What is the fastest route for medication administration?

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.

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.