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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Naloxone: Naloxone is an opioid antagonist used to reverse the effects of opioid overdose, including respiratory depression. Given that the client has overdosed on morphine and is exhibiting a critically low respiratory rate of 6/min, naloxone is the appropriate medication to administer to reverse the effects of morphine and restore normal breathing.
B) Flumazenil: Flumazenil is a benzodiazepine antagonist used to reverse the effects of benzodiazepine overdose. It is not effective for opioid overdoses, such as those caused by morphine.
C) Protamine: Protamine is used to reverse the effects of heparin, an anticoagulant, and is not relevant in the context of opioid overdose. It does not address the respiratory depression caused by morphine.
D) Epinephrine: Epinephrine is used in cases of anaphylaxis or severe allergic reactions and is not appropriate for reversing opioid overdose. It would not address the respiratory depression caused by morphine overdose.
Correct Answer is D
Explanation
A) Report the incident immediately to your supervisor upon noticing: Reporting the incident is an important step, but it should come after assessing the client's condition. Immediate assessment of the client's vital signs and overall status takes precedence to address any potential immediate health impacts due to the medication error.
B) Gather reversal agents to administer to the client: Gathering reversal agents is a critical step if the medication administered poses an immediate risk and reversal is necessary. However, this action should follow an initial assessment of the client's condition to determine if reversal is needed.
C) Notify the client's provider immediately while present with the client: Notifying the provider is essential to receive guidance on how to manage the medication error. Nonetheless, the first priority should be to assess the client's condition to provide accurate information to the provider.
D) Assess the client's vital signs: The initial action should be to assess the client’s vital signs and overall condition to determine any immediate effects of the incorrect medication. This assessment helps in identifying if the client is experiencing any adverse reactions or complications, which will guide subsequent actions such as notifying the provider and administering reversal agents if needed.
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