TG Chapter15

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1. When administering a proton pump inhibitor to a client with gastroesophageal

reflux disease (GERD), the nurse notes that the client has great difficulty
swallowing the enteric-coated pill. Which action would be most appropriate for
the nurse to do when administering this medication to the client 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 client and provide more fluid when giving the pill
D. Request an alternative medication from the prescriber
Answer: C
Rationale: Because enteric-coated pills should not be crushed or split, the

nurse's best alternative is to reposition the client and provide more fluid to aid
with swallowing. It would be inappropriate to provide a nonpharmacological
alternative to the prescribed medication.
Question format: Multiple Choice
Chapter 15: Safe Medication Use
G R A D E S B O O S T . C O M
Cognitive Level: Apply

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Caring
Reference: p. 211
2. A gerontological nurse is caring for an older adult client receiving various

medications in an acute care facility. Which will the nurse use to evaluate the
appropriateness of a medication prescription?
A. changes in gastrointestinal (GI) motility
B. body-composition factors
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C. preexisting chronic conditions
D. renal and liver function
Answer: D
Rationale: Changes in renal and liver function contribute significantly to the

changes in pharmacokinetics that are common in older adults. Consequently,
drugs can accumulate to toxic levels and cause serious adverse reactions. While
changes in GI motility, drug distribution, and preexisting conditions may be true
for many clients, these factors are inconsistent.
Integrated Process: Nursing Process
Reference: p. 207-208
3. An older adult client recently prescribed a diuretic is experiencing an irregular

heartbeat. What action(s) will the nurse take? Select all that apply.
A. Encourage intake of foods low in calcium.
B. Instruct the client on the use of magnesium replacement supplements.
C. Place the client on a cardiac monitor.
D. Administer IV fluids.
E. Limit oral fluids.
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Answer: B, C, D
Rationale: Electrolyte imbalances are a common adverse effect of diuretic use.

Hypomagnesemia is often associated with increased renal losses of magnesium
(for example, use of diuretics). The nurse will administer fluids, place the client
on cardiac monitor, monitor fluid intake and output and instruct the client on the
use of magnesium supplements. Oral fluids would be encouraged. Hypercalcemia
is not associated with the use of diuretics.
Question format: Multiple Select
Reference: p. 222
4. A nurse at a long-term care facility is teaching a group of unlicensed assistive

personnel about medications and their use in older adults. Which information
would the nurse include when characterizing adverse drug reactions? Select all
that apply.
A. "Even when a client stops taking a drug, a reaction can take place after the
fact."
B. "Even when a client 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 can have signs and symptoms of adverse reactions that are
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different from those of other older adults."
E. "While older adults are prone to adverse reactions, these reactions tend to
resolve more quickly than in younger people."
Answer: A, B, D
Rationale: The risk of adverse drug reactions is so high in older adults that
nurses should assess for complications with every assessment. 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 adults. Most drug
reactions are not age-related changes. Adverse drug reactions do not resolve
more quickly in older clients than in younger people.
Reference: p. 208
5. A nurse is reviewing the medication history of a newly admitted older adult

client. The nurse notes that the client has been taking a beta-blocker for many
years despite no apparent history of hypertension or cardiac disease. Which
action would the nurse take?
A. Hold the drug in the short term until an indication is determined

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B. Monitor the client's blood pressure and apical heart rate closely
C. Request that the health care provider reconsider the use of the drug
D. Investigate and provide non-pharmacological measures to replace the drug
Answer: C
Rationale: In the effort to minimize polypharmacy in older adults, it is important

