Pharmacology: Connections to Nursing Practice 3rd edition Adams Test Bank

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  • Published: 2015
  • ISBN-13: 978-0133923612
  • ISBN-10: 0133923614

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pharmacology connections to nursing practice 3rd edition test bank

Adams and Urban, Pharmacology: Connections to Nursing Practice, 3e Test Bank

Chapter 10

Question 1

Type: MCSA

Why is polypharmacy so prevalent in the elderly population?

  1. Multiple medical problems can usually be treated with a single drug.
  2. Clients rarely see more than one prescriber.
  3. Clients might be taking multiple medications for their comorbidities.
  4. Use of over-the-counter medications is uncommon in this age group.

Correct Answer: 3

Rationale 1: Multiple medical problems usually require the use of several drugs.

Rationale 2: Seeing more than one prescriber is typical of elderly clients.

Rationale 3: Many comorbidities increase the likelihood of polypharmacy.

Rationale 4: Use of over-the-counter medications is more common, not less, in the elderly.

Global Rationale: Many comorbidities increase the likelihood of polypharmacy. Multiple medical problems usually require the use of several drugs. Seeing more than one prescriber is typical of elderly clients. Use of over-the-counter medications is more common, not less, in the elderly.

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: VII.3. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-1 Describe factors that lead to polypharmacy in older adults.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 2

Type: MCSA

Why should the nurse ask the client about all medications the client takes, including over-the-counter and herbal medications?

  1. Minimizing the cost of medications is the highest priority.
  2. They might interact with each other or with prescribed medications.
  3. Clients should not use over-the-counter or herbal medications.
  4. Use of these agents must be reported to the Food and Drug Administration.

Correct Answer: 2

Rationale 1: Minimizing the cost of medications is one of many competing priorities.

Rationale 2: Interactions with other medications can occur with over-the-counter or herbal medications.

Rationale 3: Over-the-counter and herbal medications can be important parts of an individual’s regimen.

Rationale 4: There is no requirement that use of these medications be reported to anyone.

Global Rationale: Interactions with other medications can occur with over-the-counter or herbal medications. Minimizing the cost of medications is one of many competing priorities. Over-the-counter and herbal medications can be important parts of an individual’s regimen. There is no requirement that use of these medications be reported to anyone.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: VII.3. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-1 Describe factors that lead to polypharmacy in older adults.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 3

Type: MCSA

A health care provider in a clinic writes several prescriptions for an older client. The nurse notices several medications are in the same class as drugs listed on the client’s intake form. What should the nurse do next?

  1. Set the prescriptions to the side and follow up on the issue at a later date.
  2. Ask the primary health care provider if he was aware his client had been prescribed medications in the same drug class as those prescribed by the cardiologist.
  3. Throw the prescriptions away.
  4. Give them to the client.

Correct Answer: 2

Rationale 1: Not addressing this issue while the client is still in the clinic is likely to result in its being lost to follow-up.

Rationale 2: Duplication in therapy appears to be present; this needs to be clarified with the prescriber.

Rationale 3: The nurse should not throw the prescriptions away unless it is determined that they are inappropriate.

Rationale 4: A duplication in therapy is likely to result in a poor outcome.

Global Rationale: Duplication in therapy appears to be present; this needs to be clarified with the prescriber. Not addressing this issue while the client is still in the clinic is likely to result in its being lost to follow-up. The nurse should not throw the prescriptions away unless it is determined that they are inappropriate. A duplication in therapy is likely to result in a poor outcome.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: VII.3. Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-1 Describe factors that lead to polypharmacy in older adults.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 4

Type: MCSA

Which of these is an age-related physiological change that occurs in older adults?

  1. Brain mass increases.
  2. GI motility increases.
  3. The kidneys filter better and function more efficiently as a client ages.
  4. Blood flow to the liver decreases.

Correct Answer: 4

Rationale 1: Brain mass typically gets smaller, not larger.

Rationale 2: GI motility decreases, not increases, with age.

Rationale 3: Kidney function declines, not improves, with advancing age.

Rationale 4: Liver blood flow typically decreases with advancing age.

Global Rationale: Liver blood flow typically decreases with advancing age. Brain mass typically gets smaller, not larger. GI motility decreases, not increases, with age. Kidney function declines, not improves, with advancing age.

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-2 Identify age-related physiological changes in the older adult.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 5

Type: MCSA

A nurse notices that an older adult client has not urinated all day, despite drinking three liters of water. Which physiological change is the most likely cause for this issue?

  1. Reduction in plasma protein levels
  2. Increased glomerular filtration rate
  3. Increase in body fat
  4. Renal function impairment

Correct Answer: 4

Rationale 1: A reduction in plasma protein levels occurs as liver function declines. This will not affect urine output.

Rationale 2: Urine output will be affected when glomerular filtration rate is decreased, not increased. Glomerular filtration rate will be decreased in the elderly, not increased.

Rationale 3: Changes in body fat are not related to urine output.

Rationale 4: A decline in renal function, especially if acute, would best explain why the client has not urinated.

Global Rationale: A decline in renal function, especially if acute, would best explain why the client has not urinated. A reduction in plasma protein levels occurs as liver function declines. This will not affect urine output. Urine output will be affected when glomerular filtration rate is decreased, not increased. Glomerular filtration rate will be decreased in the elderly, not increased. Changes in body fat are not related to urine output.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-2 Identify age-related physiological changes in the older adult.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 6

Type: MCSA

Why can a reduction in albumin synthesis that may occur with aging result in exaggerated effects of a medication?

  1. Blood flow to the liver decreases.
  2. More unbound drug will be present.
  3. Pharmacodynamics will be altered.
  4. Renal elimination of the drug will be decreased.

Correct Answer: 2

Rationale 1: Blood flow to the liver is indeed decreased, but this is not related to protein binding.

Rationale 2: If the drug is protein-bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects.

Rationale 3: Pharmacodynamics is unrelated to protein binding.

Rationale 4: Renal elimination will be unchanged or increased.

Global Rationale: If the drug is protein-bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects. Blood flow to the liver is indeed decreased, but this is not related to protein binding. Pharmacodynamics is unrelated to protein binding. Renal elimination will be unchanged or increased.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

 

Question 7

Type: MCSA

What is the definition of pharmacodynamics?

  1. The mechanisms by which drugs affect the body
  2. Complying with one’s medication regimen as prescribed
  3. Taking multiple medications
  4. The mechanisms by which the body handles the drug

Correct Answer: 1

Rationale 1: Pharmacodynamics deals with how a drug affects bodily systems.

Rationale 2: This is the definition of adherence, not pharmacodynamics.

Rationale 3: This is the definition of polypharmacy, not pharmacodynamics.

Rationale 4: This is the definition of pharmacokinetics, not pharmacodynamics.

Global Rationale: Pharmacodynamics deals with how a drug affects bodily systems. Adherence is complying with one’s medication regimen, as prescribed. Polypharmacy is taking multiple medications. Pharmcokinetics is the mechanism by which the body handles the drug.

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 8

Type: MCSA

A nurse who works at a nursing home notices that a client’s hearing has diminished significantly over the past couple of days. The client has been receiving gentamicin IV for an infection. Which action by the nurse is the most appropriate?

  1. Continue gentamicin IV and check the peak level in a week.
  2. Suggest checking the client’s peak gentamicin level and immediately report the loss in hearing in the chart and to the health care provider.
  3. Tell the client that she is going to need a hearing aid.
  4. Continue gentamicin IV and suggest adding vancomycin IV to improve the ototoxicity.

Correct Answer: 2

Rationale 1: Gentamicin is a narrow-therapeutic-window drug, and levels should be assessed sooner.

Rationale 2: Gentamicin is a narrow-therapeutic-window drug that can cause ototoxicity and nephrotoxicity. A peak level can help determine the likelihood that it is the drug causing the hearing loss.

Rationale 3: It would be inappropriate to notice a sudden change in hearing and not consider that it might be drug related. Also, all adverse effects should be documented..

Rationale 4: Both vancomycin and gentamicin have the ability to cause nephrotoxicity and ototoxicity. Giving both together would not help the ototoxicity.

Global Rationale: Gentamicin is a narrow-therapeutic-window drug that can cause ototoxicity and nephrotoxicity. A peak level can help determine the likelihood that it is the drug causing the hearing loss. Gentamicin is a narrow-therapeutic-window drug, and levels should be assessed sooner. It would be inappropriate to notice a sudden change in hearing and not consider that it might be drug related. Also, all adverse effects should be documented. Both vancomycin and gentamicin have the ability to cause nephrotoxicity and ototoxicity. Giving both together would not help the ototoxicity.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 9

Type: MCSA

Which strategy can nurses implement to improve drug therapy adherence in older adult clients?

  1. Discourage the use of check-off calendars because older clients do not have adequate eyesight to use them properly.
  2. Suggest the client forgo obtaining medications that are too expensive.
  3. Suggest the client use a daily or weekly pill counter.
  4. Suggest stopping any medications that do not seem to be having an effect.

Correct Answer: 3

Rationale 1: While some older clients might have difficulty in using aids such as check-off calendars, for most they can be a valuable tool.

Rationale 2: If access to medications is limited because of cost, the nurse should help the client explore what support resources might be available.

Rationale 3: Daily or weekly pill counters are an effective, inexpensive way to promote adherence.

Rationale 4: While stopping medications that are ineffective might be appropriate, not all medications have benefits that are obvious, and medication changes should be discussed with other members of the health care team.

Global Rationale: Daily or weekly pill counters are an effective, inexpensive way to promote adherence. While some older clients might have difficulty in using aids such as check-off calendars, for most they can be a valuable tool. If access to medications is limited because of cost, the nurse should help the client explore what support resources might be available. While stopping medications that are ineffective might be appropriate, not all medications have benefits that are obvious, and medication changes should be discussed with other members of the health care team.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-4 Explain strategies that the nurse may implement to improve adherence with drug therapy in geriatric patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 10

Type: MCSA

Which evidence-based client-level factor affects nonadherence?

  1. Management of instructions by the health care provider
  2. Simplification of the regimen
  3. Identification of the client’s social support network
  4. Belief that the treatment will be effective

Correct Answer: 4

Rationale 1: The management of instructions is a health care provider-level factor, not a client-level factor.

Rationale 2: Making the regimen less complex is a health care provider-level factor, not a client-level factor.

Rationale 3: The social support network is a separate factor, not a client-level factor.

Rationale 4: Belief that the treatment will be effective is a client-level factor likely to improve adherence.

Global Rationale: Belief that the treatment will be effective is a client-level factor likely to improve adherence. The management of instructions is a health care provider-level factor, not a client-level factor. Making the regimen less complex is a health care provider-level factor, not a client-level factor. The social support network is a separate factor, not a client-level factor.

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-4 Explain strategies that the nurse may implement to improve adherence with drug therapy in geriatric patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 11

Type: MCSA

Why are older adults more prone to adverse drug reactions and interactions than younger adults?

  1. Presence of fewer chronic disease states
  2. More predictable pharmacokinetics and pharmacodynamics
  3. Use of fewer chronic medications
  4. Physiologic changes in body composition

Correct Answer: 4

Rationale 1: Older clients tend to have more chronic disease states, not fewer.

Rationale 2: Pharmacokinetics are less predictable in older clients, not more.

Rationale 3: Older clients tend to use more chronic medications, not fewer.

Rationale 4: Physiologic changes in body composition can affect drug pharmacokinetics, increasing the risk of adverse drug reactions and interactions.

Global Rationale: Physiologic changes in body composition can affect drug pharmacokinetics, increasing the risk of adverse drug reactions and interactions. Older clients tend to have more chronic disease states, not fewer. Pharmacokinetics are less predictable in older clients, not more. Older clients tend to use more chronic medications, not fewer.

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-5 Explain why older adults are more likely to experience adverse drug reactions and interactions.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 12

Type: MCSA

Which group of medications should be used cautiously, if at all, in older adult clients?

  1. Beers list
  2. Polypharmacy
  3. Washington Manual
  4. Physicians’ Desk Reference

Correct Answer: 1

Rationale 1: Beers list or Beers criteria is the correct name for this group of medications that are usually poor choices for older clients.

Rationale 2: Polypharmacy does not refer to a group of medications that are usually poor choices for older clients.

Rationale 3: The Washington Manual is a handbook of therapeutics, not a group of medications that are usually poor choices for older clients.

Rationale 4: The Physicians’ Desk Reference is a compendium of FDA-approved labeling, not a group of medications that are usually poor choices for older clients.

Global Rationale: Beers list or Beers criteria is the correct name for this group of medications that are usually poor choices for older clients. Polypharmacy does not refer to a group of medications that are usually poor choices for older clients. The Washington Manual is a handbook of therapeutics, not a group of medications that are usually poor choices for older clients. The Physicians’ Desk Reference is a compendium of FDA-approved labeling, not a group of medications that are usually poor choices for older clients.

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 13

Type: MCSA

A nurse working at a clinic notices that a client is having problems reading the prescription bottles. Sometimes the client takes medications incorrectly because of difficulty reading the small print. Which suggestion by the nurse can alleviate this problem?

  1. Put the medication in a zip-top bag with the instructions written on it in large print.
  2. Let the pharmacist get easy-open caps.
  3. Stop taking the medications, as they are more likely to cause problems than to help if not taken correctly.
  4. Ask the pharmacist to provide labels with large print that explain how to take the medication.

Correct Answer: 4

Rationale 1: Medications generally should be stored only in properly labeled containers.

Rationale 2: Although effective for clients without good dexterity, easy-open caps will not help in this instance.

Rationale 3: If the medications are necessary, then it is inappropriate to stop them.

Rationale 4: Large-print labels will make the instructions easier for the client to read.

Global Rationale: Large-print labels will make the instructions easier for the client to read. Medications generally should be stored only in properly labeled containers. Although effective for clients without good dexterity, easy-open caps will not help in this instance. If the medications are necessary, then it is inappropriate to stop them.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Explain why older adults are more likely to experience adverse drug reactions and interactions.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 14

Type: MCSA

An older adult client comes to the emergency department with complaints of confusion. Which recently prescribed medication is most likely responsible for this assessment finding?

  1. Lansoprazole (Prevacid)
  2. Atorvastatin (Lipitor)
  3. Hydroxyzine (Atarax)
  4. Amlodipine (Norvasc)

Correct Answer: 3

Rationale 1: Lansoprazole rarely causes confusion.

Rationale 2: Atorvastatin rarely causes confusion. Its major adverse effects are gastrointestinal upset and muscle weakness.

Rationale 3: Hydroxyzine is a sedating antihistamine with significant anticholinergic effects.

Rationale 4: Amlodipine rarely causes confusion. Its major adverse effects are pedal edema and headache.

Global Rationale: Hydroxyzine is a sedating antihistamine with significant anticholinergic effects, which can cause confusion. Lansoprazole rarely causes confusion. Atorvastatin rarely causes confusion. Its major adverse effects are gastrointestinal upset and muscle weakness. Amlodipine rarely causes confusion. Its major adverse effects are pedal edema and headache.

Cognitive Level: Evaluating

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 15

Type: MCSA

An older adult client comes in to the office with severe sunburn. When reviewing the client’s medication list, which is the likely cause of the client’s sunburn?

  1. Phenytoin (Dilantin)
  2. Cyclobenzaprine (Flexeril)
  3. Naproxen (Aleve)
  4. Alprazolam (Xanax)

Correct Answer: 3

Rationale 1: Phenytoin (Dilantin) does not cause increased sensitivity to sunlight. Its major adverse effects are sedation and ataxia.

Rationale 2: Cyclobenzaprine (Flexeril) does not cause increased sensitivity to sunlight. Its major adverse effects are sedation, confusion, and anticholinergic effects.

Rationale 3: Naproxin (Aleve) can cause an increase in sensitivity to sunlight.

Rationale 4: Alprazolam (Xanax) does not cause increased sensitivity to sunlight. Its major adverse effect is sedation.

Global Rationale: Naproxin (Aleve) can cause an increase in sensitivity to sunlight. Phenytoin (Dilantin) does not cause increased sensitivity to sunlight. Its major adverse effects are sedation and ataxia. Cyclobenzaprine (Flexeril) does not cause increased sensitivity to sunlight. Its major adverse effects are sedation, confusion, and anticholinergic effects. Alprazolam (Xanax) does not cause increased sensitivity to sunlight. Its major adverse effect is sedation.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: II.8. Promote achievement of safe and quality outcomes of care for diverse populations

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Identify specific drugs that are particularly hazardous for use in older patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 16

Type: MCSA

An older adult client recently started digoxin (Lanoxin) and is in the office for a routine checkup. Lab tests show a decline in the client’s renal function. Which is a priority concern for the nurse based on the lab results?

  1. Digoxin causing the decrease in renal function.
  2. Digoxin interfering with the lab test, making it appear that the client’s renal function has worsened.
  3. Increased likelihood of toxicity due to the inability to excrete digoxin.
  4. Diminished response to digoxin due to alterations in pharmacodynamics.

