A patient with renal impairment is prescribed a medication that is primarily excreted by the kidneys. What adjustment should the nurse anticipate?
Administering the medication with meals only
No dose adjustment is required
Increasing the dose to ensure therapeutic effect
Decreasing the dose to prevent toxicity
The Correct Answer is D
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Relief of heartburn is the correct outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine is used to treat and prevent conditions such as gastroesophageal reflux disease (GERD), peptic ulcer disease, and Zollinger Ellison syndrome, which are characterized by excessive acid secretion and irritation of the esophagus and stomach. Famotidine can relieve the symptoms of heartburn, which is a burning sensation in the chest or throat caused by the reflux of stomach acid into the esophagus.
Choice B reason: Cessation of diarrhea is not an outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine does not affect the motility or secretion of the intestines, and it is not used to treat diarrhea, which is a condition of frequent and loose bowel movements. Diarrhea can have various causes, such as infections, medications, food intolerance, or inflammatory bowel disease, and it requires different treatments depending on the underlying cause. Famotidine is not effective for treating diarrhea, and it may even worsen it by reducing the acidity of the stomach and increasing the risk of bacterial overgrowth.
Choice C reason: Passage of flatus is not an outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine does not affect the digestion or fermentation of food in the gastrointestinal tract, and it is not used to treat flatulence, which is the accumulation and expulsion of gas from the stomach or intestines. Flatulence can have various causes, such as swallowing air, eating certain foods, or having a bacterial imbalance in the gut, and it requires different treatments depending on the underlying cause. Famotidine is not effective for treating flatulence, and it may even increase it by reducing the acidity of the stomach and altering the gut flora.
Choice D reason: Absence of constipation is not an outcome that indicates that famotidine is therapeutic. Famotidine is a medication that belongs to the class of H2 receptor antagonists, which work by blocking the action of histamine on the H2 receptors of the stomach cells, thereby reducing the production of gastric acid. Famotidine does not affect the motility or secretion of the intestines, and it is not used to treat constipation, which is a condition of infrequent or difficult bowel movements. Constipation can have various causes, such as dehydration, lack of fiber, medications, or bowel obstruction, and it requires different treatments depending on the underlying cause. Famotidine is not effective for treating constipation, and it may even cause it by reducing the acidity of the stomach and slowing down the digestion.
Correct Answer is A
Explanation
Choice A reason: This is correct. Drinking a glass of water after taking calcium carbonate antacid can help flush the medication down the esophagus and into the stomach, where it can neutralize the excess acid. It can also prevent the medication from sticking to the esophagus and causing irritation or damage¹.
Choice B reason: This is incorrect. Decreasing bulk in the diet is not necessary when taking calcium carbonate antacid. In fact, increasing fiber intake can help prevent constipation, which is a common side effect of calcium carbonate antacid. Constipation occurs because calcium carbonate can reduce the motility of the gastrointestinal tract.
Choice C reason: This is incorrect. Taking the medication with dairy products can decrease absorption and effectiveness of calcium carbonate antacid. Dairy products contain calcium, which can bind to calcium carbonate and form insoluble complexes that are not absorbed by the body. This can reduce the amount of calcium carbonate available to neutralize the stomach acid.
Choice D reason: This is incorrect. Reducing sodium intake is not related to taking calcium carbonate antacid. Sodium is a mineral that regulates fluid balance, blood pressure, and nerve and muscle function in the body. Some medications, such as diuretics, can increase sodium excretion and require the patient to limit sodium intake. Calcium carbonate antacid is not one of them.
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