# An 82-year-old client with multiple chronic conditions is prescribed several new medications. Which nursing intervention is most important to prevent adverse drug reactions in this older adult client? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541817 > language: ko > subject: Growth & Development ## 문제 An 82-year-old client with multiple chronic conditions is prescribed several new medications. Which nursing intervention is most important to prevent adverse drug reactions in this older adult client? ## 보기 1. Administer all medications at the same time to improve compliance 2. Conduct a comprehensive medication reconciliation and review for potential drug interactions **✔ 정답** 3. Encourage the client to take medications with food to prevent gastric irritation 4. Provide written instructions for all medications in large print format **정답: 2** ## 해설 Medication reconciliation and interaction review is critical for older adults at high risk for polypharmacy complications due to age-related changes. Other options are supportive but less comprehensive for preventing adverse drug reactions. ## 심화 해설 Understanding the Core Issue When caring for an 82-year-old client with multiple chronic conditions who is starting several new medications, the primary safety concern is the heightened risk of adverse drug reactions (ADRs) and drug-drug interactions (DDIs). This risk is not simply additive; it is driven by age-related physiological changes that alter how the body handles drugs. Specifically, aging leads to changes in pharmacokinetics (what the body does to the drug, such as reduced renal clearance and altered hepatic metabolism) and pharmacodynamics (what the drug does to the body, often resulting in increased sensitivity to certain medications) [1]. When this altered physiology is combined with polypharmacy—a common consequence of managing multiple chronic conditions—the potential for a medication to cause harm increases exponentially [2]. Therefore, the nurse's most critical role is not simply to administer medications but to act as a safety checkpoint by proactively identifying and mitigating these risks before a drug is ever given. Analysis of the Correct Answer The most important intervention is to conduct a comprehensive medication reconciliation and review for potential drug interactions (Option 2). This process is a foundational element of medication safety, particularly during high-risk periods such as the initiation of new therapies. A thorough review involves creating a complete and accurate list of all medications the client is actually taking—including prescriptions, over-the-counter drugs, and supplements—and comparing it against the new orders. The goal is to proactively identify discrepancies, potentially inappropriate medications, and dangerous drug-drug interactions [1]. Evidence consistently shows that multimorbid older adults are at extreme risk for ADRs and DDIs, and that systematic, multidisciplinary assessment is the most effective strategy to prevent them [2]. This intervention directly addresses the root cause of preventable adverse events, making it the highest priority over supportive measures like providing instructions or altering administration timing. Analysis of Incorrect Answers - Option 1: Administer all medications at the same time to improve compliance. While simplifying a medication regimen can improve adherence, this approach is dangerous without a prior safety review. Administering multiple drugs simultaneously without checking for interactions could precipitate a severe adverse reaction. The priority must always be safety before compliance [1]. - Option 3: Encourage the client to take medications with food to prevent gastric irritation. This is a comfort-focused intervention that addresses a potential side effect, not a life-threatening safety risk. While preventing gastric irritation is a valid nursing consideration, it does not take precedence over identifying and preventing a potentially fatal drug-drug interaction or an ADR from an inappropriate prescription [2]. - Option 4: Provide written instructions for all medications in large print format. Providing accessible education is an important part of promoting medication adherence and is a specific accommodation for visual deficits common in older adults. However, education is only safe and effective after the medication regimen itself has been verified as safe. Providing clear instructions for a dangerous drug combination is a critical failure in the nursing process [3]. Clinical Reasoning and Priority Setting This question tests the ability to prioritize using the nursing process and a safety-focused framework. The nurse must first assess the safety of the prescribed regimen. A comprehensive medication reconciliation and review is the assessment step that uncovers the most immediate threats to physiological integrity. The other options represent planning (Option 4) and implementation (Options 1 and 3) steps that are contingent on the outcome of this initial safety assessment. For an older adult with multimorbidity, the clinical evidence is clear: the highest-risk period for medication-related harm is during transitions and changes in therapy, and the most potent interventions are those that systematically identify and resolve drug therapy problems before they reach the patient [3,4].References (research sources) - [1]Identifying and Resolving Drug-Related Problems in Geriatric Patients.Research articlePeterson ME, Stollings JL, Ely EW. (2026) · DOI: 10.1177/00185787251414339 - [2]Adverse Drug Reactions and Drug Interactions in Multimorbid Patients: A Review of Current Evidence.Research articleS H, Tripathi S, Venuturumilli R, K SP, Reddy GHV, Mukherjee B, Lakhani HA. (2025) · DOI: 10.7759/cureus.97640 - [3]Medication Management During Care Transitions: Reducing Errors and Enhancing Adherence.Research articleSchnipper JL. (2026) · DOI: 10.1016/j.mcna.2025.11.017 ## 임상 시나리오 Medication Safety in Older AdultsPreventing Adverse Drug Reactions Through Reconciliation The highest priority for an older adult starting new medications is a comprehensive medication reconciliation. This process involves creating an accurate list of all drugs, including over-the-counter and herbal supplements, and reviewing for potential drug-drug interactions. Age-related changes in pharmacokinetics, such as a decline in renal function and altered hepatic metabolism, increase drug sensitivity. This makes the risk from polypharmacy exponential, not just additive. CautionNever administer all medications at once without verifying compatibility. A medication review must be the first step before any other intervention like providing written instructions or administering with food. ## 핵심 개념 - **Medication Reconciliation** — The process of creating the most accurate list possible of all medications a patient is taking and comparing that list against the physician's admission, transfer, or discharge orders. - **Polypharmacy** — The concurrent use of multiple medications by a patient, most commonly seen in older adults, which significantly increases the risk of adverse drug events and interactions. - **Pharmacokinetics** — The study of what the body does to a drug, including absorption, distribution, metabolism, and excretion, all of which are altered in the aging process. - **Adverse Drug Reaction (ADR)** — An unintended, harmful reaction to a medicine given at a standard dose, which is a major cause of iatrogenic illness, especially in the geriatric population. ## 같은 주제 문제 - [An 82-year-old client with multiple chronic conditions is prescribed several new medicatio…](https://mymerci.kr/pages/nclex_q.php?qn_id=541814) - [A 78-year-old client with heart failure and diabetes is taking 12 different medications. 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