Chapter 06 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 06

Question 1

Type: MCSA

An older patient being treated for pneumonia is given a sedative to sleep. A few hours afterwards, the patient has a respiratory rate of 12 and cannot be aroused. What does this assessment finding indicate to the nurse?

1. The sedative was not absorbed.

2. The sedative has reached a therapeutic blood level.

3. The medication for sleep caused excessive sedation.

4. The patient is experiencing complications of pneumonia.

Correct Answer: 3

Rationale 1: It is not lack of absorption because of the excessive sedative effect.
Reference: Page 132

Rationale 2: Although sleep is desired, patients should be able to awaken after sedation. This is not a therapeutic effect.
Reference: Page 132

Rationale 3: Pharmacodynamic changes, which affect how the drug affects the body, can also occur because of the aging process. However, it is not always clear if changes in therapeutic responses are due to the pharmacodynamics or to the altered pharmacokinetics. An increased drug-receptor response can occur with benzodiazepines resulting in increased sedation.
Reference: Page 132

Rationale 4: Complications of pneumonia would present with labored respirations and other associated symptoms.
Reference: Page 132

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1. Explain the interaction between normal aging and responses to drug therapy in older people.

Question 2

Type: MCSA

An older patient who takes digoxin for an irregular heart rhythm has been experiencing nausea and vomiting and has not eaten in 2 days. The patient now is exhibiting weakness, bradycardia, and visual disturbances. What laboratory tests would the nurse monitor for this patient?

1. Hemoglobin

2. Urine analysis

3. Calcium levels

4. Serum electrolytes

Correct Answer: 4

Rationale 1: The hemoglobin is a test for red cell counts.
Reference: Page 131

Rationale 2: The urine analysis is a general indicator of renal function.
Reference: Page 131

Rationale 3: Calcium levels alone do not provide adequate information on the patients state of hydration.
Reference: Page 131

Rationale 4: With aging, body water decreases and body fat increases. Older patients 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 patients hydration status. These are best accomplished by the electrolytes and drug levels.
Reference: Page 131

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Explain the interaction between normal aging and responses to drug therapy in older people.

Question 3

Type: MCSA

An older patient has an elevated blood urea nitrogen (BUN) level, but the creatinine clearance is within normal limits. The nurse notes that the patients appetite has been poor the past few days. What should the nurse do about these laboratory findings?

1. Assess urine output.

2. Inform the physician of the BUN result.

3. Assess intake and output and dietary intake of protein.

4. Monitor for medication side effects related to decreased excretion by the kidneys.

Correct Answer: 3

Rationale 1: Urine output alone would not provide enough information related to the patients hydration status.
Reference: Page 132

Rationale 2: Informing the physician is not necessary until further assessment data is collected.
Reference: Page 132

Rationale 3: The nurse should not rely on BUN levels as an indicator of renal function in the older person. BUN is affected by muscle mass, level of hydration, diagnosis of anemia, and dietary intake of protein. The nurse needs to further assess the patients intake and output and dietary intake of protein.
Reference: Page 132

Rationale 4: Because the creatinine clearance is within a normal range, it is unlikely that medication excretion will be affected.
Reference: Page 132

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Explain the interaction between normal aging and responses to drug therapy in older people.

Question 4

Type: MCSA

An older patient admitted with chest pain is prescribed Restoril 15 mg at bedtime. The usual dosage given to adults is 30 mg. What intervention would the nurse use for this patient?

1. Administer the drug as ordered.

2. Monitor the patients renal function.

3. Ask the physician to change the dosage to 30 mg.

4. Give the drug and contact the doctor for a second dose if the patient does not fall asleep.

Correct Answer: 1

Rationale 1: The rule of thumb for drug prescriptions in older persons is to start low, go slow. Drugs, such as sedatives, are given at one half the recommended adult dosage.
Reference: Page 132

Rationale 2: The patients renal function is important to monitor, but it is not relevant in this situation.
Reference: Page 132

Rationale 3: Recommending the adult dose may result in excessive sedation.
Reference: Page 132

Rationale 4: Changing the dosage quickly may result in excessive sedation.
Reference: Page 132

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Explain the interaction between normal aging and responses to drug therapy in older people.

