Chapter 7, Drug Therapy in Older Adults - EAQ PDF

Performance Exit Chapter 7, Drug Therapy in Older Adults - EAQ Due May 26, 2024 by 11:59 pm 100% 13 out of 22 questions answered correctly Completed on May 26, 2024 11:18 pm Incorrect (9)...

Performance Exit Chapter 7, Drug Therapy in Older Adults - EAQ Due May 26, 2024 by 11:59 pm 100% 13 out of 22 questions answered correctly Completed on May 26, 2024 11:18 pm Incorrect (9) Report content error Which beta blocker is avoided in stages 4 and 5 of chronic Which beta blocker is avoided in stages 4 and 5 of chronic kidney disease? Sotalol Atenolol Bisoprolol Nadolol Rationale Sotalol is avoided in stages 4 and 5 of chronic kidney disease. Dose adjustments are made for atenolol, bisoprolol, and nadolol in cases of stage 4 and stage 5 chronic kidney disease. p. 51 Report content error Which antibiotic requires a dosage adjustment in the setting of chronic kidney disease? Azithromycin Clindamycin Metronidazole Gentamicin Rationale Gentamicin is an aminoglycoside excreted through the kidney, and it requires a dosage adjustment in the setting of chronic kidney disease. Most antibiotics, except cloxacillin, clindamycin, metronidazole, erythromycin, and azithromycin, require dosage adjustments in the setting of chronic kidney disease. p. 51 Report content error Which change causes orthostatic hypotension in older adults? Increased sensitivity in adrenergic receptors Enhanced response to beta blockers Enhanced response to beta-2 agonists Blunting of compensatory reflexes Rationale Older adults have a blunting of compensatory reflexes, a decreased sensitivity to adrenergic receptors, a decreased response to beta blockers, and a decreased response to beta-2 agonists, all of which result in orthostatic hypotension and falls. pp. 51,52  Report content error Which drug can be given to a patient with stage 4 chronic kidney disease without a dosage adjustment? Allopurinol Propranolol Digoxin Colchicine Rationale Propranolol is metabolized by the liver and can be given without a dosage adjustment in the setting of stage 4 chronic kidney disease. Allopurinol, digoxin, and colchicine are metabolized renally and require dosage adjustments. p. 51 Report content error Which physiologic change is a major cause of increased central nervous system (CNS) drug side effects in the older adult? Renal excretion decreases Compensatory reflexes are blunted Adrenergic receptors become less sensitive The blood-brain barrier becomes more permeable Rationale In older adults, the blood-brain barrier becomes more permeable, leading to increased CNS drug side effects. In the older adult, renal excretion decreases, compensatory reflexes are blunted, and adrenergic receptors become less sensitive, but these changes do not directly increase CNS drug side effects. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking and look for key words; (2) Read each answer thoroughly and see if it completely covers the material the question asks; and (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 52 Report content error Which member of the health care team is responsible for conducting a clinical review of the patient’s drugs to ensure the appropriateness of therapy and reduce the risk for polypharmacy in the older adult? Nurse Patient Primary health care provider Pharmacist Rationale Older adults should be encouraged to use only one pharmacy and should give the pharmacist a list of all the drugs taken, including prescribed, herbal, and over-the-counter therapies. A properly informed pharmacist will be able to conduct a clinical review of the patient’s drugs to ensure the appropriateness of therapy. A pharmacist can also confirm patient understanding of individual therapy and can monitor responses to drug therapy. The nurse, patient, and health care provider should be partners in this process, but it is not their primary responsibility. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, decide what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and do not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 52 Report content error The home health nurse observes that the patient has taken the medication prescribed for before breakfast at bedtime each night. When asked about the timing of the medication, the patient states, 'I know the medication is due before breakfast; I just always forget.' Which intervention by the nurse is most appropriate? Provide instructions with third-grade readability. Employ a translator for directing instructions. Educate the patient about administration skills. Use memory aids such as a pill organizer with an alarm. Rationale Educating the patient about the administration of the prescribed medication is part of effective illness management. This education