Question 1

A nurse practitioner (NP)is considering a possible drug regimen for an 80-year-old patient who reports being forgetful.To promote adherence to the regimen,the NP should:&#10;A) select drugs that can be given once or twice daily.&#10;B) provide detailed written instructions for each medication.&#10;C) order medications that can be given on an empty stomach.&#10;D) instruct the patient to take a lower dose if side effects occur.

Accepted Answer

To promote adherence in elderly patients,selecting the smallest number of medications with the simplest dose regimens is recommended,with once-daily dosing preferred.Instructions should be simplified.Drug dosing should be timed with mealtimes to help patients remember to take them.Lower dosing may be necessary with some drugs,but patients should not do this without consulting their provider.

Question 2

A thin 90-year-old patient who will begin taking warfarin has experienced a recent weight loss of 15 pounds.The NP caring for this patient should:&#10;A) obtain a baseline liver function test (LFT) before starting the drug.&#10;B) write the initial prescription at the lowest possible dose.&#10;C) encourage the patient to consume a diet high in fat and protein.&#10;D) counsel the patient to take the drug with food to enhance absorption.

Accepted Answer

A common age change that affects the distribution of drugs in older adults is a decrease in serum albumin.Significant changes that may affect drug therapy may be seen in malnourished elderly patients.Warfarin has a high binding affinity with albumin.Significant decreases in albumin may result in a greater free concentration of highly protein-bound drugs.It is important to order the lowest possible dose and titrate upward as needed.A baseline LFT is not indicated.A diet high in fat and protein is not indicated.

Question 3

A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain.To help ensure patient safety,the NP prescribing this medication should:&#10;A) assess this patient's usual sleeping patterns.&#10;B) ask the patient about problems with constipation.&#10;C) obtain a baseline creatinine clearance test before the first dose.&#10;D) perform a thorough evaluation of cognitive and motor abilities.

Accepted Answer

The body system most significantly affected by increased receptor sensitivity in elderly patients is the central nervous system,making this population sensitive to numerous drugs.It is important to evaluate motor and cognitive function before beginning drugs that affect the central nervous system to minimize the risk of falls.Assessment of sleeping patterns is important,but not in relation to patient safety.It is not necessary to evaluate stool patterns or renal function.

Question 4

An NP learns that a 90-year-old patient is chronically constipated and has frequent problems with acid reflux.The NP notes a weight loss of 20 pounds in this patient in the previous 6 months.Which of the following drugs that this patient is taking is cause for concern?

A) Quinidine
B) Naproxen
C) Calcium citrate
D) Calcium channel blocker

Accepted Answer

Naproxen has a high binding affinity for protein,and these drugs can become toxic in patients who may have low serum albumin because of the amount of free drug in serum.Constipation and acid reflux may cause problems with absorption for some drugs,but not the drugs listed.

Question 5

An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral medication 1 month prior.The patient reports no change in symptoms,and a laboratory test reveals a subtherapeutic serum drug level.The NP caring for this patient should:

A) consider ordering more frequent dosing of the drug.
B) titrate the patient's dose upward and recheck in 1 month.
C) ask the patient about any increased frequency of bowel movements.
D) determine the number of pills left in the patient's prescription bottle.

Accepted Answer

Because of cost concerns,poor understanding of a drug's actions,or confusion about how to take a medication,many elderly patients do not comply with drug regimens and may not take drugs as prescribed.Before increasing the frequency or amount of a drug,it is important to assess first whether or not the patient has been taking the drug as ordered.Counting the number of pills in the bottle will help the provider assess whether the patient is taking the drug as ordered.Changes in gastric motility do not generally have major effects on the effectiveness or serum drug levels of medications.

Question 6

An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks.At a follow-up appointment several months later,the patient reports no change in frequency of symptoms.The NP's initial action should be to:

A) order spirometry to evaluate pulmonary function.
B) prescribe a systemic corticosteroid to help with symptoms.
C) ask the patient to describe how the medications are taken each day.
D) give the patient detailed information about the use of metered-dose inhalers.

Accepted Answer

It is essential to explore with the older patient what he or she is actually doing with regard to daily medication use and compare this against the "prescribed" medication regimen before ordering further tests,prescribing any increase in medications,or providing further education.

Question 7

An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea.Using the Beers criteria,which of the following medications should the NP recommend for this patient?

A) Loratadine (Claritin)
B) Hydroxyzine (Vistaril)
C) Diphenhydramine (Benadryl)
D) Chlorpheniramine maleate (Chlorphen 12)

Accepted Answer

Loratadine is the only nonsedating antihistamine on this list.Older patients are especially susceptible to sedation side effects and should not use these medications if possible.

Deck 4: Special Populations: Geriatrics