Question 1

A patient receives heparin daily.The nurse should assess for which clinical response that indicates the need to discontinue heparin therapy?&#10;A) International normalized ratio (INR) of 2.5&#10;B) Platelet count of 150,000/mm3&#10;C) Reflux&#10;D) Hematuria

Accepted Answer

Hematuria is a serious side effect and requires temporary discontinuation of heparin therapy.A low platelet count can occur in a small percentage of patients who are receiving heparin therapy,which often resolves without intervention.The INR value is obtained to assess the effectiveness of warfarin therapy,not heparin.Heparin is administered parenterally,not by mouth,thus decreasing the risk for irritation.

Question 2

Which of the following is on the list of drugs considered suitable for the older adult?&#10;A) Indomethacin (Indocin)&#10;B) Reserpine (Reserpine)&#10;C) Chlorpheniramine (Chlor-Trimeton)&#10;D) Bupropion (Wellbutrin)

Accepted Answer

Bupropion is a safe antidepressant for an older adult that is also less likely to cause sexual dysfunction than other nonsteroidal SSRIs.Indomethacin is unsuitable for an older adult because it produces the most central nervous system effects of all nonsteroidal antiinflammatory agents.Reserpine is unsuitable for an older adult because it poses a risk of depression,sedation,and orthostatic hypotension.Chlorpheniramine and similar antihistamines are unsuitable for an older adult because of their anticholinergic properties.

Question 3

The nurse prepares to administer diltiazem (Cardizem LA)to an older adult with ischemic heart disease.When is the optimal time to administer this medication to help prevent complications of heart disease associated with rhythmical variations?

A) Midday
B) At bedtime
C) At breakfast
D) Every 4 hours

At bedtime

Accepted Answer

Diltiazem is a calcium-channel blocker used for hypertension,heart rate control,and angina from ischemic heart disease.To take advantage of rhythmical variations in heart disease,the best time to administer long-acting diltiazem (Cardizem LA)is at bedtime; the medication will then be active in the early morning hours when a cardiovascular event is most likely to take place.Midday administration is a less advantageous time for the medication administration because the main period of drug activity will occur in the evening.Morning administration is too late for administration because morning administration misses the critical period around 4 and 5 AM.Administering Cardizem LA every 4 hours is contraindicated because it is a long-acting formulation meant to be administered once daily.

Question 4

A health care provider has ordered alendronate (Fosamax)for an older adult who has been admitted for a hip fracture.Which is the best response from the nurse when educating the patient on the new medication?

A) You will need to have your calcium checked monthly while on this medication.
B) If you miss a dose, you will need to take the medication as soon as you remember.
C) Take on an empty stomach.
D) Do not take with alcohol.

Accepted Answer

Drug-food interactions may either decrease or increase the amount absorbed.For example,when a bisphosphonate such as Fosamax is taken with food of any kind,the absorption is reduced to only a few milligrams; therefore the drug has no effect on the target organ-the bones.If a patient misses a dose,then he or she should not take it as soon as remembered; it should be taken at its next scheduled dose.No current recommendations suggest that calcium levels are to be checked monthly.

Question 5

An older man is taking chlorpromazine (Thorazine),and the nurse helps him choose menu items.To prevent an exacerbation of potential adverse effects of therapy,which menu item does the nurse instruct the man to avoid?

A) Biscuits and gravy
B) Coffee with cream
C) Whole grain bread
D) Mixed green salad

Accepted Answer

Because antipsychotic medications potentially impair the body's thermoregulatory ability,the nurse instructs an older adult who takes an antipsychotic agent such as chlorpromazine to avoid caffeinated beverages because they contribute to dehydration.This man is at high risk for organ damage as a result of hyperthermia from mild elevations in the environmental temperature; therefore he must avoid dehydration,stay in cool temperatures,keep out of direct sunlight,and alert people around him and caregivers to monitor his temperature carefully and to be prepared to provide cooling sponge baths,cool liquids,and other measures to reduce his temperature quickly.The nurse instructs all older adults to avoid eating biscuits and gravy because these items have an excessively high fat content.Whole grain bread is a healthy food item to choose.Mixed green salad is a healthy food item to choose.

Question 6

A geriatric nurse practitioner prescribes an antidepressant for a patient.The patient asks,"How long will I have to be on this medication before I feel like my old self?" The nurse recalls that a therapeutic response to an antidepressant medication most often takes which one of the following?

A) 24 hours
B) 2 days
C) 2 weeks
D) 2 months

Accepted Answer

One to 2 months may be necessary to achieve a maximal response to therapy.Both 24 hours and 2 days are too short of timeframes to have a response to therapy.Patients often have an initial response to therapy 1 to 3 weeks after starting the medication.

Question 7

The nurse prepares to administer vancomycin (Vancocin)to an older adult.Which laboratory test should the nurse review before administering this medication?&#10;A) Stool culture&#10;B) Serum potassium&#10;C) Creatinine clearance&#10;D) Alkaline phosphatase

Accepted Answer

Antibiotics,as a group of drugs,are hard on the kidneys; thus the nurse should check the creatinine clearance of this individual.Although approximately 30% of absorbed vancomycin is protein bound,it is cleared by the kidneys,and creatinine clearance is the best index available of renal function.Because approximately 70% of vancomycin circulates in the bloodstream in the active form,the dose must be reduced or the dosing intervals increased to maintain the desired drug level and to prevent toxicity in the older adult who has renal dysfunction.The pathogen is already identified; however,some value can be obtained from subsequent stool cultures to determine whether the infection is eradicated.Serum potassium is a reasonable parameter to check in an older adult; however,if used as a measure of renal function,then the creatinine clearance is a better choice.Alkaline phosphatase is a measure of hepatic function and a reasonable parameter to check when administering medications; hepatic clearance is important in the metabolism of many medications.

