A thin older adult woman is admitted to the hospital after ...

[Medesa]

A thin older adult woman is admitted to the hospital after several days of vomiting, diarrhea, and poor intake of foods and fluids.
 
  She has not voided since admission. In preparing to care for this patient, the nurse will look for what laboratory values to help guide medication administration? (Select all that apply.)
  a. Creatinine clearance
  b. Gastric pH
  c. Plasma drug levels
  d. Serum albumin
  e. Serum creatinine

Question 2

A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone (Narcan) to reverse the effects of the morphine. The nurse understands that the naloxone works at the same receptor sites as the morphine to:
 
  a. block transmitter reuptake.
  b. inhibit transmitter release.
  c. interfere with transmitter storage.
  d. prevent activation of receptors.

[ms_sulzle]

Answer to Question 1

ANS: A, C, D
Creatinine clearance is the best way to evaluate renal function in the older adult. Plasma drug levels are important for determining if the patient has toxic or subtherapeutic drug levels. Serum albumin may be decreased, especially in patients who are thin, chronically undernourished, or have been vomiting, and the decreased level may result in higher levels of drugs that normally bind to proteins. Gastric pH is not important; most GI changes result in lowered absorption and less free drug. Serum creatinine levels are related to the amount of lean muscle mass, which may be low in older adult patients, and do not reflect renal function.

Answer to Question 2

ANS: D
Morphine and its antagonist, naloxone, both act directly at the same receptors. Morphine causes activation, and naloxone prevents activation. Neither morphine nor naloxone acts to alter transmitter reuptake, release, or storage.

[Medesa]

TYSM

[Jossy]

Excellent