Which issue related to antibiotic use is an increased risk for older adults Quizlet

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  • Which issue related to antibiotic use is an increased risk for older adults?
  • Which effect has resulted in the avoidance of tetracycline use in children under 8 years old?
  • Which client would require the administration of prophylactic antibiotics?

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Terms in this set (28)

The nurse caring for older patients in an acute care facility is aware of the changes in drug metabolism that can occur in older adults. Which statement explains the most important factor that affects pharmacokinetics in older patients?
A)
Changes in gastrointestinal (GI) motility increase the absorption time for many drugs.
B)
Drug distribution is unpredictable due to metabolic and body-composition factors.
C)
Preexisting chronic conditions complicate the distribution and metabolism of drugs.
D)
Decreased renal and liver function contributes to an increased half-life for many drugs.

D

Feedback:

Changes in renal and liver function contribute significantly to the changes in pharmacokinetics that are common in older adults. While changes in GI motility, drug distribution, and preexisting conditions may be true for many patients, these factors are inconsistent.

The nurse at a long-term care facility is teaching unlicensed care providers about some of the factors that characterize adverse drug reactions in the elderly residents. Which teaching points are valid? (Select all that apply.)
A)
"Even when a resident stops taking a drug, a reaction can take place after the fact."
B)
"Even when a resident has been taking a drug for a long time, a drug reaction can still occur."
C)
"Most 'drug reactions' are in fact age-related changes that are mistakenly attributed to medications."
D)
"Older adults often have signs and symptoms of adverse reactions that are very different from those of younger adults."
E)
"While older adults are prone to adverse reactions, these reactions tend to resolve more quickly than in younger people."

A, B, D

Feedback:

An adverse reaction to a drug may be demonstrated even after the drug has been discontinued. Adverse reactions can develop suddenly even with a drug that has been used over a long period of time without problems. The signs and symptoms of an adverse reaction to a given drug may differ in older persons. Most drug reactions are not age-related changes. Adverse drug reactions do not resolve more quickly in older patients than in younger people.

While reviewing a newly admitted older patient's medication history the nurse notes that the patient has been taking a β-blocker for many years despite no apparent history of hypertension or cardiac disease. What action should the nurse first take?
A)
Hold the drug in the short term until an indication is determined
B)
Monitor the patient's blood pressure and apical heart rate closely
C)
Request that the physician providing care reconsider the use of the drug
D)
Investigate and provide non-pharmacologic measures to replace the drug

C

Feedback:

In the effort to minimize polypharmacy in older adults, it is important to determine whether a drug is really needed. It would be prudent for the nurse to raise the issue with the physician responsible for the patient's medications in the hospital setting. Close BP and HR monitoring is likely not necessary and it would be inappropriate for the nurse to independently replace or hold the drug.

When administering a proton pump inhibitor to a patient with gastroesophageal reflux disease (GERD), the nurse notes that the patient has great difficulty swallowing the enteric-coated pill. What should the nurse do when administering this medication to the patient in the future?
A)
Crush the pill and mix with applesauce
B)
Split the pill in two parts and give each separately
C)
Reposition the patient and provide more fluid when giving the pill
D)
Provide an herbal alternative that also reduces stomach acid production

C

Feedback:

Since enteric-coated pills should not be crushed or split, the nurse's best alternative is to reposition the patient and provide more fluid to aid with swallowing. It would be inappropriate to provide a nonpharmacologic alternative to the prescribed medication.

The nurse is performing a home visit to an older female patient who has a history of obesity and poorly controlled hypertension. Which assessment finding would be of concern to the nurse?
A)
The patient has increased the intake of green tea to obtain more antioxidants.
B)
The patient has begun taking low-dose ASA for the prevention of cardiac disease.
C)
The patient takes insulin injections three times daily for the treatment of type 1 diabetes.
D)
The patient has started taking ginseng and St. John's wort for stamina and concentration.

D

Feedback:

Ginseng and St. John's wort can exacerbate hypertension. Green tea, low-dose aspirin, and insulin will not affect the patient's blood pressure.

An older patient with a history of arthritis has fallen after an episode of dizziness. Laboratory data reveal anemia and stool positive for occult blood. Which assessment question is the most appropriate for the patient's health situation?
A)
"Do you take any medication for high blood pressure?"
B)
"What herbal remedies or supplements do you use regularly?"
C)
"Do you take aspirin for the treatment of pain or inflammation?"
D)
"Does your family doctor ask you to get regularly scheduled blood work?"

C

Feedback:

Anemia and stool positive for occult blood could indicate the presence of gastrointestinal (GI) bleeding. Since aspirin is commonly implicated in episodes of GI bleeding this question would be the best to ask the patient at this time. The other questions may or may not relate to the patient's condition and are less likely to be related to anemia and blood in the stool.

