A nurse is caring for a 50-year-old female client in the emergency department.

Exhibits

For each prescriber prescription, click to specify if the prescription is anticipated or contraindicated for this client.

Choice A rationale

Acetylcysteine is the antidote for acetaminophen toxicity. It replenishes glutathione stores and detoxifies N-acetyl-p-benzoquinone imine (NAPQI), a toxic metabolite, preventing liver damage.

Choice B rationale

Acetylcysteine does not have a role in treating gastrointestinal bleeds. Management of gastrointestinal bleeds typically involves hemostatic agents, proton pump inhibitors, and endoscopic interventions.

Choice C rationale

Acute bronchospasm is treated with bronchodilators like albuterol, not acetylcysteine. While acetylcysteine is a mucolytic, it does not address bronchoconstriction or airway inflammation.

Choice D rationale

Morphine toxicity is treated with naloxone, an opioid antagonist. Acetylcysteine has no effect on opioid receptors and cannot reverse the central nervous system and respiratory depression caused by morphine.

Choice A rationale: Fluid intake is essential for maintaining hydration and overall health, especially for clients with bipolar disorder. However, it is not the most immediate concern unless specific signs of dehydration or other related issues are noted.

Choice B rationale: Gastrointestinal findings require follow-up because medication changes can cause nausea, vomiting, or other gastrointestinal disturbances. These symptoms can affect the client's nutrition and overall well-being, particularly with new medications in bipolar disorder management.

Choice C rationale: Muscle movement findings such as tremors, stiffness, or involuntary movements should be monitored. These can indicate side effects of psychiatric medications, including extrapyramidal symptoms or tardive dyskinesia, which require immediate medical evaluation.

Choice D rationale: Vital signs are crucial to monitor because abnormal readings can indicate adverse effects of medication. For example, certain medications used in bipolar disorder management can affect heart rate and blood pressure, which need regular assessment.

Choice E rationale: Urine output is important to track because changes in renal function can occur with certain medications. Monitoring for any alterations in urine output helps assess potential nephrotoxicity or other renal issues, which are critical for client health.