SAS 6

1. Which is the best example of polypharmacy?

a. Your patient is filling her medications at more than 1 drugstore.
b. Your patient is taking more than 2 medications.
c. Your patient is taking more than 9 medications.
d. Your patient is taking a potentially inappropriate combination of medicines.

RATIONALE: Polypharmacy refers to a potentially inappropriate combination of

medications. While it is true that a higher number of medications puts patients at risk of
polypharmacy, it is not in and of itself indicative of polypharmacy

2. Which is the most effective method of managing polypharmacy?

a. Review of medications at each office visit, to ensure an accurate med list.
b. Limit your patients’ medication list to no more than 4 medicines.
c. Regularly assess patient adherence to the medication regimen.
d. (a) and (c)

RATIONALE: Two keys to managing medication use in the elderly are accurate
medication listing and assessment of compliance.

3. Oral drugs may be absorbed less quickly in older people because:

a. Of increased number of receptors in the heart
b. Of increased liver metabolism
c. Of increased kidney function
d. Of decreased gastrointestinal motility

RATIONALE: Gastrointestinal: increase in pH(alkaline) decrease =peristalsis,

motility,and first-pass effect, all of which slows absorption of oral drugs

4. Enteric coated tablets are designed to avoid being dissolved in the highly acidic
stomach. Instead, they dissolve in the intestine. Knowing this and what you know about
gastrointestinal changes associated with age, what can you conclude about enteric
coated tablets and older patients?
a. The tablets will need to be given intravenously instead
b. These tablets will probably dissolve more slowly
c. The enteric coated tablets are unaffected by changes associated with age
d. These tablets may dissolve more quickly

RATIONALE: enteric coating prevents the tablet from dissolving and releasing its
contents at the low pH in the stomach. The coating and the tablet later dissolve and
release the drug in the higher pH of the duodenum, where the drug is rapidly absorbed
with less irritation to the mucosal cells.

5. In an older population we can expect that drugs will be:

a. Absorbed more quickly
b. Metabolized more quickly
c. Excreted more rapidly by the kidneys
d. Excreted less readily

RATIONALE: changes associated with aging is decreased renal elimination of drugs.

6. Which of the following is an age-related physiologic change that may affect the
absorption of drugs?
a. Xerostomia
b. Faster stomach emptying
c. Altered pH of the stomach contents
d. Increased gastrointestinal tract motility

RATIONALE: Age-related physiologic factors that may affect the absorption of drugs
include delayed emptying time of the stomach, altered pH of the stomach contents, and
slowed gastrointestinal tract motility.

7. The nurse is caring for a group of older adult patients who are all receiving multiple
medications. The nurse understands that it is essential to individualize each patient's
therapy. Which is the best rationale for this practice?
A. The percentage of drug absorbed often is decreased in older adults.
B. Most older adults have decreased body fat and increased lean mass.
C. Hepatic metabolism tends to increase in older adults, resulting in decreased drug
levels.
D. Renal function declines with age, leading to decreased drug excretion.

RATIONALE: Renal function declines in older adults, leading to decreased excretion

and potential drug accumulation.

8. When assessing for drug effects in the older adult, which phase of pharmacokinetics
is the greatest concern?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion
RATIONALE: Although pharmacokinetic changes in older adults affect all phases of
kinetics, drug accumulation secondary to reduced renal excretion is the most important
cause of ADRs in the older adult

9. All of the following are impacts of polypharmacy EXCEPT:

a. Increased communication between care teams
b. Adverse drug events
c. Increased healthcare costs
d. Medication non-adherence

RATIONALE: Lack of communication between treatment teams and disruption in

communication during transitions of care from the inpatient setting to the outpatient
setting and vice‐versa can precipitate polypharmacy

10. The single most important thing we can do as healthcare providers to prevent
polypharmacy is:
a. Encourage our patients to carry a list of home medications in their wallet
b. Tell our patient to appoint a lead doctor
c. Educate our patients on each of their new medications
d. Tell our patients to Google all of their medications

RATIONALE: To prevent polypharmacy, Ask patients to bring all medications to each

visit or ("brown bag review").

SAS 8

1. Which of the following is NOT a priority for patients with a life-limiting illness receiving
palliative care?
A) Relieving burden
B) Prolonging life at all costs
C) Obtaining a sense of control
D) Strengthening relationships with loved ones

RATIONALE: An early survey of patients with life-limiting diseases identified five

priorities for palliative care: receiving adequate treatment for pain and other symptoms,
avoiding inappropriate prolongation of life, obtaining a sense of control, relieving
burden, and strengthening relationships with loved ones
2. The family of a client with a terminal illness hesitates to agree to palliative care
because of not wanting to give up on a possible cure. How should the nurse respond
while also including a principle of palliative care?
a. "Most people don't realize that palliative care means there is no cure."
b. "There will not be another opportunity if palliative care is refused now."
c. "The client can continue to receive treatment intended to cure the disease."
d. "Palliative care and curative treatments cannot be provided at the same time."
RATIONALE: The Principles of Palliative care includes to Affirm life and regarding
dying as a normal process, to Neither hastens nor postpones death, to Provide relief
from pain and other distressing symptoms,to Integrate the psychological and spiritual
aspects of care.