Correct Answer: 3

Rationale 1: Digoxin does not cause decreases in renal function.

Rationale 2: Digoxin does not interfere with laboratory tests of renal function.

Rationale 3: Digoxin is largely eliminated by the kidneys. Serious toxicity can occur if the dose is not adjusted after a decline in renal function.

Rationale 4: Changes in renal function do not affect the pharmacodynamics of digoxin.

Global Rationale: Digoxin is largely eliminated by the kidneys. Serious toxicity can occur if the dose is not adjusted after a decline in renal function. Digoxin does not cause decreases in renal function. Digoxin does not interfere with laboratory tests of renal function. Changes in renal function do not affect the pharmacodynamics of digoxin.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-7 Differentiate medication responses that result from age-related alterations in specific body systems from those that occur in younger individuals.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 17

Type: MCSA

Which is the best description of the anatomic and physiological changes that occur as a result of aging?

  1. They result of pathologic changes.
  2. They are reversible.
  3. They are normal and predictable.
  4. They are a potential target for drug therapy.

Correct Answer: 3

Rationale 1: Age-related changes are not generally pathologic in nature.

Rationale 2: Anatomic and physiological changes are not generally reversible, with even the most advanced modern interventions.

Rationale 3: The anatomic and physiological changes are a normal and predictable part of aging.

Rationale 4: Because the anatomic and physiological changes are considered normal, they are not amenable to drug therapy.

Global Rationale: The anatomic and physiological changes are a normal and predictable part of aging. Age-related changes are not generally pathologic in nature. Anatomic and physiological changes are not generally reversible, with even the most advanced modern interventions. Because the anatomic and physiological changes are considered normal, they are not amenable to drug therapy.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-2 Identify age-related physiological changes in the older adult.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 18

Type: MCSA

What is the age-related change in the gastrointestinal tract that can affect medication administration?

  1. Decreased motility
  2. Reduced intestinal transit time
  3. Increased absorption of medications and nutrients
  4. Increased gastric acid production

Correct Answer: 1

Rationale 1: Decreased motility of the GI tract is a common change seen with aging.

Rationale 2: Intestinal transit time increases with aging. It does not decrease.

Rationale 3: Absorption of medications and nutrients decreases with aging.

Rationale 4: Gastric acid production decreases with aging.

Global Rationale: Decreased motility of the GI tract is a common change seen with aging. Intestinal transit time increases with aging. It does not decrease. Absorption of medications and nutrients decreases with aging. Gastric acid production decreases with aging.

Cognitive Level: Remembering

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 10-2 Identify age-related physiological changes in the older adult.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 19

Type: MCSA

Which rationale explains why anticonvulsants and antidepressants have an exaggerated effect in older adult clients?

  1. Increased binding to plasma proteins such as albumin
  2. Increased rate of hepatic metabolism
  3. Reduced intestinal transit time
  4. Declining efficiency of the blood–brain barrier

Correct Answer: 4

Rationale 1: Binding to plasma proteins such as albumin is typically decreased, not increased, with age. Additionally, an increase in protein binding would result in diminished, not exaggerated, effects.

Rationale 2: Hepatic metabolism is typically decreased, not increased, with age. Additionally, an increase in metabolism would result in diminished, not exaggerated, effects.

Rationale 3: Intestinal transit time is increased due to the decrease seen in gastrointestinal motility. Additionally, the increase in intestinal transit time would diminish, not exaggerate, the effect of medications.

Rationale 4: Declining efficiency of the blood–brain barrier could explain an increase in the effects of drugs that work in the brain such as anticonvulsants or antidepressants.

Global Rationale: Declining efficiency of the blood–brain barrier could explain an increase in the effects of drugs that work in the brain such as anticonvulsants or antidepressants. Binding to plasma proteins such as albumin is typically decreased, not increased, with age. Additionally, an increase in protein binding would result in diminished, not exaggerated, effects. Hepatic metabolism is typically decreased, not increased, with age. Additionally, an increase in metabolism would result in diminished, not exaggerated, effects. Intestinal transit time is increased due to the decrease seen in gastrointestinal motility. Additionally, the increase in intestinal transit time would diminish, not exaggerate, the effect of medications.

Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 10-7 Differentiate medication responses that result from age-related alterations in specific body systems from those that occur in younger individuals.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

Page Number:

Question 20

Type: MCSA

An older client asks the nurse how to avoid potential drug interactions. Which response by the nurse is the most appropriate?

  1. “Take over-the-counter medications rather than prescription ones whenever possible.”
  2. “Obtain all medications from one pharmacy when possible.”
  3. “Ask for free drug samples rather than getting prescriptions filled at a pharmacy.”
  4. “Use memory aids such as pill reminders.”

Correct Answer: 2

Rationale 1: Over-the-counter medications can interact with other medications. This will not lessen the likelihood of drug interactions.

Rationale 2: Obtaining all medications from one pharmacy ensures that that pharmacy has a record of all medications. This could make it easier to catch potential interactions.

Rationale 3: Using free drug samples can increase the risk of drug interactions unless the pharmacist filling the rest of a client’s prescriptions is informed that the client is obtaining medications from other sources.

Rationale 4: Using memory aids such as pill reminders can make it less likely that a client will forget to take a medication, but will not reduce the risk of drug interactions.

Global Rationale: Obtaining all medications from one pharmacy ensures that that pharmacy has a record of all medications. This could make it easier to catch potential interactions. Over-the-counter medications can interact with other medications. This will not lessen the likelihood of drug interactions. Using free drug samples can increase the risk of drug interactions unless the pharmacist filling the rest of a client’s prescriptions is informed that the client is obtaining medications from other sources. Using memory aids such as pill reminders can make it less likely that a client will forget to take a medication, but will not reduce the risk of drug interactions.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

Question 21

Type: MCSA

While providing medication education to an older adult client, which instruction by the nurse is the most appropriate?

