The nurse is administering a prescribed medication to neonatal client. Which factor is most likely to increase the risk for drug toxicity in this client?
The stomach acid has a lower pH level which results in increase absorption
The glomerular filtration rate (GFR) is increased causing rapid excretion
The liver enzyme system responsible for drug metabolism is not fully developed
The albumin levels are elevated due to rapid growth and protein binding is enhanced
The Correct Answer is C
A) The stomach acid has a lower pH level which results in increased absorption: While it is true that neonates have a lower gastric pH, which could affect the absorption of certain medications, this factor does not directly increase the risk for drug toxicity. Lower pH may increase absorption for some drugs, but it is not as critical in neonates as the immaturity of other organs, such as the liver and kidneys, which are responsible for drug metabolism and excretion.
B) The glomerular filtration rate (GFR) is increased causing rapid excretion: In neonates, the glomerular filtration rate (GFR) is actually decreased, not increased. This leads to slower excretion of medications, which can increase the risk for drug toxicity, especially for drugs that rely on renal elimination. This decreased renal function can result in accumulation of the drug in the bloodstream, potentially leading to toxicity.
C) The liver enzyme system responsible for drug metabolism is not fully developed: The liver enzyme system in neonates is immature, which significantly impacts the metabolism of drugs. Enzymatic activity is critical for breaking down medications to their active or inactive forms. Due to the underdeveloped liver function, drugs may not be metabolized properly, leading to a longer half-life and an increased risk for drug toxicity. This is a key factor in the increased risk of toxicity in neonatal clients.
D) The albumin levels are elevated due to rapid growth and protein binding is enhanced: Neonates typically have lower albumin levels, not elevated levels. Albumin is crucial for binding medications, and lower levels in neonates can result in more free (unbound) drug circulating in the bloodstream, which can increase the risk of drug toxicity. Elevated albumin would theoretically reduce this risk, but this is not typically the case in neonates.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) 1 x soft bowel movement: This is the correct answer. Psyllium is a bulk-forming laxative that helps to relieve constipation by absorbing water into the stool, making it easier to pass. A therapeutic effect of psyllium would be the client experiencing a soft bowel movement, indicating the medication has helped to regulate the client's bowel movements and relieve constipation.
B) Gastric pH 2 (Normal pH: 1-4): While this is a normal gastric pH range, it is not related to the therapeutic effect of psyllium. Psyllium works in the gastrointestinal tract to promote bowel regularity, not to alter gastric pH. The pH measurement of gastric contents is not a relevant indicator of the medication's effectiveness.
C) 500 ml of urine output: This finding is not related to the therapeutic effect of psyllium. Psyllium is intended to address bowel function, not urine output. Adequate urine output should be monitored, but it is not the expected outcome for a patient taking psyllium.
D) Blood glucose: 95 (Normal Fasting Blood Glucose: 60-120): While a normal blood glucose level is important, it is not relevant to the action of psyllium. Psyllium does not have a direct effect on blood glucose levels, so a normal blood glucose result is not indicative of a therapeutic effect of the medication.
Correct Answer is B
Explanation
A) "I will avoid alcohol and cigarettes.": This is a correct and important statement for a client with GERD. Both alcohol and cigarettes can relax the lower esophageal sphincter, increasing the likelihood of acid reflux and exacerbating GERD symptoms. Avoiding these substances is a standard recommendation for managing GERD.
B) "I will have a small snack right before bedtime.": This statement indicates the need for additional education. Eating a meal or snack right before bedtime can exacerbate GERD symptoms because lying down after eating can increase the likelihood of acid reflux. It is generally recommended for clients with GERD to avoid eating at least 2-3 hours before going to bed to reduce the risk of reflux.
C) "I will wear loose fitting clothes.": Wearing loose-fitting clothes is an appropriate measure for managing GERD. Tight clothing around the abdomen can increase pressure on the stomach, promoting acid reflux. Loose clothing helps avoid this additional pressure, which can alleviate symptoms.
D) "I will take all NSAIDs and steroids with food.": This is generally good advice for reducing the risk of stomach irritation caused by NSAIDs and steroids, which can worsen GERD symptoms or cause gastric ulcers. Taking these medications with food can help buffer the stomach lining and reduce irritation.
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