Chapter 17 Prescribing in the Older Adult: Doing More by Doing Less
27 questions in this chapter
Chapter notesQ1Mrs. Little is a 78-year-old woman with recently diagnosed Alzheimer's disease who struggles with word-finding (aphasia), difficulty following multi-step directions (apraxia), and periodic angry verbal outbursts triggered by minor routine disruptions. She lives with her daughter, who wishes to maintain her at home. When evaluating her care needs, which of the following is an inappropriate or false clinical management choice?
Q2When considering therapy for a 71-year-old man with mild to moderate depression, the PMHNP considers all of the following except
Q3A 74-year-old male presents with erratic behavior and episodic confusion over the past month after starting a new medication. Which medication is least likely to cause these delirium-like episodes?
Q4Which of the following describes the ethical principle of beneficence?
Q5An 81-year-old female is brought to the clinic by her daughter due to progressive confusion, excessive daytime drowsiness, and two near-falls over the past week. Review of records shows she was prescribed diazepam 5 mg twice daily for generalized anxiety three weeks ago. Her physical exam demonstrates mild ataxia but no focal neurological deficits. What age-related pharmacokinetic change is primarily responsible for her symptoms?
Q6A 76-year-old male with bipolar I disorder is evaluated for maintenance therapy. His baseline laboratory work reveals an eGFR of 52 mL/min and normal liver function tests. The PMHNP considers initiating lithium. When planning therapy, how does the patient's age-related change in body composition influence lithium pharmacokinetics?
Q7A 78-year-old male with a history of hypertension and mild cognitive impairment requires short-term pharmacological management for acute anxiety. He has age-related declines in hepatic Phase I oxidation. Which medication is most appropriate because its clearance relies on Phase II glucuronidation?
Q8An 81-year-old female taking metoprolol for hypertension is started on fluoxetine 20 mg daily for major depressive disorder. Three weeks later, she presents to the emergency department after a fall. Vital signs reveal a heart rate of 44 beats per minute and a blood pressure of 86/52 mmHg. Which pharmacokinetic mechanism explains this clinical presentation?