TEST BANK - LEHNES PHARMACOLOGY FOR NURSING CARE ( 10TH EDITION BY JACKUELINE
47 Test Bank - Lehne's Pharmacology for Nursing Care (10th Edition by Jacqueline Burchum)
BURCHUM)
Chapter 11: Drug Therapy in Geriatric Patients
MULTIPLE CHOICE
1. A nurse is concerned about renal function in an 84-year-old patient who is taking several
medications. What should the nurse assess?
a. Creatinine clearance
b. Sodium levels
c. Potassium levels
d. Serum creatinine
ANS: A
The proper index of renal function in older adults is creatinine clearance, which indicates renal
function in older patients whose organs are undergoing age-related deterioration. Sodium and
potassium levels are not indicative of renal function. Serum creatinine levels do not reflect
kidney function in older adults because lean muscle mass, which is the source of creatinine in
serum, declines and may be low even with reduced kidney function.
DIF: Cognitive Level: Analysis REF: Pharmacokinetic Changes in the Elderly: Excretion
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
2. A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to
follow after discharge from the hospital. To help promote adherence, what will the nurse do?
a. Ask the patient to share the teaching with a neighbor or friend soon after discharge.
b. Give the patient detailed written information about each drug.
c. Cluster medication administration times as much as possible.
d. Make sure the patient understands the actions and side effects of each drug.
ANS: C
Unintentional nonadherence often is the result of confusion and forgetfulness. Grouping
medications to reduce the number of medication times per day can simplify the regimen and help
the patient remember medication times. Enlisting a neighbor, relative, or friend is a good idea,
but this person should be included in the teaching. Asking the patient to share what is learned
may not be a reasonable expectation of a forgetful patient. Detailed written information may just
be more confusing; verbal and written information should be clear and concise. Making sure the
patient understands the actions and side effects of medications helps when intentional
nonadhe ence i an i e, b in hi ca e i ma j add o he a ien conf ion.
DIF: Cognitive Level: Application REF: Promoting Adherence
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. A n e i e ie ing an olde ad l a ien cha befo e gi ing medica ion . Which a ien
information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
, 48 Test Bank - Lehne's Pharmacology for Nursing Care (10th Edition by Jacqueline Burchum)
d. Low serum creatinine
ANS: C
Low serum albumin reduces protein binding of drugs and can cause levels of free drug to rise,
increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is not a major factor in
drug sensitivity in the older adult, although delayed gastric emptying can delay drug responses.
Increased body fat can alter drug distribution, causing reduced responses in lipid-soluble drugs.
Low serum creatinine is a function of decreased lean muscle mass and does not reflect kidney
function or drug excretion.
DIF: Cognitive Level: Application REF: Pharmacokinetic Changes in the Elderly
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
4. Based on changes in hepatic function in older adult patients, which adjustment should the nurse
expect for oral medications that undergo extensive first pass metabolism?
a. A higher dose should be used with the same time schedule.
b. The interval between doses should be increased.
c. No change is necessary; metabolism will not be affected.
d. The interval between doses should be reduced.
ANS: B
The interval between doses of the medication should be increased in older adult patients, because
drugs that undergo the first pass effect may not be broken down as well as in an individual with
full liver function. A higher dose of the medication is not indicated, because toxic effects could
occur. A change in administration may be indicated in older adults, because their metabolism is
affected. The interval between doses should not be reduced but increased.
DIF: Cognitive Level: Application
REF: Pharmacokinetic Changes in the Elderly: Metabolism TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
5. A nurse is preparing to give medications to four geriatric patients who are all taking multiple
medications. Which patient is most likely to have an adverse drug reaction related to increased
drug effects?
a. Obese patient
b. Patient with decreased serum creatinine
c. Patient with chronic diarrhea
d. Thin patient with a chronically low appetite
ANS: D
The patient who is thin and has a poor appetite has an increased risk of malnutrition, with
significant lowering of serum albumin. This can result in increased free drug levels of protein-
bound drugs and can lead to drug toxicity. Obesity, which involves increased adipose tissue,
would cause lipid-soluble drugs to deposit in adipose tissue, with a resulting reduction of drug
effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease
in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of
medications through the GI tract and reduce absorption.
