A nurse is preparing to administer a medication to a client who states, "That looks different from the pill I usually take." Which is the best response by the nurse?
"What does your usual pill look like?"
"This is the medication prescribed by your provider."
"This hospital might use a different manufacturer, but the medication is the same."
"This pill is probably from a different lot number than yours at home."
The Correct Answer is C
A. Asking what the usual pill looks like may not provide clarity and does not address the client's concern directly.
B. While the statement is accurate, it does not provide the client with reassurance or address the reason for the difference in appearance.
C. This response acknowledges the client's concern, offers an explanation about variations in medication appearance due to different manufacturers, and reassures the client that it is the same medication prescribed.
D. Suggesting that the pill is from a different lot number does not address the fact that variations in appearance can occur due to different manufacturers, which is more common and relevant to the situation.
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Correct Answer is ["B","C","F"]
Explanation
A. Morphine administered intravenously bypasses the gastrointestinal tract and liver, avoiding the first-pass effect entirely.
B. Diphenhydramine in tablet form is absorbed through the gastrointestinal tract and undergoes significant first-pass metabolism in the liver, affecting its bioavailability.
C. Famotidine in tablet form is also subject to first-pass metabolism, which can reduce its effectiveness.
D. Nitroglycerin sublingual tablets are designed to bypass the first-pass metabolism by being absorbed directly into the bloodstream through the mucous membranes.
E. The same applies to nitroglycerin 10mg sublingual tablets; they also avoid the first-pass effect due to sublingual administration.
F. Acetaminophen is taken orally and undergoes first-pass metabolism in the liver, which can significantly affect its overall bioavailability.
Correct Answer is B
Explanation
A. A high first-pass effect means that a significant amount of the drug is metabolized by the liver before reaching systemic circulation, making oral administration less effective.
B. Morphine with a high first-pass effect will be more effective when administered via non-enteral routes, such as IV or subcutaneous, to bypass the liver's initial metabolism.
C. The first-pass effect does not influence the kidney’s rate of excretion but rather the liver’s initial metabolism of the drug.
D. The liver, not the kidneys, is responsible for the first-pass metabolism, which occurs before the drug reaches systemic circulation when taken orally.