A patient who regularly takes acetaminophen returns to the clinic for a follow-up visit. Which
assessment indicates the need for a change in the patient's therapy?
1
Hemoglobin 11.2 g/dL
2
Serum bilirubin 3.2 mg/dL
3
Serum creatinine 0.8 mg/dL
4
Random blood glucose 160 mg/dL - answer✔2
Acetaminophen used for pain relief can be hepatotoxic if taken in large doses. Elevated serum
bilirubin indicates chemical damage to the liver. A serum bilirubin level of 3.2 mg/dL is much
higher than normal; it indicates hepatotoxicity and the need for a change in therapy. A
hemoglobin level of 11.2 g/dL, serum creatinine level of 0.8 mg/dL, and random blood glucose
level of 160 mg/dL are under the normal range.
A patient is prescribed oxycodone extended release (ER) for pain management. What
information is essential to include in the teaching plan? Select all that apply.
1
"Do not crush the medication."
2
"Swallow the medication whole."
3
"Take the medication frequently."
4
"Do not dissolve the medication in water."
5
"Increase the dose if you experience no pain relief." - answer✔1, 2, 4
Oxycodone ER is an extended-release dosage form. The nurse should instruct the patient not to
chew or crush the medicine to prevent excessive sedation, urinary retention, and respiratory
depression. The medication should be swallowed whole. Chewing or crushing or dissolving the
medication in water would result in increased serum concentration of the drug, which may cause
adverse effects. Rapid absorption of the drug results in severe opioid toxicity. The medication is
not taken frequently, because it is an extended-release form. This means it works for longer
periods of time. The patient should not increase the dose if there is no pain relief, but rather
should call the primary health care provider.
Which condition would contraindicate the administration of naltrexone hydrochloride?
1
Anemia
2
Asthma
3
Diabetes
4
Hepatitis - answer✔4
Administration of naltrexone hydrochloride is contraindicated in a patient who has hepatitis or
liver dysfunction. Administering naltrexone hydrochloride to these patients may produce severe
complications, because the drug is metabolized in the liver. Naltrexone hydrochloride does not
alter hemoglobin levels, respiratory function, or blood sugar levels. Thus the administration of
naltrexone hydrochloride is safe in a patient who has anemia, asthma, or diabetes.
Which condition listed in the patients' medical history could be a contraindication to
administration of morphine sulfate?
1
Cancer
2
Asthma
3
Diarrhea
4
Anorexia - answer✔2
Morphine sulfate should be used with caution in patients with asthma, because naturally
occurring opioids cause the release of histamine; a release of histamine in a patient with asthma
can trigger bronchoconstriction. Because 20% to 35% of morphine sulfate binds to protein,
cancer and anorexia are causes for concern, because both conditions can result in
hypoproteinemia and a lack of protein-binding sites for morphine, which can alter the
pharmacokinetics of the medication. The administration of morphine sulfate can help diminish
diarrhea.
Which finding alerts the nurse to the possibility that the patient is experiencing adverse effects of
morphine sulfate?
1
Diarrhea
2
Insomnia
3
Drowsiness
4
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