Geriatrics 2 Flashcards
An older patient being treated for pneumonia is given a sedative to sleep. A few hours afterwards, the patient has a respiratory rate of 12 and cannot be aroused. What does this assessment finding indicate to the nurse?
- The sedative was not absorbed.
- The sedative has reached a therapeutic blood level.
- The medication for sleep caused excessive sedation.
- The patient is experiencing complications of pneumonia.
3: Pharmacodynamic changes, which affect how the drug affects the body, can also occur because of the aging process. However, it is not always clear if changes in therapeutic responses are due to the pharmacodynamics or to the altered pharmacokinetics. An increased drug-receptor response can occur with benzodiazepines resulting in increased sedation.
An older patient who takes digoxin for an irregular heart rhythm has been experiencing nausea and vomiting and has not eaten in 2 days. The patient now is exhibiting weakness, bradycardia, and visual disturbances. What laboratory tests would the nurse monitor for this patient?
- Hemoglobin
- Urine analysis
- Calcium levels
- Serum electrolytes
4: With aging, body water decreases and body fat increases. Older patients are more susceptible to dehydration and prolonged effects of fat-soluble drugs. It would be most appropriate to monitor the therapeutic levels of the medications taken along with the patient’s hydration status. These are best accomplished by the electrolytes and drug levels.
An older patient has an elevated blood urea nitrogen (BUN) level, but the creatinine clearance is within normal limits. The nurse notes that the patient’s appetite has been poor the past few days. What should the nurse do about these laboratory findings?
- Assess urine output.
- Inform the physician of the BUN result.
- Assess intake and output and dietary intake of protein.
- Monitor for medication side effects related to decreased excretion by the kidneys.
3: The nurse should not rely on BUN levels as an indicator of renal function in the older person. BUN is affected by muscle mass, level of hydration, diagnosis of anemia, and dietary intake of protein. The nurse needs to further assess the patient’s intake and output and dietary intake of protein.
An older patient admitted with chest pain is prescribed Restoril 15 mg at bedtime. The usual dosage given to adults is 30 mg. What intervention would the nurse use for this patient?
- Administer the drug as ordered.
- Monitor the patient’s renal function.
- Ask the physician to change the dosage to 30 mg.
- Give the drug and contact the doctor for a second dose if the patient does not fall asleep.
1: The rule of thumb for drug prescriptions in older persons is to “start low, go slow.” Drugs, such as sedatives, are given at one half the recommended adult dosage.
An older patient does not take a prescribed diuretic as planned because of the inconvenience of having to urinate frequently, which interrupts scheduled activities. What action should the nurse take with this patient?
- Insist the drug be taken as prescribed.
- Contact the physician to order another drug.
- Advise to take the drug in divided dosages, half in the morning and half in the evening.
- Discuss the daily activity schedule and adjust the drug administration time accordingly.
4: The administration of diuretics can be scheduled so that the peak diuretic effect does not interrupt activities important to the patient. Assisting the patient to understand this and modifying the schedule would provide the best compliance with the medical plan of care.
An older patient experiencing abdominal pain, nausea, and vomiting brown liquid has taken an NSAID type of medication for general muscle aches. What effect might this drug have related to the patient’s manifestations?
- Diarrhea
- Constipation
- Increased BUN
- Gastric irritation and bleeding
4: NSAIDs cause gastric irritation and can be linked to the manifestations that the patient is experiencing.
After completing a medication history, the nurse notes that an older patient is prescribed 22 different medications and sees five different healthcare providers. What should the nurse determine about the patient from this information?
- A situation of polypharmacy
- Prone to missing medication doses
- Multiple health problems requiring a variety of different prescribed medications
- Cognitive impairment and not remembering the medications prescribed
1: The amount of medications and the number of healthcare providers that this patient sees is excessive, qualifying for what is defined as polypharmacy.