to determine whether a drug is truly needed. It would be prudent for the nurse
to raise the issue with the health care provider responsible for the client's
medications in the hospital setting. Close monitoring of blood pressure and heart
rate monitoring is likely not necessary and it would be inappropriate for the
nurse to independently replace or hol219d the drug.
Reference: p. 219
6. An older client 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 would be most appropriate for the nurse to ask to
ascertain the client'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?"
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D. "Does your family doctor ask you to get regularly scheduled blood work?"
Answer: C
Rationale: 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 client at this
time. Asking about the use of herbal medications, antihypertensives, or regularly
scheduled blood work may or may not relate to the client's condition but are less
likely to be related to anemia and blood in the stool.
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 205
7. A client of a long-term care facility has been experiencing pain associated with
sciatica, a newly developed health problem. Which intervention would be most
appropriate for the nurse to implement first?
A. Administer morphine or codeine
B. Prepare a dose of acetaminophen
C. Implement warm soaks to the painful areas
D. Give fentanyl or sustained-release oxycodone
Answer: C

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Rationale: Nursing guidelines for older adults with pain include exploring non-
pharmacological means to manage pain first, such as warm soaks, relaxation, or
massage. If non-pharmacological measures are unsuccessful, pain control should
begin with the weakest type and dose of analgesic and gradually increased so
that the client's response can be evaluated. Morphine, codeine, fentanyl, and
oxycodone should be used carefully in the older client.
Client Needs: Physiological Integrity: Basic Care and Comfort
Reference: p. 215
8. An older client with dementia is experiencing increasing episodes of agitation

and wandering. The client has been prescribed risperidone (Risperdal), an
atypical antipsychotic. The nurse notifies the practitioner about the order based
on which reasoning?
A. Physical restraints should be trialed before using an antipsychotic medication
B. Using atypical antipsychotics to manage the behavior of clients with dementia

is inappropriate
C. The sensory changes that accompany antipsychotic use can exacerbate the
symptoms of dementia
D. Typical antipsychotics are preferable to traditional sedatives for the treatment
of agitation and delirium
Answer: B
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Rationale: Atypical antipsychotics have been found to have their own set of side
effects that are of concern in geriatric care, such as postural hypotension,
sedation, and falls. The FDA has determined that the treatment of behavioral
disorders in older patients with dementia with atypical or second-generation
antipsychotic medications is associated with increased cerebrovascular adverse
events and mortality and issued a black box warning for these drugs. These
drugs should only be used for the treatment of schizophrenia and not for
behavioral disturbances associated with dementias. Atypical antipsychotics were
viewed as having a lower risk of adverse effects and greater tolerability, thus the
atypical antipsychotics have largely replaced the conventional/typical agents.
The use of physical restraints may or may not be indicated for this client.
Cognitive Level: Understand
Client Needs: Safe, Effective Care Environment: Safety and Infection Control
Reference: p. 225
9. During the admission interview, the nurse learns that an older adult
frequently experiences constipation. Which response by the nurse would be most
appropriate?
A. "I will make sure that a laxative is prescribed for you while you are 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 will pass
that information on to your health care provider."

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D. "There are measures that I can teach you, such as changing your diet and
increasing the amount of fluids you drink."
Answer: D
Rationale: Non-pharmacological 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. When a client reports
constipation, the nurse should assess the client carefully before suggesting or
administering a laxative. Additionally, the nurse should reinforce to older adults
and their caregivers that laxatives, although popular, are drugs and can cause
side effects and interact with other drugs.
Client Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Caring

Reference: p. 223
10. An older adult client believes taking high doses of vitamin A will help
preserve the client's eyesight. Which response about vitamin A would the nurse
incorporate into the discussion about this topic with the client?
A. "Vitamin A can build up too high in the blood."
B. "Too much vitamin A can lead to dehydration."
C. "Vitamin A will be in your system for only a short time."
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D. "Vitamin A can build up too high in the fat tissues."
Answer: D
Rationale: In the older adult, 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.
Reference: p. 207
11. An older adult client with reduced kidney function was prescribed a
barbiturate. The client experienced a severe adverse reaction, which was nearly
fatal. The nurse would identify which event as being the most likely reason for
this occurrence?
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
Answer: C

