NR 565 MIDTERM EXAM NEWEST 2024
QUESTIONS AND DETAILED CORRECT
ANSWERS INCLUDING RATIONALES (GRADED
A+)
An 82 year old male visits the clinic complaining that his pain
medications "take forever" to work after he takes his pill. What are
possible reasons you can explain to him?
Perhaps we need to increase your dosage.
Sometimes as you get older, absorption may be slower resulting in
a delayed response.
As we get older the gastric acid decreases and may slow
absorption. - ANSWER-B. Sometimes as you get older, absorption
may be slower resulting in a delayed response.
C. As we get older the gastric acid decreases and may slow
absorption.
Distribution of medication can be affected in the elderly in what
2 | P a g e
ways?
Decreased hormones
Increased body fat
Decreased lean mass
Decreased albumin - ANSWER-B. Increased body fat
C. Decreased lean mass
D. Decreased albumin
When prescribing medications, we must understand that liver
function declines with age due to what cause?
Enlarged liver
Decreased blood flow to liver
Increased activity of the hepatic enzymes - ANSWER-B.
Decreased blood flow to liver
What is the most important cause of Adverse Drug Reactions?
3 | P a g e
High drug dosages
Lack of monitoring of medications
Decreased renal excretion
Overprescribing/Polypharmacy - ANSWER-C. Decreased renal
excretion
What can a poor metabolism phenotype do to metabolism of
drugs? - ANSWER- Reduced or absent enzyme activity which can
lead to slow processing of meds (low effect) or increased risk of
SEs.
How does poor metabolism affect a high or low therapeutic index? -
ANSWER-Some Rx need to be converted to active form for use ->
low therapeutic effect
Some Rx need to be metabolized for clearance ->risk for OD
BB warning for opioids - ANSWER-Resp arrest
BB warning for Fentanyl - ANSWER-Fatal Resp Depression
4 | P a g e
BB warning for Methadone - ANSWER-QT prolongation Fatal
dysrhythmias (Torsades)
Resp Dep
BB warning for Codeine - ANSWER-10% codeine -> morphine in
liver Poss. Death in children
severe toxicity risk in BF infants
BB warning for Hydromorphone and Oxymorphone - ANSWERHIGH ABUSE POTENTIAL
Resp dep esp. when used with other sedatives i.e. alcohol
BB warning for Oxycodone - ANSWER-High abuse potential Resp
dep.
What are therapeutic uses for morphine? - ANSWER-Pain,
sedation, euphoria, resp depression, cough suppression,
suppression of GI motility, reduces anxiety
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