Question 1

The nurse notes that a client is prescribed a medication that inhibits the absorption of some nutrients. Which characteristic pharmokinetics is this medication affecting?&#10;A) Excretion&#10;B) Chelation&#10;C) Metabolism&#10;D) Bioavailability

Accepted Answer

Certain components of food such as fats and minerals can change the bioavailability of drugs, and some drugs can change the availability of nutrients, by fostering or interfering with absorption. Excretion refers to the elimination of the byproducts of metabolism. Chelation is a type of binding that occurs between a metal ion and another molecule which results in reduced bioavailability. Metabolism occurs after absorption is complete and the substances are in route to the tissues.

Question 2

The nurse is concerned that a client is at risk for an interaction that affects drug or nutrient metabolism which occurs after the digestive and absorptive processes are complete. Which alteration in pharmokinetics is this client at risk for experiencing?

A) Inhibition
B) Excretion
C) Metabolism
D) Bioavailability

Metabolism

Accepted Answer

Interactions that affect drug or nutrient metabolism occurring after digestion and absorption are complete and the substances are in the circulation en route to tissues are referred to as alterations in metabolism. Inhibition results from alteration in the use of enzymes during metabolism and results in increased drug absorption. Alterations in excretion refer to the elimination of metabolic byproducts. Alterations in bioavailability are the result of a change in absorption of drugs or nutrients.

Question 3

A client is prescribed medication that can interact with nutrients in the kidney. Which alteration in pharmokinetics is this client at risk for developing?&#10;A) Excretion&#10;B) Metabolism&#10;C) Polypharmacy&#10;D) Bioavailability

Accepted Answer

Interactions between drugs and nutrients in the kidney can cause increased excretion or reabsorption of the by-products of metabolism. Alterations in metabolism refer to alterations that occur once after digestion and absorption when substances are in the circulation. Polypharmacy refers to the use of many drugs which can increase the likelihood of drug/nutrient or drug/drug interactions. Alterations in bioavailability refer to changes in the absorption of drugs and nutrients.

Question 4

A client is prescribed a medication that requires the cytochrome P450 3A4 enzyme system for absorption. Because of this, what should the nurse instruct the client when taking this medication?&#10;A) Take on an empty stomach&#10;B) Avoid all use of grapefruit juice&#10;C) Take this medication with grapefruit juice&#10;D) Avoid eating for several hours after taking

Accepted Answer

Grapefruit juice inhibits the cytochrome P450 3A4 enzyme system responsible for "first-pass metabolism"of many drugs. The inhibition of the enzyme allows more drug to be absorbed than normally would occur, elevating plasma drug levels. The cytochrome P450 3A4 enzyme is not identified as being affected by the presence or absence of food.

Question 5

A client is prescribed a loop diuretic. Which nutrient should the nurse instruct the client to increase in the diet?&#10;A) Iron&#10;B) Potassium&#10;C) Vitamin A&#10;D) Vitamin B12

Accepted Answer

Clients taking loop diuretics are at risk for urinary loss of potassium, calcium, magnesium, and thiamine, and should be encouraged to add foods that are good sources for these nutrients into their diet. Vitamins A and B12 and iron are important nutrients but are not affected by loop diuretics.

Question 6

An older client has been overusing alcohol for 25 years. Which nutrients should the nurse recommend that this client increase ingesting?&#10;A) Vitamin D&#10;B) Potassium and iron&#10;C) Potassium and calcium&#10;D) Thiamine and folic acid

Accepted Answer

Clients who ingest large amounts of alcohol experience a decreased absorption of thiamine and folate and a urinary loss of magnesium. Vitamin D status should be monitored in clients taking antiepileptic drugs. Iron can be affected by chelation with certain antibiotics. Changes in calcium and potassium excretion occur with the use of loop diuretics.

Question 7

A client takes a corticosteroid for control of a chronic health problem. Which nutrient is most affected by this medication?&#10;A) Iron&#10;B) Calcium&#10;C) Potassium&#10;D) Vitamin A

Accepted Answer

Corticosteroid use can result in decreased absorption and increased urinary losses of calcium which can cause the loss of bone mineral density. Iron, vitamin A, and potassium are not affected by corticosteroid use.

Question 8

An older client with multiple health problems including diabetes sees several different healthcare providers and recognizes a medication by color and shape. Why should the nurse be concerned about drug-drug interactions in this client?

