The nurse is preparing to administer promethazine (Phenergan) to a client who presents with acute vomiting. What information in the client's past medical history would alert the nurse to hold the medication?
Diabetes Mellitus
Chronic Kidney Disease
Iron Deficiency Anemia
Narrow-Angle Glaucoma
The Correct Answer is D
A. Diabetes Mellitus is not a contraindication for promethazine, although caution may be needed regarding metabolic control.
B. Chronic Kidney Disease does not specifically contraindicate the use of promethazine, but dosage adjustments may be necessary due to altered drug metabolism.
C. Iron Deficiency Anemia does not contraindicate the use of promethazine and would not raise significant concerns for its administration.
D. Narrow-Angle Glaucoma is a contraindication for promethazine due to its anticholinergic properties, which can increase intraocular pressure and worsen glaucoma.
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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 ["D","E","F"]
Explanation
A. Excessive sweating is not typically associated with anticholinergic medications like scopolamine; in fact, these medications can lead to decreased sweating.
B. Bradycardia can occur with certain medications but is more commonly associated with other drug classes rather than scopolamine, which typically causes tachycardia.
C. Diarrhea is not a common side effect of scopolamine; instead, anticholinergics often cause constipation.
D. Urinary retention is a known side effect of scopolamine due to its anticholinergic properties, which can affect bladder function.
E. Constipation is a common side effect of anticholinergic medications, including scopolamine.
F. Dry mouth is another common side effect due to decreased salivary secretions resulting from anticholinergic activity.