Chapter 11: Drug Therapy in Geriatric Patients

Chapter 11: Drug Therapy in Geriatric Patients

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess?

ANS:  A

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.

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   pp. 92-93

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

2. 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?

ANS:  C

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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 93-95

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

3. A nurse is reviewing an older adult patient’s chart before giving medications. Which patient information is of most concern?

ANS:  C

Low serum albumin reduces protein binding of drugs and can cause levels of free drug to rise, increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is not a major factor in drug sensitivity in the older adult, although delayed gastric emptying can delay drug responses. Increased body fat can alter drug distribution, causing reduced responses in lipid-soluble drugs. Low serum creatinine is a function of decreased lean muscle mass and does not reflect kidney function or drug excretion.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 92

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

4. 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?

ANS:  B

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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 92-93

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential