Chapter 8 Safe Medication Use

Chapter 8  Safe Medication Use

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which pharmacokinetic parameter is affected most by decreased intestinal motility related to the aging process?
a.
Absorption
c.
Metabolism
b.
Distribution
d.
Excretion

ANS: A
Decreased intestinal motility increases the amount of time a substance remains in contact with the intestinal mucosa of the small intestine, where most absorption takes place. With increased exposure, absorption can be increased and the drug effect enhanced. Many medications taken by older adults can also decrease intestinal motility, thereby complicating the titration of medications or introducing new adverse effects through drug-to-drug interactions. Decreased body water leads to higher serum concentrations of water-soluble drugs, increased body fat increases the longevity of fat-soluble drugs, and decreased serum albumin increases the serum concentration of serum protein–bound drugs. Reduced liver mass and hepatic dysfunction can impair oxidative metabolism, which can lead to an accumulation of toxic levels of a drug. Impaired renal function can impair the excretion of drugs through the kidneys.

PTS: 1 DIF: Understand REF: 4-5 TOP: Nursing Process: Evaluation
MSC: Safe, Effective Care Environment

2. Which process is increased in the early morning?
a.
Fibrinolytic activity
c.
Asthma symptoms
b.
Blood plasma
d.
Rheumatoid arthritis pain

ANS: A
Fibrinolytic activity is increased in the early morning. Blood plasma volume falls at night, thus hematocrit increases. Asthma symptoms peak at approximately 4 to 5 AM. Pain from rheumatoid arthritis is more severe in the late afternoon.

PTS: 1 DIF: Remember REF: 44 Table 8-4
TOP: Nursing Process: Assessment MSC: Physiological Integrity

3. Which interaction between each prescription and food or nutritional supplement is favorable?
a.
Warfarin (Coumadin) and ginkgo biloba
b.
Terazosin (Hytrin) and increased fluids
c.
Lithium (Eskalith) and low-sodium diet
d.
Warfarin (Coumadin) and leafy, green vegetables

ANS: B
Increased fluids can combat the hypotensive effects of alpha-adrenergic blockers such as terazosin. Ginkgo biloba can amplify the anticoagulant effect of warfarin, leading to an increased risk of bleeding. Reduced sodium intake contributes to the toxicity of lithium. Leafy, green vegetables can diminish the anticoagulant effect of warfarin (Coumadin).

PTS: 1 DIF: Remember REF: 8-9
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment

4. Which medication is correctly matched to the condition given of an older adult patient according to current medical knowledge?
a.
Methylphenidate (Ritalin) for depression at bedtime
b.
Buspirone (BuSpar) for chronic anxiety states
c.
Amitriptyline (Elavil) for depression in the morning
d.
Haloperidol (Haldol) long-term for psychotic behavior

ANS: B
Buspirone (BuSpar) is safer for older adults with anxiety than benzodiazepines. Because it can take up to 5 to 7 days for the therapeutic benefit to be realized, it should be used only for chronic anxiety. Stimulants such as methylphenidate (Ritalin) should be administered in low doses in patients with chronic depression. To prevent insomnia, extended-release forms should be administered early in the morning and short-acting forms at the latest in the early afternoon. Tricyclic antidepressants such as amitriptyline (Elavil) are contraindicated for use with older adults because of the risk for anticholinergic and sedative effects. Tricyclic antidepressants have been replaced with selective serotonin reuptake inhibitors (SSRIs), which are more effective at lower doses with fewer side effects. Antipsychotic agents such as haloperidol (Haldol) can cause extrapyramidal effects, especially in older adults. For long-term administration, they should be used only after a thorough psychiatric evaluation.

PTS: 1 DIF: Understand REF: 26-27 TOP: Nursing Process: Evaluation
MSC: Safe, Effective Care Environment