  1. Vary the time of day that each medication is taken so that the long-term effectiveness will be preserved.
  2. Obtain information about every possible adverse effect that could possibly occur.
  3. Changes in mental status, weight, or bowel function should be reported to the prescriber.
  4. Avoid keeping a list of medication names and doses, and their purposes, because the list could be lost, resulting in a loss of privacy.

Correct Answer: 3

Rationale 1: Medications should be taken at the same time each day unless otherwise instructed. There is no rational basis for varying administration time.

Rationale 2: The nurse should not inform the client about every possible adverse effect. Only adverse effects that are common or serious should be reviewed.

Rationale 3: Changes in mental status, weight, or bowel function are common signs of an adverse drug reaction in older clients. These should be promptly reported so the possibility of an adverse reaction can be evaluated.

Rationale 4: Clients should be encouraged to keep a list of medications taken and doses, and the purpose of each. It should be safeguarded to minimize the chances of its being lost.

Global Rationale: Changes in mental status, weight, or bowel function are common signs of an adverse drug reaction in older clients. These should be promptly reported so the possibility of an adverse reaction can be evaluated. Medications should be taken at the same time each day unless otherwise instructed. There is no rational basis for varying administration time. The nurse should not inform the client about every possible adverse effect. Only adverse effects that are common or serious should be reviewed. Clients should be encouraged to keep a list of medications taken and doses, and the purpose of each. It should be safeguarded to minimize the chances of its being lost.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care

AACN Essential Competencies: IX.7. Identify personal, professional and environmental risks that impact personal and professional choices and behaviors

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-9 Generate key points for family and patient education regarding drug pharmacotherapy for older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

Question 22

Type: MCMA

The nurse planning discharge teaching for an older client with multiple prescriptions for multiple chronic illnesses may discuss which strategies to avoid medication errors at home?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. When possible, take medications at the same time each day.
  2. Keep a written record of medications taken, including the name, dose, date, and time.
  3. Use a pill holder as a memory aid.
  4. Plan to have a family member remind the client each day to take medication.
  5. Request easy-to-open bottles so the client will not have difficulty opening the bottles.

Correct Answer: 1,2,3

Rationale 1: Setting a schedule whereby medications are taken at the same time each day may prevent clients from forgetting to take medications or forgetting if they did take their medication.

Rationale 2: Keeping a written record will help clients remember to take medications and to remember if medication has been taken.

Rationale 3: Pill holders have compartments for each day of the week and time of day.

Rationale 4: This may be helpful but is not a best strategy. Many older adults do not have family members living with them or nearby.

Rationale 5: This is not a strategy to prevent a medication error.

Global Rationale: Setting a schedule whereby medications are taken at the same time each day may prevent clients from forgetting to take medications or forgetting if they did take their medication. Keeping a written record will help clients remember to take medications and to remember if medication has been taken. Pill holders have compartments for each day of the week and time of day. Planning to have a family remember remind the client to take the medications each day may be helpful but is not a best strategy. Many older adults do not have family members living with them or nearby. Requesting easy-to-open bottles so the client will not have difficulty opening them is not a strategy to prevent a medication error.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care

AACN Essential Competencies: IX.7. Identify personal, professional and environmental risks that impact personal and professional choices and behaviors

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 10-9 Generate key points for family and patient education regarding drug pharmacotherapy for older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

Question 23

Type: MCMA

The nurse is not surprised when a health care provider orders a lower than normal dose of a drug excreted by the kidneys for an older adult client because certain effects of aging cause the body to retain drugs and other substances for longer periods. Which normal effects of the aging process decrease the ability to excrete drugs?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Decrease in renal blood flow.
  2. Decrease in the number of functioning nephrons.
  3. Decrease in the ability to excrete waste products effectively.
  4. Decrease in gastric pH, causing delayed absorption.
  5. Decrease of fat storage, causing delayed absorption.

Correct Answer: 1,2,3

Rationale 1: Older adults have a decrease in blood flow to kidneys. This may affect excretion of drugs.

Rationale 2: Older adults have a decreased number of nephrons resulting in a decreased number of functioning nephrons. This may affect excretion of drugs.

Rationale 3: Because of age-related changes to the kidneys, the older adult may have difficulty excreting waste products, which may affect excretion of drugs.

Rationale 4: Delayed absorption does not affect the excretion of drugs.

Rationale 5: The elderly have an increase in fat storage, but that does not affect the excretion of drugs.

Global Rationale: Older adults have a decrease in blood flow to kidneys, a decreased number of nephrons resulting in a decreased number of functioning nephrons, and may have difficulty excreting waste products. All of these factors may affect excretion of drugs. Delayed absorption does not affect the excretion of drugs. The elderly have an increase in fat storage, but that does not affect the excretion of drugs.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 24

Type: MCMA

An older adult client complains to the nurse that a medication is causing significant nausea and vomiting. Which responses by the nurse are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “A normal consequence of aging is decreased blood flow to the stomach. This could result in the medication staying in your stomach longer, causing nausea and vomiting.”
  2. “A normal consequence of aging is slowed emptying of stomach contents. This can cause nausea and vomiting.”
  3. “A normal consequence of aging is slower absorption of medications, resulting in nausea and vomiting.”
  4. “A normal consequence of aging is an increase in liver size, which can result in nausea and vomiting.”
  5. “A normal consequence of aging is decreased carbohydrate metabolism, which can result in nausea and vomiting.”

Correct Answer: 1,2,3

Rationale 1: Decreased blood flow to and from the stomach may delay absorption, resulting in nausea and vomiting.

Rationale 2: Slowed emptying of stomach contents may allow drugs to remain longer in the gastrointestinal tract, resulting in nausea and vomiting.

