A nurse is caring for a client who is receiving nitroglycerine IV and is switching to the oral form of the medication. The nurse should identify that the oral dose will be higher than the IV dose for which of the following reasons?
The oral route has lower bioavailability compared to IV administration since it has to be metabolized by the liver, necessitating a higher dose to achieve the desired effect
The IV route has decreased absorption compared to the oral route, necessitating a higher oral dose for equivalent effect.
The oral route provides more rapid onset of action compared to IV administration, requiring a higher dose for sustained effect
The oral route bypasses hepatic metabolism, leading to quicker clearance and necessitating a higher dose for sustained effect.
The Correct Answer is A
A. The oral route has lower bioavailability compared to IV administration since it has to be metabolized by the liver, necessitating a higher dose to achieve the desired effect: Nitroglycerin undergoes extensive first-pass metabolism in the liver when taken orally, reducing the amount that reaches systemic circulation. As a result, a higher oral dose is required to achieve the same therapeutic effect as an IV dose, which bypasses hepatic metabolism.
B. The IV route has decreased absorption compared to the oral route, necessitating a higher oral dose for equivalent effect: IV administration delivers the medication directly into the bloodstream, providing 100% bioavailability. Absorption is not decreased with IV use; oral absorption is actually less efficient due to first-pass metabolism.
C. The oral route provides more rapid onset of action compared to IV administration, requiring a higher dose for sustained effect: IV nitroglycerin acts almost immediately, whereas oral nitroglycerin has a slower onset due to absorption and first-pass metabolism. Rapid onset is not the reason for higher oral dosing; it is the lower systemic availability.
D. The oral route bypasses hepatic metabolism, leading to faster clearance and necessitating a higher dose for sustained effect: Oral medications do not bypass hepatic metabolism; they undergo first-pass metabolism in the liver, which reduces bioavailability. This is why the oral dose must be higher, not due to faster clearance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Open the medication’s packaging and place it in the patient’s hand: This step occurs after verifying the patient and ensuring the correct medication. Administering before identification risks giving the wrong drug to the wrong patient.
B. Verify the patient’s name and date of birth with their wristband: Patient identification is the first and most critical step in medication administration. Confirming identity ensures the “right patient” safety principle is met before any other action.
C. Assess the patient’s oxygenation saturation: While assessing baseline status may be relevant for certain medications, cyclobenzaprine’s priority safety concern is patient identification, as it is primarily a sedating muscle relaxant.
D. Document administration of the medication: Documentation occurs after administering the drug, not before. Premature documentation would violate safe medication administration practices.
Correct Answer is B
Explanation
A. The antibacterial, Nitrofurantoin:Nitrofurantoin is primarily used to treat urinary tract infections. It has no efficacy against common pathogens causing otitis media and is not indicated for ear infections.
B. The antibacterial, Amoxicillin:Amoxicillin is the first-line treatment for acute otitis media in children. It is effective against common bacterial pathogens such as Streptococcus pneumoniaeand Haemophilus influenzae, and it is generally safe and well-tolerated.
C. The antifungal, Ketoconazole:Ketoconazole treats fungal infections and is not effective against bacterial pathogens causing otitis media. Its use would be inappropriate in this bacterial ear infection.
D. The antibacterial, Vancomycin:Vancomycin is a strong, intravenous antibiotic reserved for severe or resistant infections. It is not used as first-line therapy for uncomplicated otitis media in children.
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