Chapter 20 Pharmacologic Management

Chapter 20  Pharmacologic Management

Complete Chapter Questions And Answers
 

Sample Questions

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 patient’s:
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.

DIF: Remembering (Knowledge) REF: Page 362 OBJ: 20-4
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 patient’s:
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.

DIF: Remembering (Knowledge) REF: Page 362 OBJ: 20-4
TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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

DIF: Remembering (Knowledge) REF: Page 363 OBJ: 20-4
TOP: Nursing Process: Assessment MSC: Physiologic Integrity

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.

DIF: Understanding (Comprehension) REF: Page 368 OBJ: 20-7
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 drug’s potential effect on the patient’s 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 patient’s 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