A nurse is assessing a client who is receiving IV furosemide for peripheral edema.
Which of the following findings should the nurse identify as an indication that the client is developing dehydration?

Choice A rationale

An elevated troponin level indicates myocardial injury or infarction. While severe acetaminophen toxicity can rarely lead to cardiac dysfunction, it is not a primary or common finding. The main organ affected is the liver due to the formation of toxic metabolites.

Choice B rationale

Hyperglycemia is not a typical finding in acetaminophen toxicity. Liver damage can impair glucose regulation, but the immediate and common metabolic derangements are usually related to liver enzyme elevation and acid-base imbalances, not primary glucose elevation.

Choice C rationale

Increased alanine aminotransferase (ALT) level is a critical indicator of hepatotoxicity, the primary concern in acetaminophen overdose. N-acetyl-p-benzoquinone imine (NAPQI), a toxic metabolite, depletes glutathione, leading to hepatocellular necrosis and leakage of intracellular enzymes like ALT (normal range 7–55 U/L).

Choice D rationale

Abdominal discomfort is a common finding in acetaminophen toxicity, particularly as liver damage progresses. This discomfort, often described as right upper quadrant pain, results from hepatocellular injury and inflammation, potentially accompanied by hepatic swelling.

Choice E rationale

Diaphoresis, or excessive sweating, is an early and non-specific symptom of acute acetaminophen overdose. It often accompanies other initial gastrointestinal symptoms like nausea and vomiting, occurring as the body attempts to excrete the drug and in response to initial metabolic stress.

Choice A rationale

Bronchospasm is a constriction of the airways, commonly seen in respiratory conditions like asthma. It is mediated by inflammatory responses and smooth muscle contraction in the bronchi. Acetazolamide, a carbonic anhydrase inhibitor, does not typically cause bronchospasm; its primary effects are on fluid and electrolyte balance and intraocular pressure.

Choice B rationale

Constipation is a common gastrointestinal symptom characterized by infrequent or difficult bowel movements. It can be caused by various factors, including dietary habits, medications, and underlying medical conditions. Acetazolamide's mechanism of action, involving inhibition of carbonic anhydrase, does not directly lead to constipation as a significant adverse effect.

Choice C rationale

Diplopia, or double vision, is a visual disturbance where a single object appears as two. It can result from ocular muscle weakness, nerve damage, or other neurological conditions. Acetazolamide's therapeutic effects are on aqueous humor production in the eye to reduce intraocular pressure, but diplopia is not a recognized adverse effect of this medication.

Choice D rationale

Acetazolamide is a carbonic anhydrase inhibitor that promotes the excretion of bicarbonate, sodium, potassium, and water. This diuretic action can lead to metabolic acidosis, hypokalemia (normal range: 3.5-5.0 mEq/L), and hyponatremia (normal range: 135-145 mEq/L) due to increased renal excretion, hence requiring close monitoring of electrolyte balance.