Abrams’ Clinical Drug Therapy Rationales for Nursing Practice by Geralyn Frandsen – Test Bank

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Sample Questions Posted Below

1.	An 80-year-old woman has sought care for a dermatological health problem that most often requires treatment with an oral corticosteroid. When considering whether to prescribe steroids to this patient, the care provider should prioritize which of the following questions?
A)	“Should this patient receive a medication that was likely tested on younger adults?”
B)	“Do the potential benefits of this medication outweigh the potential harm?”
C)	“Are there plausible herbal or complementary alternatives to this medication?”
D)	“Is there a younger adult who can oversee this patient’s medication regimen?”
Ans:	B
	Feedback:
	The nurse and the prescriber must carefully consider the risk of associated adverse effects of those medications as well as possible benefits these medications might have in changing physiological processes related to disease. This consideration is a priority over the specifics of the drug’s original testing procedure or the presence of herbal alternatives. Not every older adult requires another person to oversee his or her medications.

2.	A nurse is teaching an 81-year-old man about the risk for potential adverse effects before he begins a course of antibiotics for an upper respiratory infection. What characteristic of older adults predisposes them to adverse drug reaction?
A)	Increased excretion time due to increased bowel motility
B)	Impaired distribution due to polypharmacy
C)	A decrease in overall body surface area
D)	A decrease in the number of receptors needed for distribution
Ans:	D
	Feedback:
	Older adults are prone to adverse drug reactions because of a decrease in the number of receptors needed for drug distribution. BSA does not change appreciably with age and bowel motility slows with age. Polypharmacy is a valid concern, but this phenomenon does not primarily involve distribution.

3.	A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care facility. When appraising the woman’s medication regimen in light of the Beers Criteria, the nurse will look for
A)	drugs that are known to cause adverse effects in older adults.
B)	drugs for which generic equivalents are available at lower cost.
C)	drugs that have been found to be ineffective in older adults.
D)	drugs that are known to exacerbate the aging process.
Ans:	A
	Feedback:
	Dr. Mark Beers developed the Beers Criteria list of potentially inappropriate medications used by the older adult population. The list confirms that toxic medication effects and drug-related problems affect the safety of older adults and names drugs that cause problems in this population.

4.	A nurse has noted that an older adult patient on an acute care for elders (ACE) unit has an exceptionally lengthy medication administration record. The nurse has alerted the pharmacist because one of the patient’s long-standing medications appears on the Beers list. What medication is the nurse likely addressing?
A)	Low-dose enteric-coated ASA
B)	Metoprolol (Lopressor)
C)	Digoxin (Lanoxin)
D)	Vitamin D
Ans:	C
	Feedback:
	Digoxin appears on the list of Beers Criteria due to the risk of adverse effects in older adults. ASA, metoprolol, and vitamin D do not appear on this list.

5.	A nurse has called an elderly patient’s surgeon to question the order for meperidine hydrochloride (Demerol) for pain control. The nurse’s action is prompted by the possibility of what adverse effect associated with the use of Demerol in older adults?
A)	Confusion
B)	Blood dyscrasias
C)	Gastrointestinal bleeding
D)	Hepatotoxicity
Ans:	A
	Feedback:
	Demerol is associated with confusion in older adults. It is not noted to cause blood dyscrasias, GI bleeding, or hepatotoxicity.

6.	A gerontological nurse is aware that older adults’ abilities to excrete medications diminish with age. When appraising an older adult’s ability to excrete medications, what laboratory or diagnostic finding should the nurse prioritize?
A)	Renal ultrasound
B)	Complete blood count (CBC)
C)	Serum bilirubin and albumin levels
D)	Blood urea nitrogen and creatinine levels
Ans:	D
	Feedback:
	The nurse should assess an older adult’s blood urea nitrogen and creatinine clearance (CrCl) levels to determine the patient’s ability to excrete the medications. Renal ultrasound identifies structural abnormalities in the kidneys but is less useful in diagnosing function. The patient’s CBC and bilirubin and albumin levels do not help the nurse assess the patient’s ability to excrete medications.

7.	A 90-year-old patient’s most recent blood work includes the following data: alanine aminotransferase (ALT) 1.99 μkat/L (high) and aspartate aminotransferase (AST) 3.1 μkat/L (high). What implication do these data have for the patient’s pharmacokinetics?
A)	Distribution of drugs may be erratic.
B)	Absorption of drugs may be incomplete.
C)	Excretion of drugs may be delayed.
D)	Metabolism of drugs may be impaired.
Ans:	D
	Feedback:
	AST and ALT levels are used to determine the patient’s liver function and ability to metabolize drugs.

8.	A 72-year-old woman with a 60-pack-year history of cigarette smoking has developed chronic obstructive pulmonary disease (COPD) and has consequently been prescribed albuterol, a beta₂-adrenergic agonist. When administering this medication, the nurse should be aware that
A)	the drug carries a higher potential for hepatotoxicity in this patient than in a younger patient.
B)	the drug may be less effective than in a younger patient due to decreased beta-receptor function.
C)	the patient will need to take a beta-adrenergic blocker concurrently to mitigate the likelihood of adverse effects.
D)	the patient will need to have serial complete blood counts (CBCs) drawn following the initiation of therapy.
Ans:	B
	Feedback:
	Beta-adrenergic agonists are less effective in older adults as a result of the decreased function of the beta-receptor system. The potential for hepatotoxicity is not increased, and a beta-blocker is not indicated. Serial blood work is not necessary.

