What does the term 'first pass effect' refer to?

Choice A reason: This is incorrect. Reviewing the patient’s previous blood glucose levels may not be helpful in determining the correct dose of insulin, as the blood glucose level can fluctuate depending on various factors, such as food intake, activity, stress, and illness. The previous blood glucose levels may not reflect the current insulin needs of the patient¹.

Choice B reason: This is incorrect. No review is not an option before administering insulin, as insulin is a highalert medication that can cause serious harm if given incorrectly. The nurse should always check the patient’s blood glucose level, the insulin order, the insulin type, the insulin dose, the insulin expiration date, and the insulin injection site before giving insulin.

Choice C reason: This is correct. Reviewing the Regular insulin sliding scale for administration in the patient’s electronic medical record is the best action to determine the correct dose of insulin. A sliding scale is a chart of insulin dosages based on blood glucose level and mealtime. It is used to adjust the insulin dose according to the patient’s blood glucose level and insulin sensitivity. The nurse should follow the sliding scale protocol and verify the insulin dose with another nurse before administering it.

Choice D reason: This is incorrect. Reviewing the patient’s previous insulin administration doses may not be helpful in determining the correct dose of insulin, as the insulin dose may vary depending on the patient’s blood glucose level and insulin sensitivity. The previous insulin doses may not reflect the current insulin needs of the patient¹.

Choice A reason: Vitamin C supplements are not a concern for the concurrent use with Lorazepam, which is a medication that reduces anxiety and insomnia by enhancing the effects of a neurotransmitter called gammaaminobutyric acid (GABA) in the brain¹. Vitamin C is an essential nutrient that supports the immune system and the synthesis of collagen, a protein that forms the connective tissue in the body. Vitamin C does not interact with Lorazepam or affect its metabolism or clearance.

Choice B reason: Caffeinated beverages are not a concern for the concurrent use with Lorazepam, but they may reduce its effectiveness or cause unwanted effects. Caffeine is a stimulant that increases the activity of the central nervous system and counteracts the sedative and calming effects of Lorazepam. Caffeine may also cause side effects such as nervousness, insomnia, or palpitations, especially in high doses or in sensitive individuals. The nurse should advise the patient to limit or avoid caffeine intake while taking Lorazepam, and to monitor their response to the medication.

Choice C reason: Alcohol is a concern for the concurrent use with Lorazepam, as it can increase the risk of serious and potentially fatal side effects. Alcohol is a depressant that slows down the activity of the central nervous system and enhances the effects of Lorazepam. Alcohol can cause additive effects such as excessive sedation, respiratory depression, coma, or death when taken with Lorazepam. The nurse should advise the patient to avoid alcohol consumption while taking Lorazepam, and to seek immediate medical attention if they experience any signs of overdose or toxicity.

Choice D reason: Dairy products are not a concern for the concurrent use with Lorazepam, as they do not affect its absorption, distribution, metabolism, or excretion. Dairy products are a source of calcium, protein, and other nutrients that support the bone health and the muscle function. Dairy products do not interact with Lorazepam or alter its pharmacokinetics or pharmacodynamics.