A nurse reads in a drug information guide that PO (oral) morphine has a high first-pass effect. Which of the following statements would demonstrate the nurse's understanding of the first-pass effect?

Choice A reason:
Fatty acids are essential components of many lipids, but they are not the primary building blocks of bile salts. Bile salts are synthesized from cholesterol. Fatty acids mainly function as energy storage molecules and are involved in forming complex lipids, like triglycerides and phospholipids. They don't participate directly in the production of bile salts, which are crucial for digesting and absorbing dietary fats.

Choice B reason:
Testosterone is a steroid hormone that plays a vital role in male reproductive tissues and secondary sexual characteristics. It is not involved in the synthesis of bile salts. Bile salts are derived from cholesterol, not hormones. Testosterone’s primary function is related to endocrine activities rather than hepatic functions like bile salt synthesis.

Choice C reason:
Cholesterol is the correct answer. Bile salts are synthesized from cholesterol in the liver. This process involves the conversion of cholesterol into bile acids, which are then conjugated with amino acids to form bile salts. These bile salts are critical for the digestion and absorption of fats in the small intestine. The liver’s conversion of cholesterol to bile salts helps in maintaining cholesterol homeostasis in the body.

Choice D reason:
Lecithin is a type of phospholipid that plays a significant role in cell membrane structure and function. While it is an important component of bile, it is not the substance from which bile salts are synthesized. Lecithin helps in the emulsification of fats in the digestive process but is not a precursor to bile salts. The synthesis of bile salts specifically involves cholesterol.

Choice A reason:
Aspirin is an antiplatelet medication used to prevent blood clots in the arteries but is not the primary treatment for deep vein thrombosis (DVT), which is likely in this scenario. The patient's symptoms suggest a possible DVT, which requires anticoagulation therapy.

Choice B reason:
Clopidogrel (Plavix) is another antiplatelet medication, similar to aspirin, and is not the primary treatment for DVT. It is more commonly used to prevent clotting in arterial diseases such as coronary artery disease but not for venous thromboembolism.

Choice C reason:
Enoxaparin (Lovenox) is a low molecular weight heparin used for the initial treatment of DVT. It is an anticoagulant that helps prevent further clot formation and allows the body to break down the existing clot. Given the patient's symptoms, enoxaparin is the appropriate medication to anticipate for managing DVT.

Choice D reason:
Warfarin (Coumadin) is an oral anticoagulant used for long-term prevention of thromboembolism but is not typically used for initial DVT treatment due to its slow onset of action. Enoxaparin or other forms of heparin are preferred for immediate anticoagulation.