Rationale 3: When absorption time is decreased, drugs may remain longer in the stomach, resulting in nausea and vomiting.

Rationale 4: The size of the liver does not cause risk for nausea or vomiting.

Rationale 5: Carbohydrate metabolism does not cause risk for nausea or vomiting.

Global Rationale: Decreased blood flow to and from the stomach may delay absorption, resulting in nausea and vomiting. Slowed emptying of stomach contents may allow drugs to remain longer in the gastrointestinal tract, resulting in nausea and vomiting. When absorption time is decreased, drugs may remain longer in the stomach, resulting in nausea and vomiting. The size of the liver does not cause risk for nausea or vomiting. Carbohydrate metabolism does not cause risk for nausea or vomiting.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 25

Type: MCMA

Which interventions would the nurse perform before administering the next dose of gentamicin to an older adult client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Monitor for peak and trough for toxicity.
  2. Check the health care provider’s orders for periodic lab draws.
  3. Contact the health care provider if serum concentration is not within therapeutic range.
  4. Check that this drug is prescribed with short intervals between doses.
  5. Assess client for reduced cognitive function or confusion.

Correct Answer: 1,2,3

Rationale 1: Age-related changes result in a decrease in total body water in the older adult. Because gentamicin is water soluble, this could result in higher concentration of the drug, causing toxicity.

Rationale 2: To prevent toxicity of gentamicin, periodic lab work for peak and trough must be checked.

Rationale 3: If the serum concentration is not within therapeutic range, the dose may need to be adjusted.

Rationale 4: Drugs with a long half-life have the potential to accumulate in the tissues. These drugs should be prescribed with longer intervals between doses.

Rationale 5: Gentamicin toxicity symptoms include impaired hearing, not reduced cognitive function or confusion.

Global Rationale: Age-related changes result in a decrease in total body water in the older adult. Because gentamicin is water soluble, this could result in higher concentration of the drug, causing toxicity. To prevent toxicity of gentamicin, periodic lab work for peak and trough must be checked. If the serum concentration is not within therapeutic range, the dose may need to be adjusted. Drugs with a long half-life have the potential to accumulate in the tissues. These drugs should be prescribed with longer intervals between doses. Gentamicin toxicity symptoms include impaired hearing, not reduced cognitive function or confusion.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 26

Type: MCMA

An older adult client brought to the emergency department for bloody stools has been taking warfarin (Coumadin) post stroke. Initial diagnostic lab work reveals warfarin to be within therapeutic range. The daughter asks why the client has bloody stools if the lab work is normal. Which responses by the nurse are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “Liver function declines during the aging process.”
  2. “Decreased liver function results in decreased plasma proteins.”
  3. “Decreased plasma proteins result in more free drug circulating.”
  4. “Decreased plasma proteins lead to more binding sites, resulting in lower concentrations of drugs such as this one.”
  5. “Higher levels of this drug are able to enter the blood–brain barrier, resulting in the toxic effects of bleeding.”

Correct Answer: 1,2,3

Rationale 1: Liver function declines during the aging process.

Rationale 2: As liver function declines, so does the production of plasma proteins.

Rationale 3: As the production of plasma proteins declines, an increase in highly protein-bound drugs results in higher concentrations of free drug.

Rationale 4: Decreased plasma proteins lead to fewer binding sites, resulting in higher, not lower, concentrations of free drug.

Rationale 5: The decrease in liver function and plasma proteins may cause the adverse effects of bleeding and bloody stools. It does not have anything to do with the blood–brain barrier.

Global Rationale: Liver function declines during the aging process. As liver function declines, so does the production of plasma proteins. As the production of plasma proteins declines, an increase in highly protein-bound drugs results in higher concentrations of free drug. Decreased plasma proteins lead to fewer binding sites, resulting in higher, not lower, concentrations of free drug. The decrease in liver function and plasma proteins may cause the adverse effects of bleeding and bloody stools. It does not have anything to do with the blood–brain barrier.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 27

Type: MCMA

Which clients would the nurse consider high risk for adverse drug effects related to inefficient blood–brain barrier?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Older adult taking benzodiazepines for anxiety
  2. Older adult with a current history of seizures
  3. Older adult with a history of difficulty sleeping
  4. Older adult taking high doses of antibiotics for pneumonia
  5. Older adult with a history of emphysema

Correct Answer: 1,2,3

Rationale 1: Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects.

Rationale 2: Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects.

Rationale 3: Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects.

Rationale 4: Antibiotics for pneumonia do not cross the blood–brain barrier.

Rationale 5: Drugs used for emphysema would not cross the blood–brain barrier.

Global Rationale: Drugs such as benzodiazepines, antipsychotic agents, antiseizure agents, and tranquilizers can cross the blood–brain barrier in higher concentrations, resulting in adverse effects. Antibiotics for pneumonia do not cross the blood–brain barrier. Drugs used for emphysema would not cross the blood–brain barrier.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 28

Type: MCMA

The nurse is caring for an older adult client prescribed acetaminophen (Tylenol), as needed, for frequent headaches. What can the nurse expect?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. The client may not ask for the medication as often as younger clients.
  2. This drug may be prescribed with longer interval dosing.
  3. The health care provider may order a lower than normal dose.
  4. The health care provider will order diagnostic lab work to check creatinine clearance.
  5. The health care provider will need to prescribe nausea medication.

Correct Answer: 1,2,3

Rationale 1: Reduced metabolism will result in extended duration of the drug.

Rationale 2: Acetaminophen (Tylenol) has a long half-life and remains in tissues longer, resulting in toxicity. The health care provider may prescribe longer dosing intervals.

Rationale 3: Acetaminophen (Tylenol) has a long half-life and remains in tissues longer resulting in toxicity. The health care provider may prescribe a lower dose.

Rationale 4: Creatinine clearance tests kidney function, not hepatic function.

