The nurse is providing discharge instructions to a female client who delivered a healthy, full-term infant. What information should the nurse provide about taking medications while breast feeding?

The mother should not take any medication while breast feeding in order to prevent harm to the infant

Many medications cross into the breast milk in small amounts and could cause harm to the infant

While medication can cross into the breast milk, no infants have ever been harmed because of this

It is unlikely that a large enough amount of medication will cross into the breast milk and cause harm to the infant.

Answer and Explanation

The Correct Answer is B

A) The mother should not take any medication while breast feeding in order to prevent harm to the infant: This statement is too restrictive and not accurate. While some medications should be avoided during breastfeeding, many medications can be taken safely in small amounts. The focus should be on which medications are safe for breastfeeding, not a blanket prohibition on all medications. Some medications are compatible with breastfeeding, and the benefits of taking them may outweigh any potential risks.

B) Many medications cross into the breast milk in small amounts and could cause harm to the infant: This statement is correct. While many medications do pass into breast milk in small amounts, it’s important to recognize that some medications can pose risks to the infant depending on the type of medication, dosage, and timing of breastfeeding. Nurses should educate the mother to always consult with a healthcare provider before taking any medication while breastfeeding.

C) While medication can cross into the breast milk, no infants have ever been harmed because of this: This statement is not accurate. While many medications may pass into breast milk in small amounts, there are documented cases of infants being harmed by medications transferred via breastfeeding. It is crucial to be cautious and informed about the safety of medications taken during breastfeeding.

D) It is unlikely that a large enough amount of medication will cross into the breast milk and cause harm to the infant: While it may be true that in many cases, only small amounts of medication pass into breast milk, this statement oversimplifies the issue. The amount and type of medication, as well as the infant’s age, weight, and health, are all factors that need to be considered. Some medications may pose a significant risk to the infant, and careful evaluation is necessary.

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Correct Answer is B

Explanation

A) The drugs will compete for receptor sites: While it's true that highly protein-bound drugs can compete for binding sites on proteins (like albumin), the main issue with highly protein-bound drugs interacting is not related to competition for receptor sites. The primary concern is how the drugs displace each other from the protein-binding sites, which can increase the free (active) drug levels in the bloodstream. This can lead to a higher pharmacological effect, especially if the unbound drug concentration rises to a therapeutic or toxic level.

B) The client will have increased effects of both drugs: This is the correct answer. When two highly protein-bound drugs are administered together, they can displace each other from protein-binding sites. This displacement increases the amount of free (active) drug in circulation, which may intensify the pharmacologic effects of both drugs. For example, if one drug displaces the other from its protein-binding site, more of the free drug will be available to exert its effects. This can increase the risk of side effects, toxicity, or both.

C) The client will have decreased effects of both drugs: This is incorrect. The opposite is true—when two highly protein-bound drugs are given together, the displacement of one drug increases the amount of the free drug available, leading to a stronger effect, not a weaker one. Decreased effects would occur if the drug had no access to the target receptor or if it were metabolized or eliminated too quickly, which isn't the case in this scenario.

D) Both drugs are equally bound to protein: While both drugs may bind to protein, they do not necessarily bind equally. One drug might bind more strongly or more selectively to the protein than the other, which could lead to displacement of the weaker-bound drug. The important point is that their competition for protein-binding sites can lead to an increase in free (active) drug concentrations.

A. Metoprolol XL B. C Ibuprofen EC C. Morphine ER D. Acetaminophen

Correct Answer is D

Explanation

A) Metoprolol XL: Metoprolol XL (extended-release) should not be crushed. Crushing extended-release formulations can result in the rapid release of the drug, leading to an overdose or adverse effects due to the immediate release of the full dose. The nurse should advise the client to swallow this medication whole.

B) Ibuprofen EC (enteric-coated): Enteric-coated medications should not be crushed. The enteric coating is designed to protect the stomach lining by preventing the medication from being released in the stomach. Crushing the tablet would destroy this protective mechanism and could irritate the stomach lining, leading to discomfort or ulceration.

C) Morphine ER (extended-release): Extended-release formulations of morphine should never be crushed. Crushing extended-release formulations can lead to a potentially fatal overdose because it releases the entire dose of medication at once. This can cause respiratory depression and other life-threatening effects.

D) Acetaminophen: Acetaminophen in its regular tablet form can be safely crushed if needed. Crushing acetaminophen does not affect its effectiveness or safety, and it is a non-extended-release formulation, making it safe for manipulation when necessary, such as for clients with difficulty swallowing. However, it's essential to verify with the specific prescription, as acetaminophen is also available in extended-release formulations, which should not be crushed.

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Laboratory Test	Result	Normal Range
Sodium	146 mEq/dL	135-145 mEq/L
Calcium	8.2 mg/dL	8.4-10.2 mg/dL
Magnesium	1.2 mg/dL	1.6-2.2 mg/dL
Gastric pH	6	1-4

The nurse is providing discharge instructions to a female client who delivered a healthy, full-term infant. What information should the nurse provide about taking medications while breast feeding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What happens if you give two drugs together that are highly protein bound?

Correct Answer is B

Explanation

Which prescribed medication can the nurse instruct the client to crush if needed?

Correct Answer is D

Explanation

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