Deck 10: Pharmacotherapy of the Geriatric Patient

Question 1

What is the definition of pharmacodynamics?

A)The mechanisms by which drugs affect the body
B)Complying with one's medication regimen as prescribed
C)Taking multiple medications
D)The mechanisms by which the body handles the drug

Answer 1

The mechanisms by which drugs affect the body

Question 2

Why is polypharmacy so prevalent in the elderly population?

A)Multiple medical problems can usually be treated with a single drug.
B)Clients rarely see more than one prescriber.
C)Clients might be taking multiple medications for their comorbidities.
D)Use of over-the-counter medications is uncommon in this age group.

Answer 2

Clients might be taking multiple medications for their comorbidities.

Question 3

An older adult client comes to the emergency department with complaints of confusion.Which recently prescribed medication is most likely responsible for this assessment finding?

A)Lansoprazole (Prevacid)
B)Atorvastatin (Lipitor)
C)Hydroxyzine (Atarax)
D)Amlodipine (Norvasc)

Answer 3

Hydroxyzine (Atarax)

Question 4

Why can a reduction in albumin synthesis that may occur with aging result in exaggerated effects of a medication?

A)Blood flow to the liver decreases.
B)More unbound drug will be present.
C)Pharmacodynamics will be altered.
D)Renal elimination of the drug will be decreased.

Question 5

A nurse working at a clinic notices that a client is having problems reading the prescription bottles.Sometimes the client takes medications incorrectly because of difficulty reading the small print.Which suggestion by the nurse can alleviate this problem?

A)Put the medication in a zip-top bag with the instructions written on it in large print.
B)Let the pharmacist get easy-open caps.
C)Stop taking the medications,as they are more likely to cause problems than to help if not taken correctly.
D)Ask the pharmacist to provide labels with large print that explain how to take the medication.

Question 6

Which group of medications should be used cautiously,if at all,in older adult clients?

A)Beers list
B)Polypharmacy
C)Washington Manual
D)Physicians' Desk Reference

Question 7

An older adult client comes in to the office with severe sunburn.When reviewing the client's medication list,which is the likely cause of the client's sunburn?

A)Phenytoin (Dilantin)
B)Cyclobenzaprine (Flexeril)
C)Naproxen (Aleve)
D)Alprazolam (Xanax)

Question 8

A health care provider in a clinic writes several prescriptions for an older client.The nurse notices several medications are in the same class as drugs listed on the client's intake form.What should the nurse do next?

A)Set the prescriptions to the side and follow up on the issue at a later date.
B)Ask the primary health care provider if he was aware his client had been prescribed medications in the same drug class as those prescribed by the cardiologist.
C)Throw the prescriptions away.
D)Give them to the client.

Question 9

A nurse who works at a nursing home notices that a client's hearing has diminished significantly over the past couple of days.The client has been receiving gentamicin IV for an infection.Which action by the nurse is the most appropriate?

A)Continue gentamicin IV and check the peak level in a week.
B)Suggest checking the client's peak gentamicin level and immediately report the loss in hearing in the chart and to the health care provider.
C)Tell the client that she is going to need a hearing aid.
D)Continue gentamicin IV and suggest adding vancomycin IV to improve the ototoxicity.

Question 10

Why should the nurse ask the client about all medications the client takes,including over-the-counter and herbal medications?

A)Minimizing the cost of medications is the highest priority.
B)They might interact with each other or with prescribed medications.
C)Clients should not use over-the-counter or herbal medications.
D)Use of these agents must be reported to the Food and Drug Administration.

Question 11

Which is the best description of the anatomic and physiological changes that occur as a result of aging?

A)They result of pathologic changes.
B)They are reversible.
C)They are normal and predictable.
D)They are a potential target for drug therapy.

Question 12

Which strategy can nurses implement to improve drug therapy adherence in older adult clients?

A)Discourage the use of check-off calendars because older clients do not have adequate eyesight to use them properly.
B)Suggest the client forgo obtaining medications that are too expensive.
C)Suggest the client use a daily or weekly pill counter.
D)Suggest stopping any medications that do not seem to be having an effect.

Question 13

An older client asks the nurse how to avoid potential drug interactions.Which response by the nurse is the most appropriate?

A)"Take over-the-counter medications rather than prescription ones whenever possible."
B)"Obtain all medications from one pharmacy when possible."
C)"Ask for free drug samples rather than getting prescriptions filled at a pharmacy."
D)"Use memory aids such as pill reminders."

