The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease.
The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?

Choice A rationale

Immediately before menstruation, hormonal fluctuations, particularly increased estrogen levels, can lead to breast swelling and tenderness. This physiological engorgement can obscure subtle lumps or changes, making accurate palpation difficult and potentially leading to false positives or missed abnormalities during self-examination, thereby reducing its efficacy.

Choice B rationale

Days 4-7 of the menstrual cycle, specifically post-menstruation, are optimal for breast self-examination because hormonal influences are at their lowest point. Estrogen and progesterone levels are minimal, resulting in the least breast tenderness and swelling. This makes breast tissue softer and less nodular, facilitating the detection of any new or subtle changes.

Choice C rationale

During ovulation, estrogen levels are elevated, which can cause some degree of breast fullness and tenderness due to glandular changes. This hormonal influence can make it more challenging to distinguish normal breast tissue from suspicious lumps, potentially leading to inaccurate findings and reducing the sensitivity of the self-examination process.

Choice D rationale

While consistency is important, simply choosing any same day of the month without regard to the menstrual cycle can lead to less effective examinations. Hormonal fluctuations throughout the cycle significantly impact breast tissue consistency. A fixed day may coincide with breast swelling or tenderness, hindering accurate assessment and potentially masking abnormalities, thereby reducing detection rates.

Choice A rationale

Placing the patch in the same location repeatedly can lead to skin irritation, reduced absorption due to stratum corneum thickening, and localized adverse reactions. Rotation of application sites allows the skin to recover, maintains optimal drug absorption, and prevents cumulative dermal irritation.

Choice B rationale

Transdermal patches often contain significant amounts of medication, including controlled substances or potent drugs. Discarding them in the trash can poses risks of accidental exposure to others, environmental contamination, and diversion. Proper disposal protocols, such as flushing or returning to pharmacy, are crucial.

Choice C rationale

While transdermal patches are designed for systemic absorption, specific sites are recommended to optimize efficacy and minimize adverse effects. Areas with less hair, intact skin, and good circulation are preferred. Improper placement can lead to erratic absorption or local irritation, reducing therapeutic benefit.

Choice D rationale

The nurse should always wear gloves when handling transdermal patches to prevent direct skin contact with the medication. Many transdermal drugs can be absorbed through the nurse's skin, leading to unintended pharmacological effects or sensitization. Gloves provide a crucial barrier against dermal absorption.