Question 5

Type: MCSA

An older patient does not take a prescribed diuretic as planned because of the inconvenience of having to urinate frequently, which interrupts scheduled activities. What action should the nurse take with this patient?

1. Insist the drug be taken as prescribed.

2. Contact the physician to order another drug.

3. Advise to take the drug in divided dosages, half in the morning and half in the evening.

4. Discuss the daily activity schedule and adjust the drug administration time accordingly.

Correct Answer: 4

Rationale 1: Insisting the patient take the drug without addressing the patients concerns would not improve compliance with the medical plan of care.
Reference: Page 134

Rationale 2: A new drug may not be indicated if the administration time is changed.
Reference: Page 134

Rationale 3: Drug dosages should not be modified without consultation with the physician because the therapeutic effect may be altered.
Reference: Page 134

Rationale 4: The administration of diuretics can be scheduled so that the peak diuretic effect does not interrupt activities important to the patient. Assisting the patient to understand this and modifying the schedule would provide the best compliance with the medical plan of care.
Reference: Page 134

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply principles of teaching and learning to promote compliance and adherence to the medication regimen.

Question 6

Type: MCSA

An older patient experiencing abdominal pain, nausea, and vomiting brown liquid has taken an NSAID type of medication for general muscle aches. What effect might this drug have related to the patients manifestations?

1. Diarrhea

2. Constipation

3. Increased BUN

4. Gastric irritation and bleeding

Correct Answer: 4

Rationale 1: NSAIDs typically do not cause diarrhea.
Reference: Page 136

Rationale 2: NSAIDs typically do not cause constipation.
Reference: Page 136

Rationale 3: An elevated BUN would be related to dehydration and decreased protein intake but not related to the drug the patient is taking.
Reference: Page 136

Rationale 4: NSAIDs cause gastric irritation and can be linked to the manifestations that the patient is experiencing.
Reference: Page 136

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe assessments to monitor older patients for adverse drug effects and polypharmacy.

Question 7

Type: MCSA

After completing a medication history, the nurse notes that an older patient is prescribed 22 different medications and sees five different healthcare providers. What should the nurse determine about the patient from this information?

1. A situation of polypharmacy

2. Prone to missing medication doses

3. Multiple health problems requiring a variety of different prescribed medications

4. Cognitive impairment and not remembering the medications prescribed

Correct Answer: 1

Rationale 1: The amount of medications and the number of healthcare providers that this patient sees is excessive, qualifying for what is defined as polypharmacy.
Reference: Page 140

Rationale 2: There is not enough information to determine if the patient is prone to missing medication doses.
Reference: Page 140

Rationale 3: Although the patient may have multiple conditions that warrant the medications prescribed, there is not enough information to make this determination.
Reference: Page 140

Rationale 4: There is no indication of cognitive impairment in this patient.
Reference: Page 140

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Describe assessments to monitor older patients for adverse drug effects and polypharmacy.

Question 8

Type: MCMA

An older patient is experiencing a change in mood. For which medications should the nurse assess as the possible cause of this patients cognitive change?

Standard Text: Select all that apply.

1. Steroids

2. NSAIDs

3. Antibiotics

4. Benzodiazepines

5. Antihypertensives

Correct Answer: 1,2,4,5

Rationale 1: Changes in mood can result from taking steroids.
Reference: Page 134

Rationale 2: Changes in mood can result from taking NSAIDs.
Reference: Page 134

Rationale 3: Changes in mood are not associated with taking antibiotics.
Reference: Page 134

Rationale 4: Changes in mood can result from taking benzodiazepines.
Reference: Page 134

Rationale 5: Changes in mood can result from taking antihypertensives.
Reference: Page 134

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Describe assessments to monitor older patients for adverse drug effects and polypharmacy.

