A primary health-care provider orders a medication to be administered every 6 hours prn.
What should the nurse teach the patient about this medication?
"I can give you this medication every 6 hours if you need it.”.
"I have to give you this medication every 6 hours around the clock.”.
"I must wait 6 hours before administering this medication to you.”.
"I will give this medication over 6 hours.”.
The Correct Answer is A
Choice A rationale
The "prn" abbreviation stands for "pro re nata," which is Latin for "as needed.”. This indicates that the medication should be administered based on the patient's symptoms or specific needs, rather than on a fixed schedule. The nurse assesses the patient and administers the medication only when the patient exhibits the conditions for which the medication is prescribed, adhering to the minimum 6-hour interval for safety and therapeutic efficacy. This allows for individualized pain management.
Choice B rationale
This statement is incorrect because a "prn" order does not imply around-the-clock administration. Around-the-clock dosing is typically for scheduled medications where a consistent drug level is desired to manage chronic conditions or prevent symptoms, regardless of the patient's immediate need. Administering a prn medication routinely could lead to unnecessary drug exposure or adverse effects.
Choice C rationale
While waiting 6 hours between doses is crucial to prevent drug accumulation and toxicity, stating "I must wait 6 hours before administering this medication to you" is an incomplete explanation for a PRN order. The primary determinant for administration is the patient's need, not simply the passage of time. The 6-hour interval is a safety parameter to ensure adequate drug clearance and prevent exceeding therapeutic thresholds.
Choice D rationale
Administering a medication "over 6 hours" refers to the duration of infusion, not the frequency of administration. This statement is typically relevant for intravenous infusions where the drug is diluted and infused slowly over a specific period. A prn order for oral medication generally means an immediate dose is given when needed, and the interval between doses is 6 hours, not the infusion time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Tolerance is a physiological adaptation to a drug, characterized by a decreased response to the same dose, or a need for increased doses to achieve the same effect. In this case, the increased dosage of morphine over several weeks indicates that the client's body has adapted to the drug's effects, requiring more to manage pain.
Choice B rationale
An adverse reaction is an undesirable and unintended effect of a drug, occurring at normal doses. While an increased dosage might lead to adverse effects, the described scenario specifically highlights the need for a higher dose to maintain efficacy, which is characteristic of tolerance, not simply an adverse reaction.
Choice C rationale
Idiosyncrasy refers to an unpredictable, uncharacteristic, or exaggerated response to a drug that is not an allergic reaction. It is typically a genetically determined abnormal response that occurs with initial exposure or after a few doses, unlike tolerance which develops over time with repeated exposure.
Choice D rationale
Polypharmacy refers to the concurrent use of multiple medications by a patient, often more than medically necessary. While the client is receiving medication, the scenario specifically describes a change in dosage of a single medication due to a diminished response, which is characteristic of tolerance, not polypharmacy.
Correct Answer is B
Explanation
Choice A rationale
Metabolism is primarily carried out by the liver, involving enzymatic biotransformation of drugs into more hydrophilic metabolites for excretion. While liver function can be impacted by systemic illness, renal failure's direct effect on drug metabolism is less significant than its impact on elimination. The liver's cytochrome P450 system typically remains functional.
Choice B rationale
Excretion is the primary elimination pathway for many drugs and their metabolites, mainly via the kidneys. In end-stage renal disease, glomerular filtration rate and tubular secretion are severely impaired, leading to accumulation of drugs and their toxic metabolites, necessitating dose adjustments or alternative elimination methods. Normal creatinine clearance is 80-120 mL/min.
Choice C rationale
Absorption refers to the movement of a drug from its administration site into the bloodstream. While renal failure can indirectly affect absorption through gastrointestinal changes (e.g., uremia-induced nausea), it is not the primary pharmacokinetic phase directly compromised by impaired kidney function. Bioavailability might be altered but not the fundamental absorption process.
Choice D rationale
Distribution involves the reversible movement of a drug from the systemic circulation into the interstitial and intracellular fluids. Renal failure can impact drug distribution due to fluid imbalances, altered protein binding (e.g., hypoalbuminemia), and changes in tissue perfusion, but it is not the most significant or direct pharmacokinetic impairment compared to excretion.
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