An older adult patient is admitted to the hospital for treatment ...

[bobthebuilder]

An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness.
 
  Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient's renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding?
  a. Financial concerns
  b. Inability to open drug containers
  c. Increased tolerance to the drug's effects
  d. Patient's conviction that the drug is unnecessary

Question 2

A nurse is preparing to give medications to four geriatric patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?
 
  a. Obese patient
  b. Patient with decreased serum creatinine
  c. Patient with chronic diarrhea
  d. Thin patient with a chronically low appetite

[poopface]

Answer to Question 1

ANS: A
Older adult patients who have financial concerns about paying for medications often take less of the drug or take it less often to make the drug last longer. A patient unable to open the drug container would not get any medication and would not have a detectable serum drug level. A patient with increased tolerance to a drug's effects would require more of the drug to get effects. A patient convinced that the drug is not needed would probably not fill the prescription.

Answer to Question 2

ANS: D
The patient who is thin and has a poor appetite has an increased risk of malnutrition, with significant lowering of serum albumin. This can result in increased free drug levels of protein-bound drugs and can lead to drug toxicity. Obesity, which involves increased adipose tissue, would cause lipid-soluble drugs to deposit in adipose tissue, with a resulting reduction of drug effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of medications through the GI tract and reduce absorption.

[bobthebuilder]

Excellent

[nyrave]

Gracias!