47 Test Bank - Lehne's Pharmacology for Nursing Care (10th Edition by Jacqueline Burchum)
BURCHUM)
Chapter 11: Drug Therapy in Geriatric Patients
MULTIPLE CHOICE
1. A nurse is concerned about renal function in an 84-year-old patient who is taking several
medications. What should the nurse assess?
a. Creatinine clearance
b. Sodium levels
c. Potassium levels
d. Serum creatinine
ANS: A
The proper index of renal function in older adults is creatinine clearance, which indicates renal
function in older patients whose organs are undergoing age-related deterioration. Sodium and
potassium levels are not indicative of renal function. Serum creatinine levels do not reflect
kidney function in older adults because lean muscle mass, which is the source of creatinine in
serum, declines and may be low even with reduced kidney function.
DIF: Cognitive Level: Analysis REF: Pharmacokinetic Changes in the Elderly: Excretion
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
2. A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to
follow after discharge from the hospital. To help promote adherence, what will the nurse do?
a. Ask the patient to share the teaching with a neighbor or friend soon after discharge.
b. Give the patient detailed written information about each drug.
c. Cluster medication administration times as much as possible.
d. Make sure the patient understands the actions and side effects of each drug.
ANS: C
Unintentional nonadherence often is the result of confusion and forgetfulness. Grouping
medications to reduce the number of medication times per day can simplify the regimen and help
the patient remember medication times. Enlisting a neighbor, relative, or friend is a good idea,
but this person should be included in the teaching. Asking the patient to share what is learned
may not be a reasonable expectation of a forgetful patient. Detailed written information may just
be more confusing; verbal and written information should be clear and concise. Making sure the
patient understands the actions and side effects of medications helps when intentional
nonadhe ence i an i e, b in hi ca e i ma j add o he a ien conf ion.
DIF: Cognitive Level: Application REF: Promoting Adherence
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. A n e i e ie ing an olde ad l a ien cha befo e gi ing medica ion . Which a ien
information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
, 48 Test Bank - Lehne's Pharmacology for Nursing Care (10th Edition by Jacqueline Burchum)
d. Low serum creatinine
ANS: C
Low serum albumin reduces protein binding of drugs and can cause levels of free drug to rise,
increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is not a major factor in
drug sensitivity in the older adult, although delayed gastric emptying can delay drug responses.
Increased body fat can alter drug distribution, causing reduced responses in lipid-soluble drugs.
Low serum creatinine is a function of decreased lean muscle mass and does not reflect kidney
function or drug excretion.
DIF: Cognitive Level: Application REF: Pharmacokinetic Changes in the Elderly
TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
4. Based on changes in hepatic function in older adult patients, which adjustment should the nurse
expect for oral medications that undergo extensive first pass metabolism?
a. A higher dose should be used with the same time schedule.
b. The interval between doses should be increased.
c. No change is necessary; metabolism will not be affected.
d. The interval between doses should be reduced.
ANS: B
The interval between doses of the medication should be increased in older adult patients, because
drugs that undergo the first pass effect may not be broken down as well as in an individual with
full liver function. A higher dose of the medication is not indicated, because toxic effects could
occur. A change in administration may be indicated in older adults, because their metabolism is
affected. The interval between doses should not be reduced but increased.
DIF: Cognitive Level: Application
REF: Pharmacokinetic Changes in the Elderly: Metabolism TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
5. A nurse is preparing to give medications to four geriatric patients who are all taking multiple
medications. Which patient is most likely to have an adverse drug reaction related to increased
drug effects?
a. Obese patient
b. Patient with decreased serum creatinine
c. Patient with chronic diarrhea
d. Thin patient with a chronically low appetite
ANS: D
The patient who is thin and has a poor appetite has an increased risk of malnutrition, with
significant lowering of serum albumin. This can result in increased free drug levels of protein-
bound drugs and can lead to drug toxicity. Obesity, which involves increased adipose tissue,
would cause lipid-soluble drugs to deposit in adipose tissue, with a resulting reduction of drug
effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease
in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of
medications through the GI tract and reduce absorption.
