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

The drugs will compete for receptor sites

The client will have increased effects of both drugs

The client will have decreased effects of both drugs

Both drugs are equally bound to protein

Answer and Explanation

The Correct Answer is B

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.

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Correct Answer is D

Explanation

A) This medication neutralizes gastric acid in the stomach by direct contact: Sucralfate does not neutralize gastric acid. Instead, it works by forming a protective barrier over the ulcer, which helps protect it from further damage by stomach acid and promotes healing. Sucralfate is a mucosal protectant, not an acid-neutralizing agent.

B) "You should take this medication after meals to help limit gastric acid secretion": Sucralfate should be taken on an empty stomach, typically 30 minutes to 1 hour before meals, to allow it to form an effective protective barrier over the ulcer. Taking it after meals would interfere with its action and effectiveness.

C) "This medication decreases gastric acid production by blocking histamine 2 receptors": Sucralfate does not work by blocking histamine 2 receptors. Histamine 2 receptor antagonists, such as ranitidine, work by reducing gastric acid secretion. Sucralfate works by coating and protecting the ulcer rather than by reducing acid production.

D) "You should take this medication 30 minutes to 1 hour before meals and at bedtime": Sucralfate should be taken on an empty stomach, typically 30 minutes to 1 hour before meals and at bedtime. This timing ensures that the medication can form an effective barrier over the ulcer before food intake and helps maximize its healing properties.

A. Prepare and administer the prescribed antidote. B. Notify the charge nurse, the nurse manager, and the prescriber. C. Assess the identify the presence of urgent safety issues D. Complete an incident report detailing the error

Correct Answer is C

Explanation

A) Prepare and administer the prescribed antidote: Administering an antidote would only be appropriate if the medication error resulted in a harmful reaction that requires immediate reversal. Since the issue here is the timing of medication administration, it is more important to first assess the client for any immediate effects rather than administering an antidote, which might not be necessary at this stage.

B) Notify the charge nurse, the nurse manager, and the prescriber: While notifying the appropriate staff is crucial, the first action should be assessing the client for any safety concerns or complications resulting from the medication administration error. Immediate evaluation of the client's condition should take precedence over notification.

C) Assess and identify the presence of urgent safety issues: The first priority in this situation is to assess the client for any adverse effects or reactions due to the medication being administered too quickly. This could include monitoring for signs of toxicity, adverse reactions, or changes in vital signs that may indicate a potential risk to the client’s health. Once the client's status is assessed, further actions such as notifying other staff or completing an incident report can follow.

D) Complete an incident report detailing the error: While documenting the error in an incident report is necessary, this should not be the first step. The immediate priority is to ensure the client’s safety by assessing their condition, as an error in the timing of medication administration may result in unwanted side effects or complications that need to be addressed first.

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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

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

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Naxlex Comprehensive Predictor Exams

A client has been diagnosed with an ulcer and will begin taking sucralfate. What information should the nurse include when providing education to the client?

Correct Answer is D

Explanation

A nurse recognizes they administered a medication over one hour when the order dictated the medication be given over 90 minutes. Which should be the first action performed by the nurse?

Correct Answer is C

Explanation

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