Pharmacology: Geriatrics

The nurse is administering medication to an older adult. The nurse anticipates that this patient's renal system will have which effect on the medication? 1) The medication will be excreted more quickly. 2) The medication will be metabolized more slowly. 3) The medication will be excreted more slowly. 4) The medication will be metabolized more quickly.

The medication will be excreted more slowly. Due to a decrease in renal function, older adults excrete drugs more slowly than younger patients. Metabolism and excretion are not increased in older adults.

The nurse observes that a prescribed drug for gastrointestinal problems is not having the desired therapeutic effect on an older adult. The patient takes the drug as prescribed and follows the dietary recommendations. Which other assessment finding would support this data? 1) Vitamin C deficiency 2) Use of herbal preparations 3) Drug side effects 4) Physical activity

Use of herbal preparations The use of herbal preparations, such as ginger, gingko biloba, ginseng, and garlic, interact with several medications and decrease their therapeutic effects. Vitamin C deficiency does not alter the absorption of any drugs. The patient is unlikely to experience side effects if the drugs are not absorbed and metabolized effectively. Physical activity does not alter the absorption of drugs

The nurse notes that a patient often forgets to take medicines on time. What intervention would help improve the patient's compliance with the treatment? 1) Using memory aids such as a pill organizer with an alarm 2) Providing instructions by readability tools 3) Employing a translator for directing instructions 4) Educating the patient about administration skills

Using memory aids such as a pill organizer with an alarm Educating the patient about the administration of the prescribed medication is part of effective illness management. This education includes the use of several interactive aids such as videos, pictures, pamphlets with concise descriptions, and multiple strategies. Patients who tend to forget to take their medications because of cognitive impairment can use memory aids such as a pill organizer with an alarm to alert them to take their medicine. Readability tools, translation of instructions with the help of a translator, and skills of medication administration are used by patients who do not know the medication regimen.

Which statement by the student nurse about the absorption of drugs in older adults indicates effective learning? 1) "Drug absorption in the gastrointestinal (GI) tract increases in older adults." 2) "Absorption of acidic drugs is poor in older adults." 3) "Iron and calcium tablets are absorbed readily in older adults." 4) "Enteric-coated tablets do not readily dissolve in the GI tracts of older adults."

"Absorption of acidic drugs is poor in older adults." Increased alkaline gastric secretion results in poor absorption of acidic drugs in older adults. A decrease in both blood flow and GI motility decreases drug absorption in the GI tracts of older adults. Iron and calcium tablets are not absorbed readily in older adults because of reduced gastric motility. Enteric-coated tablets dissolve in alkaline fluid, and readily dissolve in the GI tracts of older adults.

How can the nurse enhance effective medication use in an older adult? Select all that apply. 1) Develop a chart that includes the time to take each drug. 2) Explain the purpose and importance of each drug. 3) Encourage family members to monitor the patient's drug regimen. 4) Educate the patient about the side effects of each drug. 5) Provide oral rather than written instruction.

*Develop a chart that includes the time to take each drug. *Explain the purpose and importance of each drug. *Encourage family members to monitor the patient's drug regimen. *Educate the patient about the side effects of each drug. The nurse develops a chart that includes the time to take each drug so that the older adult is not confused. The nurse explains the purpose and importance of each drug to the patient to prevent confusion. The nurse also encourages family members to monitor the patient's drug regimen so that the patient does not skip any doses. The nurse educates the patient about the side effects of each drug so that the patient reports any discomfort immediately to the primary health care provider. The older adult may forget some instructions related to drug use. Therefore, the nurse provides written instructions to the patient to reinforce teaching. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

The nurse administers a medication that has a long half-life to an older adult patient. What is a priority action for the nurse? 1) Assess the patient for potential drug toxicity. 2) Consult with the health care provider for an alternative drug. 3) Administer medications early in the day. 4) Administer one-half of the medication at a time

Assess the patient for potential drug toxicity Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the patient, and the dose may need to be decreased. An alternative drug should not be needed. The time of administration will not affect the half-life. The medication should not be halved; this will not affect the half-life.

