Wold: Basic Geriatric Nursing, 5Th Edition
7-1
Test Bank
Wold: Basic Geriatric Nursing, 5th Edition
Chapter 07: Medications and Older Adults
Test Bank
MULTIPLE CHOICE
1.The nurse is aware that information derived from a pharmaceutical company’s drug testing to establish therapeutic dose ranges may not be appropriate for the older adult because testing:
a. / is not done long enough.b. / does not require adequate follow-up.
c. / is not well regulated by the U.S. Food and Drug Administration.
d. / is usually tested on healthy young persons.
ANS:D
Long and rigorously regulated drug testing procedures most often use healthy young adults as drug testers.
DIF:Cognitive Level: ComprehensionREF:131OBJ:1
TOP:Drug TestingKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
2.The nurse assesses the older adult patient for evidence of the onset of the effectiveness of an oral preparation because age-related changes in the concentration of gastric acid can:
a. / change the chemical composition of the drug.b. / increase the distribution.
c. / decrease the strength of the drug.
d. / retard absorption.
ANS:D
Decreased gastric acid can decrease the speed of absorption.
DIF:Cognitive Level: AnalysisREF:132OBJ:3
TOP:Drug AbsorptionKEY:Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
3.The nurse is aware that age-related changes in the stomach that can cause increased drug absorption and possibly toxicity include:
a. / decreased gastric motility.b. / gastric reflux disease.
c. / inability of gastric cells to transport the drug.
d. / decreased peristalsis.
ANS:A
Decreased motility leaves the drug in contact with the gastric mucosa for a longer period of time, which leads to increased absorption. Peristalsis is rhythmic movements of the bowels.
DIF:Cognitive Level: ApplicationREF:132OBJ:3
TOP:Increased AbsorptionKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
4.To help prevent lithium toxicity in the older adult, the nurse modifies the nursing care plan to include interventions to:
a. / increase fluid intake to 3500 mL daily.b. / have the patient ambulate for 10 minutes after the drug is administered.
c. / prohibit citrus fruit in the diet.
d. / administer a prescribed stool softener to ensure a daily bowel movement.
ANS:A
Increase of fluids will help allow water-soluble drugs such as lithium to be diluted in the bloodstream more effectively and excreted more rapidly.
DIF:Cognitive Level: ApplicationREF:132OBJ:8
TOP:DistributionKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Reduction of Risk
5.The nurse takes into consideration that as adipose tissue replaces muscle mass in the older adult, a person taking a fat-soluble drug such as diazepam (Valium) several times a day would exhibit:
a. / tachycardia.b. / a hangover effect.
c. / agitation.
d. / hypertension.
ANS:B
Fat-soluble drugs become trapped in the adipose tissue and are slowly released into the bloodstream, increasing the drug’s concentration.
DIF:Cognitive Level: ApplicationREF:132OBJ:3
TOP:DistributionKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
6.The nurse cautions the older adult who is taking the protein-bound drug warfarin (Coumadin) that, with age-related reduced plasma protein levels, the risk of an adverse reaction is high because:
a. / unbound active drug molecules continue to circulate in the bloodstream.b. / the bleeding and clotting times will decrease, as evidenced by the PT and INR.
c. / the drug becomes ineffective and does not deliver its intended therapeutic action.
d. / renal damage can occur from the altered drug molecules.
ANS:A
Unbound drug molecules will still be circulating, leading to excess drug in the bloodstream. In this situation the bleeding and clotting times will be decreased.
DIF:Cognitive Level: ApplicationREF:132OBJ:3
TOP:DistributionKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
7.The nurse frequently assesses the older adult who is on a psychotropic drug for an overdose because:
a. / older adults are less active.b. / the older adult has fewer cognitive capabilities.
c. / brain receptors have become hypersensitive.
d. / receptor sites have lower perfusion.
ANS:C
Brain receptors in the older adult become hypersensitive as age increases, resulting in an exaggerated response to pharmacologic therapy.
DIF:Cognitive Level: AnalysisREF:133OBJ:8
TOP:PharmacodynamicsKEY:Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
8.The major risk of polypharmacy for the older adult is:
a. / ignorance about his or her prescriptions.b. / taking over-the-counter preparations.
c. / being treated by more than one physician.
d. / taking old prescriptions rather than consulting a physician.