Rationale 5: Acetaminophen (Tylenol) does not cause nausea.

Global Rationale: Reduced metabolism will result in extended duration of the drug; therefore, the client may ask for the medication less frequently. Acetaminophen (Tylenol) has a long half-life and remains in tissues longer, resulting in toxicity. The health care provider may prescribe longer dosing intervals and at lower dosages. Creatinine clearance tests kidney function, not hepatic function. Acetaminophen (Tylenol) does not cause nausea.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-3 Explain how age-related physiological changes alter pharmacokinetics and pharmacodynamics and affect drug response in older adults.

MNL Learning Outcome: 1.1.3 Relate processes of pharmacokinetics and pharmacodynamics to the therapeutic effect(s) of a drug.

Page Number:

Question 29

Type: MCMA

The nurse is discharging an older adult client with a new medication. Which statements should be included in discharge teaching?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “You will be started on the lowest effective dose; it will gradually increase.”
  2. “You will need to come back to the clinic in 3 to 5 days for follow-up.”
  3. “Call if there are any changes in physical or emotional behavior.”
  4. “It is very important that you do not get overhydrated, since that would increase the effects of the medication.”
  5. “This would be a good time to commit to a low-protein diet in an effort to lose weight.”

Correct Answer: 1,2,3

Rationale 1: Starting the older adult on the lowest effective dose and titrating upward will decrease the risk for toxicity.

Rationale 2: Drug accumulation in older adults often occurs 3 to 5 days after the new drug has been initiated.

Rationale 3: Consider any change in physical or emotional behavior as a possible sign of toxicity.

Rationale 4: Dehydration causes drug toxicity.

Rationale 5: Low-protein diets can cause drug toxicity.

Global Rationale: Starting the older adult on the lowest effective dose and titrating upward will decrease the risk for toxicity. Drug accumulation in older adults often occurs 3 to 5 days after the new drug has been initiated. Consider any change in physical or emotional behavior as a possible sign of toxicity. Dehydration causes drug toxicity. Low-protein diets can cause drug toxicity.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care

AACN Essential Competencies: IX.7. Identify personal, professional and environmental risks that impact personal and professional choices and behaviors

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-9 Generate key points for family and patient education regarding drug pharmacotherapy for older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

Question 30

Type: MCMA

Which questions would the case manager ask the older adult client to assess for risk for nonadherence to a medication regimen?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “How do you feel about the possible side effects your medication may cause?”
  2. “If we set you up with a pill holder, do you think you will be able to remember to take the medication?”
  3. “I have put large labels on the bottles; can you see the print?”
  4. “Do you feel you can afford the cost of the medication after your insurance pays its part?”
  5. “Can your daughter visit every day to give you the medication?”

Correct Answer: 1,2,3,4

Rationale 1: Unpleasant side effects increase risk for nonadherence.

Rationale 2: Forgetfulness is a cause for nonadherence.

Rationale 3: Physical impairment such as poor vision can lead to nonadherence.

Rationale 4: Inability to purchase is a risk for nonadherence.

Rationale 5: This question assumes that the client is unable to self-administer the medication, which is not the same as assessing the older client’s ability to adhere to the medication regimen.

Global Rationale: Unpleasant side effects, forgetfulness, physical impairment, and the inability to purchase all increase the risk for nonadherence. Asking the client if a daughter can visit every day to administer a medication assumes that the client is unable to self-administer the medication, which is not the same as assessing the older client’s ability to adhere to the medication regimen.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

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Question 31

Type: MCMA

An urgent care nurse is triaging clients. Which client statements may indicate that medications are being misused?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. “I was feeling really great so I stopped taking my antibiotic and now I feel feverish.”
  2. “My retirement check didn’t come in over the holiday weekend so I didn’t have the money to get my antihypertension medication refilled. I just took one every other day instead of every day.”
  3. “I really thought I would get better quicker if I took the medication four times a day instead of two times a day. Now, I have diarrhea.”
  4. “The schedule is pretty complicated but my daughter-in-law got me a pill dispenser and that helps to keep me on schedule.”
  5. “I’ve had to borrow the money from my daughter to get my medication, but I always seem to find a way to get it.”

Correct Answer: 1,2,3

Rationale 1: Erratic use can be attributed to clients taking their medication when they feel sick and stopping the medication when feeling well.

Rationale 2: Uninsured or underinsured clients may try to make medications last longer by skipping doses or by splitting pills in half.

Rationale 3: Some clients believe taking extra doses of medication will speed recovery.

Rationale 4: This client appears to be taking medication as prescribed.

Rationale 5: This client appears to be taking medication as prescribed.

Global Rationale: Erratic use can be attributed to clients taking their medication when they feel sick and stopping the medication when feeling well. Uninsured or underinsured clients may try to make medications last longer by skipping doses or by splitting pills in half. Some clients believe taking extra doses of medication will speed recovery. The other statements do not indicate misuse of prescribed medications.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

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Question 32

Type: MCMA

The nurse is educating an older adult client on ways to decrease the risk of adverse drug reactions. Which statements will the nurse include in the teaching session?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. When possible, decrease the number of prescriptions.
  2. Take medication only when necessary.
  3. Take medication as long as possible to ensure therapeutic response.
  4. Follow up as requested by provider.
  5. Adjust doses of medication in clients with renal or hepatic impairment.

Correct Answer: 1,2,4,5

Rationale 1: The risk of an adverse effect increases with the number of drugs taken.

Rationale 2: Take medications only when they are needed.

Rationale 3: To minimize adverse effects, clients should only take medication for the shortest length of time necessary.

Rationale 4: Following up as requested by provider will alert the provider to early symptoms of adverse effects.

Rationale 5: Doses of most drugs must be adjusted for clients with age-related renal or hepatic impairment.

