The scenario highlights a complex situation involving an elderly patient, Mrs. Rodriguez, with multiple comorbidities, polypharmacy, and cognitive impairment, making her highly vulnerable to adverse drug reactions (ADRs). The primary concern is to identify the medication most likely contributing to her current presentation of increased confusion and unsteady gait.

Given Mrs. Rodriguez’s history, several medications could be implicated. Antihypertensives, while crucial for blood pressure control, can cause orthostatic hypotension, leading to dizziness and falls, especially in older adults with impaired baroreceptor function. Diuretics, often prescribed for heart failure, can lead to electrolyte imbalances (e.g., hyponatremia, hypokalemia), which can manifest as confusion and weakness. Proton pump inhibitors (PPIs), used for GERD, have been linked to vitamin B12 deficiency and, with long-term use, may increase the risk of *Clostridium difficile* infection, both of which can cause neurological symptoms. However, the most likely culprit in this scenario is the sedative-hypnotic medication, lorazepam.

Lorazepam, a benzodiazepine, is known to cause central nervous system (CNS) depression, leading to sedation, confusion, impaired coordination, and increased risk of falls, particularly in older adults. The Beers Criteria explicitly lists benzodiazepines as potentially inappropriate medications for older adults due to these risks. Furthermore, Mrs. Rodriguez’s cognitive impairment makes her even more susceptible to the adverse effects of lorazepam. The combination of lorazepam with other CNS depressants, such as antidepressants or opioids (if she were taking them), would further exacerbate these risks. Therefore, based on the presented information, lorazepam is the most likely medication contributing to Mrs. Rodriguez’s increased confusion and unsteady gait.

The scenario involves an older adult, Mr. Lee, who is experiencing significant pain due to osteoarthritis. He has a history of gastrointestinal bleeding, which contraindicates the use of NSAIDs due to their potential to cause further GI irritation and bleeding. Given his history, non-pharmacological interventions and alternative pharmacological options should be considered first. Acetaminophen can be used for mild to moderate pain, but it may not be sufficient for severe osteoarthritis pain. Opioids can be effective for pain relief but carry a risk of side effects, including constipation, sedation, and respiratory depression, and should be used cautiously in older adults. Topical agents, such as capsaicin cream, can provide localized pain relief with minimal systemic side effects and are a safer alternative for patients with a history of GI bleeding.

The scenario describes an older adult, Maria, experiencing significant weight loss and muscle weakness, indicating potential sarcopenia. Sarcopenia is characterized by a decline in muscle mass and strength, leading to functional decline and increased risk of falls, fractures, and mortality. While all the options address aspects of geriatric care, the most immediate and relevant action is to address the potential sarcopenia. A comprehensive nutritional assessment is essential to identify any deficiencies in macronutrients (protein, carbohydrates, fats) and micronutrients (vitamins, minerals) that may be contributing to the muscle loss. Assessing protein intake is particularly crucial as protein is essential for muscle synthesis. The assessment should also evaluate the patient’s overall caloric intake to determine if it meets her energy needs. This assessment forms the basis for developing a targeted nutritional intervention to address the sarcopenia and improve Maria’s overall health and functional status. While a medication reconciliation is important, it is not the immediate priority in this scenario. Similarly, while assessing for depression is important, it does not directly address the immediate problem of sarcopenia. A cognitive assessment might be relevant in the long term, but it is not the most crucial first step in addressing Maria’s current physical decline. The underlying concept is that when an older adult presents with signs of muscle wasting and weakness, addressing potential sarcopenia through a comprehensive nutritional assessment is paramount to preventing further decline.

The scenario presents a situation where an older adult, Ms. Rodriguez, is experiencing symptoms suggestive of elder abuse, including unexplained bruising and withdrawal from social activities. As a healthcare professional, the nurse has a legal and ethical obligation to report suspected elder abuse.

The MOST appropriate initial action is to report the suspected elder abuse to the appropriate authorities, such as Adult Protective Services (APS). APS is a government agency that investigates reports of elder abuse and provides protective services to vulnerable adults.

Before making a report, the nurse should gather as much information as possible about the situation, including the nature of the abuse, the identity of the alleged abuser, and the victim’s contact information. However, the nurse does not need to have definitive proof of abuse before making a report. A reasonable suspicion is sufficient to trigger the reporting requirement. While discussing the concerns with Ms. Rodriguez and her family is important, it should not delay the reporting process. The safety and well-being of the older adult is the priority.

