Chapter 20: Pharmacologic Management My Nursing Test Banks

Chapter 20: Pharmacologic Management

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. The nurse is preparing to apply a topical cream on the arm of a cognitively impaired, anorexic older adult patient in the terminal stage of lung cancer. The nurse carefully monitors the effectiveness of the medication because its effectiveness will be most negatively impacted by the patients:

a.

age.

b.

cognitive limitations.

c.

nutritional status.

d.

cancer diagnosis.

ANS: A

Topical drugs face barriers to absorption because the aged skin has decreased water content, a relative decrease in lipid content, and a decrease in tissue perfusion. These changes may result in impaired absorption of some medications that are administered via lotions, creams, ointments, and patches. The other options are not related to medication effectiveness in this situation.

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TOP: Nursing Process: Assessment MSC: Health Promotion

2. When administering medications to older adults, the nurse shows an understanding of the effect of aging on drug distribution by monitoring the patients:

a.

cardiac function.

b.

liver function.

c.

red blood cell count.

d.

plasma albumin levels.

ANS: D

With age, particularly for malnourished or frail adults, plasma albumin levels may drop and therefore should be monitored. As a result of decreased sites for protein binding, the activity of highly protein bound drugs, and any side effects caused by these drugs may be increased. The other options may be appropriate for specific drugs, but not in general.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. An older adult patient has been prescribed warfarin (coumadin). The nurses primary intervention involves daily review of the patients:

a.

prothrombin time.

b.

body for bruising.

c.

serum creatinine level.

d.

reflex tone.

ANS: A

Warfarin therapy is monitored by the international normalized ratio (INR) or INR with prothrombin time.

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4. A patient with diabetes and hypothyroidism is being admitted to an assisted living facility. During the admission assessment, the patient reports difficulty falling asleep. The nurse shows an understanding of sleep dysfunction and the older patient when asking:

a.

Have you ever been prescribed a sleeping medication?

b.

How do you feel about leaving your home to live here?

c.

How long have you been a diabetic?

d.

Are you taking medication for your thyroid problem?

ANS: D

Insomnia and anxiety are problems that commonly plague older adults. Because insomnia and anxiety often occur secondary to medication side effects or secondary to medical conditions such as dementia, thyroid abnormalities, or depression, proper diagnosis and treatment of any underlying causes of insomnia or anxiety can help this condition. The other questions are appropriate for an intake interview, but not specifically related to the insomnia.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. A patient is receiving propranolol (Inderal) for hypertension. Which outcome is the best indicator of goal success when considering the drugs potential effect on the patients quality of life?

a.

The patient verbalizes the importance of moderate exercise.

b.

The patient experiences no injuries as a result of dizziness.

c.

The patients blood pressure stays within normal limits.

d.

The patient describes symptoms indicative of an adverse drug reaction.

ANS: B

The main concerns with the use of antihypertensive medications in older adults are an increased risk of orthostatic hypotension and dehydration. Exercising and maintaining the blood pressure within normal limits are treatment goals but do not impact quality of life like dizziness or fainting. Having an adverse drug reaction would not improve quality of life.

DIF: Applying (Application) REF: N/A OBJ: 20-6

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

6. The nurse responsible for administering medications to the residents of a long-term care facility shows an understanding of the risk of injury this population experiences when:

a.

confirming the patients identity prior to providing the medication.

b.

assessing the patient for a history of drug-related allergies.

c.

implementing the 5 rights of medication administration routinely.

d.

educating patients about the purpose and side efforts of their medications.

ANS: C

The Institute of Medicine (IOM) estimates that 1.5 million ADEs and 7000 deaths occur in the United States each year secondary to medication errors. Older adults are disproportionately affected; more than half of the medication errors occur in long-term care facilities and more than 500,000 occur among ambulatory Medicare patients. Some references use the 6 rights of medication administration.