Question 9

Type: MCMA

An older patient is prescribed psyllium seed to prevent constipation. What should the nurse instruct the patient about this medication?

Standard Text: Select all that apply.

1. Do not take this medication with juice.

2. Avoid eating after taking this medication.

3. Take the medication with adequate water.

4. This medication can swell in the esophagus.

5. Limit the intake of water after taking this medication.

Correct Answer: 3,4

Rationale 1: This medication should be taken with adequate water. There is no information to suggest that this medication cannot be taken with juice.
Reference: Page 135

Rationale 2: Eating does not need to be altered when taking this medication.
Reference: Page 135

Rationale 3: This medication must be taken with adequate water to ensure it reaches the stomach.
Reference: Page 135

Rationale 4: This medication can swell in the esophagus and cause an obstruction if not taken with adequate water.
Reference: Page 135

Rationale 5: Water should not be limited when taking this medication.
Reference: Page 135

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify principles of safe medication management with older persons in a variety of patient care settings.

Question 10

Type: MCSA

An older patient with dementia has been medicated with sedatives. The healthcare provider now prescribes a lower dose of the sedative and the nursing staff is concerned that the patient will resume agitated behavior. What should be explained to the staff about the use of this medication?

1. The patients condition warrants physical restraint only.

2. The patients physical condition does not warrant use of the drug.

3. The patients family members would be upset if they were aware of the use of chemical restraints.

4. The use of psychotropic drugs may be considered excessive and harm the patients health.

Correct Answer: 4

Rationale 1: The patients physical condition may warrant control of behavior, and drug therapy may still be warranted.
Reference: Page 145

Rationale 2: The patients physical condition may warrant control of behavior, and drug therapy may still be warranted.
Reference: Page 145

Rationale 3: The nursing staff must be honest with family regarding use of chemical or physical restraints as a form of treatment for the patient.
Reference: Page 145

Rationale 4: The 1987, Omnibus Budget Reconciliation Act ruled on the appropriate use of medications in institutionalized older persons, especially as their use may constitute a chemical restraint. Chemical restraints may only be used to ensure the physical safety of older patients in emergency situations, but these medications have the potential to be used inappropriately to quiet a person or subdue certain behaviors in place of other nonpharmacologic measures. Overuse of psychotropic medications is of concern because of the chance of serious adverse events and syndromes associated with these medications.
Reference: Page 145

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify principles of safe medication management with older persons in a variety of patient care settings.

Question 11

Type: MCMA

During a home visit, the nurse learns that an older patient is taking herbal remedies in addition to prescribed medications. What should the nurse instruct the patient about this practice?

Standard Text: Select all that apply.

1. Some herbal remedies interact with medications.

2. Herbal remedies are natural products and do not harm the body.

3. Talk to the healthcare provider about the use of herbal remedies.

4. The Food and Drug Administration does not regulate herbal remedies.

5. For most herbal remedies, no studies have demonstrated effectiveness.

Correct Answer: 1,3,4,5

Rationale 1: Herbs can interact with medications.
Reference: Page 138

Rationale 2: Because the FDA does not regulate herbal medicines, there is no assurance of standardization of their ingredients, purity, dosage, or potency.
Reference: Page 138

Rationale 3: It is important for the patient to discuss the use of herbal remedies with prescribed medications with the healthcare provider.
Reference: Page 138

Rationale 4: The Food and Drug administration does not regulate herbal medicines, and these medicines may have different ingredients, purity, dosage, or potency.
Reference: Page 138

Rationale 5: For most herbal remedies, there have not been sufficient clinical trials to demonstrate their effectiveness or appropriate dosage.
Reference: Page 138

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 12

Type: MCMA

It has been determined that nonpharmacological approaches will be used to help an older patient manage pain. What should the nurse explain as the reasons for using these approaches?