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Rationale: 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 client, and there is no
reason to think the dosage was increased.
Cognitive Level: Analyze
Reference: p. 208
12. An older adult is brought to the emergency department experiencing

confusion. After ensuring the client's safety, which action should the emergency
department staff take next?
A. Prescribe an electrocardiogram
B. Administer a stimulant
C. Review the client's current medication regimen
D. Check serum electrolyte levels
Answer: C
Rationale: Varying degrees of mental dysfunction often are early symptoms of

adverse reactions to commonly prescribed medications for older adults. Even the
most subtle changes in mental status could be linked to a medication and should
be reviewed as a priority. If the client 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
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available, as it might cause an interaction with adverse results. Serum
electrolyte levels and an electrocardiogram may be needed but only after the
drug information is known.
Reference: p. 208
13. An older client is prescribed a large calcium tablet every day but objects
because it is difficult to swallow it. Which action would be most appropriate for
the nurse to take?
A. Substitute a glass of milk for the tablet
B. Ask the health care provider if it can be discontinued
C. Find a different brand or form of the same dose
D. Ask the client to swallow the tablet along with food or drink
Answer: C
Rationale: Calcium is needed by any older adult, 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.

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Reference: p. 211
14. An older client has difficulty swallowing oral medicines and sometimes spits
them out after the nurse leaves the client's room. Which action should the nurse
take to ensure the client swallows the medications?
A. Crushing any large or enteric-coated tablets
B. Prescribing liquid or suppository forms of the medicines
C. Giving the client ample fluids to make swallowing easier
D. Having the client hold the medicine in the mouth until being able to swallow
Answer: C
Rationale: Ample fluids assist with swallowing. The nurse may consult with the
client's health care provider about alternative forms of the drug but the nurse
cannot prescribe drugs. If the client's mouth is dry, the client may not be able 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.
Reference: p. 211
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15. A nurse is administering a prescribed rectal suppository to an older adult

client. The nurse takes special precautions when administering the suppository
for which reason?
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 client may resist having the suppository administered
Answer: B
Rationale: Circulation to the bowel is decreased, and the body temperature is

lower in many older adult clients. This tends to lengthen the time needed for a
suppository to melt. If no alternative route can be used and the suppository
form must be given, a special effort must be made to ensure that the
suppository is not expelled. Fecal impaction and client resistance may be
problems regardless of the client's age.
Reference: p. 211
16. The nurse learns that an older client uses antacids after every meal to treat
chronic "indigestion." The nurse would assess the client for which condition?

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A. Urinary incontinence or retention

B. Coagulation disorders and anemia
C. Hyperlipidemia and arteriosclerosis
D. Electrolyte imbalances and cardiac problems
Answer: D
Rationale: 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.
Reference: p. 215
17. For many years, an older female client has taken 1 mg of lorazepam (Ativan)
at bedtime and when experiencing episodes of anxiety. Which response by the
nurse would be appropriate?
A. "Have you ever been diagnosed with a condition called 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's
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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 health care provider."
Answer: B
Rationale: Lorazepam is a benzodiazepine. Therefore, it would be important to

discuss alternatives, both pharmacologic and nonpharmacologic. The client's
pattern of use does not necessarily indicate a diagnosis of generalized anxiety
disorder and the nurse should not be making this assumption. Benzodiazepines
are not known to have a Parkinsonian effect and they are not necessarily
inappropriate or ineffective.
Reference: p. 223
18. A nurse is assessing an older adult client. The history reveals that the client
is taking an antibiotic that was originally ordered for a previous infection. Which
information would be most important for the nurse to keep in mind?
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 adjust for decreased immune
function.

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D. Long-term use of low-dose antibiotics protects older adults from infections.
Answer: B
Rationale: 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. Cultures should be obtained when an infection is suspected or
present.
Client Needs: Safe, Effective Care Environment: Safety and Infection Control
Reference: p. 216
19. An older adult with a history of deep vein thrombosis is prescribed daily
warfarin therapy. Which response by the nurse would be appropriate?
A. "You should avoid foods high in saturated fat."