An older patient is experiencing a change in mood. For which medications should the nurse assess as the possible cause of this patient's cognitive change? Standard Text: Select all that apply. 1. Steroids 2. NSAIDs 3. Antibiotics 4. Benzodiazepines 5. Antihypertensives
1: Changes in mood can result from taking steroids.
2: Changes in mood can result from taking NSAIDs.
4: Changes in mood can result from taking benzodiazepines.
5: Changes in mood can result from taking antihypertensives.
An older patient is prescribed psyllium seed to prevent constipation. What should the nurse instruct the patient about this medication?
Standard Text: Select all that apply.
1. Do not take this medication with juice.
2. Avoid eating after taking this medication.
3. Take the medication with adequate water.
4. This medication can swell in the esophagus.
5. Limit the intake of water after taking this medication.
3: This medication must be taken with adequate water to ensure it reaches the stomach.
4: This medication can swell in the esophagus and cause an obstruction if not taken with adequate water.
An older patient with dementia has been medicated with sedatives. The healthcare provider now prescribes a lower dose of the sedative and the nursing staff is concerned that the patient will resume agitated behavior. What should be explained to the staff about the use of this medication?
- The patient’s condition warrants physical restraint only.
- The patient’s physical condition does not warrant use of the drug.
- The patient’s family members would be upset if they were aware of the use of chemical restraints.
- The use of psychotropic drugs may be considered excessive and harm the patient’s health.
4: The 1987, Omnibus Budget Reconciliation Act ruled on the appropriate use of medications in institutionalized older persons, especially as their use may constitute a chemical restraint. “Chemical restraints” may only be used to ensure the physical safety of older patients in emergency situations, but these medications have the potential to be used inappropriately to quiet a person or subdue certain behaviors in place of other nonpharmacologic measures. Overuse of psychotropic medications is of concern because of the chance of serious adverse events and syndromes associated with these medications.
During a home visit, the nurse learns that an older patient is taking herbal remedies in addition to prescribed medications. What should the nurse instruct the patient about this practice?
Standard Text: Select all that apply.
1. Some herbal remedies interact with medications.
2. Herbal remedies are natural products and do not harm the body.
3. Talk to the healthcare provider about the use of herbal remedies.
4. The Food and Drug Administration does not regulate herbal remedies.
5. For most herbal remedies, no studies have demonstrated effectiveness.
1: Herbs can interact with medications.
3: It is important for the patient to discuss the use of herbal remedies with prescribed medications with the healthcare provider.
4: The Food and Drug administration does not regulate herbal medicines, and these medicines may have different ingredients, purity, dosage, or potency.
5: For most herbal remedies, there have not been sufficient clinical trials to demonstrate their effectiveness or appropriate dosage.
It has been determined that nonpharmacological approaches will be used to help an older patient manage pain. What should the nurse explain as the reasons for using these approaches?
Standard Text: Select all that apply.
1. Nonpharmacological approaches can alleviate the pain.
2. Nonpharmacological approaches can delay the need for medication.
3. Nonpharmacological approaches can prevent the need for medication.
4. Nonpharmacological approaches can complement current medication therapy.
5. Nonpharmacological approaches do not cost the patient anything to use or implement.
1: Nonpharmacological treatments can alleviate the health condition.
2: Nonpharmacological approaches can delay the need for medication.
3: Nonpharmacological approaches can prevent the need for medication.
4: Nonpharmacological approaches have been used to complement drug therapy.
A prescribed medication is not producing the expected therapeutic effect in an older patient. What should the nurse do first in response to this finding?
- Document that the patient has not been taking the medication.
- Discuss changing the medication with the healthcare provider.
- Ask if the patient has enough money to buy food and medicine.
- Review the patient’s current diet to determine food-drug interactions.
3: If a medication is not demonstrating the expected therapeutic effect, the nurse should investigate if the patient is taking the medication at all because of cost. The patient may be embarrassed to share this information.