3. The family of a client receiving palliative care for a terminal illness hesitate to call for
the nurse since all staff seem to be too busy to address the client's needs. Which action
should the nurse take to improve the connection with the family?
a. Vary the number and type of caregivers who respond to the client's needs
b. Enter the room and stand or sit at the bedside to talk with the client and family
c. Provide the family with reading material that explains the role of palliative care
d. Attend to infusions and environmental issues while talking with the client and family

RATIONALE : The principles of Palliative Care includes Offering a support system to

help patients live as actively as possible until death and Offering a support system to
help patients’ families cope during the patient’s illness and in their own bereavement

4. Which of the following is NOT a barrier to the optimum use of palliative care at the
end of life?
A) Reimbursement policies
B) Easily determined prognoses
C) Lack of well-trained healthcare professionals
D) Attitudes of patients, families, and clinicians

RATIONALE: Among the most important barriers to the optimum use of palliative care
at the end of life are the lack of well-trained healthcare professionals; reimbursement
policies; difficulty in determining accurate prognoses; and attitudes of patients, families,
and clinicians.

5. An 80-year-old patient is receiving palliative care for heart failure. What are the
primary purposes of her receiving palliative care (select all that apply)?
A. Improve her quality of life.
B. Assess her coping ability with disease.
C. Have time to teach patient and family about disease.
D. Focus on reducing the severity of disease symptoms.
E. Provide care that the family is unwilling or unable to give.

RATIONALE: The focus of palliative care is to reduce the severity of disease

symptoms. The goals of palliative care are to prevent and relieve suffering and to
improve quality of life for patients with serious, life-limiting illnesses.

6. The home health nurse visits a 40-year-old breast cancer patient with metastatic
breast cancer who is receiving palliative care. The patient is experiencing pain at a level
of 7 (on a 10-point scale). In prioritizing activities for the visit, you would do which of the
following first?
A. Auscultate for breath sounds.
B. Administer prn pain medication.
C. Check pressure points for skin breakdown.
D. Ask family members about patient's dietary intake.

RATIONALE: Meeting the patient's physiologic and safety needs is the priority. The
priority is to treat the severe pain with pain medication.

7. You are visiting with the wife of a patient who is having difficulty making the transition
to palliative care for her dying husband. What is the most desirable outcome for the
couple?
A. They express hope for a cure.
B. They comply with treatment options.
C. They set additional goals for the future.
D. They acknowledge the symptoms and prognosis.

RATIONALE: The grief experience for the caregiver of the patient with a chronic illness
often begins long before the death. This is called anticipatory grief. Acceptance of the
expected loss is associated with more positive outcomes.

8. 67-year-old woman was recently diagnosed with inoperable pancreatic cancer.

Before the diagnosis, she was very active in her neighborhood association. Her
husband is concerned because his wife is staying at home and missing her usual
community activities. Which common end-of-life (EOL) psychologic manifestation is she
most likely demonstrating?
A. Peacefulness
B. Decreased socialization
C. Decreased decision-making
D. Anxiety about unfinished business

RATIONALE: Decreased socialization is a common psychosocial manifestation of

approaching death

9. The caregiver children of an elderly patient whose death is imminent have not left the
bedside for the past 36 hours. In your assessment of the family, which of the following
findings indicates the potential for an abnormal grief reaction by family members (select
all that apply)?
A. Family members cannot express their feelings to one another.
B. The dying patient is becoming more restless and agitated.
C. A family member is going through a difficult divorce.
D. The family talks with and reassures the patient at frequent intervals.
E. Siblings who were estranged from each other have now reunited.

RATIONALE: You must be able to recognize signs and behaviors among family
members who may be at risk for abnormal grief reactions. These may include
dependency and negative feelings about the dying person, inability to express feelings,
sleep disturbances, a history of depression, difficult reactions to previous losses,
perceived lack of social or family support, low self-esteem, multiple previous
bereavements, alcoholism, and substance abuse.

10. Which statement made by the graduate nurse working in the hospice unit with a
patient near the end of life requires intervention by the preceptor nurse?
A. "The patient has eaten only small amounts the past 48 hours; will the physician
consider placing a feeding tube?"
B. "The family seems comfortable with the long periods of silence."
C. "The physician ordered an increase in the dosage of morphine; I will administer the
new dose right away."
D. "The blood pressure is lower this afternoon than it was this morning; I will
communicate the changes to the family."

RATIONALE: Nursing management related to physical care at the end of life deals with
symptom management and caring rather than treatment aimed at curing a disease or
disorder. Meeting the patient's physiologic and safety needs is the priority. Physical care
focuses on the needs for oxygen, nutrition, pain relief, mobility, elimination, and skin
care. People who are dying deserve and require the same physical care as people who
are expected to recover.