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A patient has nine drugs prescribed to take daily. Which are common reasons for nonadherence to the drug regimen in an older adult? (Select all that apply.)
- A. Taking multiple drugs at one time
- B. Impaired memory
- C. Decreased dexterity
- D. Increased mobility
Correct Answer: A
Rationale: Rationale: Taking multiple drugs at one time can be overwhelming and lead to nonadherence due to complexity and confusion. Impaired memory can affect remembering to take medications, but not the primary reason. Decreased dexterity can make it challenging to handle medications, but it's not as common of a reason as the complexity of multiple drugs. Increased mobility doesn't directly impact medication adherence. Thus, the correct answer is A.
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Which of the following pharmacokinetic properties of the drug was most likely affected by this large first-pass effect?
- A. Volume of distribution
- B. Oral bioavailability
- C. Renal clearance
- D. Sublingual bioavailability
Correct Answer: B
Rationale: The large first-pass effect most likely affected the oral bioavailability of the drug. First-pass effect refers to the metabolism of a drug before it reaches systemic circulation, reducing the amount of drug available for action. This would impact the drug's bioavailability when administered orally.
The nurse knows that the patient should be informed about the risks and benefits related to clinical research. What ethical principle does this describe?
- A. Respect for persons
- B. Justice
- C. Beneficence
- D. Informed consent
Correct Answer: D
Rationale: The correct answer is D: Informed consent. Informed consent is a fundamental ethical principle in research that requires individuals to be fully informed about the risks and benefits before participating. This principle ensures that individuals can make autonomous decisions based on complete information. Respect for persons (A) is related but focuses more on treating individuals with dignity and autonomy. Justice (B) pertains to fair distribution of benefits and risks in research. Beneficence (C) is about maximizing benefits and minimizing harms for participants, which is important but not directly related to informing patients about risks and benefits.
Angiotensin receptor blockers (ARBs) used in the treatment of hypertension are an example of which type of action?
- A. Antagonizing nuclear receptors
- B. Agonist for cell surface receptor
- C. Antagonizing cell surface receptor
- D. None of the above
Correct Answer: C
Rationale: The correct answer is C: Antagonizing cell surface receptor. ARBs block the angiotensin II type 1 receptor on the cell surface, preventing angiotensin II from binding and exerting its vasoconstrictive effects, thus lowering blood pressure. Choice A is incorrect as ARBs do not target nuclear receptors. Choice B is incorrect as ARBs do not act as agonists for cell surface receptors. Choice D is incorrect as ARBs do exert their action by antagonizing the cell surface receptor.
The nurse is meeting with a community group about medication safety. The nurse must emphasize that patients at high risk for drug interactions include which groups? (Select all that apply.)
- A. Older patients
- B. Patients with chronic health conditions
- C. Patients taking three or more drugs
- D. Patients dealing with only one pharmacy
Correct Answer: A
Rationale: The correct answer is A (Older patients) because elderly individuals tend to have multiple comorbidities and are more likely to be prescribed multiple medications, increasing the risk of drug interactions. Older patients also tend to have age-related physiological changes that can affect drug metabolism.
Choice B (Patients with chronic health conditions) is not necessarily always at high risk for drug interactions, as it depends on the specific medications they are taking and their individual health status.
Choice C (Patients taking three or more drugs) is not always a high-risk group, as drug interactions can occur even with fewer medications based on the specific drugs being taken and individual patient factors.
Choice D (Patients dealing with only one pharmacy) is not directly related to the risk of drug interactions, as the number of pharmacies used by a patient does not necessarily correlate with the risk of drug interactions.
A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to prescribing because:
- A. Distribution of drugs to target tissue may be affected
- B. The solubility of the drug will not match the site of absorption
- C. There will be less free drug available to generate an effect
- D. Drugs bound to albumin are readily excreted by the kidney
Correct Answer: C
Rationale: Rationale for Correct Answer C:
1. Albumin is a major plasma protein that binds to drugs.
2. Hypoalbuminemia means less albumin is available to bind drugs.
3. Less albumin results in more free drug in the bloodstream.
4. Free drug is pharmacologically active and can generate effects.
5. Therefore, with less albumin, less free drug is available to generate an effect.
Summary:
A: Distribution of drugs may be affected by protein binding, not albumin levels.
B: Solubility matching absorption sites is more related to drug formulation.
D: Albumin-bound drugs are not readily excreted by the kidney; they are protected from filtration.