The scenario describes a situation where an older adult, despite having capacity and expressing clear wishes for comfort-focused care, is potentially being steered towards more aggressive interventions. The principle of autonomy dictates that individuals have the right to make their own decisions about their healthcare, even if those decisions differ from what medical professionals recommend. Beneficence involves acting in the patient’s best interest, but this must be balanced with respecting the patient’s autonomy. Non-maleficence means “do no harm,” which in this context includes avoiding unwanted interventions that could diminish quality of life. Justice refers to fairness in the distribution of resources and treatment, which is less directly applicable in this specific scenario. The ethical conflict arises because the healthcare team’s perception of beneficence may clash with the patient’s autonomous decision to prioritize comfort over aggressive treatment. The nurse’s primary responsibility is to advocate for the patient’s wishes and ensure that the healthcare team respects her autonomy, even if they disagree with her choices. This may involve facilitating discussions, providing education, and ensuring that the patient’s advance directives are honored. Ignoring the patient’s wishes would be a violation of her autonomy and could lead to unnecessary suffering.

The scenario describes a situation where an elderly patient, Mr. Habimana, is experiencing increased confusion and agitation, particularly at night. His daughter reports that he has been taking diphenhydramine, an over-the-counter antihistamine, to help him sleep. The most appropriate action for the gerontological nurse is to educate the daughter about the risks of using diphenhydramine in older adults. Diphenhydramine is an anticholinergic medication. Older adults are more susceptible to the adverse effects of anticholinergics due to age-related changes in pharmacokinetics and pharmacodynamics. Anticholinergic effects include confusion, dry mouth, constipation, urinary retention, and blurred vision. These effects can be particularly pronounced in older adults and can exacerbate existing cognitive impairment or contribute to delirium. The Beers Criteria, a widely used resource for identifying potentially inappropriate medications for older adults, lists diphenhydramine as a medication that should be avoided in older adults due to its high anticholinergic burden and increased risk of adverse effects. Recommending a different sleep aid without consulting the physician might not be appropriate, as other medications could also have potential risks. Telling the daughter that it is normal for older adults to experience confusion is dismissive and does not address the underlying cause. While informing the physician is important, the immediate action should be to educate the daughter about the risks of diphenhydramine.

The scenario describes a patient with multiple chronic conditions and a complex medication regimen, placing her at high risk for adverse drug reactions (ADRs). The Beers Criteria are evidence-based guidelines that identify medications with a high risk of ADRs in older adults. Regularly reviewing the patient’s medication list against the Beers Criteria helps identify potentially inappropriate medications (PIMs) and guides deprescribing efforts. While renal function monitoring (GFR) is crucial, it only addresses one aspect of ADR risk. Simplifying the medication regimen and educating the patient are important, but the Beers Criteria provide a systematic framework for identifying problematic medications in the first place. Assessing medication adherence, while important, doesn’t directly address the appropriateness of the medications themselves. The Beers Criteria offer specific recommendations based on the patient’s age and conditions, making it the most proactive approach to minimizing ADR risk in this scenario. Using the Beers Criteria involves checking each medication against the list to see if it’s considered potentially inappropriate for older adults or if dose adjustments are needed based on renal function or other factors. This review helps the nurse and healthcare team make informed decisions about medication management.

This question explores the physiological changes associated with aging and their impact on medication pharmacokinetics. As individuals age, there is a decline in kidney function, which leads to a decrease in glomerular filtration rate (GFR). This decline in GFR affects the excretion of medications, potentially leading to higher drug concentrations in the body and an increased risk of adverse drug reactions. While changes in body composition, such as decreased lean body mass and increased body fat, can affect drug distribution, and reduced liver function can affect drug metabolism, the primary concern related to medication clearance in older adults is the decline in renal function. Changes in gastric emptying can affect drug absorption, but this is generally less significant than the impact of reduced renal clearance. Therefore, the gerontological nurse must carefully consider the patient’s renal function when prescribing or administering medications and adjust dosages accordingly to prevent toxicity.

