A nurse is working on a geriatric unit and caring for a patient ...

[cagreen833]

A nurse is working on a geriatric unit and caring for a patient on multiple medications. While reviewing the patient's laboratory findings, the nurse notes a slightly abnormal serum creatinine level.
 
  The nurse is not concerned, because she understands that serum creatinine is not a good reflection of renal function because
  a. lean body mass decreases parallel with the decline in renal function.
  b. lean body mass is increased as renal function declines.
  c. obese body tissue sequesters creatinine.
  d. blood urea nitrogen decreases in older adults.

Question 2

A prescriber has ordered a child's dose of medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse should clarify the order with the prescriber to ensure that she _____ the medication.
 
  a. orders a lower dose of
  b. orders a higher dose of
  c. discontinues
  d. changes the route of

[srodz]

Answer to Question 1

ANS: A
In the elderly, the proper index of renal function is creatinine clearance, not serum creatinine levels. Creatinine levels do not reflect kidney function in the elderly because the sources of serum creatinine, lean muscle mass, decline in parallel with the decline in kidney function. As a result, creatinine levels may be normal even though renal function is greatly reduced.
Lean body mass is decreased, not increased as renal function declines.
Obese body tissue does not sequester creatinine.
Blood urea nitrogen does not decrease in older adults.

Answer to Question 2

ANS: A
The drug-metabolizing capacity of newborns is low. As a result, neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced.
Because of the decreased ability of hepatic metabolism in the newborn, a lower dose is required, not a higher dose.
The medication dosage should be adjusted, not discontinued, for the newborn.
No indication of route was given in the question; not enough information is provided to choose this option.

[cagreen833]

TYSM

[bulacsom]

Excellent