Standard Text: Select all that apply.

1. Nonpharmacological approaches can alleviate the pain.

2. Nonpharmacological approaches can delay the need for medication.

3. Nonpharmacological approaches can prevent the need for medication.

4. Nonpharmacological approaches can complement current medication therapy.

5. Nonpharmacological approaches do not cost the patient anything to use or implement.

Correct Answer: 1,2,3,4

Rationale 1: Nonpharmacological treatments can alleviate the health condition.
Reference: Page 148

Rationale 2: Nonpharmacological approaches can delay the need for medication.
Reference: Page 148

Rationale 3: Nonpharmacological approaches can prevent the need for medication.
Reference: Page 148

Rationale 4: Nonpharmacological approaches have been used to complement drug therapy.
Reference: Page 148

Rationale 5: There is no evidence to suggest that nonpharmacological approaches do not cost the patient anything to use or implement.
Reference: Page 148

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. List nonpharmacological therapies that may be useful as alternatives to medications.

Question 13

Type: MCSA

A prescribed medication is not producing the expected therapeutic effect in an older patient. What should the nurse do first in response to this finding?

1. Document that the patient has not been taking the medication.

2. Discuss changing the medication with the healthcare provider.

3. Ask if the patient has enough money to buy food and medicine.

4. Review the patients current diet to determine food-drug interactions.

Correct Answer: 3

Rationale 1: The nurse does not know if the patient has not been taking the medication. This is an inappropriate action by the nurse.
Reference: Page 151

Rationale 2: The nurse needs more information before discussing changing the medication with the healthcare provider.
Reference: Page 151

Rationale 3: If a medication is not demonstrating the expected therapeutic effect, the nurse should investigate if the patient is taking the medication at all because of cost. The patient may be embarrassed to share this information.
Reference: Page 151

Rationale 4: There is not enough information to support that the lack of therapeutic effect is due to a food-drug interaction.
Reference: Page 151

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply principles of teaching and learning to promote compliance and adherence to the medication regimen.

Question 14

Type: MCMA

The nurse is preparing an educational program regarding adverse drug reactions (ADR). What information should the nurse include?

Standard Text: Select all that apply.

1. ARDs refer to harm from a therapeutic regime.

2. ADRs refer to drug side effects that are serious.

3. ARDs are injuries resulting from the use of a drug.

4. Almost 11% of hospital admissions of older adults are associated with ADRs.

5. ADRs can occur from drug-drug interactions and polypharmacy.

Correct Answer: 2,4,5

Rationale 1: Iatrogenesis refers to harm from a therapeutic regimen.
Reference: Page 132

Rationale 2: Adverse drug reaction is a term that refers to drug side effects that are serious.
Reference: Page 132

Rationale 3: Adverse drug events are injuries resulting from the use of a drug.
Reference: Page 132

Rationale 4: Almost 11% of hospital admissions of older adults are associated with adverse drug reactions.
Reference: Page 132

Rationale 5: Older persons are more likely to have ADRs because of an inappropriate drug or dosing regimen, drug-drug interactions, polypharmacy, and non-adherence.
Reference: Page 132

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply principles of teaching and learning to promote compliance and adherence to the medication regimen.

Question 15

Type: MCMA

The nurse is instructing an older patient on ways to prevent esophageal irritation from taking medication. Which information should the nurse include in this teaching?

Standard Text: Select all that apply.

