Nokea
The nurse practicing in a long term care facility recognizes that elderly clients are at greater risk for drug toxicity than younger adults because of which of the following physiological changes of advancing age?
- A. Drugs are absorbed more readily from the GI tract
- B. Elders have less body water and more fat
- C. The elderly have more rapid hepatic metabolism
- D. Older people are often malnourished and anemic
Correct Answer: B
Rationale: Elders have less body water and more fat. Because elderly persons have decreased lean body tissue/water in which to distribute medications, more drug remains in the circulatory system with potential for drug toxicity. Increased body fat results in greater amounts of fat-soluble drugs being absorbed, leaving less in circulation, thus increasing the duration of action of the drug.
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The LPN is administering 0800 medications to clients on a medical floor. Which action by the LPN would warrant immediate intervention by the nurse?
- A. The LPN scores the medication to give the correct dose.
- B. The LPN checks the client's armband and birth date.
- C. The LPN administers sliding-scale insulin intramuscularly.
- D. The LPN is 30 minutes late hanging the IV antibiotic.
Correct Answer: C
Rationale: Sliding-scale insulin is given subcutaneously, not IM; this error warrants intervention to prevent improper absorption. Scoring, ID checks, or timing are less critical.
The nurse is administering carbidopa/levodopa (Sinemet) to the client. Which assessment should the nurse perform to determine if the medication is effective?
- A. Assess the client's muscle strength.
- B. Assess for cogwheel movements.
- C. Assess the carbidopa serum level.
- D. Assess the client's blood pressure.
Correct Answer: B
Rationale: Carbidopa/levodopa reduces Parkinson’s symptoms like cogwheel rigidity; decreased cogwheel movements indicate effectiveness. Strength, levels, or BP are less specific.
A client has been receiving dexamethasone (Decadron) for control of cerebral edema. Which of the following assessments would indicate that the treatment is effective?
- A. A positive Babinski's reflex
- B. Increased response to motor stimuli
- C. A widening pulse pressure
- D. Temperature of 37 degrees Celsius
Correct Answer: B
Rationale: Decadron is a corticosteroid that acts on the cell membrane to decrease inflammatory responses as well as stabilize the blood-brain barrier. Once Decadron reaches a therapeutic level, there should be a decrease in symptomatology with improvement in motor skills.
The nurse is preparing to administer the initial dose of an antibiotic in the emergency department. Which interventions should the nurse implement? Select all that apply.
- A. Assess for drug allergies.
- B. Collect needed specimens for culture.
- C. Check the client's armband.
- D. Ask the client his or her birthday.
- E. Draw peak and trough levels.
Correct Answer: A,B,C
Rationale: Allergy assessment prevents reactions, cultures guide therapy, and armband ensures identity. Birthday is redundant, and peak/trough levels are post-administration.
The client with arthritis is self-medicating with aspirin, a nonsteroidal anti-inflammatory medication. Which complication should the nurse discuss with the client?
- A. Tinnitus.
- B. Diarrhea.
- C. Tetany.
- D. Paresthesia.
Correct Answer: A
Rationale: High-dose aspirin can cause tinnitus, an early sign of salicylate toxicity, requiring education. Diarrhea, tetany, or paresthesia are less common.