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NR 508 week 8 quiz
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NR 508 week 8 QuizPrinciples of prescribing for older adults include:
1. Avoiding prescribing any newer high-cost medications
2. Starting at a low dose and increasing the dose slowly
3. Keeping the total dose at a lower therapeutic range
4. All of the above Answer- 2. Starting at a low dose and increasing the dose slowly
Sadie is a 90-year-old patient who requires a new prescription. What changes in drug
distribution with aging would influence prescribing for Sadie?
1. Increased volume of distribution
2. Decreased lipid solubility
3. Decreased plasma proteins
4. Increased muscle-to-fat ratio Answer- 3. Decreased plasma proteins
Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in
elimination should be taken into consideration when prescribing for Glen?
1. Increased glomerular filtration rate (GFR) will require higher doses of some renally
excreted drugs.
2. Decreased tubular secretion of medication will require dosage adjustments.
3. Thin skin will cause increased elimination via sweat.
4. Decreased lung capacity will lead to measurable decreases in lung excretion of
drugs. Answer- 2. Decreased tubular secretion of medication will require dosage
adjustments.
A medication review of an elderly person's medications involves:
1. Asking the patient to bring a list of current prescription medications to the visit
2. Having the patient bring all of their prescription, over-the-counter, and herbal
medications to the visit
3. Asking what other providers are writing prescriptions for them
4. All of the above Answer- 4. All of the above
Steps to avoid polypharmacy include:
1. Prescribing two or fewer drugs from each drug class
2. Reviewing a complete drug history every 12 to 18 months
3. Encouraging the elderly patient to coordinate their care with all of their providers
4. Evaluating for duplications in drug therapy and discontinuing any duplications
Answer- 4. Evaluating for duplications in drug therapy and discontinuing any
duplications
Robert is a 72-year-old patient who has hypertension and angina. He is at risk for
common medication practices seen in the elderly including:
1. Use of another person's medications
, 2. Hoarding medications
3. Changing his medication regimen without telling his provider
4. All of the above Answer- 4. All of the above
To improve positive outcomes when prescribing for the elderly the nurse practitioner
should:
1. Assess cognitive functioning in the elder
2. Encourage the patient to take a weekly "drug holiday" to keep drug costs down
3. Encourage the patient to cut drugs in half with a knife to lower costs
4. All of the above Answer- 1. Assess cognitive functioning in the elder
When an elderly diabetic patient is constipated the best treatment options include:
1. Mineral oil
2. Bulk-forming laxatives such as psyllium
3. Stimulant laxatives such as senna
4. Stool softeners such as docusate Answer- 4. Stool softeners such as docusate
Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be
followed when prescribing pain management for Delta?
1. Keep the dose of oxycodone low to prevent development of tolerance.
2. Acetaminophen is the first-line drug of choice.
3. Avoid prescribing NSAIDs.
4. Add in a short-acting benzodiazepine for a synergistic effect on pain. Answer- 2.
Acetaminophen is the first-line drug of choice.
Robert is complaining of poor sleep. Medications that may contribute to sleep problems
in the elderly include:
1. Diuretics
2. Trazodone
3. Clonazepam
4. Levodopa Answer- 1. Diuretics
The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum
creatinine of 1.1, and for a 202-pound, 25-year-old male who is 5'9" with the same
serum creatinine according to the Cockcroft Gault formula are:
1. 25ml/ min and 133 mL/min respectively
2. 25 mL/min and 103 mL/min respectively
3. 22 ml/min and 133 mL/min respectively
4. 22 ml/min and 103 mL/min respectively Answer- 2. 25 mL/min and 103 mL/min
respectively
RAT: Remember to use ideal body weight (IBW) in the formula. The woman's IBW is
105 pounds and the man's is 156 pounds. Note the huge difference in GFR based on
weight and age and the fact that looking at the serum creatinine alone can be very
misleading in predicting GFR.
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