9.	The daughter of an 80-year-old woman states that her mother has been taking alendronate (Fosamax) for several years for the treatment of osteoporosis. The daughter tells the nurse that her mother never had any complaints of nausea after taking this medication until recently. How should the nurse respond to the daughter’s statement?
A)	“It could be that your mother’s stomach empties more slowly than it used to, which is a normal result of aging.”
B)	“As your mother gets older, the medication travels down her esophagus more slowly than it used to. This can cause nausea.”
C)	“Because your mother processes drugs more slowly than when she was younger, there is more time during which they can cause nausea.”
D)	“As your mother ages, she has more of the receptors that trigger nausea. This is a normal change that accompanies the aging process.”
Ans:	A
	Feedback:
	Diminished gastric emptying also plays a role by causing the medication to be in the stomach for a longer period. This factor increases the risk of developing nausea and vomiting, thus causing elimination of the medication in emesis and promoting fluid volume deficit. This phenomenon is not attributable to receptor changes or decreased esophageal motility.

10.	An older adult’s most recent blood work reveals that his serum albumin level is 21 g/L (low). This will most influence what aspect of pharmacokinetics?
A)	Absorption
B)	Distribution
C)	Metabolism
D)	Excretion
Ans:	B
	Feedback:
	Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense.

11.	Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse indicates that his liver function has been gradually decreasing over the last several years. How will this age-related physiological change influence drug metabolism?
A)	The patient will metabolize drugs more quickly but derive less of a therapeutic benefit from them.
B)	The liver will sequester drug molecules in the hepatocytes, and they will be released at unpredictable times.
C)	Many of the patient’s medications will remain in his body for a longer time.
D)	The patient’s kidneys will be forced to metabolize a disproportionate quantity of medications.
Ans:	C
	Feedback:
	The hepatic enzymes of the liver are decreased in the older adult, altering the ability to remove metabolic by-products. It is important to understand that because older adults have a reduced metabolism, medications with a long half-life will remain in the body for a greater amount of time. The kidneys do not compensate for this loss of function. Drugs are not normally sequestered in the liver tissue.

12.	A gerontological nurse is aware that age is a salient variable that must be considered during pharmacotherapy in adults. However, the nurse knows that many other important variables must also be considered, including ethnicity. Members of which of the following ethnic groups typically require lower doses of many common medications?
A)	Native Americans
B)	Caucasian Americans
C)	Asian Americans
D)	African Americans
Ans:	C
	Feedback:
	Caucasian Americans and African Americans are poor metabolizers of medication compared with Asian Americans; Asian Americans have the ability to metabolize and excrete medications more quickly than those of Caucasian and African descent. This often means that Asian Americans require lower doses.

13.	A nurse is reviewing a new patient’s admission blood work, which indicates that the patient’s glomerular filtration rate is 51 mL/min/1.73 m² (low). What implication does this have for the patient’s subsequent pharmacotherapy?
A)	The patient may need lower-than-normal doses of some medications.
B)	The patient may require a fluid challenge prior to medication administration.
C)	The patient may need IV administration of a hypotonic solution to aid medication excretion.
D)	The patient may need to receive medications by topical and subcutaneous routes rather than parenteral.
Ans:	A
	Feedback:
	With a decreased GFR, it is necessary to reduce the dosage of the medication. IV fluid administration and alternative routes do not adequately compensate for this change in pharmacokinetics.

14.	A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for the treatment of unstable angina. When performing health education to promote adherence to his medication regimen, the nurse should emphasize which of the following?
A)	The fact that the patient will likely need medications until he no longer experiences the signs of angina
B)	The fact that the patient should take his medications as ordered even if he feels well in the short term
C)	The fact that inconsistent medication use will likely cause the onset of hypertension
D)	The fact that he should gauge his day’s dose based on how he feels that morning
Ans:	B
	Feedback:
	Being asymptomatic may contribute to nonadherence to a medication regimen. Many patients begin to feel better with the initiation of therapy and then discontinue medications altogether or miss individual doses. Patients and their families should be educated about adherence to medication regimens and taught to not skip doses, even if they feel well. Inconsistent use of nitrates and calcium channel blockers does not normally lead to hypertension.

15.	Mrs. James has been taking a diuretic and a beta-blocker for the treatment of hypertension for the past several months. During her latest clinic visit, she states that she has been measuring her blood pressure regularly at her local drug store and she claims that it is usually in the range of 130/80 mm Hg. As a result, she states that she has cut down on her doses of both drugs. Mrs. James’ actions should indicate what nursing diagnosis to the nurse?
A)	Risk for poisoning related to unilateral changes to medication regimen
B)	Acute confusion related to the necessity for medication adherence
C)	Readiness for enhanced decision making related to management of drug therapy
D)	Deficient knowledge related to self-management of drug regimen
Ans:	D
	Feedback:
	Mrs. James is evidently unaware of the need to take her medications consistently. She is presuming that symptom control means that the medication is no longer indicated. The nurse should address this lack of knowledge. There is no associated risk of poisoning, and the patient’s decision making is deficient, a fact that she may or may not be willing to address. Acute confusion denotes a deficit in cognitive processes, not a lack of information.

16.	A nurse at a long-term care facility is surprised to learn that a new resident’s medication administration record runs four pages in length. The nurse knows that polypharmacy carries which of the following risks for older adults? Select all that apply.
A)	Increased risk of complications
B)	Decreased continuity of care
C)	Decreased cognition
D)	Decreased medication adherence
E)	Decreased costs of care
Ans:	A, C
	Feedback:
	Polypharmacy and the consequent interactions of medications can lead to greater complications and diminished mental status. It does not necessarily reduce the continuity of care or medication adherence. Costs to the patient are likely to be higher, not lower.

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