The scenario describes a patient with osteoarthritis experiencing chronic pain. While opioids may provide pain relief, they are associated with significant risks in older adults, including increased risk of falls, confusion, constipation, and respiratory depression. Acetaminophen is often a first-line analgesic for osteoarthritis pain due to its relatively low risk of side effects when used at recommended doses. However, it may not provide sufficient pain relief for all patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective for managing osteoarthritis pain, but they also carry risks in older adults, including gastrointestinal bleeding, cardiovascular events, and renal dysfunction. Topical NSAIDs, such as diclofenac gel, offer a localized approach to pain relief, minimizing systemic exposure and reducing the risk of systemic side effects. They are applied directly to the affected joint, providing pain relief with fewer systemic adverse effects compared to oral NSAIDs. This makes them a safer and more appropriate option for managing chronic osteoarthritis pain in older adults, especially when other treatments have been ineffective or are contraindicated.

The scenario describes an older adult with multiple chronic conditions (heart failure, COPD, diabetes) who is experiencing adverse effects from polypharmacy. The core issue is the interaction between the various medications and the age-related physiological changes that make older adults more susceptible to adverse drug reactions (ADRs). A crucial step is to perform a comprehensive medication review, including reconciliation, to identify potential drug interactions, redundancies, and inappropriate medications. Deprescribing, under the guidance of a physician, involves systematically reducing or stopping medications that are no longer beneficial or are causing harm. This process requires careful monitoring for withdrawal symptoms or exacerbation of underlying conditions. While adjusting dosages might be necessary, it’s only one component of a broader strategy. Simply adding another medication to counteract the side effects is generally discouraged due to the risk of further complicating the medication regimen and potentially triggering a prescribing cascade. Encouraging the patient to tolerate the side effects is unethical and potentially harmful, as it ignores the patient’s discomfort and the potential for serious ADRs. The most effective approach involves a comprehensive assessment and a collaborative plan with the physician to deprescribe inappropriate medications, thereby reducing the risk of ADRs and improving the patient’s overall well-being.

The scenario describes an older adult experiencing symptoms indicative of delirium superimposed on dementia (DSD). Delirium is an acute confusional state characterized by disturbances in attention, awareness, and cognition that develop over a short period and fluctuate in severity. Dementia, on the other hand, is a chronic, progressive cognitive decline. DSD occurs when delirium is present in an individual with pre-existing dementia, making diagnosis and management more challenging. The most appropriate initial action for the CGRN is to assess the patient for reversible causes of delirium. This is because delirium is often triggered by underlying medical conditions, medications, or environmental factors that can be identified and addressed. Common reversible causes include infections (e.g., urinary tract infection, pneumonia), medication side effects or interactions, dehydration, electrolyte imbalances, pain, constipation, and environmental changes. Prompt identification and treatment of these underlying causes can improve cognitive function and prevent further complications. While other actions, such as initiating antipsychotics or immediately consulting a neurologist, may be considered later, the priority is to identify and treat any potentially reversible factors contributing to the delirium. Obtaining a detailed medication history and performing a thorough physical examination, including vital signs and neurological assessment, are crucial steps in identifying these reversible causes. The Confusion Assessment Method (CAM) or other validated delirium assessment tools can also aid in diagnosis.

The scenario describes an older adult experiencing multiple age-related physiological changes and being prescribed several medications, highlighting the complexities of pharmacokinetics and pharmacodynamics in this population. The most appropriate initial action is to conduct a comprehensive medication reconciliation. This process involves comparing the patient’s current medication list (including prescription, over-the-counter, and herbal supplements) against the physician’s orders to identify and resolve discrepancies. Given the patient’s age-related decline in renal function (decreased glomerular filtration rate) and the potential for drug interactions due to polypharmacy, medication reconciliation is crucial for preventing adverse drug reactions and optimizing therapeutic outcomes. Furthermore, age-related changes in liver function can affect drug metabolism, and changes in body composition can alter drug distribution. The Beers Criteria, developed to improve medication safety in older adults, identifies potentially inappropriate medications that should be avoided or used with caution in older adults due to their increased risk of adverse effects. This patient’s profile suggests a high likelihood of encountering medications listed in the Beers Criteria, making medication reconciliation even more important. This also helps to ensure compliance with regulations and standards of practice for geriatric care.