The nurse is preparing an educational program regarding adverse drug reactions (ADR). What information should the nurse include?
Standard Text: Select all that apply.
1. ARDs refer to harm from a therapeutic regime.
2. ADRs refer to drug side effects that are serious.
3. ARDs are injuries resulting from the use of a drug.
4. Almost 11% of hospital admissions of older adults are associated with ADRs.
5. ADRs can occur from drug-drug interactions and polypharmacy.
2: Adverse drug reaction is a term that refers to drug side effects that are serious.
4: Almost 11% of hospital admissions of older adults are associated with adverse drug reactions.
5: Older persons are more likely to have ADRs because of an inappropriate drug or dosing regimen, drug-drug interactions, polypharmacy, and non-adherence.
The nurse is instructing an older patient on ways to prevent esophageal irritation from taking medication. Which information should the nurse include in this teaching?
Standard Text: Select all that apply.
1. Drink at least 8 ounces of water with each pill.
2. Crush the pills to make them easier to swallow.
3. Take several sips of water before taking oral medications.
4. Sit up in a chair for at least 30 minutes after taking oral medications.
5. Report a dull aching pain in the chest or shoulder after taking medication to the physician.
1: One intervention to prevent esophageal irritation from taking medication is to drink at least 8 ounces of water with each pill.
3: One intervention to prevent esophageal irritation from taking medication is to take several sips of water before taking oral medications.
4: One intervention to prevent esophageal irritation from taking medication is to sit up in a chair for at least 30 minutes after taking oral medications.
5: One intervention to prevent esophageal irritation from taking medication is to report a dull aching pain in the chest or shoulder after taking medication to the physician.
An older patient has recently been put on high fall precaution after a new medication was started. The patient’s daughter questions why this precaution was put in place. How should the nurse respond to the daughter?
- “Every older patient is automatically put on high fall risk.”
- “The patient was recently started on an intravenous fluid infusion.”
- “The patient has an order to get out of bed. Anyone with this order is put on high fall risk.”
- “The patient was recently started on a medication for high blood pressure that could impact balance and cause a fall.”
4: Medications have been associated with the occurrence of falls and related injuries. Antihypertensives can cause hypotension, which can result in falls. This would indicate a need to place the patient on high fall risk.
The nurse is preparing an educational program about the use of over-the-counter (OTC) medications for residents of an assisted living community. What information should the nurse include in this program?
Standard Text: Select all that apply.
1. OTC medications can be used safely with alcohol.
2. OTC medications can safely be used with all herbal medications.
3. A person can accidentally overdose on medications containing acetaminophen.
4. The use of OTC drugs can result in increased out-of-pocket costs to patients since health insurance usually does not pay for OTC medication.
5. There is an increased risk of drug interactions with prescribed medications or overdose by the use of an OTC drug identical or similar to a prescribed drug.
3: A person could inadvertently experience an overdose when taking multiple medications with acetaminophen in them.
4: The use of OTC medications can result in increased out-of-pocket costs since health insurance usually does not pay for OTC medications.
5: The risk of drug interactions or an overdose is increased when OTC drugs are used that are identical or similar to a prescribed drug or another OTC medication.
The nurse is providing a psychotropic medication to an older patient. Which adverse effects of this medication might occur with this patient? Standard Text: Select all that apply. 1. Dystonia 2. Akathisia 3. Delusions 4. Tardive dyskinesia 5. Schizophreniform disorder
1: Dystonia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later.
2: Akathisia is an extrapyramidal symptom that can occur at any time from the first few days of treatment to years later.
4: Tardive dyskinesia is recurrent, involuntary movements that may be irreversible and is associated with antipsychotic medication.
The nurse is preparing an educational program regarding the appropriate use of antipsychotic medications in older patients. What information should the nurse include?
- Fidgeting is an appropriate indication for the use of antipsychotic medications.
