Question 1

A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence,what will the nurse do?&#10;A) Ask the patient to share the teaching with a neighbor or friend soon after discharge.&#10;B) Give the patient detailed written information about each drug.&#10;C) Cluster medication administration times as much as possible.&#10;D) Make sure the patient understands the actions and side effects of each drug.

Accepted Answer

Unintentional nonadherence often is the result of confusion and forgetfulness. Grouping medications to reduce the number of medication times per day can simplify the regimen and help the patient remember medication times. Enlisting a neighbor,relative,or friend is a good idea,but this person should be included in the teaching. Asking the patient to share what is learned may not be a reasonable expectation of a forgetful patient. Detailed written information may just be more confusing; verbal and written information should be clear and concise. Making sure the patient understands the actions and side effects of medications helps when intentional nonadherence is an issue,but in this case it may just add to the patient's confusion.

Question 2

An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital,along with other medications taken. The patient's renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding?

A) Financial concerns
B) Inability to open drug containers
C) Increased tolerance to the drug's effects
D) Patient's conviction that the drug is unnecessary

Financial concerns

Accepted Answer

Older adult patients who have financial concerns about paying for medications often take less of the drug or take it less often to make the drug last longer. A patient unable to open the drug container would not get any medication and would not have a detectable serum drug level. A patient with increased tolerance to a drug's effects would require more of the drug to get effects. A patient convinced that the drug is not needed would probably not fill the prescription.

Question 3

A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess?&#10;A) Creatinine clearance&#10;B) Sodium levels&#10;C) Potassium levels&#10;D) Serum creatinine

Accepted Answer

The proper index of renal function in older adults is creatinine clearance,which indicates renal function in older patients whose organs are undergoing age-related deterioration. Sodium and potassium levels are not indicative of renal function. Serum creatinine levels do not reflect kidney function in older adults because lean muscle mass,which is the source of creatinine in serum,declines and may be low even with reduced kidney function.

Question 4

A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?

A) Ask the patient if she has difficulty swallowing pills.
B) Count the pills in the prescription bottle.
C) Notify the provider to request more frequent dosing.
D) Request an order for renal function tests.

Accepted Answer

Intentional nonadherence is common and may occur because older adult patients are not convinced that drugs are needed or that the dose prescribed is correct. Counting the pills would be an appropriate first step as the nurse determines the cause of the low serum drug level,because it provides information about adherence. If the pill count is correct and the patient has taken the drug as prescribed,other causes may have to be investigated. If it is clear that the patient has not been taking enough of the medication,asking about her ability to swallow may be a good follow-up question. The last two options would be steps to discuss with the provider if the patient is taking the medication as prescribed.

Question 5

A nurse is preparing to give medications to four older patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?

A) Obese patient
B) Patient with decreased serum creatinine
C) Patient with chronic diarrhea
D) Thin patient with a chronically low appetite

Accepted Answer

The patient who is thin and has a poor appetite has an increased risk of malnutrition,with significant lowering of serum albumin. This can result in increased free drug levels of protein-bound drugs and can lead to drug toxicity. Obesity,which involves increased adipose tissue,would cause lipid-soluble drugs to deposit in adipose tissue,with a resulting reduction of drug effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of medications through the GI tract and reduce absorption.

Question 6

Based on changes in hepatic function in older adult patients,which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism?&#10;A) A higher dose should be used with the same time schedule.&#10;B) The interval between doses should be increased.&#10;C) No change is necessary; metabolism will not be affected.&#10;D) The interval between doses should be reduced.

Accepted Answer

The interval between doses of the medication should be increased in older adult patients,because drugs that undergo the first pass effect may not be broken down as well as in an individual with full liver function. A higher dose of the medication is not indicated,because toxic effects could occur. A change in administration may be indicated in older adults,because their metabolism is affected. The interval between doses should not be reduced but increased.