B. You should avoid foods high in salt and nitrates."
C. "You should avoid foods high in complex carbohydrates."
D. "You should avoid foods high in vitamin K."
Answer: D
Rationale: Foods high in vitamin K can induce clotting and minimize the
effectiveness of oral anticoagulant medications, such as warfarin. Foods high in
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saturated fat, salt, nitrates, and complex carbohydrates do not interact with
anticoagulant medication.
Integrated Process: Teaching/Learning
Reference: p. 206
20. The nurse caring for clients in a long-term care facility administers numerous
antidepressant medications each day. Which client should the nurse investigate
a possible change in treatment?
A. A 90-year-old client prescribed a monoamine oxidase inhibitor (MAOI) since
the death of his wife
B. An 81-year-old client who is receiving sertraline for the treatment of her
depression secondary to an extreme grief reaction
C. An 89-year-old client who takes citalopram, a selective serotonin reuptake
inhibitor, for the treatment of depression
D. A 91-year-old client who has been taking a tricyclic antidepressant since the
onset of his physical decline several years prior
Answer: D
Rationale: Tricyclic antidepressants are noted to have numerous side effects that
pose a threat to older adults, including anticholinergic effects, orthostatic
hypotension, and arrhythmias. Monoamine oxidase inhibitors, sertraline, and

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citalopram (both selective serotonin reuptake inhibitors) have a lower risk of

complications and side effects.
Reference: p. 224
21. An older adult has been prescribed a potassium-sparing diuretic and a beta
blocker for hypertension. Which action should be a priority for the nurse?
A. Monitoring the client for tachycardia
B. Closely monitoring the client's electrolyte levels
C. Ensuring the client does not change position quickly
D. Assessing the client for changes in level of consciousness
Answer: C
Rationale: Antihypertensive therapy, especially when first initiated or changed,

carries a risk of orthostatic hypotension and subsequent falls. This is especially
true when diuretics and β-beta-blockers are prescribed together. Although
electrolytes would be monitored, the potassium-sparing nature of the diuretic
makes this less urgent than ensuring safety. Cognitive changes and changes in
level of consciousness are less likely side effects of diuretic and β-blocker
therapy. Beta blockers tend to slow the heart rate down, not increase it.
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Reference: p. 219
22. An older adult, with a history of atrial fibrillation, takes digoxin daily. The
nurse holds the medication and notifies the health care provider based on which
assessment finding?
A. Blood pressure is 98/55 mm Hg
B. Heart rate is 62 beats/min
C. New onset of agitation and delirium
D. Oxygen saturation level is 92% by pulse oximeter
Answer: C
Rationale: Agitation and delirium are manifestations of digoxin toxicity. The

medication should be withheld and the health care provider notified of the
client's manifestations. A low blood pressure is not typically associated with
digoxin. An oxygen saturation level of 92% is within normal limits. A heart rate
of 60 beats/min is typically the lowest acceptable range for administering the
medication.

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Reference: p. 222
23. The nurse is caring for an older adult client with a history of chronic
obstructive pulmonary disease (COPD). The nurse would be alert for an
increased risk of adverse reactions if the client is prescribed which
medication(s)? Select all that apply.
A. Aspirin
B. NSAIDs
C. Bupropion
D. Beta-blockers
E. Long-acting benzodiazepines
Answer: D, E
Rationale: A high potential for adverse reactions exists in clients with COPD
when taking long-acting benzodiazepines and beta-blockers. A high potential for
adverse reactions does not exist in clients with COPD when taking aspirin,
NSAIDs, or bupropion.
Reference: p. 210
24. The nurse assesses an older adult client who self-manages the medication
regimen at home. After completing an assessment, the nurse determines that
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the client is at risk for medication errors. Which assessment finding(s) would
support the nursing diagnosis? Select all that apply.
A. Hand weakness
B. Hearing deficit
C. Use of laxatives
D. Limited finances
E. Walks with a cane
Answer: A, B, D
Rationale: Risk factors for medication errors include hearing deficits, weak
hands, and limited finances. The use of laxatives and walking with a cane do not
increase an older client's risk of medication errors.
Client Needs: Health Promotion and Maintenance
Reference: p. 212
25. After completing a medication history, the nurse is concerned that an older
adult client is at risk for drug toxicity. Which assessment finding(s) would
support the nurse's suspicion? 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 drug levels