- Use of antipsychotic medications would never be considered a chemical restraint.
- People prescribed antipsychotic drugs must have efforts to discontinue these drugs.
- Impaired memory is an appropriate indication for the use of antipsychotic medications.
3: There are many federal and state regulations regarding appropriate medication use in long-term care facilities. One such regulation states that residents who use antipsychotic drugs must receive gradual dose reductions, drug holidays, or behavioral programming unless clinically contraindicated, in an effort to discontinue the use of these drugs.
Which statement made by a nurse indicates a misunderstanding regarding the nurse’s role in medication management?
- “I am responsible for monitoring potassium level on a patient who is receiving a thiazide diuretic.”
- “I am responsible for documenting whether the therapeutic effect of a medication is being achieved.”
- “I am responsible for teaching a patient how to correctly store, prepare, and self-administer medications.”
- “I am responsible for a medication error if I administered the medication, not if I delegated that responsibility to an unlicensed person.”
4: Delegation of medication administration to an unlicensed person depends upon the state laws. Delegation does not remove responsibility of the nurse for assessing and monitoring the patient for therapeutic and adverse effects.
The nurse is instructing an older patient about medication management. What information should the nurse include?
Standard Text: Select all that apply.
1. Obtain all of your medications from the same pharmacy.
2. Request that medications be placed in childproof packages and caps.
3. Develop a method for remembering if medications have been taken, such as moving it to a different place.
4. Schedule medications at mealtimes or in conjunction with other specific activities unless contraindicated.
5. Establish a routine for taking medications, such as preparing medication for each day in different containers.
1: Encouraging patients to obtain all of their medications from the same pharmacy will help the pharmacist to monitor medication use.
3: One way to help older patients manage medications is to develop a method with the patient for remembering if the medication has been taken, such as moving it to another place.
4: One way to help older patients manage medications is to schedule medications at mealtime or in conjunction with other specific daily activities.
5: One way to help older patients manage medications is to establish a routine for taking medications, such as preparing medications for the day in different containers.
Which nursing action indicates that medication reconciliation for an older patient is incomplete?
- Medications prescribed by physicians were the focus.
- Medications were identified, verified, and compared with the physician’s orders.
- All medications, including herbal or mineral supplements and vitamins, were reviewed.
- Medication reconciliation occurred when the patient was transferred to another care area.
1: Medication reconciliation is a process that involves verification of all medications, including herbal or mineral supplements and vitamins that a patient takes, not just medication prescribed by a physician.
The nurse has completed an educational program for residents of a retirement community regarding unsafe medication practices. Which statement made by a resident indicates the need for further education?
- “I will not take medication that is more than 1 year old.”
- “I will buy all of my medication from the same pharmacy.”
- “I will not take medication that has been prescribed for someone else.”
- “Medication can be obtained from an Internet pharmacy, as long as it says the medication was made in the United States or Canada.”
4: The use of medication imported from or obtained in another country is controversial and is considered illegal. Quality standards for drugs approved for use in other countries may not be a stringent as in the United States. Claims for where the medication was made are not always true. Medications should only be obtained from pharmacies licensed in the United States.
The home care nurse is reviewing the medications that an older patient is currently taking. Which guidelines should the nurse follow when conducting this review?
Standard Text: Select all that apply.
1. Review the patient’s allergies.
2. Review the drug for number of refills.
3. Review the drugs for duplicate therapy.
4. Review the patient’s medical conditions.
5. Review each drug for interactions with other drugs.
1: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing the patient’s allergies.
3: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing the drugs for duplicate therapy.
4: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing the patient’s medical conditions.
5: When assessing an older patient’s appropriate use of medications, the nurse should follow the guideline of reviewing each drug for interactions with other drugs.
An older patient who is repeatedly admitted to the hospital tells the nurse it is because of the inability to purchase prescribed medications. What should the nurse respond to the patient?
- “Do you not have insurance?”