The nurse administers a medication that has a long half-life to an older adult patient. What is a priority action for the nurse? 1)Assess the patient for potential drug toxicity. 2) Consult with the health care provider for an alternative drug. 3) Administer medications early in the day. 4) Administer one-half of the medication at a time

Assess the patient for potential drug toxicity. Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the patient, and the dose may need to be decreased. An alternative drug should not be needed. The time of administration will not affect the half-life. The medication should not be halved; this will not affect the half-life.

Which symptom presenting in an older adult would cause the nurse to suspect drug toxicity? 1) Decreased urine output 2) Bradycardia 3) Confusion 4) Constipation

Confusion Confusion is one of the first signs of drug toxicity in an older adult. Decreased urine output, bradycardia and constipation are not typical symptoms of drug toxicity.

What are some of the effects of polypharmacy that may be seen in an older adult? Select all that apply. 1) Confusion 2) Falls 3) Nonadherence 4) Urinary retention 5) Rapid drug excretion

Confusion Falls Nonadherence Polypharmacy, or use of multiple medications such as antidepressants, muscle relaxants, and antihistamines, may have anticholinergic effects and cause confusion. The patient is also at an increased risk for falls due to dizziness and other adverse drug reactions. There is a risk for nonadherence to the medication regime if the patient experiences adverse drug reactions or is unable to afford medications. Urinary retention is not an effect of polypharmacy, but a side effect of antidepressants. Drug excretion is slow in older adults because of a decrease in renal blood flow. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

An elderly patient who has cancer is treated with opioids for controlling pain. Which symptoms suggest opioid-induced complications? Select all that apply. 1) Constipation 2) Gastric ulceration 3) Bleeding episodes 4) Respiratory depression

Constipation Respiratory depression Opioid-induced complications may manifest as constipation, and respiratory depression. Gastric ulceration and bleeding episodes are not complications of opioids, as these drugs do not act on the specific receptors.

The nurse will administer a drug to an elderly patient. How will the nurse assess the patient's renal function to administer this drug safely? 1) Urine urea 2) Serum troponin 3) Urine creatinine 4) Creatinine clearance

Creatinine clearance The renal function of a patient is assessed by measuring the creatinine clearance by collecting urine samples for 24 hours. This parameter helps to assess whether the drug would be excreted effectively from the kidneys or not. Blood urea is useful to assess renal function, not urine urea. Serum troponin and urine creatinine are not helpful in assessing renal function.

The nurse is explaining to an elderly patient about age-related gastrointestinal changes that have an impact on drug action. What changes does the nurse include in the teaching? 1) Reduced gastric pH 2) Altered metabolism 3) Increased peristalsis 4) Delayed gastric emptying

Delayed gastric emptying The age-related physiologic change of the elderly patient results in delayed gastric emptying due to a decrease in peristalsis. As a result, the drug may take more time to bring about the therapeutic action. With aging, the gastric pH tends to increase due to less acid secretion. This may lead to altered absorption of nutrients and drugs. Aging causes decreased peristalsis resulting in ineffective drug absorption.

While assessing the renal function in an elderly patient, a nurse learns that the patient has reduced renal blood flow. What is the impact of this age-related change on drug action? 1) Decreased excretion 2) Decreased metabolism 3) Increased protein binding 4) Increased first pass metabolism

Decreased excretion The impact of reduced blood flow to the kidney due to increasing age results in decreased drug excretion. Therefore, the drug may remain in the blood for a relatively long time. As a result, the dosage would need to be adjusted. Reduced renal blood flow in elderly patients does not decrease metabolism of the drug, because it usually happens in the liver. Renal system has no role in protein binding or the first pass metabolism of the drug.

While assessing the renal function in an elderly patient, a nurse learns that the patient has reduced renal blood flow. What is the impact of this age-related change on drug action? 1)Decreased excretion 2) Decreased metabolism 3) Increased protein binding 4) Increased first pass metabolism

Decreased excretion The impact of reduced blood flow to the kidney due to increasing age results in decreased drug excretion. Therefore, the drug may remain in the blood for a relatively long time. As a result, the dosage would need to be adjusted. Reduced renal blood flow in elderly patients does not decrease metabolism of the drug, because it usually happens in the liver. Renal system has no role in protein binding or the first pass metabolism of the drug.

