The nurse is preparing to administer medications to a 54-year-old client. Which medications taken would be affected by the first-pass effect? (Select All that Apply.)
Morphine 2mg IV (Intravenously)
Diphenhydramine (Benadryl) 25mg Tablet
Famotidine 10mg Tablet
Nitroglycerin 4mg Sublingual Tablet
Nitroglycerin 10mg Sublingual Tablet
Acetaminophen 325mg Capsule
Correct Answer : B,C,F
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.
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Correct Answer is D
Explanation
A. Prophylactic therapy is used to prevent infection in at-risk individuals, not to treat suspected infections before confirming lab results.
B. Palliative therapy is intended for symptom relief, often in cases where curing the disease is not the goal.
C. Maintenance therapy is designed to maintain health stability rather than to treat suspected infections without lab confirmation.
D. Empiric therapy involves starting treatment based on clinical judgment before lab results are available. This approach is useful to manage infections promptly when waiting for cultures could delay necessary care.
Correct Answer is C
Explanation
A. A BMI greater than 30 is a consideration, but it is not an absolute contraindication for the use of POPs.
B. Ginger does not interact adversely with progestin-only pills and is not a contraindication.
C. A history of hypertension can increase the risk of cardiovascular events, and while POPs are generally safer than combined hormonal contraceptives for women with hypertension, it should still be monitored and reported to the healthcare provider.
D. Having no intention of conceiving is not a contraindication; in fact, it is a common reason for using contraceptive methods like POPs.