The nurse is teaching a client about their medications for a psychological disorder. Which statement should not be included in the client education?

Renal disease may impact drug choice and dose in some clients

These medications have the risk for cytochrome P450 interactions that impact the action of the medication

Psychopharmacological medications have similar dosing across all age groups

Hepatic disease can impact dose

Answer and Explanation

The Correct Answer is C

Choice A reason: Renal disease affects drug clearance, particularly for psychopharmacological medications like lithium, which is renally excreted. Impaired renal function can lead to toxicity, necessitating dose adjustments or alternative drugs. This statement is accurate, as renal function is critical in tailoring psychotropic therapy to ensure safety and efficacy.

Choice B reason: Many psychopharmacological drugs, like SSRIs, are metabolized by cytochrome P450 enzymes, leading to potential drug interactions. Inhibitors or inducers of these enzymes can alter medication levels, affecting efficacy or toxicity. This statement is accurate, as P450 interactions are a key consideration in psychotropic prescribing.

Choice C reason: Psychopharmacological dosing varies significantly across age groups. Elderly patients often require lower doses due to slower metabolism and higher sensitivity, while children’s doses are weight-based. This statement is inaccurate, as age-specific dosing adjustments are essential to prevent adverse effects and ensure therapeutic efficacy.

Choice D reason: Hepatic disease impacts drug metabolism, particularly for psychotropics like antipsychotics or SSRIs, which are hepatically cleared. Liver dysfunction can increase drug levels, risking toxicity, requiring dose adjustments. This statement is accurate, as hepatic function is a critical factor in psychopharmacological dosing and safety.

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Correct Answer is D

Explanation

Choice A reason: Chronic kidney disease (CKD) does not primarily cause anemia by leaking red blood cells (RBCs) into urine. While hematuria may occur in some renal conditions, anemia in CKD results mainly from reduced erythropoietin production, not RBC loss. This statement is inaccurate, as it misrepresents the primary mechanism of anemia in CKD.

Choice B reason: Inflammation in CKD may contribute to anemia by suppressing erythropoiesis through cytokine release, but it does not directly attack RBCs. The primary cause is erythropoietin deficiency due to impaired renal function. This statement is inaccurate, as it overstates inflammation’s role and ignores the key hormonal mechanism in CKD-related anemia.

Choice C reason: High vascular pressure in CKD can damage kidneys but does not directly cause RBCs to burst (hemolysis). Anemia in CKD stems from reduced erythropoietin, not mechanical RBC destruction. This statement is inaccurate, as it incorrectly links hypertension’s renal effects to direct RBC damage, misrepresenting the anemia’s cause.

Choice D reason: CKD causes anemia due to reduced erythropoietin synthesis by damaged kidneys. Erythropoietin stimulates RBC production in bone marrow. In CKD, impaired renal function decreases erythropoietin, leading to anemia. This statement is accurate, as it correctly identifies the hormonal deficiency as the primary cause of low RBC counts in CKD.

A. Metformin is generally safe for the kidneys but requires monitoring in case of renal impairment B. Metformin is nephrotoxic and can directly damage your kidneys over time C. Metformin increases the risk of kidney stones due to changes in urine composition D. Metformin has no effect on the kidneys and does not require monitoring

Correct Answer is A

Explanation

Choice A reason: Metformin is safe for kidneys in patients with normal renal function but is excreted renally, requiring monitoring in chronic kidney disease (CKD). Reduced glomerular filtration rate (GFR) can lead to metformin accumulation, increasing lactic acidosis risk. Regular renal function tests (e.g., creatinine, GFR) are needed, making this statement accurate.

Choice B reason: Metformin is not nephrotoxic; it does not directly damage kidneys. Its primary risk in renal impairment is lactic acidosis due to reduced clearance, not direct toxicity. This statement is inaccurate, as metformin is generally renal-safe when monitored appropriately in patients with adequate kidney function.

Choice C reason: Metformin does not increase kidney stone risk. It lowers blood glucose by reducing hepatic gluconeogenesis and improving insulin sensitivity, without altering urinary composition linked to stones. Kidney stones are more associated with conditions like hyperuricemia or dehydration, making this statement inaccurate for metformin’s effects.

Choice D reason: Metformin requires renal function monitoring, as it is cleared by the kidneys. In renal impairment, accumulation can cause lactic acidosis, a rare but serious complication. This statement is inaccurate, as monitoring (e.g., eGFR) is essential to ensure safe use, especially in patients with kidney disease risk.

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The nurse is teaching a client about their medications for a psychological disorder. Which statement should not be included in the client education?

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