The scenario describes an older adult with type 2 diabetes who is experiencing frequent hypoglycemic episodes despite adhering to their prescribed insulin regimen. This situation highlights the importance of considering age-related pharmacokinetic and pharmacodynamic changes when managing diabetes in older adults. As people age, their renal function declines, which can affect the clearance of insulin and oral hypoglycemic agents. Reduced renal clearance can lead to increased drug levels and a higher risk of hypoglycemia. While changes in diet, increased physical activity, and insulin injection technique can also contribute to hypoglycemic episodes, reduced renal clearance is a particularly important consideration in older adults with diabetes. The liver also plays a role in drug metabolism, but renal clearance is often the more significant factor for insulin. Therefore, the most likely contributing factor to the patient’s frequent hypoglycemic episodes is reduced renal clearance of insulin.

The scenario describes a patient with multiple chronic conditions (COPD, hypertension, osteoarthritis) who is taking several medications. This puts her at high risk for polypharmacy and adverse drug reactions. The Beers Criteria is a widely recognized tool for identifying potentially inappropriate medications (PIMs) for older adults, aiming to reduce the risk of ADRs and improve medication safety. The goal is to minimize the number of medications and the risk of adverse drug events. Medication reconciliation involves comparing the patient’s current medication list with the medications they are supposed to be taking to identify and resolve discrepancies. Deprescribing is the process of tapering or stopping medications that are no longer needed or are causing harm. A thorough review of all medications is necessary, and the Beers criteria provide a framework for identifying potentially inappropriate medications. It is important to note that while potentially inappropriate medications are identified using Beers criteria, it does not automatically mean stopping the medications but careful evaluation of risk versus benefit.

The scenario describes a situation where an elderly patient, despite receiving standard treatment for pneumonia, is not responding as expected and is experiencing a significant decline in cognitive function. This raises suspicion for delirium, a common geriatric syndrome often triggered by infections, medications, or underlying medical conditions. Delirium is characterized by acute onset and fluctuating cognitive impairment, which can manifest as confusion, disorientation, and altered levels of consciousness. While pneumonia itself can cause some degree of cognitive slowing, the rapid and pronounced decline, coupled with the lack of improvement despite antibiotic treatment, points towards delirium. The nurse’s best course of action is to conduct a thorough assessment specifically for delirium, utilizing validated tools like the Confusion Assessment Method (CAM) or the Delirium Rating Scale-Revised-98 (DRS-R-98). These tools help differentiate delirium from other cognitive impairments like dementia and identify its specific features. Ruling out delirium is crucial because it requires a different management approach, including identifying and addressing the underlying cause, providing supportive care, and avoiding medications that can worsen cognitive function. Delaying the diagnosis and treatment of delirium can lead to prolonged hospital stays, increased morbidity and mortality, and long-term cognitive decline. Therefore, assessing for delirium is the most appropriate initial action in this scenario.

The scenario describes an older adult, Maria, with multiple chronic conditions (hypertension, osteoarthritis, and type 2 diabetes) who is experiencing a significant decline in cognitive function and increased agitation. Her medication list is extensive, raising concerns about polypharmacy and potential drug interactions. The key here is to recognize that delirium is characterized by acute onset, fluctuating course, inattention, and altered level of consciousness. Dementia, while also causing cognitive decline, typically has a more gradual onset and progression. Depression can cause cognitive impairment (pseudodementia), but the acute onset and fluctuating symptoms are less typical. While Maria may have underlying dementia, the *sudden* change in her condition points more strongly to delirium superimposed on possible dementia. Therefore, the most appropriate initial action is to assess for delirium using a standardized assessment tool like the Confusion Assessment Method (CAM) or the Delirium Rating Scale-Revised-98 (DRS-R-98). Ruling out delirium is crucial because it is often reversible if the underlying cause is identified and treated promptly. Addressing potential causes like medication side effects, infections, or metabolic imbalances is paramount. Once delirium is ruled out or addressed, further evaluation for dementia and depression can proceed. The nurse needs to differentiate delirium from dementia or depression, all of which can present with cognitive and behavioral changes in older adults.