ANS:C
Although all the options may offer an opportunity for polypharmacy, the major risk is that of the patient being treated by more than one physician at the same time.
DIF:Cognitive Level: ApplicationREF:134OBJ:4
TOP:PolypharmacyKEY:Nursing Process Step: N/A
MSC:NCLEX: N/A
9.The home health nurse would be most concerned about self-medicating errors for the older adult living alone who is a type 1 diabetic and is:
a. / afflicted with early Parkinson disease.b. / visually impaired.
c. / a rheumatoid arthritic with stiffened hands.
d. / paralyzed from the waist down.
ANS:B
The visually impaired diabetic is at the greatest risk for a medication error by incorrectly preparing an insulin injection.
DIF:Cognitive Level: AnalysisREF:134OBJ:11
TOP:Sensory ChangesKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Physiological Adaptation
10.The medication nurse is aware that the most reliable method of patient identification for administration of medications is:
a. / a photograph of the patient.b. / an identification bracelet.
c. / asking the patient to repeat his or her name.
d. / use of the patient’s room number.
ANS:B
The use of an identification bracelet is the most accurate and reliable method to identify the patient.
DIF:Cognitive Level: ComprehensionREF:142OBJ:9
TOP:Patient IdentificationKEY:Nursing Process Step: Assessment
MSC:NCLEX: Safe, Effective Care Environment: Safety and Infection Control
11.The physician has written an order to convert an enteric-coated medication from the pill form to the liquid form. The nurse should:
a. / transcribe the order and change the medication administration record to show the liquid form.b. / use up the rest of the tablets by crushing them and giving them dissolved in water.
c. / order the liquid form from the pharmacy as ordered.
d. / inquire if the physician wants the dose to be the same as the pill.
ANS:D
Because liquids are absorbed more rapidly, the dose might need to be lowered or the schedule of administration changed to avoid an overdose. Enteric-coated medications should not be crushed.
DIF:Cognitive Level: AnalysisREF:143OBJ:9
TOP:Liquid MedicationKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
12.When the patient complains that the several pills at the 8 AM dose stick in her throat, the nurse could facilitate administration by:
a. / suggesting that she take all the pills at one time with a mouthful of water.b. / offering the patient one pill at a time.
c. / crushing all the pills and mixing them in the patient’s breakfast cereal.
d. / offering a sip of water before and after each pill.
ANS:D
Offering water before and after administration counteracts the dry mouth that causes the pills to stick. Offering one pill at a time without water does not address the problem of sticking.
DIF:Cognitive Level: ApplicationREF:144OBJ:9
TOP:Pill AdministrationKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
13.The nurse is aware that medicating with transdermal patches requires that the nurse should:
a. / apply the patch at the same site every day and carry out documentation.b. / fold and dispose of the used patch in the sharps container.
c. / warm the patch in his or her hands before application.
d. / cover the patch with a light gauze dressing to prevent dislodgement.
ANS:B
The used patch should be folded with the sticky sides together and disposed of in the sharps container for environmental safety.
DIF:Cognitive Level: ApplicationREF:145, Box 7OBJ:6
TOP:Transdermal PatchesKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
14.When the medication nurse offers a pill to the older adult patient, the patient asks, “What is this and what is it for?” The nurse’s best response would be:
a. / “I’m not at liberty to discuss your medication. You need to talk to your doctor.”b. / “That’s a ‘feel good’ pill that will make you feel better.”
c. / “It’s a cephalosporin that has been ordered to treat your URI.”
d. / “It’s an antibiotic for the infection in your urine.”
ANS:D
Patients have the right to know what they are taking and given a reasonable rationale for its use that they can understand.
DIF:Cognitive Level: ApplicationREF:146OBJ:10
TOP:Right to KnowKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Basic Care and Comfort
15.When the 80-year-old female patient refuses to take a medication because it burns her stomach, the medication nurse should:
a. / crush the pill and mix it with the dessert on her meal tray.b. / insist that she take it “for her own good.”
c. / circle and initial the dose time to show nonadministration.
d. / document the reason for refusal and report the refusal to the charge nurse.
ANS:D
The nurse should carry out documentation of the reason for refusal and report the refusal.