1. Drink at least 8 ounces of water with each pill.

2. Crush the pills to make them easier to swallow.

3. Take several sips of water before taking oral medications.

4. Sit up in a chair for at least 30 minutes after taking oral medications.

5. Report a dull aching pain in the chest or shoulder after taking medication to the physician.

Correct Answer: 1,3,4,5

Rationale 1: One intervention to prevent esophageal irritation from taking medication is to drink at least 8 ounces of water with each pill.
Reference: Page 136

Rationale 2: The patient should not divide or break up tablets or capsules without consulting the pharmacist since some drugs may be enteric coated or compounded as a sustained-release preparation; chewing or breaking them apart could result in toxicity as more of the drug becomes immediately available for absorption.
Reference: Page 136

Rationale 3: One intervention to prevent esophageal irritation from taking medication is to take several sips of water before taking oral medications.
Reference: Page 136

Rationale 4: One intervention to prevent esophageal irritation from taking medication is to sit up in a chair for at least 30 minutes after taking oral medications.
Reference: Page 136

Rationale 5: One intervention to prevent esophageal irritation from taking medication is to report a dull aching pain in the chest or shoulder after taking medication to the physician.
Reference: Page 136

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply principles of teaching and learning to promote compliance and adherence to the medication regimen.

Question 16

Type: MCSA

An older patient has recently been put on high fall precaution after a new medication was started. The patients daughter questions why this precaution was put in place. How should the nurse respond to the daughter?

1. Every older patient is automatically put on high fall risk.

2. The patient was recently started on an intravenous fluid infusion.

3. The patient has an order to get out of bed. Anyone with this order is put on high fall risk.

4. The patient was recently started on a medication for high blood pressure that could impact balance and cause a fall.

Correct Answer: 4

Rationale 1: Every older patient is not automatically put on high fall risk.
Reference: Page 136

Rationale 2: Intravenous fluids would not indicate a need for high fall precautions.
Reference: Page 136

Rationale 3: Orders for getting out of bed would not indicate a need for high fall precautions.
Reference: Page 136

Rationale 4: Medications have been associated with the occurrence of falls and related injuries. Antihypertensives can cause hypotension, which can result in falls. This would indicate a need to place the patient on high fall risk.
Reference: Page 136

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify principles of safe medication management with older persons in a variety of patient care settings.

Question 17

Type: MCMA

The nurse is preparing an educational program about the use of over-the-counter (OTC) medications for residents of an assisted living community. What information should the nurse include in this program?

Standard Text: Select all that apply.

1. OTC medications can be used safely with alcohol.

2. OTC medications can safely be used with all herbal medications.

3. A person can accidentally overdose on medications containing acetaminophen.

4. The use of OTC drugs can result in increased out-of-pocket costs to patients since health insurance usually does not pay for OTC medication.

5. There is an increased risk of drug interactions with prescribed medications or overdose by the use of an OTC drug identical or similar to a prescribed drug.

Correct Answer: 3,4,5

Rationale 1: Alcohol can interact with medications, including OTC medications.
Reference: Page 137

Rationale 2: Herbs can interact with medications, including OTC medications.
Reference: Page 137

Rationale 3: A person could inadvertently experience an overdose when taking multiple medications with acetaminophen in them.
Reference: Page 137

Rationale 4: The use of OTC medications can result in increased out-of-pocket costs since health insurance usually does not pay for OTC medications.
Reference: Page 137

Rationale 5: The risk of drug interactions or an overdose is increased when OTC drugs are used that are identical or similar to a prescribed drug or another OTC medication.
Reference: Page 137

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify principles of safe medication management with older persons in a variety of patient care settings.

Question 18

Type: MCMA

The nurse is providing a psychotropic medication to an older patient. Which adverse effects of this medication might occur with this patient?

Standard Text: Select all that apply.

1. Dystonia

2. Akathisia

3. Delusions

4. Tardive dyskinesia

5. Schizophreniform disorder

Correct Answer: 1,2,4

Rationale 1: Dystonia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later.
Reference: Page 147

Rationale 2: Akathisia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later.
Reference: Page 147

Rationale 3: Delusional disorder is one indication for the use of antipsychotic medication.
Reference: Page 147

Rationale 4: Tardive dyskinesia is recurrent, involuntary movements that may be irreversible and is associated with antipsychotic medication.
Reference: Page 147

Rationale 5: Schizophreniform disorder is one indication for the use of antipsychotic medication.
Reference: Page 147

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2. Identify principles of safe medication management with older persons in a variety of patient care settings.

