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A nurse is caring for a client who is receiving acetaminophen for mild pain.
The nurse should monitor the client for which of the following adverse effects of this medication?

Fever.

Jaundice.

Diarrhea.

Tinnitus.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Fever is not a common side effect of acetaminophen. In fact, acetaminophen is often used to reduce fever.

Choice B rationale:

Jaundice, which is a yellowing of the skin or eyes, can be a sign of liver damage, a rare but serious side effect of acetaminophen.

Choice C rationale:

Diarrhea is not a common side effect of acetaminophen.

Choice D rationale:

Tinnitus, or ringing in the ears, is not a common side effect of acetaminophen.

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Correct Answer is C

Explanation

Choice A rationale:

Asking for a home phone number is not an effective method for identifying a patient. Phone numbers can be easily forgotten or mixed up, especially in a hospital setting where a patient may be under stress or experiencing health issues.

Choice B rationale:

Room numbers can change if the patient is moved, and other patients may have previously occupied the same room. Therefore, room numbers are not reliable identifiers.

Choice C rationale:

Asking the patient to confirm their own name is one of the most direct and reliable ways to verify their identity. This method respects patient autonomy and privacy while ensuring accurate identification.

Choice D rationale:

Age alone is not a reliable identifier because it does not distinguish between different patients of the same age.

A. "I am going to take the medication with food.” B. "I understand that the medication can slow my heart rate.” C. "I should feel the effects of the medication within 5 minutes.” D. "I will take the medication every 10 minutes until the pain goes away.”

Correct Answer is C

Explanation

Choice Arationale:

The statement about taking the medication with food is incorrect. Nitroglycerin sublingual tablets should not be taken with food. They work much faster when absorbed through the lining of the mouth.

Choice B rationale:

The statement that the medication can slow the heart rate is incorrect. Nitroglycerin does not slow the heart rate. In fact, it can cause a reflex tachycardia, where the heart rate increases.

Choice C rationale:

The statement that the effects of the medication should be felt within 5 minutes is correct. This indicates an understanding of the instructions.

Choice Drationale:

Taking the medication every 10 minutes until the pain goes away is incorrect. Nitroglycerin sublingual tablets usually give relief in 1 to 5 minutes. However, if the pain is not relieved, a second tablet can be taken 5 minutes after the first tablet. If the pain continues for another 5 minutes, a third tablet may be used. Taking the medication every 10 minutes could lead to an overdose.

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A nurse is caring for a client who is receiving acetaminophen for mild pain.The nurse should monitor the client for which of the following adverse effects of this medication?

Nursing Test Bank

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A nurse is caring for a client who is receiving acetaminophen for mild pain.
The nurse should monitor the client for which of the following adverse effects of this medication?