A resident of a long-term care facility has been experiencing pain associated with sciatica, a health problem that has not previously been present. Which intervention should the nurse implement first to help control this patient's pain?
A)
Provide morphine or codeine
B)
Prepare a dose of acetaminophen
C)
Implement nonpharmacologic measures
D)
Administer fentanyl or sustained-release oxycodone

C

Feedback:

Nursing guidelines for older adults with pain include exploring nonpharmacologic means to manage pain first. If nonpharmacologic measures are unsuccessful, begin with the weakest type and dose of analgesic and gradually increase so that the patient's response can be evaluated. Morphine, codeine, fentanyl, and oxycodone should be used carefully in the older patient.

An older patient with Alzheimer's disease is experiencing increasing episodes of agitation and wandering. The patient has been prescribed risperidone (Risperdal), an atypical antipsychotic. Why should the nurse question this medication order?
A)
Physical restraints should be trialed before using an antipsychotic medication
B)
It is inappropriate to use antipsychotics to manage the behavior of patients with dementia
C)
The sensory changes that accompany antipsychotic use exacerbate the symptoms of dementia
D)
Atypical antipsychotics are preferable to traditional sedatives for the treatment of agitation and delirium

B

Feedback:

Atypical antipsychotics should not be used for the treatment of dementia-related behavioral disturbances. They do not exacerbate the symptoms of dementia but rather increase the risk of cerebrovascular adverse events and mortality. The use of physical restraints may or may not be indicated for this patient.

An older patient is prescribed a diuretic for the treatment of hypertension. For which health problem should the nurse assess this patient?
A)
Constipation
B)
Cognitive changes
C)
Decreased gastric emptying and nausea
D)
Manifestations of fluid and electrolyte imbalances

D

Feedback:

Electrolyte imbalances are a common adverse effect of diuretic use. Constipation, cognitive changes, decreased gastric emptying, and nausea are not common adverse effects of diuretic use.

During the admission interview, the nurse learns that an older patient frequently experiences constipation. What should the nurse respond to the patient?
A)
"I'll make sure that a laxative is ordered for you while you're here in the hospital."
B)
"Many older adults find that increasing their activity level and taking a mild laxative daily provides relief."
C)
"Constipation is usually a sign of a more serious health problem, so I'll pass that information on to your physician."
D)
"There are measures that I can teach you such as changing your diet and increasing the amount of fluids you drink."

D

Feedback:

Nonpharmacologic measures for treating and preventing constipation are preferable to laxatives. Constipation is a common problem among older adults and is related to several lifestyle and age-related factors; it is not necessarily a sign of a more serious illness.

An older female patient believes taking high doses of vitamin A will help preserve her eyesight. What information about vitamin A should the nurse include when responding to the patient?
A)
The vitamin can build up too high in the blood.
B)
Taking too much vitamin A can lead to dehydration.
C)
The vitamin can be displaced at protein-binding sites.
D)
The vitamin can build up too high in the adipose tissues.

D

Feedback:

In the elderly, especially women, adipose tissue increases compared with lean body mass. Drugs stored in adipose tissue, such as lipid-soluble vitamins like vitamin A, will have increased tissue concentrations and longer duration in the body. Vitamin A is not highly protein bound, will not be stored in the blood, and does not lead to dehydration.

Barbiturates were given to an older man with reduced kidney function, and he nearly died as a result. What was the most likely reason for this near-fatality?
A)
Increased drug dosage
B)
Increased kidney filtration
C)
Increased biological half-life of the drug
D)
Increased reabsorption of the drugs into the blood

C

Feedback:

When kidney function is reduced, the biological half-life can increase as much as 40% and increase the risk of adverse drug reactions. Reabsorption into the blood and kidney filtration is decreased in this patient, and there is no reason to think the dosage was increased.

Which action should the emergency department staff take first for an older patient who is demonstrating extreme confusion?
A)
Order an ECG
B)
Administer a stimulant
C)
Review the drugs being taken
D)
Check serum electrolyte levels

C

Feedback:

The risk of adverse reactions to drugs is so high in older people that some health care providers suggest that any symptom in an older adult be suspected as being related to a drug until proven otherwise. If the patient or an accompanying person knows what drugs are being taken and the dosages, the cause of the dysfunction may be immediately apparent. No stimulant should be given until that information is available, as it might cause an interaction with adverse results. Serum electrolyte levels and an ECG may be needed but only after the drug information is known.

An older patient is prescribed a large calcium tablet every day but objects because it is difficult to swallow it without choking. What action should the nurse take in this situation?
A)
Substitute a glass of milk for the tablet
B)
Ask the physician if it can be discontinued
C)
Find the most concentrated form of the same dose
D)
Ask the patient to swallow the tablet along with food or drink

C

Feedback:

Calcium is needed by any elderly person, and in greater amounts than provided by a glass of milk. Also, many people are lactose intolerant. Tablets from various sources differ in size and shape, making some easier to swallow than others. Taking a tablet with food and perhaps even crushing it if the tablet is not coated, may help somewhat, but a smaller tablet is the easiest solution. Discontinuing the supplement is not a viable option.