includes the use of several interactive aids such as videos, pictures, pamphlets with concise descriptions, and multiple strategies. Patients who tend to forget to take their medications because of cognitive impairment can use memory aids such as a pill organizer with an alarm to alert them to take their medicine. Readability tools, translation of instructions with the help of a translator, and skills of medication administration are used by patients who do not know the medication regimen. p. 53 Report content error Which pharmacokinetic alteration necessitates medication dosage adjustments in the older adult patient with decreased renal blood flow? Decreased excretion Decreased metabolism Increased protein binding Increased first-pass metabolism Rationale The effect of reduced blood flow to the kidneys caused by increasing age results in decreased drug excretion. Therefore the drug may remain in the blood for a relatively long time. As a result, the dosage would need to be adjusted. Reduced renal blood flow in elderly patients does not decrease metabolism of the drug because it usually happens in the liver. The renal system has no role in protein binding and does not influence  the first-pass metabolism of the drug. p. 51 Report content error Which change causes orthostatic hypotension in older adults? Increased sensitivity in adrenergic receptors Enhanced response to beta blockers Enhanced response to beta-2 agonists Blunting of compensatory reflexes Rationale Older adults have a blunting of compensatory reflexes, a decreased sensitivity to adrenergic receptors, a decreased response to beta blockers, and a decreased response to beta-2 agonists, all of which result in orthostatic hypotension and falls. pp. 51,52 Correct (13)  Report content error Which term describes the use of more medications than is medically necessary? Addiction Drug abuse Polypharmacy Drug interactions Rationale Polypharmacy refers to the use of more medications than is medically necessary. Addiction describes a dependency on drugs. Drug abuse describes using drugs other than as prescribed. Drug interactions are side effects that may occur as a result of taking more than one drug. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly because there usually is no pattern to the answers. p. 52 Report content error Which method is a cornerstone to drug adherence in older adults? Education of the patient Simplified drug administration Prescriptions from one pharmacy Close monitoring by the nurse Rationale The education of the patient, family, and caregivers is acornerstone to drug adherence in older adults. Simplified drug administration, prescriptions from one pharmacy, and close monitoring by the nurse are methods to increase adherence. p. 52 Report content error Which common phrase may help the nurse remember the general practice recommended to reduce the chances of drug toxicity in older adults? Start low and go fast. Start low and go slow. Start high and go fast. Start high and go slow. Rationale Drugs for older adults should initially be prescribed at low dosages with a gradual increase in dosage based on therapeutic response; this practice is commonly stated as 'start low and go slow.' It is not advisable to start low and go fast, start high and go fast, or start high and go slow. p. 50 Report content error Which reason influences the commonly stated practice of “start low and go slow” in older patients? Reduce the cost of treatment. Evaluate allergic reactions. Decrease drug toxicity. Manage multiple pills. Rationale Drug toxicity in the elderly can be seen in the recommended therapeutic range. This range may be safe for younger adults, but physiologic changes in the body as it ages can result in drug toxicity. This is the reason for the “start slow and go slow” approach. This practice is not done to reduce the cost of treatment, evaluate allergic reactions, or manage multiple pills. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. p. 50 Report content error A patient who presents with severe gastric pain is diagnosed with peptic ulcer disease caused by a Helicobacter pylori infection. The nurse learns the patient does not have health insurance and is most concerned with planning care to prevent which occurrence? Use of herbal preparations Lack of adequate nutrition Nonadherence to the drug regimen Failure to understand the drug purpose Rationale The patient is at risk for nonadherence to the drug regimen, because he or she may be unable to afford the medication costs. The patient is not confused; therefore it is unlikely that the patient will fail to understand the drug's purpose. The patient may be able to afford dietary expenses and other necessities but may not be willing to spend money on medication; therefore lack of adequate nutrition would not necessarily be a concern. The use of herbal preparations is a practice that does not necessarily apply to all patients who lack health insurance. p. 52 Report content error Which effect of aging occurs on the renal excretion of drugs? Increases with age Decreases with age Not affected by age Decreases only if glomerular filtration rate (GFR) increases Rationale Renal excretion of drugs decreases with age. It does not increase, and it is affected by age. Renal excretion of drugs decreases as GFR declines. Test-Taking Tip: Look for options that are similar. