The nurse is teaching a patient who has been diagnosed with a gastric ulcer and has been prescribed an antacid. The patient demonstrates understanding when they state:

Choice A reason: This is correct. The kidneys are the main organs for excreting water-soluble substances, including most drugs and their metabolites. The kidneys filter the blood and remove waste products and excess fluid as urine. Drugs can be excreted by glomerular filtration, tubular secretion, or tubular reabsorption.

Choice B reason: This is incorrect. The pancreas is not involved in excretion of drugs. The pancreas is an organ that produces digestive enzymes and hormones, such as insulin and glucagon.

Choice C reason: This is incorrect. The gallbladder is not involved in excretion of drugs. The gallbladder is an organ that stores and concentrates bile, a fluid that helps digest fats.

Choice D reason: This is incorrect. The liver is not primarily responsible for excretion of drugs, although it plays an important role in drug metabolism. The liver is an organ that performs many functions, such as detoxifying substances, synthesizing proteins, and producing bile. The liver can transform drugs into more polar and water-soluble compounds, which can then be excreted by the kidneys or the biliary system.

Choice A reason: Administering the medication with meals only is not a valid adjustment for a medication that is primarily excreted by the kidneys. The food intake does not affect the renal clearance of the drug, unless it alters the pH of the urine or the blood flow to the kidneys. The nurse should follow the instructions on the medication label or the prescriber's order regarding the timing of the administration.

Choice B reason: No dose adjustment is required is an incorrect statement for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function.

Choice C reason: Increasing the dose to ensure therapeutic effect is a dangerous and inappropriate adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should not increase the dose without the prescriber's order and should monitor the patient for signs of overdose or toxicity.

Choice D reason: Decreasing the dose to prevent toxicity is the correct and rational adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function. The nurse should also monitor the patient for the therapeutic response and the adverse effects of the drug.