Deck 12: Pharmacotherapy of the Geriatric Patient

Question 1

A nurse works at a hospital and notices that a 75-year-old client has not urinated all day, despite drinking three liters of water.What physiological change that occurs in the elderly most likely explains this?
1)Renal function impairment
2)Hair loss
3)Vision impairment
4)Increase in body fat

Answer 1

1

Question 2

A client is in the office for a routine checkup.Lab tests show a decline in the client's renal function.You notice a recent prescription for digoxin (Lanoxin). The nurse should be most concerned about:
1)Increased likelihood of toxicity due to the inability to excrete digoxin.
2)Diminished response to digoxin due to alterations in pharmacodynamics.
3)Digoxin causing the decrease in renal function.
4)Digoxin interfering with the lab test, making it appear that the patient's renal function has worsened.

Answer 2

1

Question 3

Which of the following is a group of medications that a panel of experts has determined should be used cautiously if at all in elderly clients?
1)Beers list
2)Washington Manual
3)Physicians' Desk Reference
4)Baker's dozen

Answer 3

1

Question 4

Which of these is a reason why older adults are more likely to experience adverse drug reactions and interactions compared with younger adults?
1)Use of fewer chronic medications
2)Physiologic changes in body composition
3)More predictable pharmacokinetics and pharmacodynamics
4)Presence of fewer chronic disease states

Question 5

An older client is seeking the nurse's advice for avoiding potential drug interactions.Which of the following would be an appropriate response?
1)"Take over-the-counter medications rather than prescription ones whenever possible."
2)"Use memory aids such as pill reminders."
3)"Obtain all medications from one pharmacy when possible."
4)"Ask for free drug samples rather than getting prescriptions filled at a pharmacy."

Question 6

Which of these is an age-related physiologic change that occurs in older adults?
1)The kidneys filter better and function more efficiently as a client ages.
2)GI motility increases.
3)Blood flow to the liver decreases.
4)Brain mass increases.

Question 7

Which of the following could explain why anticonvulsants and antidepressants can have exaggerated effects in older clients?
1)Increased binding to plasma proteins such as albumin
2)Increased rate of hepatic metabolism
3)Increased permeability of the blood-brain barrier
4)Reduced intestinal transit time

Question 8

A nurse works at a primary care physician practice, and has already been handed the prescriptions the primary care physician has written for a client.The nurse is looking at the patient's medication history, and notices that Mr.Smith's cardiologist has him taking carvedilol 6.25 mg p.o.b.i.d., lisinopril 10 mg p.o.daily, and spirinolactone 25 mg p.o.b.i.d.The prescriptions in the nurse's hand are for metoprolol 200 mg p.o.b.i.d.and enalapril 5 mg daily.What do you suggest the nurse do next?
1)Ask the primary care provider if he was aware his patient had been prescribed medications in the same drug class as those prescribed by the cardiologist.
2)Throw the prescriptions away.
3)Go ahead and give them to the patient.
4)Set the prescriptions to the side and follow up on the issue at a later date.

Question 9

Which of these is a reason why polypharmacy is prevalent in the elderly?
1)Multiple medical problems can usually be treated with a single drug.
2)Patients rarely see more than one prescriber.
3)Use of over-the-counter medications is uncommon in this age group.
4)Patients might be taking multiple medications for their comorbidities.

Question 10

Age-related changes in the gastrointestinal tract include:
1)Decreased motility.
2)Reduced intestinal transit time.
3)Increased gastric acid production.
4)Increased absorption of medications and nutrients.

Question 11

Which of these is a strategy nurses can implement to improve adherence with drug therapy in geriatric clients?
1)Suggest the client use a daily or weekly pill counter.
2)Discourage the use of check-off calendars because older clients do not have adequate eyesight to use them properly.
3)Suggest the client forgo obtaining medications that are too expensive.
4)Suggest stopping any medications that do not seem to be having an effect.

Question 12

A reduction in albumin synthesis due to aging can result in exaggerated effects of a medication because:
1)Renal elimination of the drug will be decreased.
2)Pharmacodynamics will be altered.
3)Blood flow to the liver decreases.
4)More unbound drug will be present.

Question 13

A nurse works at a nursing home and 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.What should the nurse do?
1)Suggest checking the client's peak gentamicin level, and immediately report the loss in hearing in the chart and to the physician.
2)Tell Mrs.Jones that she is going to need a hearing aid.
3)Continue gentamicin IV, and check the peak level in a week.
4)Continue gentamicin IV, and suggest adding vancomycin IV to improve the ototoxicity.

Question 14

The anatomic and physiologic changes that happen as humans age should be considered:
1)Normal and predictable.
2)The result of pathological changes.
3)A potential target for drug therapy.
4)Reversible.

Question 15

The nurse should ask the patient about all medications a patient takes, including over-the-counter and herbal medications, because:
1)Minimizing the cost of medications is the highest priority.
2)Clients should not use over-the-counter or herbal medications.
3)They might interact with each other or with prescribed medications.
4)Use of these agents must be reported to the Food and Drug Administration.

Question 16

A client comes in to the office complaining of increased sun sensitivity.Which of the following medications is most likely to be the causative agent?
1)Alprazolam (Xanax)
2)Cyclobenzaprine ( Flexeril)
3)Naproxen (Aleve)
4)Phenytoin (Dilantin)

Question 17

A client comes to the Emergency Department with complaints of confusion.Which of the following recently prescribed medications is most likely to be responsible?
1)Lansoprazole (Prevacid)
2)Amlodipine (Norvasc)
3)Atorvastatin (Lipitor)
4)Hydroxyzine (Atarax)

Question 18

Which of these is a reason why older adults are more likely to experience adverse drug reactions and interactions compared with younger adults?
1)Use of fewer chronic medications
2)Physiologic changes in body composition
3)More predictable pharmacokinetics and pharmacodynamics
4)Presence of fewer chronic disease states

Question 19

A nurse working at a clinic notices that a client is having problems reading his prescription bottles.Sometimes the client takes medications incorrectly because of the small print.What is a suggestion that the nurse can make to alleviate this problem?
1)Ask the pharmacist to provide labels with large print that explain how to take the medication.
2)Let the pharmacist get easy-open caps.
3)Stop taking the medications, as they are more likely to cause problems than to help if not taken correctly.
4)Put the medication in a zip-top bag with the instructions written on it in large print.

Question 20

Which of these do studies suggest is a client-level factor affecting nonadherence?
1)Receiving manageable instructions from the health care provider
2)Belief that the treatment will be effective
3)The client's social support network
4)Making the regimen less complex

Question 21

While providing medication education, the nurse should instruct a client:
1)About every possible adverse effect that could possibly occur.
2)To avoid keeping a list of medication names, doses, and purposes, because it could be lost, resulting in a loss of privacy.
3)To vary the time of day that each medication is taken so that the long-term effectiveness will be preserved.
4)That changes in mental status, weight, or bowel function should be reported to the prescriber.