Question 14

What is the age-related change in the gastrointestinal tract that can affect medication administration?

A)Decreased motility
B)Reduced intestinal transit time
C)Increased absorption of medications and nutrients
D)Increased gastric acid production

Question 15

Why are older adults more prone to adverse drug reactions and interactions than younger adults?

A)Presence of fewer chronic disease states
B)More predictable pharmacokinetics and pharmacodynamics
C)Use of fewer chronic medications
D)Physiologic changes in body composition

Question 16

Which evidence-based client-level factor affects nonadherence?

A)Management of instructions by the health care provider
B)Simplification of the regimen
C)Identification of the client's social support network
D)Belief that the treatment will be effective

Question 17

Which of these is an age-related physiological change that occurs in older adults?

A)Brain mass increases.
B)GI motility increases.
C)The kidneys filter better and function more efficiently as a client ages.
D)Blood flow to the liver decreases.

Question 18

An older adult client recently started digoxin (Lanoxin)and is in the office for a routine checkup.Lab tests show a decline in the client's renal function.Which is a priority concern for the nurse based on the lab results?

A)Digoxin causing the decrease in renal function.
B)Digoxin interfering with the lab test,making it appear that the client's renal function has worsened.
C)Increased likelihood of toxicity due to the inability to excrete digoxin.
D)Diminished response to digoxin due to alterations in pharmacodynamics.

Question 19

Which rationale explains why anticonvulsants and antidepressants have an exaggerated effect in older adult clients?

A)Increased binding to plasma proteins such as albumin
B)Increased rate of hepatic metabolism
C)Reduced intestinal transit time
D)Declining efficiency of the blood-brain barrier

Question 20

A nurse notices that an older adult client has not urinated all day,despite drinking three liters of water.Which physiological change is the most likely cause for this issue?

A)Reduction in plasma protein levels
B)Increased glomerular filtration rate
C)Increase in body fat
D)Renal function impairment

Question 21

An older adult client is being discharged with multiple new prescriptions.Which strategies could the home health nurse employ to encourage adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Communicate the purpose the new medications serve toward treatment of the condition.
B)Ensure the medication is dispensed in containers that are easily opened.
C)Make sure all drugs are clearly labeled with instructions.
D)Place daily follow-up phone calls to high-risk older clients.
E)Simplify the regimen to twice-a-day dosing and reduce the number of medications the older client must take.

Question 22

While providing medication education to an older adult client,which instruction by the nurse is the most appropriate?

A)Vary the time of day that each medication is taken so that the long-term effectiveness will be preserved.
B)Obtain information about every possible adverse effect that could possibly occur.
C)Changes in mental status,weight,or bowel function should be reported to the prescriber.
D)Avoid keeping a list of medication names and doses,and their purposes,because the list could be lost,resulting in a loss of privacy.

Question 23

The nurse is discharging an older adult client with a new medication.Which statements should be included in discharge teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"You will be started on the lowest effective dose; it will gradually increase."
B)"You will need to come back to the clinic in 3 to 5 days for follow-up."
C)"Call if there are any changes in physical or emotional behavior."
D)"It is very important that you do not get overhydrated,since that would increase the effects of the medication."
E)"This would be a good time to commit to a low-protein diet in an effort to lose weight."

Question 24

Which questions would the case manager ask the older adult client to assess for risk for nonadherence to a medication regimen? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"How do you feel about the possible side effects your medication may cause?"
B)"If we set you up with a pill holder,do you think you will be able to remember to take the medication?"
C)"I have put large labels on the bottles; can you see the print?"
D)"Do you feel you can afford the cost of the medication after your insurance pays its part?"
E)"Can your daughter visit every day to give you the medication?"

Question 25

An urgent care nurse is triaging clients.Which client statements may indicate that medications are being misused? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"I was feeling really great so I stopped taking my antibiotic and now I feel feverish."
B)"My retirement check didn't come in over the holiday weekend so I didn't have the money to get my antihypertension medication refilled.I just took one every other day instead of every day."
C)"I really thought I would get better quicker if I took the medication four times a day instead of two times a day.Now,I have diarrhea."
D)"The schedule is pretty complicated but my daughter-in-law got me a pill dispenser and that helps to keep me on schedule."
E)"I've had to borrow the money from my daughter to get my medication,but I always seem to find a way to get it."