DIF: Applying (Application) REF: N/A OBJ: 20-3

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

7. An older adult diabetic patient is mildly hypertensive. The nurse prepares to educate the patient regarding angiotensin IIblocking agents. These drugs are especially useful in older adults because they:

a.

protect the kidneys function.

b.

have a well-defined therapeutic window.

c.

are more effective than other drugs in the same class.

d.

can be given when liver function is compromised.

ANS: A

The ACEIs and ARBs also have demonstrated value in decreasing the chance of cardiac mortality in patients with heart failure. They also confer renal protection, which is particularly beneficial for patients with diabetes. The other statements are not related to both the patients conditions.

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TOP: Teaching-Learning MSC: Physiologic Integrity

8. The nurse shows an understanding of medication-related risk factors common to older adults when asking:

a.

Are you aware of the possible side effects of your medications?

b.

Do you regularly take any dietary supplements?

c.

How do you keep track of when your medications are due?

d.

How many different physicians are prescribing medications for you?

ANS: B

About 52% of older adults living in the United States take some sort of dietary supplement on a regular basis in addition to prescription medications. This increases the potential for drug-drug interactions. The other questions are important assessment questions to include in a medication review.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

9. An older adult patient is having difficulty remembering when to take several of the prescribed medications. To improve the patients compliance with the medication regimen, the nurse:

a.

asks the patients spouse to consistently administer the drugs.

b.

checks the drug guide to see if decreasing the frequency if the drugs is possible.

c.

informs the patients physician about the drug noncompliance.

d.

teaches the patient to administer daily pills with a pill dispenser.

ANS: D

The regimen should be simplified as much as possible; using a drug dispenser could make the daily process less complicated. If the patient is still unable to manage this task, the nurse could consult with the provider about decreasing frequency or changing medications, or the nurse could ask the spouse to administer the medications if this were acceptable to the patient. But the easiest and most cost-effective action is to try a pill dispenser.

DIF: Application (Applying) REF: N/A OBJ: 20-4

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

10. The nurse is caring for an older adult who reports severe chronic pain. To best assess age-related physiologic changes that could influence plans for initiating an appropriate drug regimen, the nurse prepares the patient for which laboratory evaluation?

a.

White blood count

b.

Glomerular filtration rate

c.

Serum complement level

d.

Electroencephalogram

ANS: B

Many drugs are renally excreted, and there are age-related reductions in renal function. The nurse wanting to assess for such factors that influence the selection of drugs would most likely anticipate the patient having renal function studies done, including an evaluation of the patients glomerular filtration rate.

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11. An older adult patient is being assessed for possible alcohol abuse. To best assess the patients risk potential, the nurse asks:

a.

Have you ever experienced a memory loss as a result of consuming alcohol?

b.

Would you drink to relax after a particularly stressful day?

c.

Do you ever drink when you are alone?

d.

How many alcoholic drinks do you consume each week?

ANS: D

The nurse should start the assessment for alcohol abuse by inquiring as to the number of drinks the patient consumes each week. The other questions can be part of an abuse assessment, but it is easiest to start with a simple, quantitative question to open the discussion.

DIF: Applying (Application) REF: N/A OBJ: 20-10

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

12. An older adult patient is currently undergoing detoxification for alcohol at a rehabilitation center. When assessing the patient using the Clinical Institute Withdrawal Assessment tool, the nurse determines the patients current score to be 23. The nurse:

a.

immediately institutes seizure precautions.

b.

monitors the patients vital signs every 2 hours.

c.

arranges for the patient to be transferred to an acute care hospital.

d.

shares with the patient that the detoxification process is almost complete.

ANS: C

The maximum score on this tool is 67, and patients who score higher than 20 should be admitted to a hospital. The other options are incorrect.

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TOP: Nursing Process: Implementation MSC: Physiologic Integrity

13. A 68-year-old man with a history of alcohol abuse is admitted to the acute care facility for reports of abdominal pain. Based on your understanding of alcohol withdrawal, the nurse knows that if patient is currently abusing alcohol, he will most likely:

a.

experience delirium tremors within 4 hours of hospitalization.

b.

develop withdrawal symptoms 48 to 72 hours after the last intake of alcohol.

c.

receive 1 ounce of alcohol every 4 hours while awake.

d.

be prescribed oxazepam (Serax).

