1
NCLEX PN Exam Bank Geriatric Pharmacology and
Polypharmacy Risk
Table of Contents
Subtopic 1: Principles of Geriatric Pharmacology and Age-Related Changes ..................... 2
Subtopic 2: Antihypertensive Therapy in the Geriatric Population.................................... 10
Subtopic 3: Diuretic Use in Geriatric Patients – Monitoring, Risks, and Electrolyte Balance
.................................................................................................................................. 19
Subtopic 4: Drug Interactions and Adverse Effects in Polypharmacy among Older Adults . 27
Subtopic 5: Safe Medication Administration and Monitoring in Older Adults .................... 36
Subtopic 6: Pharmacologic Management of Hypertension with Coexisting Conditions in
Older Adults ............................................................................................................... 45
Subtopic 7: Polypharmacy Interactions and Risk Reduction Strategies ............................ 54
Subtopic 8: Monitoring Parameters and Lab Values for Antihypertensive and Diuretic
Therapy ...................................................................................................................... 62
Subtopic 9: Medication Adherence and Patient Education in the Elderly .......................... 71
Subtopic 10: Prevention and Management of Drug Interactions in Polypharmacy for
Geriatric Patients ........................................................................................................ 80
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Subtopic 1: Principles of Geriatric Pharmacology and
Age-Related Changes
Question 1
Which physiological change in older adults most significantly affects drug metabolism?
A. Increased gastrointestinal motility
B. Decreased renal blood flow
C. Decreased liver enzyme activity
D. Increased serum albumin levels
Correct Answer: C. Decreased liver enzyme activity
Rationale: Aging leads to a decline in hepatic enzyme activity, which reduces drug
metabolism. This change may result in increased drug half-life and toxicity in elderly
patients.
Question 2
What is a major reason polypharmacy increases the risk of adverse drug reactions in older
adults?
A. Improved adherence to medication
B. Altered pharmacokinetics due to age-related organ decline
C. Increased hydration status
D. Enhanced immune system response
Correct Answer: B. Altered pharmacokinetics due to age-related organ decline
Rationale: Polypharmacy combined with age-related changes in liver and kidney function
increases the risk of adverse effects and drug accumulation.
Question 3
, 3
An older adult patient is taking multiple medications prescribed by different specialists.
What nursing action is most appropriate to reduce medication-related risks?
A. Refer the patient to a physical therapist
B. Perform a comprehensive medication reconciliation
C. Encourage the use of over-the-counter herbal supplements
D. Instruct the patient to stop taking medications when symptoms subside
Correct Answer: B. Perform a comprehensive medication reconciliation
Rationale: Medication reconciliation identifies potential drug interactions, duplications, or
contraindications and is essential in managing polypharmacy.
Question 4
Why are older adults more sensitive to the effects of central nervous system (CNS)
depressants?
A. Faster metabolism of CNS drugs
B. Increased neurotransmitter activity
C. Decreased blood-brain barrier permeability
D. Reduced number of neurons and slower neurotransmission
Correct Answer: D. Reduced number of neurons and slower neurotransmission
Rationale: Age-related changes in the CNS make older adults more sensitive to sedative
and psychotropic medications, increasing fall and confusion risk.
Question 5
Which laboratory value should be closely monitored in an older adult prescribed digoxin?
A. Hemoglobin
B. Serum creatinine
, 4
C. Sodium
D. White blood cell count
Correct Answer: B. Serum creatinine
Rationale: Digoxin is primarily excreted through the kidneys. Impaired renal function,
common in older adults, can lead to toxicity.
Question 6
Which symptom in an elderly patient taking multiple medications suggests possible drug
toxicity?
A. Increased appetite
B. Confusion and altered mental status
C. Improved mobility
D. Decreased urine output
Correct Answer: B. Confusion and altered mental status
Rationale: Confusion is a common indicator of drug toxicity in older adults due to
increased drug sensitivity and altered metabolism.
Question 7
Which factor most increases the risk of drug-drug interactions in elderly patients?
