Chapter 3: Lifespan Considerations
When teaching a pregnant mother about the effects of medication on the fetus, the nurse recognizes that the greatest harm from maternally ingested medications occurs during which time period? A) First trimester B) Second trimester C) Third trimester D) Birthing process
A. First trimester During the first trimester of pregnancy, the fetus is at the greatest risk for drug-induced developmental defects. During this period the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate.
The physiologic changes that normally occur in the older adult have which implication for drug response in this patient? A) Drug metabolism is faster. B) Drug half-life is lengthened. C) Drug elimination is faster. D) Protein binding is more efficient.
B. Drug half-life is lengthened. Drug half-life is extended secondary to diminished liver and renal function in the elderly.
Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.) A. The levels of microsomal enzymes are decreased. B. Perfusion to the kidneys may be decreased and may result in reduced renal function. C. Firstpass elimination is increased because of higher portal circulation. D. Firstpass elimination is reduced because of the immaturity of the liver. E. Total body water content is much less than in adults. F. Gastric emptying is slowed because of slow or irregular peristalsis. G. Gastric emptying is more rapid because of increased peristaltic activity.
A,B,D,F
Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) A. The levels of microsomal enzymes are decreased. B. Fat content is increased because of decreased lean body mass. C. Fat content is decreased because of increased lean body mass. D. The number of intact nephrons is increased. E. The number of intact nephrons is decreased. F. Gastric pH is less acidic. G. Gastric pH is more acidic.
A,B,E,F
Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity? A) Decrease the amount of drug given B) Increase the amount of drug given C) Shorten the time interval between doses D) Administer the medication intravenously
A. Decrease the amount of drug given Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity?
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? A) Drug interactions B) Cost of medications C) Schedule of medications D) Nonadherence to drug regimen
A. 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 the risk for drug interactions.
The nurse is trying to give a liquid medication to a yearold child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? A. Give the medication with spoonfuls of sherbet. B. Add the medication to the child's bottle. C. Tell the child you have candy for him. D. Add the medication to a cup of milk..
ANS: A Sherbet or another nonessential food disguises the taste of the medication. The other options are not correct. If the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future.
For accurate medication administration to pediatric patients, the nurse must take into account which criteria? A. Weight and organ maturity B. Renal output and weight C. Weight, body temperature, and age D. Height and age
ANS: A To administer medications to pediatric patients accurately, one must take into account the body surface area (including weight and height), age, and organ maturity. The other options are not correct; renal output and body temperature are not considerations, and height and age alone are not sufficient.
An 83yearold woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems? A. Constipation and anorexia B. Fatigue and dehydration C. Daytime sedation and lethargy D. Edema, nausea, and blurred vision
ANS: B Electrolyte imbalance, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly.
The nurse is administering drugs to neonates and should consider which factor that may contribute to drug toxicity? A. The lungs are immature. B. The kidneys are small. C. The liver is not fully developed. D. Excretion of the drug occurs quickly.
ANS: C A neonate's liver is not fully developed and cannot detoxify many drugs. The other options are not correct. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion of the drug is slow, not fast, because of organ immaturity.
Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? A. Decreased fetal surface area B. Increased placental surface area C. Enhanced placental blood flow D. Increased amount of proteinbound drug in maternal circulation
ANS: C Drug transfer to the fetus is more likely during the last trimester as a result of enhanced placental blood flow. The other options are not correct. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta's surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not proteinbound drug, in the mother's circulation.
The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration (FDA) pregnancy safety category? A. Category B B. Category C C. Category D D. Category X
ANS: C Pregnancy category D fits the description given. Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. Category X consists of drugs that should not be used in pregnant women because of reports of fetal abnormalities and positive evidence of fetal risk in humans.
The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses of an elderly patient who is taking which type of drug? A. Laxatives B. Anticoagulants C. Sedatives D. Diuretics
ANS: C Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly. Laxatives, anticoagulants, and diuretics may cause adverse effects in the elderly, but not the ones specified in the question.
An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? A. Drug therapy will be based on the patient's weight. B. Drug therapy will be based on the patient's age. C. The patient will receive the maximum dose that is expected to reduce the blood pressure. D. The patient will receive the lowest possible dose at first, and then the dose will be adjusted as needed.
