Pharm Chapter 6: Geriatric Considerations & NCLEX Study Questions

Nursing action for taking too many drugs at different times (barrier to effective drug use): - answer-Develop a chart indicating times to take drugs. Provide a space to place a mark for each drug taken. Coordinate the drug regimen with ADLs and events. Use an organizer container (daily or weekly). Have patient bring all drugs-including OTC, herbal, vitamin, and mineral supplements-to all health appointments Nursing action for visual and hearing disturbances (barrier to effective drug use): - answer-suggest eye and ear examinations (glasses or hearing aids) Older adults can have normal ______ _______ _____ results and still have impaired hepatic enzyme activity. - answer-liver function test (LFT) Older adults have a ____ to ____ reduction in total body water which affects water soluble drugs. - answer-10% to 15% Older adults have a _____% decrease in albumin. - answer-10 Pharmacodynamic geriatric considerations: - answer--age-related changes in central nervous system & cardiovascular system -changes in the number of drug receptors -changes in the sensitivity of receptors to drugs -compensatory response to physiological changes is decreased Physiological changes in older adults: - answer--reduction in total body water & lean body mass -reduction in kidney mass and function -reduction in liver mass and function -reduction in physiological processes that maintain equilibrium Polypharamcy: - answer-the use of more medication than is medically necessary. Reduced albumin levels can result in: - answer-decreased protein binding of drugs and increased free drug available to exert therapeutic effects -also increases the risk for drug toxicity Renal excretion of drugs ______ with age. - answer-decreases The increase in body fat means: - answer-lipid-soluble drugs have a greater volume of distribution, increased drug storage, reduce elimination, and a prolonged period of action. The nurse is developing teaching materials for an 82-year-old African-American man with macular degeneration, who is being discharged on two new drugs. Which strategies would be best to use to impart the information? (Select all that apply) a. Limit distractions in the room when teaching b. Wait until discharge to teach so information is fresh in the memory c. Augment teaching with audio material d. Use "honey" and other terms of familiarity to promote trust e. Use large, dark print on a light background for written material - answer-a. Limit distractions in the room when teaching c. Augment teaching with audio material e. Use large, dark print on a light background for written material The nurse is reviewing a patient's list of drugs. The nurse understands that the older adult's slower absorption or oral drugs is primarily because of which phenomenon? a. Decreased cardiac output b. Increased gastric emptying time c. Decreased gastric blood flow d. Increased gastric acid secretion - answer-c. Decreased gastric blood flow The older adult patient has questions about oral drug metabolism. Information on what subject is most important to include in this patient's teaching plan? a. First-pass effect b. Enzyme function c. Glomerular filtration rate d. Motility - answer-a. First-pass effect To assess liver function, _______ ______ must be checked - answer-liver enzymes What changes with aging alter drug distribution? (Select all that apply): a. An increase in muscle mass and a decrease in fat b. A. decrease in muscle mass and an increase in fat c. A decrease in serum albumin d. An increase in total body water e. A decrease in kidney mass - answer-b. A. decrease in muscle mass and an increase in fat c. A decrease in serum albumin e. A decrease in kidney mass What factors contribute to polypharmacy in the elderly? (Select all that apply) a. Multiple health care providers b. Multiple chronic disease c. Use of a single pharmacy d. Care coordination by a nurse e. Few hospitalizations - answer-a. Multiple health care providers b. Multiple chronic disease What is the best measure for the nurse to use to determine a patient's kidney function? a. Creatinine clearance b. Estimated glomerular filtration c. Serum creatinine level d. Blood urea nitrogen level - answer-b. Estimated glomerular filtration With aging, adults experience a decline in muscle mass and a ______ to _____ increase in fat. - answer-20%-40%