Chapter 5 Pharmacology and the Care of the Adult

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Chapter 5  Pharmacology and the Care of the Adult

 

 

Complete chapter Questions And Answers
 

Sample Questions

 

 

  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?
    1. A)  “Should this patient receive a medication that was likely tested on younger adults?”
    2. B)  “Do the potential benefits of this medication outweigh the potential harm?”
    3. C)  “Are there plausible herbal or complementary alternatives to this medication?”
    4. 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?
    1. A)  Increased excretion time due to increased bowel motility
    2. B)  Impaired distribution due to polypharmacy
    3. C)  A decrease in overall body surface area
    4. 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.

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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

  1. A)  drugs that are known to cause adverse effects in older adults.
  2. B)  drugs for which generic equivalents are available at lower cost.
  3. C)  drugs that have been found to be ineffective in older adults.
  4. 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?

  1. A)  Low-dose enteric-coated ASA
  2. B)  Metoprolol (Lopressor)
  3. C)  Digoxin (Lanoxin)
  4. 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?

  1. A)  Confusion
  2. B)  Blood dyscrasias
  3. C)  Gastrointestinal bleeding
  4. 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.

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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?

  1. A)  Renal ultrasound
  2. B)  Complete blood count (CBC)
  3. C)  Serum bilirubin and albumin levels
  4. 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 kat/L (high) and aspartate aminotransferase (AST) 3.1 kat/L (high). What implication do these data have for the patient’s pharmacokinetics?

  1. A)  Distribution of drugs may be erratic.
  2. B)  Absorption of drugs may be incomplete.
  3. C)  Excretion of drugs may be delayed.
  4. 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.

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