ANS: B

Symptoms tend to peak 48 to 72 hours after a patients last drink, although they may occur within 4 to 12 hours. The patient may or may not have DTs. The patient should not receive alcohol and may or may not need medication.

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14. When working with a patient suspected of substance abuse, the nurse is particularly interested in determining the cause of a patients:

a.

acute abdominal pain.

b.

recurring insomnia.

c.

extensive history of falls.

d.

chlordiazepoxide (Librium) prescription.

ANS: C

Frequently, the symptoms of substance abuse are subtle or atypical, or they mimic symptoms of other age-related illnesses and remain undiagnosed. Patients presenting symptoms may be erratic changes in affect, mood, or behavior; malnutrition; bladder and bowel incontinence; gait disturbances; and recurring falls, burns, and head trauma. Acute abdominal pain, insomnia, and prescriptions for Librium may or may not be related to substance abuse, but falling is.

DIF: Applying (Application) REF: N/A OBJ: 20-10

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

15. A 67-year-old woman presents at the emergency department with symptoms that suggest possible abuse of a narcotic analgesic. To best assure the patients safe care, the nurse asks:

a.

When did you first start using the analgesic?

b.

Have you experienced withdrawal symptoms before?

c.

Why did you initially need an analgesic?

d.

What prescribed drugs are you currently taking?

ANS: D

First, if prescription drug abuse is suspected, the nurse should ask the patient or a family member to identify all medications that the patient is currently using. The nurse and physician can then plan for safe detoxification. In addition, the physician can try to prevent any untoward drug interactions resulting from prescribing a new medication that is contraindicated because of an existing prescription.

DIF: Applying (Application) REF: N/A OBJ: 20-10

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

16. Your patient reports frequent constipation as a result of prescription medications and asks the nurse for advice about using a daily over-the-counter laxative. The most appropriate response by the nurse is to:

a.

tell the patient to consult the health practitioner before using nonprescription drugs.

b.

educate the patient about the side effects of regular laxative use.

c.

tell the patient to avoid laxatives because they can interfere with medications already being taken.

d.

tell the patient to consult a dietician about ways to correct chronic constipation.

ANS: A

Education regarding the importance of contacting the health practitioner (physician or pharmacist) before taking nonprescription medication is essential for reducing the number of unintentional medication interactions. Educating the patient on side effects and teaching the patient nonpharmaceutical ways to manage constipation are also appropriate.

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17. When initially planning care for the older adult patient who is prescribed clonidine patches as part of a smoking cessation program, the nurse:

a.

assesses the patient for any skin disorders on the upper arms and back.

b.

determines how many cigarettes or cigars the patient smokes per day.

c.

asks if the patient is currently taking any antihypertensive medications.

d.

educates the patient to the possible side effects of clonidine therapy.

ANS: C

Clonidine is an antihypertensive, so knowledge of the patients medication history is vital to avoid inducing hypotension. The other assessments are not related to patient safety.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

18. The nurse explains to ancillary staff that caffeine abuse is difficult to diagnose in the older adult patient because caffeine intoxication symptoms:

a.

can be confused with normal effects of aging.

b.

often mimic those of some cardiac disorders.

c.

produce fewer symptoms in older adults than in younger adults.

d.

resemble the side effects of several antihypertensive drugs.

ANS: B

Caffeine stimulates the sympathetic nervous system, often producing the rapid pulse associated with cardiac disorders. Caffeine effects are not mistaken for normal signs of aging, produce fewer symptoms in older adults, or resemble side effects of antihypertensives.

