A male adult is admitted due to an overdose of acetaminophen.
After being transferred to the mental health unit, the patient is informed that he has liver damage.
What is the most crucial information for the nurse to include in the patient’s discharge plan?
Avoid exposure to large crowds.
Call the crisis hotline if feeling lonely.
Do not take any over-the-counter medications.
Follow a high carbohydrate, low fat, low protein diet.
The Correct Answer is C
Choice A rationale
While avoiding exposure to large crowds can help prevent infections, especially for patients with compromised immune systems, it is not the most crucial information for a patient with liver damage due to an overdose of acetaminophen.
Choice B rationale
While emotional support is important for patients dealing with health issues, calling a crisis hotline if feeling lonely is not the most crucial information for a patient with liver damage due to an overdose of acetaminophen.
Choice C rationale
This is the most crucial information for the patient. Acetaminophen is found in many over-the- counter medications, and further intake could exacerbate liver damage.
Choice D rationale
While a balanced diet is important for overall health, following a high carbohydrate, low fat, low protein diet is not the most crucial information for a patient with liver damage due to an overdose of acetaminophen.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Offering the client oral fluids is important for hydration, but it may not be appropriate for all patients, especially those with certain medical conditions or those who are NPO (nothing by mouth)7.
Choice B rationale
Feeding the client a snack can help maintain energy levels, but it may not be appropriate for all patients, especially those with dietary restrictions or those who are NPO7.
Choice C rationale
Assessing breath sounds is an important part of respiratory assessment, but it is not typically within the scope of practice for unlicensed assistive personnel (UAP). This task should be performed by a licensed nurse.
Choice D rationale
Emptying the urinary drainage bag is an appropriate task for a UAP to perform each time the client is turned. This helps ensure accurate measurement of urinary output and prevents infection by keeping the bag below the level of the bladder.
Correct Answer is D
Explanation
Choice A rationale
Mixing the dextrose in a 50 mL piggyback for a total volume of 100 mL is not the appropriate method for administering the medication. This would dilute the dextrose, reducing its concentration and potentially making it less effective.
Choice B rationale
Diluting the dextrose in one liter of 0.9% normal saline solution is not the appropriate method for administering the medication. This would significantly dilute the dextrose, reducing its concentration and potentially making it less effective.
Choice C rationale
Requesting the pharmacist to add the dextrose to a total parenteral nutrition (TPN) solution is not the appropriate method for administering the medication. While dextrose is often a component of TPN solutions, in this case, the patient requires a concentrated dose of dextrose to treat insulin shock.
Choice D rationale
This is the correct answer. Administering the undiluted dextrose slowly through the currently infusing IV is the appropriate method for administering the medication. This allows for the rapid administration of a concentrated dose of glucose, which is necessary to quickly raise the patient’s blood glucose level in the case of insulin shock.
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