Which are the pharmacokinetic changes that may be evident due to age-related changes in cardiac, hepatic, and renal functions in geriatric patients? Select all that apply. 1) Decreased excretion 2) Increased absorption 3) Increased distribution 4) Decreased metabolism 5) Increased first pass metabolism

Decreased excretion Decreased metabolism The age-related changes in renal and hepatic function will result in decreased excretion and decreased metabolism, respectively. Cardiac changes will result in decreased absorption and distribution of drugs. First pass metabolism does not increase in elderly patients; it actually decreases due to impaired liver function.

The nurse is caring for an older adult who takes medication for a heart arrhythmia. The patient asks the nurse about the effect of age on the drug used and its effectiveness. The nurse frames a response recognizing that the older adult's cardiac system can lead to: 1) Delayed transportation of drugs to the body tissues 2) Slowed absorption of oral drugs 3) Increased transportation of drugs to the body tissues 4) Increased absorption of oral drugs

Delayed transportation of drugs to the body tissues Administration of medication to an older adult can result in delayed transportation of the drugs to the tissues because of changes in the older adult's cardiac system. The cardiac system usually will not cause slower absorption of oral drugs.

The nurse is aware that the physiologic changes that normally occur in the older adult have which implication for drug response? 1) Drug metabolism is faster. 2) Drug half-life is lengthened. 3) Drug elimination is faster. 4) Protein binding is more efficient

Drug half-life is lengthened Drug half-life is extended secondary to diminished liver and renal function in the elderly.

The nurse is aware that the physiologic changes that normally occur in the older adult have which implication for drug response? 1) Drug metabolism is faster. 2) Drug half-life is lengthened. 3) Drug elimination is faster. 4) Protein binding is more efficient

Drug half-life is lengthened. Drug half-life is extended secondary to diminished liver and renal function in the elderly.

Which physiological change that normally occurs in the older adult has implications for the nurse assessing drug response? 1) Drug half-life is lengthened. 2) Drug metabolism is faster. 3) Drug elimination is faster. 4) Protein binding is more efficient.

Drug half-life is lengthened. Drug half-life is extended secondary to diminished liver and renal function in the older adult. Metabolism is slower, not faster, in the older adult. Drug elimination is also generally slower in the older adult, and protein binding is not more efficient in the older adult.

A nurse working with elderly patients is concerned about the number of medications each patient is taking. Which will the nurse assess as the highest priority for the patients related to polypharmacy? 1) Drug interactions 2) Cost of medications 3) Schedule of medications 4) Nonadherence to drug regimen

Drug interactions The highest priority for patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications a patient takes, the higher is the risk of drug interactions.

The nurse is aware that the physiologic changes that normally occur in the older adult have which implication for drug response? 1) Drug metabolism is faster. 2) Drug half-life is lengthened. 3) Drug elimination is faster. 4) Protein binding is more efficient.

Drug metabolism is faster. Drug half-life is extended secondary to diminished liver and renal function in the elderly.

An elderly patient will begin taking a nonsteroidal antiinflammatory drug (NSAID) to manage somatic pain. The patient reports epigastric pain after 2 days. What action does the nurse take? 1) Increase the dose of the NSAID. 2) Supplement with corticosteroids. 3) Supplement with opioid analgesics. 4) Notify the health care provider.

Notify the health care provider A common complication of NSAIDs is gastric ulceration, which clinically presents as epigastric pain. Therefore, the nurse should contact the health care provider to avoid further damage to the stomach lining. The NSAID dose should not be increased as it would further increase gastric ulceration. Corticosteroids aggravate gastric ulcerations. Opioids relieve the epigastric pain, but they offer no help towards healing the ulcers.

The nurse is assessing a diabetic patient who also has dementia. The nurse finds that the patient did not take a prescribed oral antidiabetic drug in the morning and now has elevated blood sugar levels. What is the possible reason for the patient not taking the drug in the morning? 1) Noncompliant attitude of the patient 2) Restrictive religious beliefs of the patient 3) Emotional status of the patient 4) Impaired memory of the patient

Impaired memory of the patient Patients with dementia have an impaired memory status, which presents a barrier for effective management of illness. These patients may forget to take medicines on time. This problem can be resolved by obtaining the assistance of family members, caregivers, or health care professionals. Several interactive devices are also used for medication administration. Assessments of ethnicity, religious beliefs, and emotional status are done prior to administration of the drug therapy, and may not directly affect the patient's compliance with drug therapy.