An older patient has difficulty swallowing oral medicines and sometimes spits them out after the nurse leaves the hospital room. Which action should the nurse take to ensure the patient swallows the medications?
A)
Crushing any large or enteric-coated tablets
B)
Prescribing liquid or suppository forms of the medicines
C)
Giving the patient ample fluids to make swallowing easier
D)
Having the patient hold the medicine in the mouth until being able to swallow

C

Feedback:

Ample fluids assist with swallowing. The nurse may consult with the patient's health care provider about alternative forms of the drug but cannot prescribe drugs. If the patient's mouth is dry, the patient may not need to swallow for a long time, and some medicines will disintegrate in the mouth and cause an unpleasant taste unless they are swallowed immediately. Enteric-coated tablets should not be crushed.

Why does the nurse take special precautions when administering a rectal suppository to an older patient?
A)
Circulation to the bowel is increased
B)
The time for melting may be prolonged
C)
Fecal impaction is likely and will interfere
D)
The patient may try to expel it before it melts

B

Feedback:

Circulation to the bowel is decreased, and the body temperature is lower in many elderly patients. This tends to lengthen the time needed for a suppository to melt. Fecal impaction and patient resistance may be problems regardless of the patient's age.

The nurse learns that an older patient uses antacids after every meal to treat chronic "indigestion." For which health problems should the nurse assess in this patient?
A)
Urinary incontinence or retention
B)
Coagulation disorders and anemia
C)
Hyperlipidemia and arteriosclerosis
D)
Electrolyte imbalances and cardiac problems

D

Feedback:

Ongoing antacid use and complaints of indigestion can indicate cardiac problems and cause electrolyte imbalances due to the composition of common antacids. Urinary incontinence, urinary retention, coagulation disorders, anemia, hyperlipidemia, and arteriosclerosis are not associated with the chronic use of antacids.

For many years, an older female patient has taken 1 mg of the benzodiazepine lorazepam at bedtime and with episodes of anxiety. What should the nurse respond to learning of this information?
A)
"Have you been diagnosed with generalized anxiety disorder?"
B)
"Have you considered other methods beyond medication to help you sleep and relieve your anxiety?"
C)
"This drug can lead to problems with coordination that mimic Parkinson disease, so it's best to minimize its use."
D)
"Drugs like this have been shown to be inappropriate and ineffective; it would be useful for you to discuss this fact with your doctor."

B

Feedback:

It is important to discuss alternatives, both pharmacologic and nonpharmacologic, to benzodiazepine use with older adults. The patient's pattern of use does not necessarily indicate a diagnosis of generalized anxiety disorder and the nurse should not be making this decision. Benzodiazepines are not known to have a Parkinsonian effect and they are not necessarily inappropriate or ineffective.

Which statement about antibiotic use will the nurse use as a guide when assessing an older patient's use of this type of medication?
A)
Antibiotics are best delivered intravenously rather than orally for older adults.
B)
Excessive antibiotic use contributes to the spread of antibiotic-resistant bacteria.
C)
Older adults need higher antibiotic doses to compensate for decreased immune function.
D)
Long-term use of low-dose antibiotics provides protection against infections for older adults.

B

Feedback:

Excessive use of antibiotics has contributed to the emergence and spread of antibiotic-resistant bacteria. Prophylactic antibiotic use is not normally warranted and older adults require neither higher doses nor different routes of administration.

An older female patient with a history of deep vein thrombosis is prescribed daily anticoagulant therapy. Which foods should the nurse instruct the patient to monitor to ensure the effectiveness of the medication regimen?
A)
Foods high in saturated fat such as bacon and butter
B)
Foods high in salt and nitrates such as processed meat
C)
Foods high in complex carbohydrates such as bread and rice
D)
Foods high in vitamin K such as asparagus and green leafy vegetables

D

Feedback:

Foods high in vitamin K can induce clotting and minimize the effectiveness of anticoagulant medications. Foods high in saturated fat, salt, nitrates, and complex carbohydrates do not interact with anticoagulant medication.

The nurse caring for residents in a long-term care facility administers numerous antidepressant medications each day. For which residents should the nurse investigate a possible change in treatment?
A)
A 90-year-old resident prescribed a monoamine oxidase inhibitor (MAOI) since the death of his wife
B)
An 81-year-old resident who is responding to cognitive therapy for the treatment of her grief and depression
C)
An 89-year-old resident who takes citalopram, a selective serotonin reuptake inhibitor, for the treatment of depression
D)
A 91-year-old resident who has been taking a tricyclic antidepressant since the onset of his physical decline several years prior

D

Feedback:

Tricyclic antidepressants are noted to have numerous side effects that pose a threat to older adults, including anticholinergic effects, orthostatic hypotension, and arrhythmias. The other antidepressant medications have a lower risk of complications and side effects.