Question 26

The nurse is caring for an older adult client prescribed acetaminophen (Tylenol),as needed,for frequent headaches.What can the nurse expect? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)The client may not ask for the medication as often as younger clients.
B)This drug may be prescribed with longer interval dosing.
C)The health care provider may order a lower than normal dose.
D)The health care provider will order diagnostic lab work to check creatinine clearance.
E)The health care provider will need to prescribe nausea medication.

Question 27

The nurse recognizes that which physiological changes may have what effects on medication responses? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Decreased production of serum albumin may result in toxic levels of highly protein-bound drugs.
B)Declining efficiency of the blood-brain barrier may result in increased central nervous system symptoms.
C)Decreased contractility of the heart may result in decreased distribution of drugs.
D)Decreased gastric pH may result in decreased absorption.
E)Decreased body fat may result in decreased absorption of fat-soluble drugs.

Question 28

The nurse is not surprised when a health care provider orders a lower than normal dose of a drug excreted by the kidneys for an older adult client because certain effects of aging cause the body to retain drugs and other substances for longer periods.Which normal effects of the aging process decrease the ability to excrete drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Decrease in renal blood flow.
B)Decrease in the number of functioning nephrons.
C)Decrease in the ability to excrete waste products effectively.
D)Decrease in gastric pH,causing delayed absorption.
E)Decrease of fat storage,causing delayed absorption.

Question 29

An older adult client brought to the emergency department for bloody stools has been taking warfarin (Coumadin)post stroke.Initial diagnostic lab work reveals warfarin to be within therapeutic range.The daughter asks why the client has bloody stools if the lab work is normal.Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Liver function declines during the aging process."
B)"Decreased liver function results in decreased plasma proteins."
C)"Decreased plasma proteins result in more free drug circulating."
D)"Decreased plasma proteins lead to more binding sites,resulting in lower concentrations of drugs such as this one."
E)"Higher levels of this drug are able to enter the blood-brain barrier,resulting in the toxic effects of bleeding."

Question 30

The nurse planning discharge teaching for an older client with multiple prescriptions for multiple chronic illnesses may discuss which strategies to avoid medication errors at home? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)When possible,take medications at the same time each day.
B)Keep a written record of medications taken,including the name,dose,date,and time.
C)Use a pill holder as a memory aid.
D)Plan to have a family member remind the client each day to take medication.
E)Request easy-to-open bottles so the client will not have difficulty opening the bottles.

Question 31

A nurse who provides care to older adult clients must be aware that which factors may increase the risk for adverse drug reactions in this population? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Longevity results in increased risk for illnesses,which may require multiple medications.
B)Many older clients will use over-the-counter medications to treat common symptoms such as constipation or joint pain in addition to prescription drugs.
C)Older clients may see several health care specialists.
D)The rate of absorption in older clients is unpredictable.
E)Increased volume of total body water results in an increase in concentrations of drugs in the blood.

Question 32

An older adult client complains to the nurse that a medication is causing significant nausea and vomiting.Which responses by the nurse are appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"A normal consequence of aging is decreased blood flow to the stomach.This could result in the medication staying in your stomach longer,causing nausea and vomiting."
B)"A normal consequence of aging is slowed emptying of stomach contents.This can cause nausea and vomiting."
C)"A normal consequence of aging is slower absorption of medications,resulting in nausea and vomiting."
D)"A normal consequence of aging is an increase in liver size,which can result in nausea and vomiting."
E)"A normal consequence of aging is decreased carbohydrate metabolism,which can result in nausea and vomiting."

Question 33

Which interventions would the nurse perform before administering the next dose of gentamicin to an older adult client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Monitor for peak and trough for toxicity.
B)Check the health care provider's orders for periodic lab draws.
C)Contact the health care provider if serum concentration is not within therapeutic range.
D)Check that this drug is prescribed with short intervals between doses.
E)Assess client for reduced cognitive function or confusion.

Question 34

The nurse is educating an older adult client on ways to decrease the risk of adverse drug reactions.Which statements will the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)When possible,decrease the number of prescriptions.
B)Take medication only when necessary.
C)Take medication as long as possible to ensure therapeutic response.
D)Follow up as requested by provider.
E)Adjust doses of medication in clients with renal or hepatic impairment.

Question 35

Which clients would the nurse consider high risk for adverse drug effects related to inefficient blood-brain barrier? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Older adult taking benzodiazepines for anxiety
B)Older adult with a current history of seizures
C)Older adult with a history of difficulty sleeping
D)Older adult taking high doses of antibiotics for pneumonia
E)Older adult with a history of emphysema