DIF:Cognitive Level: ApplicationREF:146OBJ:10
TOP:Refusal of TreatmentKEY:Nursing Process Step: Implementation
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
16.For the older adult patient receiving the bronchodilator theophylline, the nurse would assess for ______as evidence of an overdose.
a. / tachycardiab. / confusion
c. / hypotension
d. / lethargy
ANS:A
Tachycardia is a significant side effect of theophylline.
DIF:Cognitive Level: ApplicationREF:141OBJ:7
TOP:Drug OverdoseKEY:Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
17.When the 75-year-old man who has been on a protocol of chlorpromazine (Thorazine) begins to ______and complain of difficulty swallowing, the nurse notifies the physician.
a. / coughb. / wheeze
c. / drool
d. / gag
ANS:C
Drooling and difficulty swallowing are signs of drug toxicity to chlorpromazine (Thorazine).
DIF:Cognitive Level: ApplicationREF:141OBJ:7
TOP:Drug ToxicityKEY:Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
18.The nurse preparing to administer 1 mL of vitamin B12 intramuscularly to an emaciated 82-year-old patient would choose a _____-inch needle to inject into the _____ site.
a. / 1.5; upper outer quadrant of the gluteus maximusb. / 1.5; ventral gluteal
c. / 1; deltoid
d. / 1; ventral gluteal
ANS:D
The 1-inch needle to be injected into the ventral gluteal site is the safest choice for the emaciated patient. The location is easily accessible and free from major nerves of vessels. The deltoid is a poor site except for very small dosages.
DIF:Cognitive Level: ApplicationREF:145-146OBJ:9
TOP:Intramuscular InjectionKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Reduction of Risk
19.The nurse explains that the Beers criteria provide guidelines for:
a. / medications best avoided by the elderly independent of diagnosis.b. / diagnostic procedures that are considered inappropriate for a diagnosis.
c. / penalties for extended care facilities that allow administration of particular drugs.
d. / assessments necessary before the prescription of particular drugs.
ANS:A
The Beers criteria lists medications best not prescribed for the elderly. The lists are updated regularly, most recently in 2010.
DIF:Cognitive Level: ComprehensionREF:134OBJ:5
TOP:Beers CriteriaKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Reduction of Risk
20.The nurse preparing to crush a patient’s oral medications can crush the:
a. / plain antihypertensive medication tablet.b. / sublingual tablet of nitroglycerin.
c. / timed-release capsule for gastric reflux.
d. / enteric-coated aspirin.
ANS:A
Only the plain tablet can be crushed. Timed-release, sublingual medications, and enteric-coated medications should not be crushed.
DIF:Cognitive Level: ApplicationREF:144, Box 7OBJ:9
TOP:Crushing MedicationKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
MULTIPLE RESPONSE
1.The nurse planning to set up a self-medication program for a 70-year-old resident in an extended-care facility will ensure the provision of ______. (Select all that apply.)
a. / delivery of adequate supply of medicationb. / payment for medication
c. / locked medication storage at bedside
d. / medication administration record
e. / assessment of effectiveness of medication
ANS:A, C, D, E
For self-medication in an extended-care facility, the nurse should make provisions for adequate medication supply, locked storage, medication administration record, and an assessment of the effectiveness of the medication. Payment is not in the purview of the nurse.
DIF:Cognitive Level: ComprehensionREF:146-147OBJ:4
TOP:Medication AdministrationKEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Reduction of Risk
2.The nurse includes information in the nursing care plan pertinent to the patient’s needs as they relate to drug administration, which include ______. (Select all that apply.)
a. / schedule for drawing blood valuesb. / patient’s need for crushing medication
c. / patient’s preference as to the use of medium in which to give crushed medicines
d. / schedule of medication and dose times
e. / parameters of pulse or blood pressure, if significant to administration
ANS:A, B, C, E
Schedule and dose information are not considered part of the nursing care plan.