- “I’m not surprised that you can’t afford them. You are on a lot of medications.”
- “There are ways to reduce the cost of medications, such as using Medicare Part D.”
- “I will contact our social services department so the hospital will provide your medications.”
3: Medicare Part D prescription drug coverage has assisted many with drug costs.
Which assessment finding places an older patient at the greatest risk factor for the development of Alzheimer’s disease?
- Age
- Genetic predisposition
- Environmental exposure
- History of previous head injury
1: Advanced age is the single greatest factor for the development of Alzheimer’s disease.
Which treatment should the nurse prepare to provide to an older patient diagnosed with progressive dementia?
- None
- Vitamin E
- Estrogen therapy
- Gingko biloba extract
1: There is no cure available at the present time for dementia. Treatments are directed at improving function and slowing the progression of the disease.
An older patient newly diagnosed with Alzheimer’s disease is prescribed galantamine (Razadyne). How will the nurse instruct the patient about this medication?
Standard Text: Select all that apply.
1. Take at bedtime.
2. Take the medication with food.
3. The dosage may be changed every 4 weeks.
4. Side effects of this medication are minimal.
5. Do not take the medication with an NSAID.
2: This medication can cause gastrointestinal upset and should be taken with food.
3: This medication is titrated at 4-week intervals. The dosage may be changed every 4 weeks.
5: This medication should be used with caution if also prescribed NSAIDs since this could increase the risk of gastrointestinal bleeding.
An older patient is diagnosed with dementia caused by Lewy bodies. What will the nurse most likely assess in this patient? Standard Text: Select all that apply. 1. Tremor 2. Rigidity 3. Postural instability 4. Personality changes 5. Visual hallucinations
1: Clinical symptoms of dementia caused by Lewy bodies include a tremor.
2: Clinical symptoms of dementia caused by Lewy bodies include rigidity.
3: Clinical symptoms of dementia caused by Lewy bodies include postural instability.
5: Clinical symptoms of dementia caused by Lewy bodies include visual hallucinations.
An older patient is diagnosed with early-mild Alzheimer’s disease. Which should be done at the time of diagnosis?
- Discuss treatment options and wishes with the patient.
- Identify a long-term care facility for immediate transfer.
- Explain that this stage of the disorder can last up to 10 years.
- Instruct family members to slowly improve the home environment for safety.
1: Early diagnosis provides the family and the older person with the opportunity to discuss treatment options and wishes while the older person still has decision-making capacity.
An older patient is being evaluated for dementia. What manifestations need to be present to diagnose this disorder?
Standard Text: Select all that apply.
1. Intermittent forgetfulness
2. Inability to manage finances
3. Misplacing personal belongings
4. Repetitive questions or conversations
5. Difficulty thinking of common words while speaking
2: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Inability to manage finances indicates impaired reasoning and handling of complex tasks.
3: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Misplacing personal belongings indicates impaired ability to acquire and remember new information.
4: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Repetitive questions or conversations indicate impaired ability to acquire and remember new information.
5: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Difficulty thinking of common words while speaking indicates impaired language functions.
An older patient with Alzheimer’s disease is demonstrating agnosia. Which intervention would be important to include in this patient’s plan of care?
- List choices for the patient to select.
- Provide deadlines for self-care activities.
- Refrain from providing verbal instructions.
- Remove inedible items from the environment.
4: Agnosia is the inability to recognize objects and causes functional impairment and predisposes the patient to safety hazards such as eating inedible objects.
What should the nurse teach the family of an older patient with Alzheimer’s disease to help with spatial disorientation?
Standard Text: Select all that apply.
1. Use color to contrast objects and items.
2. Keep furniture in the same familiar place.
3. Fill the patient’s room with memorabilia.
4. Remove cues for exiting the home away from the doors.
5. Place family photos or recognizable familiar items in a prominent spot.
1: The use of color to contrast objects and items is a form of a pop-up cue and helps with spatial disorientation.