Global Rationale: The risk of an adverse effect increases with the number of drugs taken. Take medications only when they are needed. Following up as requested by provider will alert the provider to early symptoms of adverse effects. Doses of most drugs must be adjusted for clients with age-related renal or hepatic impairment. To minimize adverse effects, clients should only take medication for the shortest length of time necessary.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience

AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-8 Develop nursing interventions that maximize pharmacotherapeutic outcomes in older adults.

MNL Learning Outcome: 1.2.1 Apply the five steps of the nursing process as it relates to pharmacotherapy.

Page Number:

Question 33

Type: MCMA

An older adult client is being discharged with multiple new prescriptions. Which strategies could the home health nurse employ to encourage adherence?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Communicate the purpose the new medications serve toward treatment of the condition.
  2. Ensure the medication is dispensed in containers that are easily opened.
  3. Make sure all drugs are clearly labeled with instructions.
  4. Place daily follow-up phone calls to high-risk older clients.
  5. Simplify the regimen to twice-a-day dosing and reduce the number of medications the older client must take.

Correct Answer: 1,2,3

Rationale 1: It is important that older clients understand the purpose of medications and their importance to the treatment plan.

Rationale 2: It is important for older clients to be able to easily access the medication.

Rationale 3: Clearly labeled instructions may encourage the client to take the medication as directed.

Rationale 4: Follow-up phone calls to high-risk older clients are important, but the frequency will depend on the client.

Rationale 5: Reducing the number of medications and frequency of dosing will decrease risk for nonadherence, but twice-a-day dosing may not be possible.

Global Rationale: It is important older clients understand the purpose of medications and their importance to the treatment plan. It is important for older clients to be able to easily access the medication. Clearly labeled instructions may encourage the client to take the medication as directed. Follow-up phone calls to high-risk older clients are important, but the frequency will depend on the client. Reducing the number of medications and frequency of dosing will decrease risk for nonadherence, but twice-a-day dosing may not be possible.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.2 Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values

AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-4 Explain strategies that the nurse may implement to improve adherence with drug therapy in geriatric patients.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

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Question 34

Type: MCMA

A nurse who provides care to older adult clients must be aware that which factors may increase the risk for adverse drug reactions in this population?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Longevity results in increased risk for illnesses, which may require multiple medications.
  2. Many older clients will use over-the-counter medications to treat common symptoms such as constipation or joint pain in addition to prescription drugs.
  3. Older clients may see several health care specialists.
  4. The rate of absorption in older clients is unpredictable.
  5. Increased volume of total body water results in an increase in concentrations of drugs in the blood.

Correct Answer: 1,2,3

Rationale 1: Longevity inevitably leads to increased illnesses, which in turn necessitate the use of multiple medications, which may result in adverse reactions.

Rationale 2: When a client takes over-the-counter drugs in conjunction with prescribed medication, polypharmacy may occur, resulting in adverse reactions.

Rationale 3: Adverse reactions may occur when multiple health providers prescribe medications.

Rationale 4: The rate of absorption is predictable and would not cause an adverse reaction.

Rationale 5: The decreased volume of total body water may lead to higher concentrations of drugs in the serum.

Global Rationale: Longevity inevitably leads to increased illnesses, which in turn necessitate the use of multiple medications, which may result in adverse reactions. When a client takes over-the-counter drugs in conjunction with prescribed medication, polypharmacy may occur, resulting in adverse reactions. Adverse reactions may occur when multiple health providers prescribe medications. The rate of absorption is predictable and would not cause an adverse reaction. The decreased volume of total body water may lead to higher concentrations of drugs in the serum.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.1 Elicit patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care

AACN Essential Competencies: III.1. Explain the interrelationships among theory, practice and research

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Explain why older adults are more likely to experience adverse drug reactions and interactions.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

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Question 35

Type: MCMA

The nurse recognizes that which physiological changes may have what effects on medication responses?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

  1. Decreased production of serum albumin may result in toxic levels of highly protein-bound drugs.
  2. Declining efficiency of the blood–brain barrier may result in increased central nervous system symptoms.
  3. Decreased contractility of the heart may result in decreased distribution of drugs.
  4. Decreased gastric pH may result in decreased absorption.
  5. Decreased body fat may result in decreased absorption of fat-soluble drugs.

Correct Answer: 1,2,3

Rationale 1: Decreased production of serum albumin in the older client may produce toxic levels of highly protein-bound drugs.

Rationale 2: Declining efficiency of the blood–brain barrier may result in more substances crossing the blood–brain barrier, resulting in increased central nervous system symptoms.

Rationale 3: Decreased contractility of the heart may decrease the distribution of drugs.

Rationale 4: Gastric pH is increased in the older client, resulting in medications that require high levels of acid to take longer to be absorbed.

Rationale 5: Body fat is increased in the older client, resulting in increased absorption of fat-soluble drugs.

Global Rationale: Decreased production of serum albumin in the older client may produce toxic levels of highly protein-bound drugs. Declining efficiency of the blood–brain barrier may result in more substances crossing the blood–brain barrier, resulting in increased central nervous system symptoms. Decreased contractility of the heart may decrease the distribution of drugs. Gastric pH is increased in the older client, resulting in medications that require high levels of acid to take longer to be absorbed. Body fat is increased in the older client, resulting in increased absorption of fat-soluble drugs.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.A.1 Integrate understanding of multiple dimensions of patient centered care:

  • patient/family/community preferences, values
  • coordination and integration of care
  • information, communication, and education
  • physical comfort and emotional support
  • involvement of family and friends
  • transition and continuity

AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-7 Differentiate medication responses that result from age-related alterations in specific body systems from those that occur in younger individuals.

MNL Learning Outcome: 1.2.3 Compare pharmacologic implications across the life span and various community health settings.

pharmacology connections to nursing practice 3rd edition test bank