Question 1

To minimize the possible complications of polypharmacy among older adult clients, the nurse assesses this population for which of the following? Select all that apply.&#10;A)Number of physicians providing medical care&#10;B)Location of pharmacies where prescriptions are filled&#10;C)Presence of chronic illnesses&#10;D)Tendency to borrow medication from family or friend&#10;E)Use of over-the-counter medication to self-medicate

Accepted Answer

Older adults are especially vulnerable to polypharmacy because many have one or more chronic conditions requiring several medications for management. To complicate matters, patients may see more than one provider for the same health problem and may have prescriptions filled at more than one pharmacy (Emmons B F: Factors contributing to polypharmacy, A m J Health Syst Pharm 65:1992, 2008). Additional contributors to polypharmacy include the use of over-the-counter and alternative medicines or supplements in the treatment of conditions (Qato D M, Alexander G C, Conti R M, et al: Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States, JAMA 300:2867 - 2878, 2008). As a result, the patient may end up taking duplicate drugs, similar drugs from the same drug class, and drugs that are contraindicated when taken together.

Question 2

An older adult client has been ordered to receive the drug warfarin (Coumadin).The nurse's primary intervention involves monitoring the client for drug toxicity by daily review of his:&#10;A)prothrombin time.&#10;B)body for bruising.&#10;C)serum creatinine level.&#10;D)reflex tone.

Accepted Answer

Warfarin toxicity is determined by an international normalized ratio (INR) or INR with prothrombin time.

Question 3

The nurse shows an understanding of medication-related risk factors common to older adults when asking:&#10;A)&#34;Are you aware of the possible side effects of your medications?&#34;&#10;B)&#34;Do you regularly take any dietary supplements?&#34;&#10;C)&#34;How do you keep track of when your medications are due?&#34;&#10;D)&#34;How many different physicians are prescribing medications for you?&#34;

Accepted Answer

According to a recent study, almost half (49%) of older adults living in the United States take some sort of dietary supplement on a regular basis (Qato D M, Alexander G C, Conti R M, et al: Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States, JAMA 300:2867-2878,2008). The same study identified that more than half (52%) of older adults who take prescription medications also take supplements, which increase the potential for drug-drug interactions.

Question 4

A 65-year-old client is receiving propranolol (Inderal) for hypertension.Which outcome is the best indicator of goal success when considering the drug's potential effect on the client's quality of life?

A)The client verbalizes the importance of moderate exercise and a low-sodium diet.
B)The client experiences no injuries as a result of dizziness.
C)The client maintains his blood pressure within normal limits.
D)The client describes symptoms indicative of an adverse drug reaction.

Accepted Answer

The main concerns with the use of antihypertensive medications in older adults are an increased risk of orthostatic hypotension and dehydration.

Question 5

When administering medications to older adults, the nurse shows an understanding of the effect of aging on drug distribution by monitoring the client's:&#10;A)cardiac function.&#10;B)liver function.&#10;C)red blood cell count.&#10;D)plasma albumin levels.

Accepted Answer

With age, particularly for malnourished or frail adults, albumin levels may drop. As a result of decreased sites for protein binding, the activity of highly protein bound drugs, and any side effects caused by these drugs, may be increased.

Question 6

A 72-year-old client with a history of diabetes and hypothyroidism is being admitted to an assisted living facility.During the admission assessment the client reports difficulty falling asleep.The nurse shows an understanding of sleep dysfunction and the older client when asking:

A)"Have you ever been prescribed a sleeping medication?"
B)"How do you feel about leaving your home to live here?"
C)"How long have you been a diabetic?"
D)"Are you taking medication for your thyroid problem?

Accepted Answer

Insomnia and anxiety are problems that commonly plague older adults. Because insomnia and anxiety often occur secondary to medication side effects or secondary to medical conditions such as dementia, thyroid abnormalities, or depression, proper diagnosis and treatment of any underlying causes of insomnia or anxiety can decrease the inappropriate use of these medications.

Question 7

An older adult client is having difficulty remembering when to take several of her prescribed medications.To improve the client's compliance with her medication, regimen the nurse:&#10;A)asks the client's husband to consistently administer the drugs.&#10;B)checks the drug guide to see if decreasing their frequency is possible.&#10;C)informs the client's physician about the drug noncompliance.&#10;D)teaches the client to administer daily pills with a pill dispenser.

Accepted Answer

The regimen should be simplified as much as possible; using a drug dispenser could make the daily process less complicated.

Question 8

An older adult diabetic client is mildly hypertensive.The nurse prepares to educate the client regarding angiotensin II-blocking agents since these drugs are especially useful in older adults because they:

A)protect the kidney's function.
B)have a well-defined therapeutic window.
C)are more effective than other drugs in the same class.
D)can be given when liver function is compromised.

Accepted Answer

The ACEIs and ARBs also have demonstrated value in decreasing the chance of cardiac mortality in patients with heart failure. They also confer renal protection, which is particularly beneficial for patients with diabetes.

Question 9

The nurse responsible for administering medications to the residence of a long-term care facility shows an understanding of the risk of injury this population experiences when:&#10;A)confirming the client's identity prior to providing the medication.&#10;B)assessing the client for a history of drug related allergies.&#10;C)implementing the 5 Rights of medication administration routinely.&#10;D)educating the client to the purpose and side efforts of their medications.

Accepted Answer

The Institute of Medicine (IOM) estimates that 1.5 million ADEs and 7000 deaths occur in the United States each year secondary to medication errors (Preventing medication errors: quality chasm Series, 2007). Older adults are disproportionately affected; more than half of the medication errors occur in long-term care facilities and more than 500,000 occur among ambulatory Medicare patients.

Question 10

The nurse is preparing to apply a topical cream on the arm of a cognitively impaired, anorexic older adult client in the terminal stage of lung cancer.The nurse carefully monitors the effectiveness of the medication since its effectiveness will be most negatively impacted by the client's:

A)age.
B)cognitive limitations.
C)nutritional status.
D)cancer diagnosis.

Accepted Answer

Topical drugs face barriers to absorption since the aged skin has decreased water content, a relative decrease in lipid content, and a decrease in tissue perfusion. These changes may result in impaired absorption of some medications that are administered via lotions, creams, ointments, and patches.

Deck 22: Pharmacologic Management