Which of the following would be the best choice for treating mild back pain in an older adult who has chronic kidney disease? Liver enzymes are within normal limits.

Choice A reason: This is incorrect because over-the-counter NSAIDs are not generally harmless, especially for older adults. NSAIDs can cause gastrointestinal bleeding, renal impairment, hypertension, and increased risk of cardiovascular events. Older adults are more susceptible to these adverse effects due to age-related changes in pharmacokinetics and pharmacodynamics, as well as the presence of comorbidities and polypharmacy. Therefore, NSAIDs should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice B reason: This is correct because stool softeners and laxatives should be used with opioids. Opioids can cause constipation, which can lead to abdominal pain, nausea, vomiting, fecal impaction, and bowel obstruction. Older adults are more prone to constipation due to decreased intestinal motility, reduced fluid intake, and use of other medications that affect bowel function. Therefore, stool softeners and laxatives should be prescribed along with opioids to prevent and treat constipation in older adults.

Choice C reason: This is incorrect because opioids are not less effective in older clients than in younger clients. Opioids are potent analgesics that can relieve moderate to severe pain in older adults. However, opioids can also cause respiratory depression, sedation, confusion, delirium, falls, and dependence. Older adults are more sensitive to these side effects due to altered pharmacokinetics and pharmacodynamics, as well as the presence of cognitive impairment and frailty. Therefore, opioids should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice D reason: This is incorrect because the dose limit for acetaminophen is not difficult to reach for older adults. Acetaminophen is a safe and effective analgesic for mild to moderate pain in older adults. However, acetaminophen can cause hepatotoxicity, especially at high doses or in combination with other medications that contain acetaminophen. The recommended maximum daily dose of acetaminophen for older adults is 3 grams, which can be easily reached if the patient is not aware of the amount of acetaminophen they are taking. Therefore, acetaminophen should be used with caution and at the lowest effective dose for the shortest duration possible in older adults.

Choice A reason: Older African American women do not have the highest risk of suicide among older adults. According to the CDC, suicide rates are highest among adults age 75 and older, and highest among males age 75 and older.

Choice B reason: Older adults and younger adults do not manifest suicidal intent in a similar manner. Older adults tend to plan suicide more carefully, use more lethal means, and have fewer warning signs than younger adults.

Choice C reason: A major crisis experienced by the client can contribute to the risk of suicide. Older adults may face various stressors, such as bereavement, loneliness, chronic illness, or loss of independence, that can trigger suicidal thoughts or behavior.

Choice D reason: Ethics do not require that the nurse respects a person’s intent to terminate his or her own life. Nurses have a duty to protect the safety and well-being of their clients, and to intervene if they suspect suicidal risk.