The scenario describes a patient experiencing symptoms suggestive of a urinary tract infection (UTI), a common condition in older adults. Older adults often present with atypical symptoms of UTIs, such as confusion, falls, and functional decline, rather than the classic symptoms of dysuria, frequency, and urgency. This is due to age-related changes in the immune system and altered physiological responses to infection. According to the Beers Criteria, nitrofurantoin should be avoided in individuals with significantly decreased kidney function (CrCl < 30 mL/min) due to the risk of accumulation and increased adverse effects. While antibiotics are often necessary to treat UTIs, antibiotic stewardship is crucial to minimize the risk of antibiotic resistance and Clostridium difficile infection. Non-pharmacological interventions, such as increasing fluid intake and ensuring adequate bladder emptying, can also help to prevent and manage UTIs. A urine culture and sensitivity should be obtained to guide antibiotic selection and ensure appropriate treatment.

The scenario describes a complex situation involving an elderly patient, Mrs. Rodriguez, with multiple comorbidities (COPD, heart failure), polypharmacy, and recent hospitalization for pneumonia. The key issue is her increasing confusion and agitation, which could be indicative of delirium, a common geriatric syndrome. Delirium is characterized by acute onset and fluctuating course, with disturbances in attention, cognition, and level of consciousness. Given Mrs. Rodriguez’s risk factors (age, multiple medical conditions, infections, polypharmacy, hospitalization), delirium is the most likely explanation for her sudden change in mental status. While depression can cause cognitive changes, it typically presents more gradually. Dementia is a chronic, progressive cognitive decline, and while it can be exacerbated by acute illness, the sudden onset points more towards delirium. Medication side effects are also a possibility, but the acute onset and fluctuating nature of her symptoms are more characteristic of delirium. The nurse’s priority should be to assess Mrs. Rodriguez for delirium using a validated assessment tool such as the Confusion Assessment Method (CAM) and identify and address any underlying causes (e.g., infection, medication interactions, dehydration).

The scenario presents a complex case involving an elderly patient, Mrs. Rodriguez, with multiple comorbidities and polypharmacy, who is experiencing a significant decline in cognitive function and recurrent falls. The core issue is determining the most appropriate initial intervention to address this multifaceted problem. The key here is to prioritize interventions based on their potential to yield the most significant positive impact while minimizing harm.

Mrs. Rodriguez’s symptoms (cognitive decline, falls, polypharmacy) suggest several potential underlying issues, including adverse drug reactions, drug-drug interactions, and age-related physiological changes affecting drug metabolism and excretion. The first step should be a comprehensive medication review and reconciliation. This involves carefully examining all medications Mrs. Rodriguez is taking, including prescription drugs, over-the-counter medications, and supplements, to identify potential interactions, duplications, and inappropriate medications. Deprescribing, the process of carefully reducing or stopping medications that are no longer necessary or are causing harm, should be considered. Addressing polypharmacy can often improve cognitive function, reduce the risk of falls, and enhance overall well-being in older adults.

While physical therapy, neurological consultation, and home safety assessment are all important, they should ideally follow the medication review. Physical therapy can help improve strength and balance, but it may be less effective if the underlying cause of the falls is medication-related. A neurological consultation is warranted to investigate the cognitive decline further, but it is best to rule out medication-related causes first. A home safety assessment is crucial for preventing future falls, but it is most effective after addressing the underlying medical issues contributing to the falls.

This question assesses knowledge of common sleep disorders in older adults. Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep. Several factors can contribute to insomnia in older adults, including age-related changes in sleep patterns, medical conditions, medications, and lifestyle factors. The nurse should assess the patient’s sleep history, identify potential contributing factors, and recommend appropriate interventions, such as sleep hygiene strategies, cognitive behavioral therapy for insomnia (CBT-I), or medication.

The scenario describes a patient with multiple chronic conditions (COPD, hypertension, osteoarthritis) and multiple medications, representing a classic case of polypharmacy. The patient is experiencing a new onset of confusion, which could be related to medication interactions or adverse drug reactions. A Beers Criteria review is the most appropriate initial action because it specifically identifies medications that are potentially inappropriate for older adults due to their risk of adverse effects. This review can help pinpoint medications that may be contributing to the patient’s confusion. While a Mini-Mental State Examination (MMSE) is useful for assessing cognitive function, it doesn’t directly address the potential role of medications. Similarly, while consulting a geriatric psychiatrist is valuable, it’s premature without first ruling out medication-related causes. Encouraging increased fluid intake is a general measure that may be helpful, but it doesn’t specifically address the potential cause of the confusion in the context of polypharmacy. The Beers Criteria provides a structured, evidence-based approach to identify and address potentially inappropriate medications in older adults, making it the most relevant initial action. This aligns with the CGRN’s role in medication safety and optimizing care for older adults with complex health needs.