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option. p. 51 Report content error Which physiologic change in older adults puts them at risk compared to younger adults in relation to medications? Increased hepatic clearance Enhanced renal excretion Expansion of lean body mass Reduction in liver blood flow Rationale Physiologic changes associated with aging include a reduction in liver size and blood flow, which leads to decreased hepatic clearance. Decreased kidney mass leads to decreased renal excretion. A reduction in lean body mass and total body water results in decreased metabolism and excretion of drugs, resulting in increased levels of toxicity. p. 50 Report content error Which condition leads to increased central nervous system (CNS) drug side effects in an older adult? Decreased blood flow to the brain Impermeable blood-brain barrier Increased cholinergic receptors Increased dopaminergic receptors Rationale With advancing age, there is decreased blood flow to the brain, a more permeable blood-brain barrier, decreased cholinergic receptors, and decreased dopaminergic receptors. These lead to an increased risk for CNS drug side effects. Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action. p. 52 Report content error Which action would be taken for an older adult with impaired memory in regard to their drug regimen? Explain the purpose and drug action.  Provide time for reinforcement. Have family or caregivers monitor the drug regimen. Contact the social services department. Rationale The nurse would encourage family members and caregivers to constantly monitor the patient’s drug regimen if the patient has impaired memory. Explaining the purpose and drug action is required, but the patient is likely to forget. Providing time for reinforcement is not likely to have much of an effect. The social services department can be contacted if the patient has no family or caregivers. p. 53 Report content error Which beta blocker is avoided in stages 4 and 5 of chronic kidney disease? Sotalol Atenolol Bisoprolol Nadolol Rationale Sotalol is avoided in stages 4 and 5 of chronic kidney disease. Dose adjustments are made for atenolol, bisoprolol, and nadolol in cases of stage 4 and stage 5 chronic kidney disease. p. 51 Report content error Which antibiotic requires a dosage adjustment in the setting of chronic kidney disease? Azithromycin Clindamycin Metronidazole Gentamicin Rationale Gentamicin is an aminoglycoside excreted through the kidney, and it requires a dosage adjustment in the setting of chronic kidney disease. Most antibiotics, except cloxacillin, clindamycin, metronidazole, erythromycin, and azithromycin, require dosage adjustments in the setting of chronic kidney disease. p. 51  Report content error Which drug can be given to a patient with stage 4 chronic kidney disease without a dosage adjustment? Allopurinol Propranolol Digoxin Colchicine Rationale Propranolol is metabolized by the liver and can be given without a dosage adjustment in the setting of stage 4 chronic kidney disease. Allopurinol, digoxin, and colchicine are metabolized renally and require dosage adjustments. p. 51 Report content error Which physiologic change is a major cause of increased central nervous system (CNS) drug side effects in the older  adult? Renal excretion decreases Compensatory reflexes are blunted Adrenergic receptors become less sensitive The blood-brain barrier becomes more permeable Rationale In older adults, the blood-brain barrier becomes more permeable, leading to increased CNS drug side effects. In the older adult, renal excretion decreases, compensatory reflexes are blunted, and adrenergic receptors become less sensitive, but these changes do not directly increase CNS drug side effects. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking and look for key words; (2) Read each answer thoroughly and see if it completely covers the material the question asks; and (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 52 1 topics covered Chapter 7, Drug Therapy in Older Adults Novice McCuistion: Pharmacology, 11th Edition Novice Intermediate Proficient Questions answered You 22 Quiz me on this topic