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. A pulse oximetry of 92% indicates mild hypoxia but does not directly contraindicate the use of verapamil.
B. A respiratory rate of 12 is within the normal range for adults and does not indicate a need to hold the medication.
C. A pulse of 78 is within the normal range but should be assessed in the context of the client’s overall condition; however, if the pulse were significantly lower (e.g., <60 bpm), it would necessitate holding the medication due to the risk of bradycardia.
D. A history of myocardial infarction a week ago would warrant caution but is not an absolute reason to hold verapamil unless other contraindications are present, as verapamil can be beneficial for managing hypertension post-MI.
Correct Answer is A
Explanation
A. Following the insertion of the Nexplanon rod, it is important to inform the client that backup contraception methods are needed for the first 24 hours to ensure pregnancy prevention while the implant becomes effective.
B. While smoking cessation is advised due to the increased risk of thrombotic events with hormonal contraceptives, it is not the priority instruction immediately following the insertion of Nexplanon.
C. The statement regarding weight loss is incorrect; Nexplanon is more commonly associated with weight gain rather than loss, so advising clients on calorie consumption is misleading.
D. Although Nexplanon has a high efficacy rate in preventing pregnancy, stating a prevention rate of 100% is inaccurate and misleading, as no contraceptive method is completely foolproof.