Which factor can decrease the desired drug effect in older adults? 1) Increase in body fat 2) Increase in gastric acidity 3) Increase in hepatic enzyme production 4) Increase in renal circulation

Increase in body fat An increase in body fat in older adults causes greater absorption of lipid-soluble drugs. Therefore, the desired drug effect decreases in older adults. A decrease in gastric acidity alters the absorption rate of drugs in older adults. A decrease in hepatic enzyme production causes a reduction in drug metabolism. A decrease in renal blood flow decreases drug excretion and increases the risk for drug toxicity. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

The nurse administers an adult dose of a highly water-soluble drug to an elderly patient. What is the impact of such administration on this patient? 1) Decreased drug action 2) No change in drug action 3) Increased drug concentration 4) Increased hypersensitive reactions

Increased drug concentration In an elderly patient there is a gross reduction in the total body water. Hence, the administration of an adult dose results in an increased drug concentration. Drug action is either prolonged or increased. There is no hypersensitive reaction due to the administration of an adult dose of a highly water-soluble drug in elderly patients

The nurse administers warfarin to an elderly patient. What is the impact of the administration of an adult dose of warfarin to the patient? 1) Clinically insignificant effect 2) Increased protein binding of the drug 3) Increased unbound drug in plasma 4) Decreased efficacy of drug action

Increased unbound drug in plasma Warfarin is a highly protein-bound drug. As elderly patients have reduced serum proteins due to various causes, the unbound (free) form of the drug is increased in plasma. As a result, the free form of the drug is readily available for pharmacological action, causing increased toxicity of warfarin in elderly patients. The bound form of the drug does not increase; rather it decreases due to reduced protein levels in elderly patients. Therefore, there is no decrease in the drug efficacy.

The nurse is administering medication to an older adult. The nurse anticipates that this patient's hepatic system will have which effect on the medication? 1) Excretion of the medication will be increased. 2) Metabolism of the medication will be decreased. 3) Excretion of the medication will be decreased. 4) Metabolism of the medication will be increased

Metabolism of the medication will be decreased. Administration of medication to an older adult can result in a slowed metabolism of the drug due to decreased functioning of the liver as the patient ages. Few drugs are excreted through the hepatic system.

During an assessment, the nurse finds that an older adult who is seeking treatment for a gastrointestinal problem does not have health insurance. The patient expresses a concern about treatment costs and duration. Which patient risk is highest in this case? 1) Failure to understand the drug purpose 2) Lack of adequate nutrition 3) Nonadherence to the drug regimen 4) Use of herbal preparations

Nonadherence to the drug regimen The patient is at risk for nonadherence to the drug regimen because he or she may be unable to afford the medication costs. The patient is not confused; therefore, it is unlikely that the patient will fail to understand the drug's purpose. The patient may be able to afford dietary expenses and other necessities, but may not be willing to spend money on medication; therefore, lack of adequate nutrition would not necessarily be a concern. The use of herbal preparations is a practice that does not necessarily apply to all patients who lack health insurance.

What are the different phases of biotransformation? Select all that apply. 1) Oxidation reaction 2) Drug absorption 3) Drug distribution 4) Conjugation reaction 5) Drug excretion

Oxidation reaction Conjugation reaction Biotransformation, or drug metabolism, occurs in the liver in two phases. Phase I is characterized by the action of hepatic microsomal enzymes, causing oxidation of the drug. The drug is biotransformed to its active metabolite during this phase. Phase II involves the conjugation reaction in which the drug is inactivated and excreted in the urine. Drug absorption is not a part of the biotransformation phase. It refers to the absorption of the drug in the body. Drug distribution and drug excretion are other parameters of pharmacokinetics, but not phases of biotransformation. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

An elderly patient is treated with digoxin. What appropriate nursing assessment is performed to adjust the dose in the patient? 1) Renal function 2) Hepatic function 3) Integumentary function 4) Cerebral function

Renal function Digoxin undergoes renal excretion, and assessment of renal function is performed when adjusting the dose of digoxin in elderly patients. The assessment of hepatic, integumentary, and cerebral function is not indicated for digoxin dose adjustment as these systems are not involved in digoxin metabolism.

