A patient requires a high dose of a new antihypertensive medication because the new medication has a significant first-pass effect. What does this mean?

Correct Answer: C

Rationale: The first-pass effect refers to the extensive metabolism of a drug in the liver before it reaches systemic circulation. This reduces the bioavailability of the drug, necessitating a higher dose to achieve therapeutic effects. The medication does not need to pass through the bloodstream multiple times (A), nor is it primarily excreted in the kidneys (B). The drug’s effectiveness is not related to cumulative dosing (D).

Correct Answer: A

Rationale: Phenytoin is an antiepileptic medication that can induce hepatic enzymes, which can lead to a decrease in the effectiveness of hormonal contraceptives, including birth control pills. This interaction can increase the risk of unintended pregnancy. Therefore, it is important for the client to be advised about the decreased effectiveness of birth control pills while on phenytoin therapy and discuss alternative contraceptive options with her healthcare provider.

Correct Answer: A

Rationale: Morphine, an opioid, depresses the respiratory center, and a rate of 10 breaths per minute signals potential overdose, requiring immediate intervention (e.g., naloxone) to reverse life-threatening hypoventilation. Blood pressure and pulse are normal, not urgent. Pain at 4/10 suggests control, not distress. Respiratory depression is morphine's most dangerous effect, especially in acute settings, where even slight drops below 12 bpm demand action. This aligns with opioid pharmacology'mu-receptor agonism slows breathing'making A the priority finding to address swiftly for client safety.

Correct Answer: C

Rationale: One major side effect to monitor in a patient taking Lithium for bipolar I disorder is the risk of seizures. Lithium is known to lower the seizure threshold, increasing the likelihood of seizures occurring, especially if the patient has any pre-existing risk factors for seizures. Therefore, it is critical to closely monitor patients on Lithium for any signs or symptoms of seizures and promptly address them if they occur to prevent any complications. Monitoring lithium levels and maintaining them within the therapeutic range can also help reduce the risk of seizures.

Correct Answer: B

Rationale: Trimethoprim inhibits dihydrofolate reductase, not activates it, blocking folate synthesis in bacteria, so that's false. It's a weak base, a true statement, aiding its concentration in acidic environments like urine. It has good prostate penetration, effective in prostatitis, making that false. It distributes into CSF, useful in meningitis, so that's incorrect. It's teratogenic, not harmless in pregnancy. Its basic nature enhances its antibacterial efficacy, a key pharmacokinetic advantage in urinary tract infections.