Which amount of urine production should the nurse evaluate as adequate output for a typical adult client?

This is because older adults have a reduced ability to excrete drugs and their metabolites through the kidneys, which can lead to drug accumulation and toxicity. Decreased renal function can also affect the pharmacokinetics and pharmacodynamics of many drugs, altering their absorption, distribution, metabolism, and elimination.

Choice A is wrong because reduced muscle mass does not directly affect drug metabolism or clearance, although it may affect the volume of distribution of some drugs that are highly protein-bound or lipophilic.

Choice C is wrong because slowed gastrointestinal motility does not increase the risk of adverse drug events in older adults, although it may affect the rate and extent of drug absorption.

Choice D is wrong because thinning of the layers of the skin does not affect drug metabolism or clearance, although it may increase the risk of skin infections or injuries.

An idiosyncratic drug effect is an unpredictable and uncommon reaction to a drug that is not related to the dose, the pharmacology, or the patient’s allergy or intolerance. It may be caused by genetic factors, metabolic abnormalities, or interactions with other drugs or substances. An example of an idiosyncratic drug effect is paradoxical agitation or excitement after receiving a sedative.

B. A toxic drug effect is a harmful reaction to a drug that is related to the dose or the pharmacology of the drug. It may cause symptoms such as nausea, vomiting, drowsiness, confusion, or respiratory depression. A toxic drug effect is unlikely to cause agitation after receiving a sedative unless there is an overdose or a drug interaction that increases the level of the sedative in the blood.

C. An allergic drug response is an immunological reaction to a drug that is not related to the dose or the pharmacology of the drug. It may cause symptoms such as rash, itching, swelling, fever, or anaphylaxis. An allergic drug response is unlikely to cause agitation after receiving a sedative unless there is a severe anaphylactic reaction that affects the brain or the circulation.

D. An unexpected drug interaction is a modification of the effect of one drug by another drug or substance that is not predictable based on their pharmacology. It may cause an increase or a decrease in the efficacy or toxicity of one or both drugs. An unexpected drug interaction may cause agitation after receiving a sedative if there is a synergistic effect that enhances the central nervous system stimulation of another drug or substance (such as caffeine, cocaine, or amphetamines) or if there is an antagonistic effect that reduces the central nervous system depression of the sedative (such as flumazenil, naloxone, or physostigmine). However, these interactions are usually known and avoidable by checking the patient’s history and medication list.