The nurse administers sedative medication to an elderly patient. What effect may this have on this patient? 1) No impact 2) Inadequate dosing 3) Prolonged sedation 4) Paradoxical excitation

Prolonged sedation Sedatives are highly lipid-soluble drugs and primarily get distributed into adipose tissues. In elderly patients there is an increase in body fat, and sedatives have a prolonged effect, and sometimes even cause toxic effects. As the drug is lipid-soluble, the dosing is more than adequate. There is no paradoxical excitation or rebound phenomenon observed due to prolonged sedation.

The nurse is caring for an older patient who has impaired memory. What interventions will the nurse take to enhance compliance in this patient? 1) Provide audiovisual materials for education. 2) Provide weekly pill containers. 3) Provide medication containers with alarm. 4) Provide computerized educational materials.

Provide medication containers with alarm. Older adults may experience problems remembering the medication regimen. This may lead to their noncompliance to the regimen. Nurses must pay special attention to preventing noncompliance in such patients and accordingly can make use of several interactive methods. Providing medication or pill containers with built-in alarms can be effective. These containers remind patients of the time and the date of medication dosage with an alarm for effective drug administration. Audiovisuals, weekly pill containers, and computerized education materials are appropriate reminders for patients with intact memory. These approaches to patient education may not be helpful in patients with memory impairment.

An elderly patient who is suffering from constipation due to reduced smooth muscle tone and motor activity begins using laxatives. What impact does laxative use have on the action of drugs? 1) Reduced excretion 2) Reduced absorption 3) Reduced distribution 4) Reduced metabolism

Reduced absorption Laxatives increase motility of the gastrointestinal tract. Therefore, the use of laxatives can cause reduced absorption of drugs. Laxative use has no impact on excretion, distribution, or metabolism of drugs.

The nurse is caring for an elderly patient. The laboratory reports reveal decreased liver function. How does this change impact the drug action? 1 Increased excretion 2 Reduced absorption 3 Reduced metabolism 4 Increased first pass metabolism

Reduced metabolism Most drugs get metabolized in the liver. The decreased liver function will lead to reduced metabolism of drugs. As a result, drugs may not be available for therapeutics effect or excretion may be reduced, causing drug toxicity. Reduced liver function does not cause increased drug excretion, as drug excretion take place through kidneys. Liver impairment does not affect absorption, as it is a function of the stomach and intestines. Impaired liver function may decrease first pass metabolism.

What does the nurse evaluate in an older adult who is taking digoxin (Lanoxin) therapy? Select all that apply. 1) Risk of bleeding 2) Serum digoxin levels 3) Creatinine clearance test results 4) Vital signs 5) Urinary retention

Serum digoxin levels Creatinine clearance test results Vital signs Digoxin has a narrow therapeutic range of 0.5 to 2 ng/mL. Therefore, the nurse should monitor the patient's serum digoxin levels to detect toxicity. Creatinine clearance test results will help the nurse to understand the patient's renal function. The nurse should monitor the patient's vital signs such as apical pulse rate before administering the drug to prevent fluctuations in heart rate. Digoxin is a cardiac glycoside and does not cause bleeding. Digoxin does not cause urinary retention in older adults. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

What effect may the older adult's gastrointestinal system have on drug administration in this patient? 1) Delayed transportation of drugs to the body tissues 2) Slowed absorption of oral drugs 3) Increased transportation of drugs to the body tissues 4) Increased absorption of oral drugs

Slowed absorption of oral drugs Administration of medication to an older adult can result in slowed absorption of oral drugs. The gastrointestinal system changes should not result in a change in the transportation of drugs to the body tissues.

What does the nurse expect the primary health care provider to prescribe to an older adult for insomnia? A Digoxin (Lanoxin) B Temazepam (Restoril) C Fluoxetine (Prozac) D Ketorolac (Toradol)

Temazepam (Restoril) Temazepam (Restoril), an intermediate-acting benzodiazepine, is biotransformed in the liver by conjugation, and the principle metabolite is excreted in the urine. Therefore, the drug is prescribed for older adults. Digoxin (Lanoxin) is a cardiac glycoside, not a hypnotic or sleep-inducing drug. Fluoxetine (Prozac) is an antidepressant. Ketorolac (Toradol) is an analgesic, which is usually not prescribed to older adults because it causes serious gastrointestinal toxicity.