Question 19

Type: MCSA

The nurse is preparing an educational program regarding the appropriate use of antipsychotic medications in older patients. What information should the nurse include?

1. Fidgeting is an appropriate indication for the use of antipsychotic medications.

2. Use of antipsychotic medications would never be considered a chemical restraint.

3. People prescribed antipsychotic drugs must have efforts to discontinue these drugs.

4. Impaired memory is an appropriate indication for the use of antipsychotic medications.

Correct Answer: 3

Rationale 1: Fidgeting is not a sole indication for the use of antipsychotic medications.
Reference: Page 146

Rationale 2: Antipsychotic medications could be considered as a chemical restraint.
Reference: Page 146

Rationale 3: There are many federal and state regulations regarding appropriate medication use in long-term care facilities. One such regulation states that residents who use antipsychotic drugs must receive gradual dose reductions, drug holidays, or behavioral programming unless clinically contraindicated, in an effort to discontinue the use of these drugs.
Reference: Page 146

Rationale 4: Impaired memory is not a sole indication for the use of antipsychotic medications.
Reference: Page 146

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 20

Type: MCSA

Which statement made by a nurse indicates a misunderstanding regarding the nurses role in medication management?

1. I am responsible for monitoring potassium level on a patient who is receiving a thiazide diuretic.

2. I am responsible for documenting whether the therapeutic effect of a medication is being achieved.

3. I am responsible for teaching a patient how to correctly store, prepare, and self-administer medications.

4. I am responsible for a medication error if I administered the medication, not if I delegated that responsibility to an unlicensed person.

Correct Answer: 4

Rationale 1: The nurse is responsible for monitoring medications for efficacy and clinically significant adverse consequences.
Reference: Page 150

Rationale 2: The nurse is responsible for documenting if the therapeutic effects of a medication are being achieved.
Reference: Page 150

Rationale 3: The nurse is responsible for teaching a patient about the storage, preparation, and self-administration of medications.
Reference: Page 150

Rationale 4: Delegation of medication administration to an unlicensed person depends upon the state laws. Delegation does not remove responsibility of the nurse for assessing and monitoring the patient for therapeutic and adverse effects.
Reference: Page 150

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 21

Type: MCMA

The nurse is instructing an older patient about medication management. What information should the nurse include?

Standard Text: Select all that apply.

1. Obtain all of your medications from the same pharmacy.

2. Request that medications be placed in childproof packages and caps.

3. Develop a method for remembering if medications have been taken, such as moving it to a different place.

4. Schedule medications at mealtimes or in conjunction with other specific activities unless contraindicated.

5. Establish a routine for taking medications, such as preparing medication for each day in different containers.

Correct Answer: 1,3,4,5

Rationale 1: Encouraging patients to obtain all of their medications from the same pharmacy will help the pharmacist to monitor medication use.
Reference: Page 151

Rationale 2: Childproof packages and caps may be difficult for the older patient to open and use.
Reference: Page 151

Rationale 3: One way to help older patients manage medications is to develop a method with the patient for remembering if the medication has been taken, such as moving it to another place.
Reference: Page 151

Rationale 4: One way to help older patients manage medications is to schedule medications at mealtime or in conjunction with other specific daily activities.
Reference: Page 151

Rationale 5: One way to help older patients manage medications is to establish a routine for taking medications, such as preparing medications for the day in different containers.
Reference: Page 151

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 22

Type: MCSA

Which nursing action indicates that medication reconciliation for an older patient is incomplete?