2: Keeping furniture in the same familiar place provides landmarks and helps with spatial disorientation.
5: Placing family photos or familiar items in a prominent spot provides landmarks and helps with spatial disorientation.
An older patient with Alzheimer’s disease has wandered away from the home several times. What can the nurse suggest that the spouse do to reduce the patient’s risk for wandering?
Standard Text: Select all that apply.
1. Place car keys on a rack by the front door.
2. Install motion detectors on the door of the patient’s room.
3. Remove scatter rugs from the kitchen and bathroom areas.
4. Add slide bolt locks at the bottom of exit doors in the home.
5. Place emergency telephone numbers on the refrigerator door.
2: Installing motion detectors on the door of the patient’s room would alert family members that the patient is mobile and could potentially wander from the home.
4: Adding slide bolt locks at the bottom of exit doors in the home provides a mechanical barrier to prevent the patient from wandering.
After a neurologic assessment, the nurse determines that an older patient is exhibiting normal signs of aging. What did the nurse assess in this patient? Standard Text: Select all that apply. 1. Slow movements 2. Intermittent hand tremor 3. Ataxia with position changes 4. Decreased sensation in the feet 5. Slight impairment of coordination
1: Slower movements are a normal neurologic sign of aging.
2: Intermittent hand tremor is a normal neurologic sign of aging.
4: Decreased sensation in the feet is a normal neurologic sign of aging.
5: Slight impairment of coordination is a normal neurologic sign of aging.
The nurse instructs an older patient with Parkinson’s disease about carbidopa-levodopa (Sinemet). Which patient statement indicates that teaching has been effective?
- “I will take the medication with my meals.”
- “I will sit up on the side of the bed before standing.”
- “This medication will cure my Parkinson’s disease in time.”
- “This medication will not affect my blood pressure medications.”
2: The older person may experience postural hypotension. The nurse needs to teach strategies to prevent falling, such as sitting on the side of the bed before standing.
The nurse suspects that an older patient is experiencing Parkinson's disease. What did the nurse observe in this patient? Standard Text: Select all that apply. 1. Chorea 2. Tremor 3. Apraxia 4. Agnosia 5. Dystonia
1: Chorea is involuntary twitching of the limbs or facial muscles which is an extrapyramidal manifestation of Parkinson’s disease.
2: A tremor is an extrapyramidal manifestation of Parkinson’s disease.
5: Dystonia is involuntary muscle contractions forcing unusual or painful positions and is an extrapyramidal manifestation of Parkinson’s disease.
The nurse is preparing an educational session on stroke prevention for a group of senior citizens. What information would be important for the nurse to provide to these participants?
Standard Text: Select all that apply.
1. Stop smoking.
2. Limit exercise to once a week.
3. Maintain a healthy body weight.
4. Follow a low-sodium diet as prescribed.
5. Take blood pressure medication as prescribed.
1: Healthy aging tips for stroke prevention include smoking cessation.
3: Healthy aging tips for stroke prevention include losing weight if overweight.
4: Healthy aging tips for stroke prevention include ingesting below 2 to 3 grams of sodium each day.
5: Healthy aging tips for stroke prevention include reducing blood pressure to at least 140/90 mm Hg.
An older patient begins to experience status epilepticus. Which action will the nurse take to help this patient?
- Measure vital signs.
- Orient the patient between seizures.
- Prevent chilling with warmed bed linens.
- Ensure an intravenous access line is available.
4: Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient.
The nurse suspects an older patient is having a grand mal seizure. What did the nurse observe in the patient?
- Rhythmic jerking of the muscles
- Rigid extremities lasting for several minutes
- Brief loss of attention similar to daydreaming
- Rigid extremities followed by rhythmic flexion
4: A period of rigidity followed by rhythmic jerking or flexion of the extremities is characteristic of grand mal seizures.