ANS: D As a general rule, dosing for the elderly should follow the admonition, "Start low and go slow," which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, based on patient response.
The nurse is assessing a newly admitted 83yearold patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? A. The patient has lower risk for drug interactions. B. The patient takes one medication for an illness several times a day. C. The patient risks problems only if overthecounter medications are also taken. D. The patient takes multiple medications simultaneously
ANS: D Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, possibly prescribed by different specialists who may be unaware of other treatments the patient is undergoing. The other options are not correct. Polypharmacy would cause a higher risk for drug interactions. Polypharmacy means the patient is taking several different medications, not just one. Polypharmacy can include prescription drugs, overthecounter medications, and herbal products.
It is not uncommon for an elderly patient to experience a reduction in the stomach's ability to produce hydrochloric acid. This change may result in which effect? A. Delayed gastric emptying B. An increase in gastric acidity C. Decreased intestinal absorption of medications D. Altered absorption of weakly acidic drugs such as aspirin
ANS: D Reduction in the stomach's ability to produce hydrochloric acid is an agingrelated change that results in a decrease in gastric acidity and may alter the absorption of weakly acidic drugs, such as aspirin. The other options are not results of reduced hydrochloric acid production.
When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? A. West nomogram B. Clark rule C. Heighttoweight ratio D. Mg/kg formula
ANS: D The mg/kg formula is the most common method of calculating doses for pediatric patients. The other options are available methods but are not the most commonly used. Heighttoweight ratio is not used.
Which actions will the nurse perform to ensure the medication dose for a pediatric patient is correct? (Select all that apply.) A) Use the patient's weight in pounds. B) Use a current drug reference to determine usual dosage per 24 hours. C) Determine the dose parameters by multiplying the weight by the minimum and maximum daily doses of the drug (the safe range). D) Determine the total amount of the drug to administer per dose and per day. E) Compare the drug dosage prescribed with the calculated safe range. F) If the drug dosage prescribed varies from recommended reference range, notify the provider.
B,C,D,E,F The patient's weight needs to be in kilograms, not pounds. All other information listed is correct and must be followed by the nurse to ensure the correct pediatric dosage.
The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor? A. Maternal blood type B. Fetal sex C. Drug properties D. Diet of the mother
C. Drug properties Drug properties have a direct correlation to the safety or potential harm of drug therapy during pregnancy, and nurses working in prenatal settings need to be aware of information related to drug properties.
The nurse is preparing to give an injection to a 4 year old child. Which intervention is age-appropriate for this child? A. Give the injection with out any advanced preparation. B. Give the injection, and then explain the reason for the procedure afterwards. C. Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present. D. Prepare the child in advance with details about the procedure without the parent or cargiver
C. Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present.
The nurse is admitting an 82-year-old patient for treatment of heart failure. During assessment of the patient's history, the nurse notes a subjective complaint of chronic constipation. Of the prescribed medications the patient was taking prior to admission, which would the nurse suspect might contribute to this gastrointestinal complaint? A. naproxen (Aleve), a nonsteroidal antiinflammatory drug B. warfarin sodium (Coumadin), an anticoagulant C. verapamil (Calan), a calcium channel-blocking drug D. spironolactone (Aldactone), a potassium-sparing diuretic
C. verapamil (Calan), a calcium channel-blocking drug Calcium channel-blocking drugs may worsen constipation in the elderly population and thus should be avoided.
A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the appropriate response for this patient? A) "You should not take any medication while breastfeeding." B) "Only certain medications pass to infants while breastfeeding." C) "I will leave the doctor a message to return your call." D) "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."
D. "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breastfeeding should be assessed on a case-by-case basis, including assessment of the medication the patient is taking.
When calculating pediatric dosages, what will the nurse take into consideration? A) Utilization of drug reference recommendations based on mg/kg of body weight is the preferred method. B) Calculated doses based on body weight need to be increased by 10% due to immature renal and hepatic function. C) Dosage calculation according to body weight is the most accurate method because it takes into account differences in maturational development. D) Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.
D. Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.
