Gerontological Nursing The Essential Guide to Clinical Practice, 2nd Edition by Patricia A.
Gerontological Nursing The Essential Guide to Clinical Practice, 2nd Edition by Patricia A.
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Chapter 18- Safe Medication Use
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | The nurse caring for older patients in an acute care facility is aware of the changes in drug metabolism that can occur in older adults. Which statement explains the most important factor that affects pharmacokinetics in older patients? | |
| A) | Changes in gastrointestinal (GI) motility increase the absorption time for many drugs. | |
| B) | Drug distribution is unpredictable due to metabolic and body-composition factors. | |
| C) | Preexisting chronic conditions complicate the distribution and metabolism of drugs. | |
| D) | Decreased renal and liver function contributes to an increased half-life for many drugs. | |
| Ans: | D | |
| Feedback: | ||
| Changes in renal and liver function contribute significantly to the changes in pharmacokinetics that are common in older adults. While changes in GI motility, drug distribution, and preexisting conditions may be true for many patients, these factors are inconsistent. | ||
| Origin: Chapter 18- Safe Medication Use, 2
Chapter: 18 Client Needs: D2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/learning Objective: 1 Page and Header: 231, Increased Risk of Adverse Reactions |
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| 2. | The nurse at a long-term care facility is teaching unlicensed care providers about some of the factors that characterize adverse drug reactions in the elderly residents. Which teaching points are valid? (Select all that apply.) | |
| A) | “Even when a resident stops taking a drug, a reaction can take place after the fact.” | |
| B) | “Even when a resident has been taking a drug for a long time, a drug reaction can still occur.” | |
| C) | “Most ‘drug reactions’ are in fact age-related changes that are mistakenly attributed to medications.” | |
| D) | “Older adults often have signs and symptoms of adverse reactions that are very different from those of younger adults.” | |
| E) | “While older adults are prone to adverse reactions, these reactions tend to resolve more quickly than in younger people.” | |
| Ans: | A, B, D | |
| Feedback: | ||
| An adverse reaction to a drug may be demonstrated even after the drug has been discontinued. Adverse reactions can develop suddenly even with a drug that has been used over a long period of time without problems. The signs and symptoms of an adverse reaction to a given drug may differ in older persons. Most drug reactions are not age-related changes. Adverse drug reactions do not resolve more quickly in older patients than in younger people. | ||
| Origin: Chapter 18- Safe Medication Use, 3
Chapter: 18 Client Needs: D2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing process Objective: 2 Page and Header: 231, Reviewing Necessity and Effectiveness of Prescribed Drugs |
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| 3. | While reviewing a newly admitted older patient’s medication history the nurse notes that the patient has been taking a b-blocker for many years despite no apparent history of hypertension or cardiac disease. What action should the nurse first take? | |
| A) | Hold the drug in the short term until an indication is determined | |
| B) | Monitor the patient’s blood pressure and apical heart rate closely | |
| C) | Request that the physician providing care reconsider the use of the drug | |
| D) | Investigate and provide non-pharmacologic measures to replace the drug | |
| Ans: | C | |
| Feedback: | ||
| In the effort to minimize polypharmacy in older adults, it is important to determine whether a drug is really needed. It would be prudent for the nurse to raise the issue with the physician responsible for the patient’s medications in the hospital setting. Close BP and HR monitoring is likely not necessary and it would be inappropriate for the nurse to independently replace or hold the drug. | ||
| Origin: Chapter 18- Safe Medication Use, 4
Chapter: 18 Client Needs: D2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing process Objective: 2 Page and Header: 233, Promoting Safe and Effective Administration |
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| 4. | When administering a proton pump inhibitor to a patient with gastroesophageal reflux disease (GERD), the nurse notes that the patient has great difficulty swallowing the enteric-coated pill. What should the nurse do when administering this medication to the patient in the future? | |
| A) | Crush the pill and mix with applesauce | |
| B) | Split the pill in two parts and give each separately | |
| C) | Reposition the patient and provide more fluid when giving the pill | |
| D) | Provide an herbal alternative that also reduces stomach acid production | |
| Ans: | C | |
| Feedback: | ||
| Since enteric-coated pills should not be crushed or split, the nurse’s best alternative is to reposition the patient and provide more fluid to aid with swallowing. It would be inappropriate to provide a nonpharmacologic alternative to the prescribed medication. | ||
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