What does the term 'first pass effect' refer to?
The initial phase of drug distribution
The rapid absorption of a drug in the intestine
The initial rapid excretion of a drug through the urinary system
The metabolism of a drug before it reaches the systemic circulation
The Correct Answer is D
Choice A reason: The initial phase of drug distribution is not the correct definition of the term 'first pass effect'. Drug distribution is the process by which a drug moves from the bloodstream to the tissues and organs of the body. The initial phase of drug distribution is influenced by factors such as blood flow, tissue permeability, plasma protein binding, and tissue binding. The first pass effect is not related to drug distribution, but to drug metabolism, which is the chemical transformation of a drug in the body.
Choice B reason: The rapid absorption of a drug in the intestine is not the correct definition of the term 'first pass effect'. Drug absorption is the process by which a drug enters the bloodstream from the site of administration. The rapid absorption of a drug in the intestine depends on factors such as the drug formulation, the pH of the gastrointestinal tract, the presence of food or other drugs, and the surface area and motility of the intestine. The first pass effect is not related to drug absorption, but to drug metabolism, which is the chemical transformation of a drug in the body.
Choice C reason: The initial rapid excretion of a drug through the urinary system is not the correct definition of the term 'first pass effect'. Drug excretion is the process by which a drug or its metabolites are eliminated from the body. The initial rapid excretion of a drug through the urinary system is influenced by factors such as the renal blood flow, the glomerular filtration rate, the tubular secretion and reabsorption, and the urine pH. The first pass effect is not related to drug excretion, but to drug metabolism, which is the chemical transformation of a drug in the body.
Choice D reason: The metabolism of a drug before it reaches the systemic circulation is the correct definition of the term 'first pass effect'. Drug metabolism is the process by which a drug is chemically transformed in the body, usually by enzymes in the liver or other tissues. The first pass effect is a phenomenon of drug metabolism that occurs when a drug is administered orally and passes through the gastrointestinal tract and the liver before reaching the systemic circulation. The first pass effect can reduce the bioavailability and the effectiveness of the drug, as some or most of the drug may be metabolized and inactivated before reaching the site of action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Serum potassium level of 5.5 mEq/L is above the normal range of 3.55.0 mEq/L, but it is not a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can also cause the loss of potassium in the urine, which can lead to hypokalemia, a condition that causes muscle weakness, cramps, arrhythmias, or cardiac arrest. The nurse should monitor the serum potassium level and administer potassium supplements or potassium sparing diuretics as prescribed to prevent hypokalemia.
Choice B reason: Blood pressure of 130/80 mmHg is slightly above the normal range of 120/80 mmHg, but it is not a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can reduce the fluid volume and the peripheral resistance, which can lower the blood pressure and prevent or treat hypertension, edema, or heart failure. The nurse should monitor the blood pressure regularly and adjust the dose of Lasix as prescribed to maintain a normal blood pressure.
Choice C reason: Serum potassium level of 3.0 mEq/L is below the normal range of 3.55.0 mEq/L, and it is a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can also cause the loss of potassium in the urine, which can lead to hypokalemia, a condition that causes muscle weakness, cramps, arrhythmias, or cardiac arrest. The nurse should notify the health care provider immediately and prepare to administer interventions such as potassium supplements or potassium sparing diuretics to correct hypokalemia.
Choice D reason: Serum sodium level of 140 mEq/L is within the normal range of 135145 mEq/L, and it is not a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can cause the loss of sodium in the urine, which can lead to hyponatremia, a condition that causes confusion, seizures, coma, or death. The nurse should monitor the serum sodium level and administer sodium supplements or fluids as prescribed to prevent hyponatremia.
Correct Answer is D
Explanation
Choice A reason: Administering the medication with meals only is not a valid adjustment for a medication that is primarily excreted by the kidneys. The food intake does not affect the renal clearance of the drug, unless it alters the pH of the urine or the blood flow to the kidneys. The nurse should follow the instructions on the medication label or the prescriber's order regarding the timing of the administration.
Choice B reason: No dose adjustment is required is an incorrect statement for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function.
Choice C reason: Increasing the dose to ensure therapeutic effect is a dangerous and inappropriate adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should not increase the dose without the prescriber's order and should monitor the patient for signs of overdose or toxicity.
Choice D reason: Decreasing the dose to prevent toxicity is the correct and rational adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function. The nurse should also monitor the patient for the therapeutic response and the adverse effects of the drug.
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