A. Decreased fat-to-lean body mass ratio
B. Polypharmacy
C. Increased gastrointestinal absorption
D. Use of herbal teas
Correct Answer: B. Polypharmacy
NCLEX PN Exam Bank Geriatric Pharmacology and
Polypharmacy Risk
Table of Contents
Subtopic 1: Principles of Geriatric Pharmacology and Age-Related Changes ..................... 2
Subtopic 2: Antihypertensive Therapy in the Geriatric Population.................................... 10
Subtopic 3: Diuretic Use in Geriatric Patients – Monitoring, Risks, and Electrolyte Balance
.................................................................................................................................. 19
Subtopic 4: Drug Interactions and Adverse Effects in Polypharmacy among Older Adults . 27
Subtopic 5: Safe Medication Administration and Monitoring in Older Adults .................... 36
Subtopic 6: Pharmacologic Management of Hypertension with Coexisting Conditions in
Older Adults ............................................................................................................... 45
Subtopic 7: Polypharmacy Interactions and Risk Reduction Strategies ............................ 54
Subtopic 8: Monitoring Parameters and Lab Values for Antihypertensive and Diuretic
Therapy ...................................................................................................................... 62
Subtopic 9: Medication Adherence and Patient Education in the Elderly .......................... 71
Subtopic 10: Prevention and Management of Drug Interactions in Polypharmacy for
Geriatric Patients ........................................................................................................ 80
, 2
Subtopic 1: Principles of Geriatric Pharmacology and
Age-Related Changes
Question 1
Which physiological change in older adults most significantly affects drug metabolism?
A. Increased gastrointestinal motility
B. Decreased renal blood flow
C. Decreased liver enzyme activity
D. Increased serum albumin levels
Correct Answer: C. Decreased liver enzyme activity
Rationale: Aging leads to a decline in hepatic enzyme activity, which reduces drug
metabolism. This change may result in increased drug half-life and toxicity in elderly
patients.
Question 2
What is a major reason polypharmacy increases the risk of adverse drug reactions in older
adults?
A. Improved adherence to medication
B. Altered pharmacokinetics due to age-related organ decline
C. Increased hydration status
D. Enhanced immune system response
Correct Answer: B. Altered pharmacokinetics due to age-related organ decline
Rationale: Polypharmacy combined with age-related changes in liver and kidney function
increases the risk of adverse effects and drug accumulation.
Question 3
, 3
An older adult patient is taking multiple medications prescribed by different specialists.
What nursing action is most appropriate to reduce medication-related risks?
A. Refer the patient to a physical therapist
B. Perform a comprehensive medication reconciliation
C. Encourage the use of over-the-counter herbal supplements
D. Instruct the patient to stop taking medications when symptoms subside
Correct Answer: B. Perform a comprehensive medication reconciliation
Rationale: Medication reconciliation identifies potential drug interactions, duplications, or
contraindications and is essential in managing polypharmacy.
Question 4
Why are older adults more sensitive to the effects of central nervous system (CNS)
depressants?
A. Faster metabolism of CNS drugs
B. Increased neurotransmitter activity
C. Decreased blood-brain barrier permeability
D. Reduced number of neurons and slower neurotransmission
Correct Answer: D. Reduced number of neurons and slower neurotransmission
Rationale: Age-related changes in the CNS make older adults more sensitive to sedative
and psychotropic medications, increasing fall and confusion risk.
Question 5
Which laboratory value should be closely monitored in an older adult prescribed digoxin?
A. Hemoglobin
B. Serum creatinine
, 4
C. Sodium
D. White blood cell count
Correct Answer: B. Serum creatinine
Rationale: Digoxin is primarily excreted through the kidneys. Impaired renal function,
common in older adults, can lead to toxicity.
Question 6
Which symptom in an elderly patient taking multiple medications suggests possible drug
toxicity?
A. Increased appetite
B. Confusion and altered mental status
C. Improved mobility
D. Decreased urine output
Correct Answer: B. Confusion and altered mental status
Rationale: Confusion is a common indicator of drug toxicity in older adults due to
increased drug sensitivity and altered metabolism.
Question 7
Which factor most increases the risk of drug-drug interactions in elderly patients?
A. Decreased fat-to-lean body mass ratio
B. Polypharmacy
C. Increased gastrointestinal absorption
D. Use of herbal teas
Correct Answer: B. Polypharmacy