The scenario describes an older adult experiencing symptoms suggestive of digoxin toxicity. Age-related physiological changes, particularly decreased renal function, significantly impact digoxin pharmacokinetics. Older adults often have reduced glomerular filtration rate (GFR), leading to decreased digoxin excretion and increased serum levels, even within the standard dosage range. The Beers Criteria, a guideline for potentially inappropriate medication use in older adults, highlights digoxin as a high-risk medication due to its narrow therapeutic index and potential for toxicity, especially in the presence of renal impairment. Monitoring serum digoxin levels and renal function is crucial. Concurrent use of medications like amiodarone, quinidine, or verapamil can further elevate digoxin levels by inhibiting its renal clearance or reducing its volume of distribution. Symptoms of digoxin toxicity are often non-specific in older adults, including gastrointestinal disturbances (nausea, vomiting, anorexia), neurological symptoms (confusion, visual disturbances), and cardiac arrhythmias (bradycardia, AV block). The nurse must recognize these signs, assess renal function, review the patient’s medication list for potential interactions, and anticipate the need for a digoxin level and possible dose adjustment or discontinuation of the drug. The physiological changes increase the risk of toxicity and the need for careful monitoring.

The scenario describes a patient with multiple risk factors for falls, including advanced age, impaired mobility, visual impairment, and a history of falls. A comprehensive fall risk assessment is essential to identify specific risk factors and develop a tailored fall prevention plan. The Hendrich II Fall Risk Model is a widely used and validated tool for assessing fall risk in hospitalized patients. It considers factors such as confusion/disorientation, depression, altered elimination, dizziness/vertigo, male gender, and certain medications. Based on the assessment findings, the nurse should implement evidence-based fall prevention strategies, such as ensuring proper lighting, removing tripping hazards, providing assistive devices, and educating the patient and family about fall prevention. In this case, the nurse should also consult with physical therapy to assess the patient’s mobility and balance and develop an exercise program to improve strength and coordination. Medication review is also crucial to identify and address any medications that may increase the risk of falls, such as sedatives, diuretics, and antihypertensives. The nurse should also consider the patient’s visual impairment and ensure that he has appropriate corrective lenses and adequate lighting.

The scenario describes a common situation involving an elderly patient with multiple chronic conditions and a complex medication regimen, highlighting the challenges of polypharmacy. The most appropriate initial action is to conduct a thorough medication reconciliation. Medication reconciliation involves creating a complete and accurate list of all medications the patient is taking, including dosages, frequency, and route of administration. This list is then compared to the physician’s orders to identify any discrepancies, duplications, omissions, or potential drug interactions. This process is crucial in identifying and preventing medication errors, reducing the risk of adverse drug reactions, and optimizing medication therapy. While assessing adherence, educating the patient, and consulting with the pharmacist are all important aspects of managing polypharmacy, medication reconciliation is the foundational step that informs these subsequent actions. By identifying discrepancies and potential problems early on, the nurse can work with the healthcare team to develop a safer and more effective medication plan for the patient. This aligns with best practices in geriatric care, emphasizing patient safety and minimizing the risks associated with polypharmacy.

This question addresses the management of heart failure in older adults, specifically focusing on the use of diuretics. Diuretics are commonly used to manage fluid overload in patients with heart failure, but they can also increase the risk of dehydration, electrolyte imbalances, and orthostatic hypotension in older adults. Orthostatic hypotension, a drop in blood pressure upon standing, can lead to dizziness, falls, and syncope. Therefore, it is important to educate patients about the risk of orthostatic hypotension and strategies to prevent it, such as rising slowly from a sitting or lying position, avoiding prolonged standing, and staying well-hydrated. Monitoring blood pressure and electrolytes regularly is also important.