When teaching a patient about temazepam (Restoril), the nurse advises the patient to take it 1 hour prior to going to bed. Why does the nurse give this advice to the patient? 1) Temazepam (Restoril) may cause gastrointestinal upset. 2) Temazepam (Restoril) induces sleep in approximately 1 hour. 3) Temazepam (Restoril) causes early awakening after sleep. 4) The therapeutic activity of temazepam (Restoril) is reduced with sleep.

Temazepam (Restoril) induces sleep in approximately 1 hour. The onset of action of temazepam (Restoril) is 1 hour. Thus, the nurse should advise the patient to take the medication 1 hour before going to bed. Gastrointestinal upset is a side effect associated with benzodiazepine drugs. This effect may not be prevented by taking the drug 1 hour before bed. The drug is known to prevent early morning awakening. Drug activity is not affected if the patient sleeps immediately. However, the patient will not be able to sleep immediately after taking the drug as the drug requires some time to show its effect.

An older adult patient has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the patient? 1) The older adult patient should not take sedative hypnotics. 2) The older adult patient should be prescribed a drug with a short half-life. 3) The older adult patient should alternate different sedatives every other day so as not to become dependent. 4) The older adult patient should use alternative therapies and herbal remedies rather than sedatives

The older adult patient should be prescribed a drug with a short half-life The older adult patient may have difficulty with elimination of drugs, so a drug with a short half-life is preferred. If used correctly, sedative hypnotics are safe for the older adult. There is no benefit to giving two different sedatives to a patient. Alternative therapies and herbal remedies may be tried; however, there is no indication they are better than traditional therapies.

An older adult patient has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the patient? 1) The older adult patient should not take sedative hypnotics. 2) The older adult patient should be prescribed a drug with a short half-life. 3) The older adult patient should alternate different sedatives every other day so as not to become dependent. 4) The older adult patient should use alternative therapies and herbal remedies rather than sedatives.

The older adult patient should be prescribed a drug with a short half-life. The older adult patient may have difficulty with elimination of drugs, so a drug with a short half-life is preferred. If used correctly, sedative hypnotics are safe for the older adult. There is no benefit to giving two different sedatives to a patient. Alternative therapies and herbal remedies may be tried; however, there is no indication they are better than traditional therapies.

An older adult patient has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the patient? 1)The older adult patient should not take sedative hypnotics. 2) The older adult patient should be prescribed a drug with a short half-life. 3) The older adult patient should alternate different sedatives every other day so as not to become dependent. 4) The older adult patient should use alternative therapies and herbal remedies rather than sedatives.

The older adult patient should be prescribed a drug with a short half-life. The older adult patient may have difficulty with elimination of drugs, so a drug with a short half-life is preferred. If used correctly, sedative hypnotics are safe for the older adult. There is no benefit to giving two different sedatives to a patient. Alternative therapies and herbal remedies may be tried; however, there is no indication they are better than traditional therapies.

The nurse observes that an older adult appears confused and impoverished. The nurse also learns that the patient experienced a fall the previous week. The patient is taking antidepressants, antihypertensives, and gastrointestinal drugs. What can the nurse conclude from these findings? 1) The patient is experiencing memory problems due to aging. 2) The patient is experiencing adverse effects of one of the drugs. 3) The patient is experiencing the adverse effects of taking multiple medications. 4) The patient has an increase in hepatic enzyme production.

The patient is experiencing the adverse effects of taking multiple medications. Confusion, malnutrition, and falls are common effects of polypharmacy, or multiple drug use. The patient may experience a change in dietary patterns due to the effects of taking multiple drugs. Malnutrition and falls show that the patient's problem is not related to memory. All drugs have potential side effects, which are three to seven times greater in older adults than in younger adults or adolescents. Hepatic enzyme production decreases with age, and reduces drug metabolism in patients.

An older adult experiences insomnia after discontinuing riazolam (Halcion). The nurse finds that the patient did not start any other drug therapy, and there has been no change in any environmental factors or diet. What could be the possible reason for the patient's condition? 1) The drug has a short half-life, which is ineffective for older adults. 2) The patient took the medication at bedtime. 3) The patient did not take the medication with food. 4) The patient stopped the medication abruptly

The patient stopped the medication abruptly. An older adult is likely to experience rebound insomnia if riazolam (Halcion), a hypnotic, is discontinued abruptly. Therefore, the patient should taper the dose in accordance with the instructions of the primary health care provider. Riazolam (Halcion) has a short half-life, which is safer for older adults because there is no risk of toxicity. It is safer to take the medication at bedtime so that there is no risk for falls due to dizziness. Taking riazolam (Halcion) with food will not decrease its therapeutic effects.

