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 more effective when given in a nonenteral route.

The drug will be most effective when given orally

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 blood stream

Answer and Explanation

The Correct Answer is A

A. The drug will be more effective when given in a nonenteral route:
Morphine has a high first-pass effect when taken orally, meaning that a significant amount of the drug is metabolized in the liver before it reaches systemic circulation. This reduces the amount of active drug available in the bloodstream. To avoid this extensive metabolism, morphine is often administered through nonenteral routes, such as intravenous or subcutaneous, where it bypasses the digestive system and liver first-pass metabolism, resulting in higher systemic bioavailability and effectiveness.

B. The drug will be most effective when given orally:
Due to the high first-pass effect of oral morphine, a significant portion of the drug is metabolized by the liver before it reaches systemic circulation. This means that oral morphine is often less effective compared to other routes of administration, such as intravenous, because the bioavailability of the drug is reduced.

C. The drug is excreted by the kidneys at a slower rate than most medications:
The high first-pass effect primarily affects the drug's absorption and systemic availability rather than its excretion rate. The rate at which a drug is excreted by the kidneys is generally unrelated to its first-pass effect. Morphine’s excretion is influenced by its metabolism and clearance, but not directly by the first-pass effect.

D. The kidney will metabolize some of the drug before it reaches the bloodstream:
The first-pass effect occurs primarily in the liver, not the kidneys. It involves the metabolism of the drug by the liver before it reaches systemic circulation. Therefore, this option incorrectly attributes the first-pass effect to kidney metabolism.

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Correct Answer is A

Explanation

A. Encourage elderly clients to keep a list of all medications, including dose and frequency, with them at all times:
Maintaining an accurate list of all medications, including doses and frequencies, helps prevent polypharmacy by ensuring that healthcare providers have a complete picture of what the patient is taking. This list can be critical in preventing drug interactions, avoiding duplicate therapies, and ensuring that the patient does not inadvertently take conflicting medications. It also aids in coordinating care among multiple providers.

B. Provide only written instructions for medications to elderly clients:
While written instructions are helpful, relying solely on them may not be sufficient. Elderly clients may have difficulty reading or understanding written instructions due to various factors like visual impairments or cognitive decline. A comprehensive approach, including verbal instructions and opportunities for clarification, is often more effective.

C. Encourage patients to use multiple pharmacies for convenience:
Using multiple pharmacies can increase the risk of polypharmacy because it may lead to a lack of coordination and awareness of all the medications the patient is taking. A single pharmacy or a centralized medication management system is generally more effective in tracking and managing medications to avoid interactions and duplications.
D. Teach elderly clients to have a spouse or family member be responsible for all of their medications:
While involving family members in medication management can be beneficial, it is not a strategy to prevent polypharmacy. The primary responsibility for managing medications should lie with the patient, in collaboration with healthcare providers, to ensure accuracy and understanding. Family members can assist, but they should not replace the need for personal medication management and monitoring.

A. Distribution, Excretion, Absorption Metabolism B. Absorption, Excretion, Metabolism, Distribution C. Absorption, Distribution, Metabolism. Excretion D. Absorption, Metabolism, Distribution, Excretion

Correct Answer is C

Explanation

A) Distribution, Excretion, Absorption, Metabolism: This order is incorrect because absorption should occur before distribution. The medication must first be absorbed into the bloodstream before it can be distributed throughout the body. Excretion and metabolism follow after distribution, not before.

B) Absorption, Excretion, Metabolism, Distribution: This sequence is incorrect because distribution occurs after absorption and before metabolism. Excretion is the final step and occurs after metabolism.

C) Absorption, Distribution, Metabolism, Excretion: This is the correct order. After oral administration, the medication is first absorbed into the bloodstream from the gastrointestinal tract. It is then distributed throughout the body. Following distribution, the medication undergoes metabolism (primarily in the liver) to be converted into more water-soluble forms for elimination. Finally, the medication is excreted from the body, typically through the kidneys

D) Absorption, Metabolism, Distribution, Excretion: This order is incorrect because metabolism occurs after distribution, not before. After absorption, the drug must be distributed to various tissues before it is metabolized. Excretion is the final step following metabolism.

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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?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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Correct Answer is C

Explanation

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