Based on physiological changes in the kidney during pregnancy, which adjustment would a nurse anticipate for a patient in her third trimester who has been taking a drug excreted only by the kidneys?
a. Decreased dosage to protect the fetus
b. Increased dosage because of accelerated clearance
c. Rescheduling of drug administration times
d. No changes would be expected
ANS: B
By the third trimester, renal blood flow is doubled, causing a large increase in the glomerular filtration rate. As a result, there is accelerated clearance of drugs eliminated by glomerular filtration. To compensate for accelerated excretion, the dosage must be increased.
A decreased dosage is not indicated in this instance.
Rescheduling of the drug is not indicated in this instance.
With an increase in the glomerular filtration rate, the dosage must be increased, not left the same.
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