Question 7

The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates understanding of the teaching?&#10;A) &#34;An inability to pay for medications contributes to most intentional nonadherence among older adults.&#34;&#10;B) &#34;Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens.&#34;&#10;C) &#34;Most nonadherence in older adults results in drug toxicity and adverse drug effects.&#34;&#10;D) &#34;The majority of older patients who do not adhere to drug regimens do so intentionally.&#34;

Accepted Answer

Intentional nonadherence is common. It accounts for 75% of nonadherence among older adults and may occur because older adult patients are not convinced that drugs are needed or that the dose prescribed is correct. The inability to pay for medications and complicated drug regimens result in nonintentional nonadherence. Although nonadherence may result in therapeutic failure and drug toxicity,subtherapeutic dosing is by far the most common result.

Question 8

A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine [Demerol] for severe pain. What will the nurse do?

A) Administer the medication as prescribed and initiate a fall risk protocol.
B) Ask for a PRN order for diphenhydramine [Benadryl] for the expected side effect of itching.
C) Request an order for morphine instead of meperidine [Demerol].
D) Suggest to the surgeon that the patient receive diazepam [Valium] to reduce anxiety and the need for narcotics.

Accepted Answer

In older adults,meperidine is not effective at usual doses and causes more confusion than in younger patients. Morphine is recommended for severe pain. A fall risk protocol is appropriate,but the drug ordered is not. Diphenhydramine is not recommended for older adult patients,because it causes blurred vision. Both diphenhydramine and diazepam have central nervous system (CNS)sedative effects,which will compound the CNS effects of the narcotic. Diazepam also produces prolonged sedation in older adults.

Question 9

A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?&#10;A) &#34;Alteration in hepatic function requires more frequent drug dosing.&#34;&#10;B) &#34;Changes in GI function in older adult patients lead to lower serum drug levels.&#34;&#10;C) &#34;Most adverse drug reactions in older adult patients are related to altered renal function.&#34;&#10;D) &#34;Most nonadherence among older adult patients is intentional.&#34;

Accepted Answer

Changes in hepatic function in older adult patients lead to decreased metabolism,meaning that drugs metabolized by the liver have prolonged half-lives and should be given less frequently. Altered GI function does not have much effect in this population,but most known effects from this cause are related to poor absorption and less available drug. Alterations in renal function are the cause of most adverse drug effects in the older adult. In most cases,nonadherence to drug regimens is intentional,usually because the patient doesn't believe that the drug is needed or that the dose prescribed is not necessary.

Question 10

A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together create a reason for concern?&#10;A) Acetaminophen [Tylenol] and oxycodone&#10;B) Amitriptyline [Elavil] and diphenhydramine [Benadryl]&#10;C) Fexofenadine [Allegra] and an over-the-counter laxative&#10;D) Zolpidem [Ambien] and sertraline [Zoloft]

Accepted Answer

Both amitriptyline and diphenhydramine are on the BEERS list,amitriptyline for anticholinergic effects and diphenhydramine because it causes blurred vision. Additionally,they both have CNS effects that can compound each other when the drugs are given together. Acetaminophen and oxycodone are both acceptable and may be given together. Fexofenadine is a second-generation antihistamine with fewer side effects,and it is not contraindicated for use with a laxative. Zolpidem is a sedative that has less risk of physical dependence and less risk of confusion,falls,and cognitive impairment; sertraline is a safer antidepressant,because it has a shorter half-life than others.

Question 11

A nurse is reviewing an older adult patient's chart before giving medications. Which patient information is of most concern?&#10;A) Chronic constipation&#10;B) Increased body fat&#10;C) Low serum albumin&#10;D) Low serum creatinine

Accepted Answer

The answer of A nurse is reviewing an older adult...

Question 12

A thin older adult woman is admitted to the hospital after several days of vomiting,diarrhea,and poor intake of foods and fluids. She has not voided since admission. In preparing to care for this patient,the nurse will look for what laboratory values to help guide medication administration? (Select all that apply.)

A) Creatinine clearance
B) Gastric pH
C) Plasma drug levels
D) Serum albumin
E) Serum creatinine

Accepted Answer

The answer of A thin older adult woman is admitted...

Deck 11: Drug Therapy in Geriatric Patients