The nurse is aware that a patient with liver disease and a ...

[newyorker26]

The nurse is aware that a patient with liver disease and a decreased albumin level may develop which of the following effects?
 
  a. Toxicity on normal doses of medication
  b. Less active medication available in the body
  c. Reduction in therapeutic effect
  d. Accelerated biotransformation of the medication

Question 2

A patient is admitted to the medical unit following a cerebrovascular accident (CVA). Evidence of left-sided hemiparesis is noted, and the nurse will be following up on ROM and other exercises performed in physical therapy.
 
  The nurse should correctly teach the patient and family members which of the following principles of ROM exercises? a. Flex the joint to the point of discomfort.
  b. Medicate the patient after the ROM exercise session.
  c. Move the joints quickly.
  d. Provide support for distal joints.

[paavo]

Answer to Question 1

A
Most medications bind to albumin to some extent. When medications bind to albumin, they are unable to exert pharmacological activity. Only the unbound or free medication is active. Older adults and patients with liver disease or malnutrition have reduced albumin, which increases their risk for medication toxicity. With less albumin to bind with the medication, more free or active medication is present in the body. This would result in an increase in therapeutic effect and possibly in toxicity. Most biotransformation occurs in the liver, although the lungs, kidneys, blood, and intestines also play a role. Patients (e.g., elderly, those with chronic disease) are at risk for medication toxicity if their organs that metabolize medications do not function correctly.

Answer to Question 2

D
When performing active-assisted or passive ROM exercises, support the joint by holding the distal portion of the extremity, or by using a cupped hand to support the joint. The joint should be flexed to the point of resistance, not to the point of discomfort. Assess the patient's level of comfort (on a scale of 0 to 10, with 10 being the worst pain) before performing exercises. Before beginning ROM exercises, determine whether the patient would benefit from pain medication. Joints should be moved slowly through the ROM. Quick movement could cause injury.

[newyorker26]

Thank you!

[paavo]

Always glad to help...