Question 8

Which herbal supplement(s)when taken with an anticoagulant increases the effectiveness of the medication and should be avoided during anticoagulant therapy?&#10;A) Chamomile&#10;B) Garlic&#10;C) Ginkgo&#10;D) Hawthorn&#10;E) Ginseng&#10;F)Green tea

Accepted Answer

The intake of chamomile,garlic,ginkgo,ginseng,and green tea supplements at home should be avoided because each increases the effectiveness of anticoagulation.Individuals should avoid these herbal supplements while taking an anticoagulant because the patient's blood will be significantly less able to clot,exposing him or her to the risk of a catastrophic injury in the event of a fall or trauma.The use of Hawthorn supplements has not been shown to affect the use of anticoagulants.

Question 9

Through which pathway(s)are drugs and their metabolites eliminated?&#10;A) Sweat&#10;B) Saliva&#10;C) Kidneys&#10;D) Spleen

Accepted Answer

Drugs and their metabolites are excreted in sweat,saliva,and other secretions but primarily through the kidneys.Metabolites are not eliminated through the spleen.

Question 10

When completing medication reconciliation for an older woman,the nurse notes that the patient is being discharged home on anticoagulant therapy.The nurse also notes that at admission,the patient reported that she uses herbal supplements at home.Which instruction should the nurse include during discharge teaching?

A) "You may need to supplement with only ginkgo while on anticoagulant therapy."
B) "You may need to increase the use of garlic supplements while on anticoagulant therapy."
C) "Avoid using Hawthorn supplements while taking an anticoagulant medication."
D) "Avoid using chamomile supplements while on anticoagulant therapy."

Accepted Answer

The nurse's priority is to stop this older adult's intake of chamomile supplements at home; they will increase the effectiveness of anticoagulation.The nurse instructs this individual to avoid chamomile while she is taking an anticoagulant because the woman's blood will be much less able to clot,exposing her to a very high risk of a catastrophic injury in the event of a fall or trauma.The patient does not need to supplement with only ginkgo; the patient should cease taking ginkgo while on anticoagulant therapy,as well as the use of garlic supplements.Both increase the effectiveness of anticoagulation.The use of Hawthorn supplements has not been shown to affect the use of anticoagulant medications.

Question 11

Which medication is correctly matched to the condition given of an older adult patient according to current medical knowledge?&#10;A) Methylphenidate (Ritalin) for depression at bedtime&#10;B) Buspirone (BuSpar) for chronic anxiety states&#10;C) Amitriptyline (Elavil) for depression in the morning&#10;D) Haloperidol (Haldol) long-term for psychotic behavior

Accepted Answer

The answer of Which medication is correctly matched to the...

Question 12

In questioning an older adult,which question is likely to elicit the most accurate information about the individual's adherence to the medication plan?&#10;A) &#34;You take digoxin (Lanoxin) at the correct time, don't you?&#34;&#10;B) &#34;Why didn't you take all of your digoxin (Lanoxin) last month?&#34;&#10;C) &#34;How many doses of digoxin (Lanoxin) do you think you missed?&#34;&#10;D) &#34;You have never missed a dose of digoxin (Lanoxin), have you?&#34;

Accepted Answer

The answer of In questioning an older adult,which question is...

Question 13

Which interaction between each prescription and food or nutritional supplement is favorable?&#10;A) Warfarin (Coumadin) and ginkgo biloba&#10;B) Terazosin (Hytrin) and increased fluids&#10;C) Lithium (Eskalith) and low-sodium diet&#10;D) Warfarin (Coumadin) and leafy, green vegetables

Accepted Answer

The answer of Which interaction between each prescription and food...

Question 14

An older woman who takes escitalopram (Lexapro)10 mg by mouth daily states she does not feel better after 1 week of treatment.Rank the interventions in order,starting with the first intervention the nurse should implement to facilitate patient compliance with therapy.

A) Tell her that the beneficial effects can take 4 to 6 weeks to appear.
B) Instruct her to take the medication as prescribed without stopping.
C) Suggest hard candy, ice chips, and sips of water for a dry mouth.
D) Collaborate with the health care provider to provide an increased dose.
E) None of the above

Accepted Answer

The answer of An older woman who takes escitalopram (Lexapro)10...

Question 15

Which pharmacokinetic parameter is affected most by decreased intestinal motility related to the aging process?&#10;A) Absorption&#10;B) Distribution&#10;C) Metabolism&#10;D) Excretion

Accepted Answer

The answer of Which pharmacokinetic parameter is affected most by...

Question 16

The nurse provides instruction about medication safety to older adults.Which instruction should the nurse provide?&#10;A) Nausea and vomiting are common, harmless drug side effects.&#10;B) Keep a supply of medications at the bedside for convenience.&#10;C) Ask the health care provider to describe the purpose of therapy.&#10;D) Take your daily medications on an empty stomach with water.

Accepted Answer

The answer of The nurse provides instruction about medication safety...

Question 17

An older man is taking aripiprazole (Abilify)for agitation.Which patient assessment is the nurse's priority to prevent catastrophic effects of the medication?&#10;A) Oral and facial dyskinesia&#10;B) Mask facies, shuffling gait&#10;C) Muscle spasms of the face&#10;D) Repetitive aimless walking

Accepted Answer

The answer of An older man is taking aripiprazole (Abilify)for...

Question 18

Which process is increased in the early morning?&#10;A) Fibrinolytic activity&#10;B) Blood plasma&#10;C) Asthma symptoms&#10;D) Rheumatoid arthritis pain

Accepted Answer

The answer of Which process is increased in the early...

Deck 8: Safe Medication Use