A nurse is caring for a client who is receiving meperidine.
Which of the following is the nurse's priority assessment before administering the medication?

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

Nystagmus, an involuntary rhythmic eye movement, is not a recognized or common adverse effect of oral albuterol. Albuterol is a beta-2 adrenergic agonist primarily acting on bronchial smooth muscle to cause bronchodilation. Its side effects are typically related to sympathetic nervous system stimulation, not oculomotor dysfunction.

Choice B rationale

Tachycardia is a common adverse effect of oral albuterol due to its systemic absorption and stimulation of beta-1 adrenergic receptors in the heart, in addition to its primary beta-2 effects on the lungs. This leads to an increased heart rate (normal range 60-100 bpm) and can cause palpitations, especially in sensitive individuals or with higher doses.

Choice C rationale

Drowsiness is not a typical adverse effect of oral albuterol. In fact, due to its stimulant properties, albuterol is more likely to cause central nervous system excitation, leading to insomnia, nervousness, or tremors rather than sedation. Its action is to activate adrenergic pathways, which generally promote alertness.

Choice D rationale

Oral fungal infections, such as oral candidiasis (thrush), are commonly associated with inhaled corticosteroids, not oral albuterol. Inhaled corticosteroids suppress the local immune response in the oral cavity, allowing opportunistic fungal growth. Oral albuterol does not have immunosuppressive effects on the oral mucosa.