A) Age
B) Multiple health problems
C) High risk for polypharmacy.
D) Drug-food interactions with a diabetic diet

Accepted Answer

An older client who takes many medications from multiple health care providers and only recognizes a medication by color and shape, the client is at risk for possible drug-drug interactions. The nurse should not assume the client is at risk based on age. Having multiple health problems is not a risk in itself; the risk comes from the multiple medications that may be needed to treat the problems. A client following a diabetic diet is not necessarily at greater risk than the client following a regular diet.

Question 9

A client who takes metoprolol, furosemide, and terazosin is experiencing a new onset of leg cramps. Which reason should the nurse suspect as causing this client to have this symptom?&#10;A) Hypokalemia&#10;B) Iron deficiency&#10;C) Folate deficiency&#10;D) Vitamin D deficiency

Accepted Answer

Clients taking loop diuretics, in this case would be furosemide, are at increased risk for loss of potassium resulting in hypokalemia. Iron is lost during chelation with certain antibiotics. Folate is lost with excessive use of alcohol. Vitamins D levels can be decreased in clients using anticonvulsant medication.

Question 10

A client taking warfarin after aortic valve replacement surgery reports taking gingko biloba every day. For which reason should the nurse report this information to the healthcare provider?&#10;A) Warfarin may increase the production of clots&#10;B) Ginkgo biloba plays a role in synthesis of clotting factors and can increase the risk of clot formation&#10;C) Warfarin may decrease the effect of ginkgo biloba and decrease the international normalized ratio (INR)&#10;D) Ginkgo biloba alters blood clotting and when combined with warfarin could lead to prolonged bleeding times

Accepted Answer

Ginkgo biloba also alters blood clotting and when combined with warfarin could lead to prolonged bleeding times. Warfarin potentiates the effect of ginkgo biloba, resulting in increased bleeding times rather than the formation of clots. Vitamin K plays a role in the synthesis of clotting factors and can increase the risk of clot formation.

Question 11

A client is prescribed a monoamine oxidase inhibitor (MAOI). Which food item should the nurse instruct this client to avoid?&#10;A) Fish&#10;B) Poultry&#10;C) Spinach&#10;D) Aged cheese

Accepted Answer

The answer of A client is prescribed a monoamine oxidase...

Question 12

A client is prescribed a thiazide diuretic. Which nutrient should be monitored in this client?&#10;A) Calcium&#10;B) Phosphate&#10;C) Vitamin D&#10;D) Magnesium

Accepted Answer

The answer of A client is prescribed a thiazide diuretic....

Question 13

A client is prescribed anticoagulants. The client should be instructed to avoid eating large portions of which foods?&#10;A) Meat and poultry&#10;B) Aged meat and cheese&#10;C) Green, leafy vegetables&#10;D) Yellow vegetables and squash

Accepted Answer

The answer of A client is prescribed anticoagulants. The client...

Question 14

A client taking lithium has been altering the daily intake of sodium to reduce high blood pressure. What should the nurse realize this client is at risk for developing? (Select all that apply.)&#10;A) Hypocalcemia&#10;B) Increased risk of lithium toxicity&#10;C) Increased urinary losses of lithium&#10;D) Increased urinary losses of magnesium&#10;E) Increased lithium reabsorption in the kidneys

Accepted Answer

The answer of A client taking lithium has been altering...

Question 15

A client is experiencing diarrhea after starting a new medication. Which additive in the medication most likely is causing this client's new symptom?&#10;A) Gluten&#10;B) Sodium&#10;C) Sorbitol&#10;D) Yellow dye #5

Accepted Answer

The answer of A client is experiencing diarrhea after starting...

Question 16

A client is prescribed a fluoroquinolone to be taken for 10 days. What should the nurse instruct the client to avoid while taking this medication?&#10;A) Gluten&#10;B) Dairy products&#10;C) High-sodium foods&#10;D) Soda with citrus juice

Accepted Answer

The answer of A client is prescribed a fluoroquinolone to...

Question 17

A client taking a protease inhibitor has a detectable HIV viral load and reports taking St. John's wort to help with feelings of depression. What should the nurse explain about St. John's wort?&#10;A) It can be used in small amounts with few side effects&#10;B) It is a natural product which rarely have adverse effects&#10;C) It causes decreased absorption of protease inhibitors and should be avoided&#10;D) It has been reported to be helpful with depression and is better than taking chemicals

Accepted Answer

The answer of A client taking a protease inhibitor has...

Deck 18: Food, Nutrient, and Drug Interactions