the patch on injured skin."

a. "Aging increases the risk of having an allergic reaction to medication delivered by patch." b. "Since you have problems with digestion, this is a good way to take your medication." c. "Please show me how you would apply your patch." e. "Be sure to avoid placing the patch on injured skin." Aging does increase the risk of developing an allergic reaction due to its affect on the immune system and decreased gastric motility. Transdermal medications bypass the gastrointestinal tract and so do not cause digestion problem and their effectiveness is not affected by digestive problems. Demonstrating the application process is an excellent way to evaluate the client's understanding and technique.

A 77-year-old Hispanic Catholic Nun (retired) who immigrated to the United States 15 years ago lives alone but in an apartment complex where her sister lives as well. She is being discharged home after a hospitalization for congestive heart failure with prescriptions for eight different medications. She is considered at risk for noncompliance due to contributing factors that include: Select all that apply. a. Language barrier b. Living alone c. Large number of medications d. Ethnic background e. Religious background

a. Language barrier b. Living alone c. Large number of medications Language barriers, living alone, and a large number of medications are all factors that have been shown to contribute to noncompliance in older adults.

When performing the initial assessment on a new client in the geriatric outpatients practice, the most effective method the nurse can implement to elicit an accurate medication assessment is to ask that the client: a. make a list of all their current medications b. work with a family member to make a list of their medications c. bring in all of the medications that they are currently taking d. allow their previous primary care provider to provide a list of medications

bring in all of the medications that they are currently taking The gold standard is to use the "brown bag" approach. The patient is asked to bring all medications including prescription drugs, OTC drugs, and herbal and dietary supplements. The patient may not remember all of the medications they are taking

The area in which nurses have the greatest effect on the safe, effective medication therapy of an older client is: a. educating the client to all aspects of the medication. b. assessing for adverse reactions to the medication. c. monitoring overall health of the client as it is affected by the medication d. evaluating the outcomes resulting form the medication

educating the client to all aspects of the medication. Nurses have the greatest opportunity to impact medication use and improve treatment outcomes through patient education.

Factors that affect the pharmacokinetics of lipophilic medications in older include: a. greater adipose tissue ratio to body mass b. decreased total body water c. increased glomerular filtration rate d. increased creatinine clearance.

greater adipose tissue ratio to body mass Older adults have a higher ratio of adipose (fat) tissue where lipophilic (fat soluble) medications can be stored thus resulting in a potential for an accumulation of the medication and potentially fatal overdoses. Older adults have a decrease in lean body mass and an increase in fat.

The Beers list is an effective tool for healthcare professionals prescribing and/or managing the medication therapy of older adults since it identifies medications that for this population: a. are not typically covered by drug benefit plans. b. have a higher than usual risk for injury c. are likely to be abused d. generally cause allergic reactions

have a higher than usual risk for injury

When developing a teaching plan for an older, newly diagnosed diabetic client, the nurse best ensures an understanding of oral hypoglycemic medications when providing: a. the package insert and assessing the client's reading skills b. the client with the website address for the American Diabetes Association c. oral explanations and sending the client home with a written copy d. the information in paragraph form as opposed to numbered line fashion

oral explanations and sending the client home with a written copy Providing memory aids such as written information including charts is effective in reinforcing teaching.

The nurse suspects that a client is experiencing tardive dyskinesia when observing: a. that the client can't seem to stop moving b. the client's facial muscles are twisting involuntarily c. the client not able to get up out of a chair d. that the client's hand tremors so much that drinking from a cup is difficult

the client's facial muscles are twisting involuntarily Facial movements and involuntary twisting of the limbs, trunk, neck, and face is the definition of tardive dyskinesia.