A nurse is preparing to administer acetaminophen to a client who has a fever.
Which of the following actions should the nurse take? (Select all that apply)
Check the client’s blood pressure
Assess the client’s liver function tests
Verify the dosage with another nurse
Ask the client about any allergies
Monitor the client’s temperature.
Correct Answer : B,D,E
The correct answers are: B) Assess the client’s liver function tests, D) Ask the client about any allergies, and E) Monitor the client’s temperature.
Choice A rationale:
Checking the client’s blood pressure is not a standard action specifically related to administering acetaminophen. While monitoring vital signs is important, blood pressure is not directly affected by acetaminophen.
Choice B rationale:
Assessing the client’s liver function tests is crucial because acetaminophen is metabolized by the liver. High doses or prolonged use can lead to hepatotoxicity, so it’s important to ensure the liver is functioning properly.
Choice C rationale:
Verifying the dosage with another nurse is typically required for high-risk medications, such as insulin or anticoagulants, but not for acetaminophen. However, it is always good practice to double-check dosages independently.
Choice D rationale:
Asking the client about any allergies is essential before administering any medication, including acetaminophen, to prevent allergic reactions.
Choice E rationale:
Monitoring the client’s temperature is important to evaluate the effectiveness of acetaminophen in reducing fever. This helps in assessing whether the medication is achieving its intended therapeutic effect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
The correct answers are: B) Assess the client’s liver function tests, D) Ask the client about any allergies, and E) Monitor the client’s temperature.
Choice A rationale:
Checking the client’s blood pressure is not a standard action specifically related to administering acetaminophen. While monitoring vital signs is important, blood pressure is not directly affected by acetaminophen.
Choice B rationale:
Assessing the client’s liver function tests is crucial because acetaminophen is metabolized by the liver. High doses or prolonged use can lead to hepatotoxicity, so it’s important to ensure the liver is functioning properly.
Choice C rationale:
Verifying the dosage with another nurse is typically required for high-risk medications, such as insulin or anticoagulants, but not for acetaminophen. However, it is always good practice to double-check dosages independently.
Choice D rationale:
Asking the client about any allergies is essential before administering any medication, including acetaminophen, to prevent allergic reactions.
Choice E rationale:
Monitoring the client’s temperature is important to evaluate the effectiveness of acetaminophen in reducing fever. This helps in assessing whether the medication is achieving its intended therapeutic effect.
Correct Answer is B
Explanation
Carbamazepine is an anticonvulsant drug that can induce the activity of cytochrome P450 enzymes in the liver.These enzymes are responsible for metabolizing acetaminophen into a toxic intermediate called N-acetyl-p-benzoquinone imine (NAPQI), which can cause liver injury by depleting glutathione and covalently binding to cellular proteins. Therefore, taking carbamazepine with acetaminophen can increase the risk of hepatotoxicity by enhancing the formation of NAPQI.
Choice A is wrong because warfarin is an anticoagulant drug that does not affect the metabolism of acetaminophen.However, acetaminophen can increase the anticoagulant effect of warfarin by inhibiting its metabolism, which can increase the risk of bleeding.
Choice C is wrong because furosemide is a diuretic drug that does not interact with acetaminophen.However, furosemide can cause dehydration and electrolyte imbalance, which can affect liver function and increase the susceptibility to acetaminophen-induced liver injury.
Choice D is wrong because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that does not affect the metabolism of acetaminophen.However, ibuprofen can cause gastrointestinal irritation and renal impairment, which can also increase the risk of acetaminophen-induced liver injury.Additionally, taking both acetaminophen and ibuprofen can increase the risk of overdose and toxicity.
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