A client is ordered to receive 1000ml of 0.9% saline over 4 hours. At what rate will the nurse set the IV pump in mL/hr? (Enter a number only).

A) The drugs will compete for receptor sites: While it's true that highly protein-bound drugs can compete for binding sites on proteins (like albumin), the main issue with highly protein-bound drugs interacting is not related to competition for receptor sites. The primary concern is how the drugs displace each other from the protein-binding sites, which can increase the free (active) drug levels in the bloodstream. This can lead to a higher pharmacological effect, especially if the unbound drug concentration rises to a therapeutic or toxic level.

B) The client will have increased effects of both drugs: This is the correct answer. When two highly protein-bound drugs are administered together, they can displace each other from protein-binding sites. This displacement increases the amount of free (active) drug in circulation, which may intensify the pharmacologic effects of both drugs. For example, if one drug displaces the other from its protein-binding site, more of the free drug will be available to exert its effects. This can increase the risk of side effects, toxicity, or both.

C) The client will have decreased effects of both drugs: This is incorrect. The opposite is true—when two highly protein-bound drugs are given together, the displacement of one drug increases the amount of the free drug available, leading to a stronger effect, not a weaker one. Decreased effects would occur if the drug had no access to the target receptor or if it were metabolized or eliminated too quickly, which isn't the case in this scenario.

D) Both drugs are equally bound to protein: While both drugs may bind to protein, they do not necessarily bind equally. One drug might bind more strongly or more selectively to the protein than the other, which could lead to displacement of the weaker-bound drug. The important point is that their competition for protein-binding sites can lead to an increase in free (active) drug concentrations.

A) This medication neutralizes gastric acid in the stomach by direct contact: Sucralfate does not neutralize gastric acid. Instead, it works by forming a protective barrier over the ulcer, which helps protect it from further damage by stomach acid and promotes healing. Sucralfate is a mucosal protectant, not an acid-neutralizing agent.

B) "You should take this medication after meals to help limit gastric acid secretion": Sucralfate should be taken on an empty stomach, typically 30 minutes to 1 hour before meals, to allow it to form an effective protective barrier over the ulcer. Taking it after meals would interfere with its action and effectiveness.

C) "This medication decreases gastric acid production by blocking histamine 2 receptors": Sucralfate does not work by blocking histamine 2 receptors. Histamine 2 receptor antagonists, such as ranitidine, work by reducing gastric acid secretion. Sucralfate works by coating and protecting the ulcer rather than by reducing acid production.

D) "You should take this medication 30 minutes to 1 hour before meals and at bedtime": Sucralfate should be taken on an empty stomach, typically 30 minutes to 1 hour before meals and at bedtime. This timing ensures that the medication can form an effective barrier over the ulcer before food intake and helps maximize its healing properties.