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TOP: Teaching-Learning MSC: Physiologic Integrity

19. An older adult patient shares with the admitting nurse that she drinks one shot of whiskey nightly to help her sleep. The nurse documents the need to:

a.

assess the patient for slurred speech, lack of coordination, and nystagmus.

b.

address the effects of alcohol abuse with the patient.

c.

provide the patient with an alcohol substitute.

d.

assess the patient for signs of agitation, as well as anxiety and seizures.

ANS: D

It is important to assess older patients for the possibility of alcohol withdrawal if agitation, hallucinations, anxiety, or seizures develop. Because the patient admits to a shot a day, it is possible she drinks more or uses alcohol to self-medicate for problems other than insomnia. The nurse should monitor the patient for signs of withdrawal as a priority, because this is a medical emergency. Slurred speech, lack of coordination, and nystagmus are signs of overindulging. The nurse should not provide an alcohol substitute. It is appropriate to discuss the effects of alcohol, but safety comes first.

DIF: Applying (Application) REF: N/A OBJ: 20-10

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

20. The nurse is assessing patients for impending alcohol withdrawal. The nurse assesses the patient with which of the following conditions as a priority?

a.

Pulse, 58 beats/min; and BP 100/60

b.

Pulse, 118 beats/min; and BP 160/90

c.

Dozing off in chair and not recognizing staff

d.

Reporting muscle aches and frequent stumbling

ANS: B

Manifestations of alcohol withdrawal are elevated blood pressure, elevated pulse, and autonomic hyperactivity. In addition, fever; increased hand tremors; insomnia; nausea and vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures may occur. The nurse should see the hypertensive, tachycardic patient as the priority.

DIF: Applying (Application) REF: N/A OBJ: 20-12

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

MULTIPLE RESPONSE

1. To minimize the possible complications of polypharmacy among older adult patients, the nurse assesses this population for which of the following? (Select all that apply.)

a.

Number of physicians providing medical care

b.

Location of pharmacies where prescriptions are filled

c.

Presence of chronic illnesses

d.

Tendency to borrow medication from family or friend

e.

Use of over-the-counter medication to self-medicate

ANS: A, B, C, E

Older adults are especially vulnerable to polypharmacy because many have one or more chronic conditions requiring several medications for management. To complicate matters, patients may see more than one provider for the same health problem and may have prescriptions filled at more than one pharmacy. Additional contributors to polypharmacy include the use of over-the-counter and alternative medicines or supplements in the treatment of conditions. As a result, the patient may end up taking duplicate drugs, similar drugs from the same drug class, and drugs that are contraindicated when taken together. Borrowing medications is not usually an issue.

DIF: Applying (Application) REF: N/A OBJ: 20-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. The nurse must be able to distinguish between alcohol intoxication and alcohol withdrawal to intervene appropriately. The nurse suspects alcohol intoxication when the patient does which of the following? (Select all that apply.)

a.

Slurs his speech when answering questions

b.

Has difficulty remembering his address

c.

Reports seeing snakes in the corner of the room

d.

Documents his blood pressure as 168/90

e.

Experiences difficulty when walking to the bathroom

ANS: A, B, E

Signs associated with alcohol intoxication include the scent of alcohol on the breath, slurred speech, lack of coordination, unsteady gait, nystagmus, impairment in attention or memory, and stupor or coma. Manifestations of alcohol withdrawal are elevated blood pressure, elevated pulse, and autonomic hyperactivity. In addition, fever; increased hand tremors; insomnia, nausea and vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures may occur.

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3. A 69-year-old was prescribed a benzodiazepine 3 years ago. This medication regimen increases the patients risk for injury related to drug abuse and requires frequent patient assessment for which of the following? (Select all that apply.)

a.

Daytime sleepiness

b.

Unsteady gait

c.

Shortness of breath

d.

Easy bleeding

e.

Forgetfulness

ANS: A, B, E

Benzodiazepines can cause excessive sedation, impaired memory, decreased psychomotor performance, and balance disturbances and may lead to drug dependence and should not be prescribed for extended periods of time. Shortness of breath and bleeding are not signs of side effects.

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