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D. Takes daily doses of digoxin and carbamazepine

E. Drinks grapefruit juice while taking gabapentin
Answer: D, E
Rationale: 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 client's risk of toxicity. Transient dizziness does
not indicate toxicity. Having blood work done every 3 months would help reduce
the risk of toxicity.
Reference: p. 218
26. An older adult client is prescribed nicotinic acid to correct cholesterol

imbalances. After teaching the client about possible adverse effects, the nurse
determines that the teaching was successful when the client identifies which
adverse effect(s)? Select all that apply.
A. Gas
B. Itching
C. Tingling
D. Flushing
E. Muscle pain
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Answer: B, C, D
Rationale: The nurse should instruct the client about the main side effects of
nicotinic acid, also known as Niacin, that include flushing, itching, tingling, and
headache. 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.
Reference: p. 220

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GRADESBOOST.

1. When administering a proton pump inhibitor to a client with gastroesophageal

Rationale: Because enteric-coated pills should not be crushed or split, the

Cognitive Level: Apply

2. A gerontological nurse is caring for an older adult client receiving various

Rationale: Changes in renal and liver function contribute significantly to the

3. An older adult client recently prescribed a diuretic is experiencing an irregular

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Rationale: Electrolyte imbalances are a common adverse effect of diuretic use.

4. A nurse at a long-term care facility is teaching a group of unlicensed assistive

5. A nurse is reviewing the medication history of a newly admitted older adult

GRADESBOOST.COM #1 TEST BANKS WEBSITE

Rationale: In the effort to minimize polypharmacy in older adults, it is important

6. An older client with a history of arthritis has fallen after an episode of

GRADESBOOST.COM #1 TEST BANKS WEBSITE

8. An older client with dementia is experiencing increasing episodes of agitation

B. Using atypical antipsychotics to manage the behavior of clients with dementia

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Rationale: Non-pharmacological measures for treating and preventing

Integrated Process: Caring

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12. An older adult is brought to the emergency department experiencing

Rationale: Varying degrees of mental dysfunction often are early symptoms of

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Question format: Multiple Choice

15. A nurse is administering a prescribed rectal suppository to an older adult

Rationale: Circulation to the bowel is decreased, and the body temperature is

GRADESBOOST.COM #1 TEST BANKS WEBSITE

A. Urinary incontinence or retention

Rationale: Ongoing antacid use and complaints of indigestion can indicate

Rationale: Lorazepam is a benzodiazepine. Therefore, it would be important to

GRADESBOOST.COM #1 TEST BANKS WEBSITE

D. Long-term use of low-dose antibiotics protects older adults from infections.

Rationale: Excessive use of antibiotics has contributed to the emergence and

A. "You should avoid foods high in saturated fat."

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citalopram (both selective serotonin reuptake inhibitors) have a lower risk of

Rationale: Antihypertensive therapy, especially when first initiated or changed,

Rationale: Agitation and delirium are manifestations of digoxin toxicity. The

GRADESBOOST.COM #1 TEST BANKS WEBSITE

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D. Takes daily doses of digoxin and carbamazepine

Rationale: Anticonvulsant and digitalis preparations taken concurrently

26. An older adult client is prescribed nicotinic acid to correct cholesterol

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