A nurse reads in a drug information guide that PO morphine has a high first-pass effect. Which of the following would the nurse expect?
The drug will be most effective when given orally.
The drug will be more effective when given in a non-enteral route.
The drug is excreted by the kidneys at a slower rate than most medications.
The kidney will metabolize some of the drug before it reaches the bloodstream.
The Correct Answer is B
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.
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Correct Answer is C
Explanation
A. Glucose tablets are appropriate for clients with mild hypoglycemia who are alert and able to chew and swallow; they are not suitable for someone who is difficult to arouse.
B. Epinephrine is not used as a treatment for hypoglycemia; it does not directly increase blood glucose levels.
C. IVP (intravenous push) dextrose 50% is indicated for severe hypoglycemia in clients who are lethargic or unresponsive, as it rapidly increases blood glucose levels.
D. Orange juice is effective for mild hypoglycemia but is not appropriate in this case due to the client’s altered mental status and risk of aspiration.
Correct Answer is ["B","D","F"]
Explanation
A. Dry mouth is not a cholinergic side effect; cholinergic effects typically increase secretions.
B. Diarrhea is a common cholinergic side effect due to increased gastrointestinal motility.
C. Decreased urination is not expected; cholinergic agents may increase urination.
D. Excessive lacrimation (tearing) is a common cholinergic effect, as these agents stimulate glandular secretions.
E. Tachycardia is not a cholinergic side effect; bradycardia is more likely due to cholinergic effects.
F. Excessive sweating is a cholinergic effect due to increased glandular activity.