The nurse is caring for a group of clients. Which client has the greatest risk for decreased drug metabolism?

A. A client with a low serum albumin: Low albumin levels affect protein binding of highly protein-bound drugs, increasing the free drug concentration and potential toxicity. While this influences drug distribution and effects, it does not directly impair hepatic metabolism. B. A client diagnosed with renal failure: Renal failure primarily affects drug excretion rather than metabolism. Drugs cleared by the kidneys may accumulate, but hepatic metabolism may remain largely intact unless concomitant liver disease is present. C. A client with slowed gastric emptying: Slowed gastric emptying affects the rate and sometimes the extent of drug absorption. While this can delay onset of action, it does not significantly alter hepatic metabolism of the medication. D. A client with cirrhosis of the liver: Cirrhosis significantly impairs hepatic function, reducing the liver’s ability to metabolize drugs through phase I and phase II reactions. This increases drug half-life, risk of accumulation, and potential toxicity, making these clients the highest risk for decreased drug metabolism.