A nurse notices that an older adult client has not urinated all ...

[Coya19@aol.com]

A nurse notices that an older adult client has not urinated all day, despite drinking three liters of water. Which physiological change is the most likely cause for this issue?
 
  1. Reduction in plasma protein levels
  2. Increased glomerular filtration rate
  3. Increase in body fat
  4. Renal function impairment

Question 2

Why can a reduction in albumin synthesis that may occur with aging result in exaggerated effects of a medication?
 
  1. Blood flow to the liver decreases.
  2. More unbound drug will be present.
  3. Pharmacodynamics will be altered.
  4. Renal elimination of the drug will be decreased.

[Leostella20]

Answer to Question 1

Correct Answer: 4
Rationale 1: A reduction in plasma protein levels occurs as liver function declines. This will not affect urine output.
Rationale 2: Urine output will be affected when glomerular filtration rate is decreased, not increased. Glomerular filtration rate will be decreased in the elderly, not increased.
Rationale 3: Changes in body fat are not related to urine output.
Rationale 4: A decline in renal function, especially if acute, would best explain why the client has not urinated.
Global Rationale: A decline in renal function, especially if acute, would best explain why the client has not urinated. A reduction in plasma protein levels occurs as liver function declines. This will not affect urine output. Urine output will be affected when glomerular filtration rate is decreased, not increased. Glomerular filtration rate will be decreased in the elderly, not increased. Changes in body fat are not related to urine output.

Answer to Question 2

Correct Answer: 2
Rationale 1: Blood flow to the liver is indeed decreased, but this is not related to protein binding.
Rationale 2: If the drug is protein-bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects.
Rationale 3: Pharmacodynamics is unrelated to protein binding.
Rationale 4: Renal elimination will be unchanged or increased.
Global Rationale: If the drug is protein-bound, a decrease in albumin will result in higher concentrations of free drug and increased pharmacologic effects. Blood flow to the liver is indeed decreased, but this is not related to protein binding. Pharmacodynamics is unrelated to protein binding. Renal elimination will be unchanged or increased.

[Coya19@aol.com]

Thanks for the timely response, appreciate it

[kishoreddi]

Excellent