An older adult experiences insomnia after discontinuing riazolam (Halcion). The nurse finds that the patient did not start any other drug therapy, and there has been no change in any environmental factors or diet. What could be the possible reason for the patient's condition? 1) The drug has a short half-life, which is ineffective for older adults. 2) The patient took the medication at bedtime. 3) The patient did not take the medication with food. 4) The patient stopped the medication abruptly.

The patient stopped the medication abruptly. An older adult is likely to experience rebound insomnia if riazolam (Halcion), a hypnotic, is discontinued abruptly. Therefore, the patient should taper the dose in accordance with the instructions of the primary health care provider. Riazolam (Halcion) has a short half-life, which is safer for older adults because there is no risk of toxicity. It is safer to take the medication at bedtime so that there is no risk for falls due to dizziness. Taking riazolam (Halcion) with food will not decrease its therapeutic effects.

The nurse finds that an older adult who is taking diuretics for hypertension has developed hypokalemia. What can the nurse conclude from this finding? 1) The patient took a higher drug dose. 2) The patient was engaged in physical activity. 3) The patient has skipped a few doses. 4) The patient has reduced dietary salt.

The patient took a higher drug dose. Hypokalemia is an electrolyte imbalance that occurs due to higher doses of diuretics in older adults. Physical activity will not cause an electrolyte imbalance in the patient; however, it may affect the patient's blood pressure. Skipping a few doses of a diuretic would not have the desired therapeutic effect on the patient and, in that case, there would be little possibility of electrolyte imbalance. Salt reduction helps to decrease hypertension. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

The nurse is preparing to administer digoxin (Lanoxin) to an older adult. Which is a contraindication to administration of the drug? 1) The patient has a history of left ventricular heart failure. 2) The patient's creatinine clearance value is 110 mL/min. 3) The patient's serum digoxin levels were 1 ng/mL after the previous dose. 4) The patient's apical pulse is 50 beats per minute

The patient's apical pulse is 50 beats per minute An apical pulse of less than 60 beats per minute is a contraindication in this patient because the patient's heart rate will decrease further if the nurse administers digoxin. Digoxin is a cardiac glycoside that helps to treat left ventricular heart failure. A creatinine clearance value of 80 to 130 mL/min is a normal finding in an adult patient. A serum digoxin level between 0.5 and 2 ng/mL is also a normal finding.

An older adult patient has been diagnosed with hypertension. A diuretic has been prescribed. Which assessment finding will most concern the nurse? 1) The patient's heart rate is irregular. 2) The patient is complaining of symptoms of a cold. 3) The patient has a blood pressure of 140/90 mm Hg. 4) The patient's temperature is 98.4° F.

The patient's heart rate is irregular Diuretics are frequently prescribed for the older adult. They can cause electrolyte imbalances and must be prescribed in smaller doses. An irregular heart rate could be a sign of potassium imbalance.

The nurse is assessing an older adult who is taking diazepam (Valium). The nurse finds that the patient's liver function is normal. However, the patient experiences drug toxicity, even at the prescribed dose. What can the nurse conclude from this? 1) The patient's hepatic microsomal oxidation is impaired. 2) The drug was inactivated, due to the patient's old age. 3) The patient's 24-hour creatinine clearance value is 100 mL/min. 4) Diazepam was absorbed in the patient's body fat

The patient's hepatic microsomal oxidation is impaired Aging impairs hepatic microsomal oxidation, or Phase I drug metabolism. Therefore, the patient's plasma-serum diazepam level remains high, causing toxicity. Drugs that are inactivated and excreted in the urine do not have active metabolites. However, diazepam is a drug that undergoes an oxidation reaction because it biotransforms to its active metabolite, desmethyldiazepam. A creatinine clearance value of 100 mL/min indicates normal renal function. Absorption of the drug in body fat will decrease the desired effect of the drug, not cause toxicity.