Chapter 12: Geriatric Pharmacology Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 12: Geriatric Pharmacology

Test Bank

MULTIPLE CHOICE

1. The nurse plans to closely monitor an older adult client who is receiving multiple drugs for evidence of adequate excretion of the medications. Which two major organs affecting drug clearance from the body should be monitored when an older adult client is receiving multiple drugs?

a.

Kidneys and lungs

b.

Kidneys and pancreas

c.

Liver and pancreas

d.

Liver and kidneys

ANS: D

The older adult client may experience a decrease in hepatic enzyme production, hepatic blood flow, and total liver function. These decreases cause a reduction in drug metabolism. A decrease in renal blood flow and decrease in glomerular filtration rate of 40% to 50% can also occur.

DIF: Cognitive Level: Application REF: p. 189

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is aware that increased _____ may affect the absorption of medications.

a.

gastric motility

b.

alkaline gastric secretion

c.

intestinal emptying time

d.

peristalsis

ANS: B

An increase in alkaline gastric secretions may affect the absorption of medications, because gastric motility, gastric emptying time, and peristalsis are all decreased with increased alkaline gastric secretions.

DIF: Cognitive Level: Comprehension REF: p. 189

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The older adult client is prescribed a drug that is excreted through the urine. The nurse anticipates that which laboratory test will be prescribed to evaluate renal function before administration of the medication?

a.

Blood urea nitrogen

b.

Serum albumin

c.

Serum electrolytes

d.

White blood cell count

ANS: A

Drug dosages are adjusted according to the older adults weight, adipose tissue, laboratory results (e.g., serum protein, electrolytes, liver enzymes, blood urea nitrogen, creatinine), and current health problems.

DIF: Cognitive Level: Application REF: p. 194

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse recognizes that polypharmacy is more likely to occur in an older adult client because the older client:

a.

has difficulty maintaining a list of current medications.

b.

experiences changes in visual capability.

c.

experiences alterations in mental capacity.

d.

may obtain prescribed drugs from various providers.

ANS: D

Polypharmacy is the prescription and administration of many drugs during the same period. This is more likely with the older client, who may see various healthcare providers to manage the health concerns that may accompany aging.

DIF: Cognitive Level: Application REF: pp. 187-188

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Health Promotion and Maintenance

5. The diuretic hydrochlorothiazide (HCTZ; HydroDIURIL) is usually prescribed for the older adult in a lower dose. The nurse recognizes that this is an attempt to prevent the older adult from experiencing a(n):

a.

increase in potassium loss.

b.

decrease in sodium loss.

c.

decrease in blood sugar levels.

d.

increase in red and white blood cell count.

ANS: A

HCTZ is a potassium-wasting diuretic.

DIF: Cognitive Level: Application REF: pp. 190-191

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse notes that Cimetidine has been prescribed for an older adult client. The nurses highest priority would be to call:

a.

the physician.

b.

the pharmacist.

c.

the nursing supervisor.

d.

Poison Control.

ANS: A

Cimetidine is not recommended for the older adult because of its side effects and multiple potential drug interactions. Famotidine, nizatidine, and ranitidine may be prescribed for the geriatric client instead of cimetidine.

DIF: Cognitive Level: Analysis REF: p. 191

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. An older adult client says that he has difficulty removing the cap from his medication bottle. He says, Thats why I dont always take my medication. The nurse should suggest that he:

a.

ask a neighbor to help him remove the bottle cap.

b.

ask the pharmacist to put the drug in a nonchildproof container.

c.

have a family member visit daily to prepare his medications.

d.

ask the healthcare provider not to prescribe drugs that come in childproof bottles.

ANS: B

Childproof caps may be difficult to remove for older adults with arthritis or decreased strength or motor function.

DIF: Cognitive Level: Application REF: p. 194

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Health Promotion and Maintenance

8. A client is demonstrating signs and symptoms of disorientation. Which question by the nurse would be appropriate, related to the clients medication use?

a.

