A patient with severe liver disease is receiving the angiotensin converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic?

Correct Answer: D

Rationale: The correct answer is D: Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active. Rationale: 1. In severe liver disease, the liver's ability to metabolize drugs can be compromised. 2. Captopril is not a prodrug, meaning it does not require liver metabolism to become active. 3. This characteristic of captopril is advantageous in liver disease as it avoids potential issues related to impaired liver metabolism. Summary: A: Captopril can cause first-dose hypotensive effects, so it is not the advantage for a patient with severe liver disease. B: Captopril can affect electrolyte levels, so it is not the advantage for a patient with severe liver disease. C: Captopril being a prodrug and requiring liver metabolism would be a disadvantage for a patient with severe liver disease.

Correct Answer: C

Rationale: The correct answer is C: Obtain an order for a spacer device. This intervention is most appropriate as a spacer device can help improve the delivery of medication from the MDI, even if the patient is unable to coordinate inhalation with activation. The spacer device acts as an intermediary between the inhaler and the patient, allowing the medication to be inhaled more effectively. This ensures that the patient receives the full dose of the medication. Incorrect answers: A: Notifying the doctor that the patient is unable to use the MDI does not directly address the issue of coordination and does not provide a solution. B: Obtaining an order for a peak flow meter is not the most appropriate intervention in this scenario, as it does not address the patient's inability to coordinate the use of the MDI. D: Asking the prescriber if the medication can be given orally is not necessary if the patient can still benefit from using the MDI with the help of a spacer device.

Correct Answer: A

Rationale: Microsomal oxidation is primarily mediated by cytochrome P450 enzymes located in the endoplasmic reticulum of hepatocytes. Lipid-soluble drugs can easily penetrate cell membranes to reach the microsomes where cytochrome P450 enzymes are located, making microsomal oxidation most prominent for lipid-soluble drugs. Water-soluble drugs have limited access to microsomes, reducing the likelihood of undergoing significant microsomal oxidation. Low molecular weight drugs are generally more likely to be lipid-soluble and undergo microsomal oxidation, while high molecular weight drugs may be too large to efficiently access microsomes for this metabolic pathway. Therefore, the correct choice is A: Lipid soluble.

Correct Answer: A

Rationale: The correct answer is A. Chemical antagonism refers to the interaction between two drugs where they combine to form an inactive compound. This results in a decrease in the overall pharmacological effect of the drugs. In contrast, options B, C, and D are incorrect because they describe scenarios where the combination of drugs leads to a more active, more water-soluble, or more fat-soluble compound, which would typically result in enhanced pharmacological effects rather than antagonism.

Correct Answer: B

Rationale: The correct answer is B: Low potency. Tetracaine is a potent local anesthetic with high potency. It has a slow onset, long duration, and high toxicity. Low potency would imply weaker anesthetic effects, which is not true for tetracaine. Other choices are incorrect as tetracaine is known for its strong anesthetic properties.