NSG 4067: MEDICATIONS AND OTHER BIOACTIVE SUBSTANCES
1. A nurse assesses the eating habits of a 75-year-old client who takes iron supplements for iron
deficiency anemia. Which of the following statements by the client indicates a need for further
teaching?
A) "I drink orange juice with my iron."
B) "I prefer coffee to take my pills."
C) "I take all my pills with a glass of warm water."
D) "I take my iron in between my meals."
Ans: B
Feedback:
Foods that change the pH of the gastrointestinal (GI) system interfere with the absorption of iron.
It is best taken on an empty stomach, but if it causes GI upset, then it can be taken with orange
juice, which helps absorption. Caffeine and some foods interfere with iron absorption. The
temperature of the water should not impact the medication absorption.
2. A healthy 70-year-old has been using diphenhydramine (Benadryl) for allergic rhinitis. One
week later, the client begins to exhibit signs of confusion and disorientation. The spouse calls the
primary care facility to speak with the nurse. Which event should the nurse suspect first?
A) The older adult has hyponatremia, leading to delirium.
B) The older adult is having transient ischemic attacks.
C) The older adult has an overwhelming infection.
D) The older adult is experiencing an adverse drug effect.
Ans: D
Feedback:
The older adult has been taking diphenhydramine, which can have an anticholinergic effect.
Anticholinergic drugs can lead to medication-induced cognitive impairment. There is no reason
to think that the client has hyponatremia. Rhinitis does not generally cause delirium in older
adults. The client is more likely to be having adverse reaction than transient ischemic attacks.
3. An older adult, aged 72, with type 2 diabetes and coronary artery disease is admitted to a long-
term care facility. The client takes glipizide (Glucotrol) and isosorbide mononitrate (Imdur). The
medical history states that the client drank 4 ounces of whiskey per day for many years. Which
of the following actions should be a priority for the admitting nurse?
A) Assess and observe for depression.
B) Assess for hypoglycemia and hypotension.
C) Evaluate the client for renal failure.
, D) Evaluate blood work for changes in electrolytes.
Ans: B
Feedback:
Older adults are more susceptible to developing medication–alcohol interactions. Age-related
changes in body composition can cause higher levels of alcohol to be absorbed into the
bloodstream. Alcohol enhances vasodilation when an individual takes a nitrate, and there is
potentiation of oral hypoglycemics by alcohol. CNS depression occurs when alcohol interacts
with barbiturates and meprobamate, which this client is not taking. There is no need to evaluate
for renal failure or changes in electrolytes; these are not known medication–alcohol interactions.
4. An older adult wants to take ginkgo biloba, valsartan (Diovan), and hydrochlorothiazide for
hypertension. He also takes an aspirin daily. Which of the following statements best reflects the
advice his nurse should give him?
A) "Ginkgo biloba may cause postprandial hypotension in older adults."
B) "Ginkgo biloba has the potential to interact with hydrochlorothiazide."
C) "Ginkgo biloba can interact with valsartan, reducing its effectiveness."
D) "Ginkgo biloba taken with aspirin can potentially cause a drug interaction."
Ans: D
Feedback:
Medications that are likely to be affected by herbs are warfarin, insulin, aspirin, digoxin,
cyclosporine, and ticlopidine. Ginkgo biloba has the potential to increase blood glucose levels in
type 2 diabetes. Its use is contraindicated with monoamine oxidase inhibitors. It is not known to
have any interaction with valsartan or hydrochlorothiazide.
5. A nurse assesses an older adult who has been having a difficult time sleeping throughout the
night and incontinence. Which of the following questions by the nurse will best provide clues to
these problems?
A) "How many times a night do you get up to urinate?"
B) "What did your health care practitioner tell you about your medications?"
C) "What medications do you take when you need to stay asleep?"
D) "What beverages do you drink on a regular basis?"
Ans: D
Feedback:
Determining what medications the client has used PRN can be helpful, but an increase in
caffeine intake might be making it difficult for the older adult to sleep. Sleep problems can be
handled by decreasing caffeine intake rather than by giving the older adult a sleeping medication.