The scenario describes an older adult, Mrs. Lee, with a history of heart failure and a new symptom of lower extremity edema. The key issue is determining the most appropriate initial intervention to assess the cause of the edema. A comprehensive medication reconciliation is the most appropriate first step. Many medications can cause or exacerbate edema, including NSAIDs, calcium channel blockers, and certain diabetes medications. By reviewing Mrs. Lee’s medication list, the nurse can identify potential culprits and discuss alternative options with the physician. While elevating her legs, increasing her diuretic dose, and ordering a serum albumin level may be appropriate interventions depending on the underlying cause of the edema, they should not be the initial step. Elevating her legs may provide temporary relief, but it does not address the underlying cause. Increasing her diuretic dose without knowing the cause of the edema could lead to dehydration and electrolyte imbalances. Ordering a serum albumin level may be helpful in determining if hypoalbuminemia is contributing to the edema, but it is not the most appropriate initial step. A thorough medication reconciliation is essential to identify and address potential medication-related causes of edema.

The scenario describes a situation where an elderly patient, despite having a documented allergy, was prescribed and administered a medication they are allergic to. This directly violates the patient’s right to informed consent and the nurse’s duty to ensure patient safety by verifying medication orders against known allergies. The nurse is obligated to report this medication error to the appropriate authorities within the healthcare facility (e.g., supervisor, risk management) to initiate a review of the incident and prevent future occurrences. Failing to report such an error could lead to further harm to the patient and legal repercussions for both the nurse and the institution. Furthermore, the error should be documented in the patient’s medical record, including the details of the incident, the patient’s reaction (if any), and the corrective actions taken. Reporting also allows for system-wide improvements in medication safety protocols. Ignoring the error is unethical and potentially illegal. Contacting the patient’s family without first reporting through the proper channels is a breach of protocol. While the nurse should provide supportive care to the patient, the primary responsibility is to report the error.

This question addresses the complexities of medication reconciliation in older adults, particularly those transitioning from hospital to home. A crucial step in medication reconciliation is to compare the discharge medication list with the patient’s pre-admission medication list, as well as any medications they were taking during their hospital stay. This comparison helps identify any discrepancies, such as medications that were added, discontinued, or changed during hospitalization. Addressing these discrepancies is essential to ensure that the patient understands their medication regimen and to prevent medication errors. Simply providing the discharge medication list without comparing it to the patient’s previous medications can lead to confusion and potential harm.

The scenario describes an older adult experiencing a constellation of symptoms – unintentional weight loss, decreased grip strength, and self-reported exhaustion – that strongly suggest frailty. Frailty is a geriatric syndrome characterized by decreased physiological reserve and increased vulnerability to stressors. The Fried phenotype, also known as the Cardiovascular Health Study (CHS) frailty criteria, specifically includes unintentional weight loss, self-reported exhaustion, weakness (decreased grip strength), slow walking speed, and low physical activity. Identifying frailty is important because it predicts adverse outcomes such as falls, hospitalization, and mortality. While malnutrition, sarcopenia, and depression can contribute to frailty, the combination of symptoms described is most indicative of the overall frailty syndrome as defined by the Fried phenotype.

The scenario describes a patient with multiple chronic conditions (COPD, hypertension, osteoarthritis) and a recent diagnosis of type 2 diabetes. The addition of metformin, an oral hypoglycemic, to her existing medication regimen (inhaled bronchodilators, antihypertensives, NSAIDs) significantly increases her risk of polypharmacy and potential drug interactions. Given her age (78), age-related pharmacokinetic changes (decreased renal function, altered hepatic metabolism) further exacerbate this risk. NSAIDs are known to increase the risk of renal impairment and gastrointestinal bleeding, especially in older adults. Metformin is primarily cleared renally, and impaired renal function increases the risk of lactic acidosis. The combination of antihypertensives and metformin can increase the risk of hypoglycemia. Inhaled bronchodilators can cause tachycardia and tremor, potentially exacerbating cardiovascular issues. The best immediate action is to conduct a thorough medication reconciliation and deprescribing assessment. This involves reviewing all of the patient’s medications, identifying potential drug interactions and redundancies, and working with the patient and her physician to reduce the number of medications to the minimum necessary to achieve her therapeutic goals, prioritizing those with the greatest benefit and least risk. This is in line with geriatric best practices and guidelines for managing polypharmacy in older adults.