CHAPTER 6 Pharmacology and Older Adults

CHAPTER 6 Pharmacology and Older Adults

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

6.1•A 60-year-old client is admitted to the medical unit for symptoms of fever and pneumonia. The client has a history of hepatitis and renal disease. In reviewing the medications ordered for this client, the nurse sees that a sedative is ordered for bedtime. Two hours after administering this medication to this client, the nurse cannot awaken the client. Blood pressure and pulse are within normal limits and respiratory rate is 12/min. This response is most directly related to

1. therapeutic level of the sedative.
2. lack of absorption of the drug.
3. complications of pneumonia.
4. excessive sedation related to medication administered for sleep.

Answer: 4

Rationale: Despite the client’s biological age, the fact that this client has comorbidities and other diagnosed diseases would indicate that the symptoms presented are the result of an adverse effect of the sedative. Although sleep is desired, clients should be able to awaken after sedation. Therefore, it is not a therapeutic effect. It is not lack of absorption because of the excessive sedative effect, and complications of pneumonia would present with labored respirations and other associated symptoms.

Assessment

Physiological Integrity

Analysis

6.2•A 75-year-old client takes Digoxin for an irregular heart rhythm. Over the past week the client has had nausea and vomiting, and has not eaten in 2 days. The client now presents with weakness, bradycardia, and visual disturbances. What laboratory tests would the nurse monitor for this client?

1. hemoglobin
2. serum electrolytes and therapeutic drug levels
3. urine analysis
4. calcium levels

Answer: 2

Rationale: With aging, body water decreases and body fat increases. Elderly clients are more susceptible to dehydration and prolonged effects of fat-soluble drugs. It would be most appropriate to monitor the therapeutic levels of the medications taken along with the client’s hydration status. These are best accomplished by the electrolytes and drug-level assays. The hemoglobin is a test for red cell counts, the urine analysis is a general indicator of renal function, and calcium levels alone do not provide adequate information on the client’s state of hydration.

Assessment

Physiological Integrity

Application

6.3•The nurse is reviewing laboratory studies of an 85-year-old client admitted for pneumonia. The client has had a decrease in appetite and has not eaten well in the past few days. The BUN is elevated but the creatinine clearance is within normal values. The nurse’s assessment of this finding would indicate the need to

1. inform the physician of the BUN result.
2. assess urine output.
3. assess intake and output and dietary intake of protein.
4. monitor the client for medication side effects related to decreased excretion by the kidneys.

Answer: 3

Rationale: BUN can be affected by muscle mass, level of hydration, and dietary intake of protein. Therefore, elevations may not be a good indicator of renal function. Informing the physician is not necessary until further assessment data is collected. Urine output alone would not provide enough information related to the client’s hydration status and, because the creatinine clearance is within a normal range, it is unlikely that medication excretion will be affected.

Assessment

PsychosocialIntegrity

Application

6.4•A 92-year-old client is admitted to the cardiac unit with chest pain. The physician ordered Restoril 15 mg at bedtime. The usual dosage given to adults is 30 mg. What interventions would the nurse take for this client?

1. administer the drug as ordered
2. ask the physician to change the dosage to 30 mg
3. monitor the client’s renal function
4. give the client the drug and contact the doctor for a second dose if the client does not fall asleep

Answer: 1

Rationale: The rule of thumb for drug prescriptions in older persons is to “start low, go slow.” Therefore, drugs, such as sedatives, are given at one half the recommended adult dose. The client’s renal function is important to monitor but not relevant in this situation, and to change the dosage quickly or to the recommended adult dose may result in excessive sedation.

Implementation

Physiological Integrity

Application