1. A nurse assesses the eating habits of a 75-year-old client who takes iron supplements for iron
deficiency anemia. Which of the following statements by the client indicates a need for further
teaching?
A) "I drink orange juice with my iron."
B) "I prefer coffee to take my pills."
C) "I take all my pills with a glass of warm water."
D) "I take my iron in between my meals."
Ans: B
Feedback:
Foods that change the pH of the gastrointestinal (GI) system interfere with the absorption of iron.
It is best taken on an empty stomach, but if it causes GI upset, then it can be taken with orange
juice, which helps absorption. Caffeine and some foods interfere with iron absorption. The
temperature of the water should not impact the medication absorption.
2. A healthy 70-year-old has been using diphenhydramine (Benadryl) for allergic rhinitis. One
week later, the client begins to exhibit signs of confusion and disorientation. The spouse calls the
primary care facility to speak with the nurse. Which event should the nurse suspect first?
A) The older adult has hyponatremia, leading to delirium.
B) The older adult is having transient ischemic attacks.
C) The older adult has an overwhelming infection.
D) The older adult is experiencing an adverse drug effect.
Ans: D
Feedback:
The older adult has been taking diphenhydramine, which can have an anticholinergic effect.
Anticholinergic drugs can lead to medication-induced cognitive impairment. There is no reason
to think that the client has hyponatremia. Rhinitis does not generally cause delirium in older
adults. The client is more likely to be having adverse reaction than transient ischemic attacks.
3. An older adult, aged 72, with type 2 diabetes and coronary artery disease is admitted to a long-
term care facility. The client takes glipizide (Glucotrol) and isosorbide mononitrate (Imdur). The
medical history states that the client drank 4 ounces of whiskey per day for many years. Which
of the following actions should be a priority for the admitting nurse?
A) Assess and observe for depression.
B) Assess for hypoglycemia and hypotension.
C) Evaluate the client for renal failure.
, D) Evaluate blood work for changes in electrolytes.
Ans: B
Feedback:
Older adults are more susceptible to developing medication–alcohol interactions. Age-related
changes in body composition can cause higher levels of alcohol to be absorbed into the
bloodstream. Alcohol enhances vasodilation when an individual takes a nitrate, and there is
potentiation of oral hypoglycemics by alcohol. CNS depression occurs when alcohol interacts
with barbiturates and meprobamate, which this client is not taking. There is no need to evaluate
for renal failure or changes in electrolytes; these are not known medication–alcohol interactions.
4. An older adult wants to take ginkgo biloba, valsartan (Diovan), and hydrochlorothiazide for
hypertension. He also takes an aspirin daily. Which of the following statements best reflects the
advice his nurse should give him?
A) "Ginkgo biloba may cause postprandial hypotension in older adults."
B) "Ginkgo biloba has the potential to interact with hydrochlorothiazide."
C) "Ginkgo biloba can interact with valsartan, reducing its effectiveness."
D) "Ginkgo biloba taken with aspirin can potentially cause a drug interaction."
Ans: D
Feedback:
Medications that are likely to be affected by herbs are warfarin, insulin, aspirin, digoxin,
cyclosporine, and ticlopidine. Ginkgo biloba has the potential to increase blood glucose levels in
type 2 diabetes. Its use is contraindicated with monoamine oxidase inhibitors. It is not known to
have any interaction with valsartan or hydrochlorothiazide.
5. A nurse assesses an older adult who has been having a difficult time sleeping throughout the
night and incontinence. Which of the following questions by the nurse will best provide clues to
these problems?
A) "How many times a night do you get up to urinate?"
B) "What did your health care practitioner tell you about your medications?"
C) "What medications do you take when you need to stay asleep?"
D) "What beverages do you drink on a regular basis?"
Ans: D
Feedback:
Determining what medications the client has used PRN can be helpful, but an increase in
caffeine intake might be making it difficult for the older adult to sleep. Sleep problems can be
handled by decreasing caffeine intake rather than by giving the older adult a sleeping medication.