An older patient has been prescribed a potassium-sparing diuretic and a β-blocker for hypertension. Which action should be a priority for the nurse?
A)
Monitor the patient for constipation
B)
Closely monitor the patient's electrolyte levels
C)
Ensure the patient does not change position quickly to prevent a fall
D)
Assess the patient for changes in level of consciousness and cognition

C

Feedback:

Antihypertensive therapy, especially when first initiated or changed, carries a risk of orthostatic hypotension and subsequent falls. Although electrolytes would be monitored, the potassium-sparing nature of the diuretic makes this less urgent than ensuring safety. Cognitive changes and constipation are less likely side effects of diuretic and β-blocker therapy.

An older patient with a history of atrial fibrillation is prescribed digoxin 62.5 μg daily. For which assessment finding should the nurse hold the medication and reassess the patient later?
A)
Blood pressure is 98/55 mm Hg
B)
Heart rate is 60 beats per minute
C)
Demonstrating agitation and delirium
D)
Oxygen saturation level is 90% by pulse oximeter

C

Feedback:

Agitation and delirium are manifestations of digitalis toxicity. The medication should be withheld and the health care provider notified of the patient's manifestations. A low blood pressure is not typically associated with digoxin. An oxygen saturation level of 90% is within normal limits. A heart rate of 60 beats per minute is typically the lowest acceptable range for administering the medication.

The nurse is caring for an older patient with a history of chronic obstructive pulmonary disease (COPD). Which medications could cause adverse reactions in this patient? (Select all that apply.)
A)
Aspirin
B)
NSAIDs
C)
Bupropion
D)
β-Blockers
E)
Long-acting benzodiazepines

D, E

Feedback:

A high potential for adverse reactions exists in patients with COPD when taking long-acting benzodiazepines and β-blockers. A high potential for adverse reactions does not exist in patients with COPD when taking aspirin, NSAIDs, or bupropion.

After completing an assessment the nurse determines that an older patient is at risk for medication errors. What did the nurse most likely assess in this patient? (Select all that apply.)
A)
Weak hands
B)
Hearing deficit
C)
Use of laxatives
D)
Limited finances
E)
Walks with a cane

A, B, D

Feedback:

Risk factors for medication errors include hearing deficits, weak hands, and limited finances. Use of laxatives and walking with a cane do not increase an older patient's risk of medication errors.

After completing a medication history the nurse is concerned that an older patient is at risk for drug toxicity. What did the nurse most likely assess in this patient? (Select all that apply.)
A)
Takes medication for glaucoma
B)
Experiences transient dizziness after taking anticonvulsant medication
C)
Has blood work done every 3 months to check anticonvulsant drug levels
D)
Takes digoxin for a cardiac dysrhythmia and carbamazepine for seizures once a day
E)
Takes prescribed gabapentin for peripheral neuropathy with grapefruit juice every day

D, E

Feedback:

Anticonvulsant and digitalis preparations taken concurrently significantly increase the risk of toxicity from both drugs. Grapefruit increases the risk of toxicity when taken with an anticonvulsant medication. Medication for glaucoma does not increase the patient's risk of toxicity. Transient dizziness does not indicate toxicity. Having blood work done every 3 months would help reduce the risk of toxicity.

An older patient is prescribed nicotinic acid to correct cholesterol imbalances. For which side effects of this medication should the nurse instruct the patient? (Select all that apply.)
A)
Gas
B)
Itching
C)
Tingling
D)
Flushing
E)
Muscle pain

B, C, D

Feedback:

The nurse should instruct the patient about the main side effects of nicotinic acid as being flushing, itching, and tingling. Gas is a side effect of bile acid resins. Muscle pain is a side effect of statins and should be reported immediately to the health care provider.

An older patient admitted to the hospital with renal failure is overheard asking his family to bring in the bag of red licorice from the kitchen. The nurse is concerned because licorice can cause which adverse effects? (Select all that apply.)
A)
Edema
B)
Bradycardia
C)
Hypokalemia
D)
Hypertension
E)
Hypernatremia

A, C, D, E

Feedback:

Potential adverse effects from licorice include edema, hypertension, hypokalemia, and hypernatremia. These adverse effects could be detrimental to the patient with renal failure. Licorice is not known to cause bradycardia.

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Which issue related to antibiotic use is an increased risk for older adults?

Which effect has resulted in the avoidance of tetracycline use in children under 8 years old?

Which client would require the administration of prophylactic antibiotics?