TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 11-15
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 nonadherence is an
issue, but in this case it may just add to the patient’s confusion.
DIF: Cognitive Level: Application REF: Promoting Adherence
TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. A nurse is reviewing an older adult patient’s chart before giving medications. Which
patient information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
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.
DIF: Cognitive Level: Analysis REF: Pharmacokinetic Changes in the
Elderly TOP: Nursing Process: Diagnosis MSC: NCLEX Client
Needs Category: Physiologic Integrity: Physiologic Adaptation
6. A nurse is caring for an older adult patient during the immediate postoperative period
after a total hip replacement. The surgeon has ordered meperidine (Demerol) for severe
pain. What will the nurse do?
a. Administer the medication as prescribed and initiate a fall risk protocol.
b. Ask for a PRN order for diphenhydramine (Benadryl) for the expected side effect
of itching.
c. Request an order for morphine instead of meperidine (Demerol).
d. Suggest to the surgeon that the patient receive diazepam (Valium) to reduce
anxiety and the need for narcotics.
ANS: C
In older adults, meperidine is not effective at usual doses and causes more confusion
than in younger patients. Morphine is recommended for severe pain. A fall risk
protocol is appropriate, but the drug ordered is not. Diphenhydramine is not
recommended for older adult patients, because it causes blurred vision. Both
diphenhydramine and diazepam have central nervous system (CNS) sedative effects,
which will compound the CNS effects of the narcotic. Diazepam also produces
prolonged sedation in older adults.
DIF: Cognitive Level: Application REF: Table 11-2 TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic
Integrity: Physiologic Adaptation
CHAPTERS 11-15
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 nonadherence is an
issue, but in this case it may just add to the patient’s confusion.
DIF: Cognitive Level: Application REF: Promoting Adherence
TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. A nurse is reviewing an older adult patient’s chart before giving medications. Which
patient information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
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.
DIF: Cognitive Level: Analysis REF: Pharmacokinetic Changes in the
Elderly TOP: Nursing Process: Diagnosis MSC: NCLEX Client
Needs Category: Physiologic Integrity: Physiologic Adaptation
6. A nurse is caring for an older adult patient during the immediate postoperative period
after a total hip replacement. The surgeon has ordered meperidine (Demerol) for severe
pain. What will the nurse do?
a. Administer the medication as prescribed and initiate a fall risk protocol.
b. Ask for a PRN order for diphenhydramine (Benadryl) for the expected side effect
of itching.
c. Request an order for morphine instead of meperidine (Demerol).
d. Suggest to the surgeon that the patient receive diazepam (Valium) to reduce
anxiety and the need for narcotics.
ANS: C
In older adults, meperidine is not effective at usual doses and causes more confusion
than in younger patients. Morphine is recommended for severe pain. A fall risk
protocol is appropriate, but the drug ordered is not. Diphenhydramine is not
recommended for older adult patients, because it causes blurred vision. Both
diphenhydramine and diazepam have central nervous system (CNS) sedative effects,
which will compound the CNS effects of the narcotic. Diazepam also produces
prolonged sedation in older adults.
DIF: Cognitive Level: Application REF: Table 11-2 TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic
Integrity: Physiologic Adaptation