Are you taking any new medications?

b.

Do you take medications with a full glass of water?

c.

Do your medications make you constipated?

d.

Have you been diagnosed with dementia?

ANS: A

A new medication may be associated with changes in sensorium or other behavioral characteristics. This should be evaluated.

DIF: Cognitive Level: Application REF: p. 193

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Health Promotion and Maintenance

9. The nurse is caring for an older adult client and a middle-aged adult client. The nurse anticipates that the medication doses for the older adult will be _____ those for the middle-aged adult.

a.

the same as

b.

less than

c.

slightly more than

d.

twice as much as

ANS: B

Because of changes in metabolism and excretion, doses are generally decreased to avoid accumulation and toxicity.

DIF: Cognitive Level: Application REF: p. 187

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. An older adult client is ordered to receive digoxin (Lanoxin). The client has decreased renal function. Which condition could indicate digoxin toxicity?

a.

Elevated blood pressure

b.

Decreased blood pressure

c.

Heart rate greater than 100 beats per minute

d.

Heart rate less than 60 beats per minute

ANS: D

Digoxin slows and strengthens the heart. Toxicity may be manifested by bradycardia.

DIF: Cognitive Level: Analysis REF: p. 191

TOP: Nursing Process: Evaluation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client takes ibuprofen to deal with the pain of arthritis. The client complains of gastrointestinal symptoms. Which is an appropriate strategy for the nurse to teach the client?

a.

Take the medication on an empty stomach.

b.

Do not take the medication if it has side effects.

c.

Try to take an antacid 1 hour before the dose.

d.

You must take the medication anyway.

ANS: C

An antacid may decrease the gastrointestinal side effects of the NSAID. It may also impair absorption, so it must be evaluated for effectiveness.

DIF: Cognitive Level: Application REF: p. 191

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A nurse is administering medication to an older adult client. The nurse is aware that the clients half-life is longer than that of middle-aged adults. What nursing intervention is indicated by this premise?

a.

Provide higher doses to achieve therapeutic effects.

b.

Assess the client for adverse reactions.

c.

Monitor the client for signs of accumulation.

d.

Provide education to the client on drug reactions.

ANS: C

Because older adults may have less efficient medication elimination, monitoring for accumulation is an important component of nursing care.

DIF: Cognitive Level: Application REF: p. 189

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is caring for an older adult client who complains that she has to take multiple medications at various times throughout the day. What is the most appropriate nursing intervention for the nurse to implement with this client?

a.

Encourage family members or friends to monitor drug regimen.

b.

Explain the purpose, drug action, and importance of medication.

c.

Develop a chart indicating times to take drugs.

d.

Provide time for questions; reinforce with written information.

ANS: C

The nurse should help the client develop a chart indicating times to take drugs. Space should be provided to mark each drug taken. An organizer or calendar can be used to mark days and weeks.

DIF: Cognitive Level: Analysis REF: p. 193

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The physician is recommending a benzodiazepine medication for an older adult client who has previously been treated with Valium. The nurse recognizes that which medication would be most appropriate for this client?

a.

Librium

b.

Dalmane

c.

Ativan

d.

Equanil

ANS: C

A short-acting benzodiazepine, such as Ativan, would be preferable to any of the other drugs to avoid prolonged sedation and addiction.

DIF: Cognitive Level: Application REF: p. 192

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. Which older adult client is most likely to experience digoxin toxicity?

a.

72-year-old man who is also experiencing hyperkalemia

b.

74-year-old woman who is also experiencing hypokalemia

c.

66-year-old woman who is also experiencing hypercalcemia

d.

62-year-old woman who is also experiencing hypocalcemia

ANS: B

Hypokalemia enhances the effect of digoxin, thus increasing the possibility of toxicity.

DIF: Cognitive Level: Application REF: p. 194

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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