1. Medications prescribed by physicians were the focus.

2. Medications were identified, verified, and compared with the physicians orders.

3. All medications, including herbal or mineral supplements and vitamins, were reviewed.

4. Medication reconciliation occurred when the patient was transferred to another care area.

Correct Answer: 1

Rationale 1: Medication reconciliation is a process that involves verification of all medications, including herbal or mineral supplements and vitamins that a patient takes, not just medication prescribed by a physician.
Reference: Page 152

Rationale 2: Medication reconciliation involves identifying, verifying, and comparing medications with the physicians orders.
Reference: Page 152

Rationale 3: All medications, including herbal or mineral supplements and vitamins, are to be included.
Reference: Page 152

Rationale 4: The medication reconciliation process should be used whenever an individual moves from one care setting to another.
Reference: Page 152

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 23

Type: MCSA

The nurse has completed an educational program for residents of a retirement community regarding unsafe medication practices. Which statement made by a resident indicates the need for further education?

1. I will not take medication that is more than 1 year old.

2. I will buy all of my medication from the same pharmacy.

3. I will not take medication that has been prescribed for someone else.

4. Medication can be obtained from an Internet pharmacy, as long as it says the medication was made in the United States or Canada.

Correct Answer: 4

Rationale 1: Generally, medications should not be kept longer than a year.
Reference: Page 153

Rationale 2: Patients should be encouraged to obtain all of their medications from the same pharmacy.
Reference: Page 153

Rationale 3: Patients should not take medication that has been prescribed for someone else.
Reference: Page 153

Rationale 4: The use of medication imported from or obtained in another country is controversial and is considered illegal. Quality standards for drugs approved for use in other countries may not be a stringent as in the United States. Claims for where the medication was made are not always true. Medications should only be obtained from pharmacies licensed in the United States.
Reference: Page 153

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 24

Type: MCMA

The home care nurse is reviewing the medications that an older patient is currently taking. Which guidelines should the nurse follow when conducting this review?

Standard Text: Select all that apply.

1. Review the patients allergies.

2. Review the drug for number of refills.

3. Review the drugs for duplicate therapy.

4. Review the patients medical conditions.

5. Review each drug for interactions with other drugs.

Correct Answer: 1,3,4,5

Rationale 1: When assessing an older patients appropriate use of medications, the nurse should follow the guideline of reviewing the patients allergies.
Reference: Page 154

Rationale 2: Reviewing the drug for number of refills is not a guideline when assessing an older patients appropriate use of medications.
Reference: Page 154

Rationale 3: When assessing an older patients appropriate use of medications, the nurse should follow the guideline of reviewing the drugs for duplicate therapy.
Reference: Page 154

Rationale 4: When assessing an older patients appropriate use of medications, the nurse should follow the guideline of reviewing the patients medical conditions.
Reference: Page 154

Rationale 5: When assessing an older patients appropriate use of medications, the nurse should follow the guideline of reviewing each drug for interactions with other drugs.
Reference: Page 154

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Question 25

Type: MCSA

An older patient who is repeatedly admitted to the hospital tells the nurse it is because of the inability to purchase prescribed medications. What should the nurse respond to the patient?

1. Do you not have insurance?

2. Im not surprised that you cant afford them. You are on a lot of medications.

3. There are ways to reduce the cost of medications, such as using Medicare Part D.

4. I will contact our social services department so the hospital will provide your medications.

Correct Answer: 3

Rationale 1: Asking the patient about insurance is not an appropriate response for the nurse to make.
Reference: Page 155

Rationale 2: The nurses opinion about the number of medications the patient is prescribed is an inappropriate response for the nurse to make.
Reference: Page 155

Rationale 3: Medicare Part D prescription drug coverage has assisted many with drug costs.
Reference: Page 155

Rationale 4: The social services department does not facilitate the hospital providing the patient with prescribed medications.
Reference: Page 155

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7. Discuss issues related to ensuring the safe use of drug therapy by the older person.

Leave a Reply