DIF:Cognitive Level: ApplicationREF:142OBJ:8
TOP:Medication Information in the Nursing Care Plan
KEY:Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
3.The home health nurse reviews all medications of a patient because the nurse is aware that with the high cost of prescription drugs, older adults will ______. (Select all that apply.)
a. / simply not fill a new prescriptionb. / take less than prescribed to preserve their supply
c. / fill all prescriptions at once to get a discount
d. / save old prescription drugs for later use
e. / share medications
ANS:A, B, D, E
Filling prescriptions at one time can be costly even with a discount; therefore the older adult may pick and choose which ones to fill. All the other behaviors listed are methods whereby persons on a limited budget will attempt to preserve their supply of medications and contain costs.
DIF:Cognitive Level: ApplicationREF:140OBJ:12
TOP:Risks Related to Financial FactorsKEY:Nursing Process Step: Implementation
MSC:NCLEX: Psychosocial Integrity: Coping and Adaptation
4.The nurse is aware that the older adult is more at risk for medication-related problems related to ______. (Select all that apply.)
a. / drug-testing methodologyb. / age-related changes
c. / polypharmacy
d. / cognitive and sensory changes
e. / lack of adequate medical follow-up
ANS:A, B, C, D
Lack of follow-up is not identified as a factor in medication-related problems.
DIF:Cognitive Level: ComprehensionREF:132OBJ:1
TOP:Factors in Medication-Related ProblemsKEY:Nursing Process Step: N/A
MSC:NCLEX: N/A
5.The nurse reminds the older adult that self-medication with OTC drugs can be hazardous because OTC drugs can ______. (Select all that apply.)
a. / increase the effect of a prescribed drugb. / interfere with the efficacy of a prescribed drug
c. / mask significant symptoms of primary disease
d. / create symptomatology of their own
e. / cause overdose because they are not considered to be “real drugs”
ANS:A, B, C, D, E
The overuse of OTC drugs can cause all these medication-related problems.
DIF:Cognitive Level: ComprehensionREF:139OBJ:11
TOP:Overuse of OTC DrugsKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
6.The nurse crushes a pill and disguises the dose in the mashed potatoes of a resident in a long-term care facility who previously refused the drug. It is then fed to the patient by the nursing assistant. This should be considered an error because it ______. (Select all that apply.)
a. / violates the patient’s right to refuse medicationb. / involves delegation of medication administration to the nursing assistant
c. / increases the amount of time for the drug administration pass
d. / becomes impossible to confirm the patient received the entire dose
e. / alters the food
ANS:A, B, D
Hiding a dose of drug in a food serving that the patient had previously refused is unethical. Delegating the administration of a drug to a nonqualified person is illegal, and because there is no guarantee the entire serving of food will be consumed, the intended dose may not be delivered.
DIF:Cognitive Level: ApplicationREF:145OBJ:9
TOP:Disguising Drugs in FoodKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
COMPLETION
1.The nurse informs a group of older adults that ____% of all prescriptions are written for adults age 65 and older.
ANS:40
DIF:Cognitive Level: KnowledgeREF:131OBJ:1
TOP:Recipients of PrescriptionsKEY:Nursing Process Step: N/A
MSC:NCLEX: N/A
2.The nurse clarifies that the term ______refers to the study of how persons respond to medicines.
ANS:pharmacodynamics
DIF:Cognitive Level: KnowledgeREF:132OBJ:4
TOP:Medicating the Older AdultKEY:Nursing Process Step: N/A
MSC:NCLEX: N/A
3.The primary organ of drug metabolism is the ______.
ANS:liver
DIF:Cognitive Level: KnowledgeREF:133OBJ:3
TOP:Drug MetabolismKEY:Nursing Process Step: N/A
MSC:NCLEX: N/A
4.The home health nurse periodically interviews patients relative to their use of ______because it is the most commonly consumed and abused nonprescription drug used by adults.
ANS:alcohol
DIF:Cognitive Level: ComprehensionREF:139OBJ:11
TOP:Use of AlcoholKEY:Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
OTHER
1.Arrange the steps for preparing crushed medications to be given by feeding tube in order of priority.
a. Flush the tube to clear feeding.
b. Thoroughly crush the medication.
c. Administer each medication separately.
d. Dissolve each crushed medication in a medicine cup.
e. Flush the tube to clear the medication from the tube.
f. Reconnect the feeding tube.
ANS:B, D, A, C, E, F
DIF:Cognitive Level: ApplicationREF:145OBJ:6
TOP:Crushed Medication per TubeKEY:Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Pharmacological Therapies
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