A pregnant client tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. Which response by the nurse is the most appropriate?
1. "This is because your blood volume has increased."
2. "This is because high estrogen levels increase stomach acid, which may decrease absorption."
3. "Maybe the medication has expired; check the label."
4. "Tell me how you have been taking your medication."
Correct Answer: 2
Rationale 1: The increase in blood volume would result in higher concentrations of "free" drug in the plasma. This would result in an increase in drug response, not decreased effectiveness.
Rationale 2: High estrogen levels can increase hydrochloric acid in the stomach, which can affect the absorption of some medications.
Rationale 3: This is not the best response. If she routinely took the medication before her pregnancy, it is unlikely the medication would have expired.
Rationale 4: This might be an appropriate question after other factors have been established. This is not the best response.
Global Rationale: High estrogen levels can increase hydrochloric acid in the stomach, which can affect the absorption of some medications. The increase in blood volume would result in higher concentrations of "free" drug in the plasma. This would result in an increase in drug response, not decreased effectiveness. If she routinely took the medication before her pregnancy, it is unlikely the medication would have expired. After other factors have been established it would be appropriate for the nurse to ask how the client has been taking the medications.
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