The geriatric nurse is administering nightly medications to a 65-year-old woman with dysphagia. The patient is able to swallow crushed medications with thickened liquids. Which of the following medications should the nurse not crush?

Correct Answer: A

Rationale: Rationale: The correct answer is A) Pantoprazole ER. Pantoprazole ER is an extended-release medication, which means it is designed to release the drug slowly over time. Crushing an extended-release medication like Pantoprazole ER can disrupt the special coating that controls the release of the medication. When crushed, the medication is absorbed too quickly, which can lead to potential overdose or adverse effects due to the rapid release of the entire dose at once. Option B) Multivitamins, and Option C) Acetaminophen are medications that can typically be crushed for patients with swallowing difficulties, like the 65-year-old woman in this scenario. These medications do not have special coatings or formulations that are altered by crushing, making them safe to crush for administration with thickened liquids. Option D) Potassium chloride should also not be crushed, as it is a medication that can be irritating to the gastrointestinal tract. Crushing potassium chloride can lead to gastrointestinal irritation or even ulceration due to its high potency. It is often recommended to use alternative dosage forms or formulations for patients who have difficulty swallowing tablets or capsules. In an educational context, it is crucial for nurses to understand the implications of crushing medications, especially when caring for patients with dysphagia or swallowing difficulties. Nurses must be aware of which medications can and cannot be crushed to ensure the safety and effectiveness of drug administration. Proper medication administration techniques are essential in preventing medication errors and adverse reactions in vulnerable patient populations, such as the elderly.

Correct Answer: A

Rationale: In this question, the correct answer is A) Reduced kidney functioning. The rationale behind this is crucial for nurses to understand in the context of medication administration among older adults. Age-related changes in the kidneys, such as decreased glomerular filtration rate, impair the ability of the kidneys to efficiently excrete medications. This can lead to a buildup of drugs in the system, increasing the risk of medication toxicity in older adults. Option B) Reduced esophageal stricture is incorrect because esophageal stricture is not a physiological change associated with aging. Option C) Increased gastric motility is incorrect as gastric motility actually decreases with age. Option D) Increased liver mass is also incorrect as liver mass tends to decrease in older adults, affecting drug metabolism. Educationally, this question highlights the importance of understanding how age-related physiological changes impact medication administration in older adults. Nurses must be vigilant in monitoring for signs of medication toxicity in this population due to altered drug metabolism and excretion processes. Understanding these age-related changes can help nurses provide safe and effective care to older adult patients.

Correct Answer: A

Rationale: The nurse should follow Nurse Practice Acts and safe narcotic administration guidelines by having a nurse witness the 'wasted' medication. The nurse cannot return the wasted medication to the medication dispenser. Wasted portions of medications are not placed in sharps containers. The nurse should not leave the narcotic unattended and call the health care provider to obtain matching dosages; the nurse is expected to obtain the correct dose.

Correct Answer: B

Rationale: A spacer is indicated for a patient who has difficulty coordinating the steps, like patients with limited mobility/coordination. An alert adolescent with a repaired cleft palate would not need a spacer. Hearing impairment may make teaching the patient to use the inhaler difficult, but it does not indicate the need for a spacer. Although a patient with left-sided hemiparesis could have coordination problems, a patient using a dry powder inhaler does not require the use of spacers.

Correct Answer: C

Rationale: The ventrogluteal site is the preferred and safest site for all adults, children, and infants. While the vastus lateralis is a large muscle that could be used, it is not the preferred and safest. The dorsal gluteal site is a location for a subcutaneous injection, and this patient requires an IM injection. The deltoid is easily accessible, but this muscle is not well developed and is not the preferred site.