A nurse is monitoring a client who is receiving warfarin and has an INR of 4 (0.8 to 1.1). Which of the following medications should the nurse plan to administer?

Choice A rationale

Ipratropium is an anticholinergic bronchodilator that blocks muscarinic receptors in the bronchial smooth muscle, leading to bronchodilation. A common adverse effect of anticholinergic medications is reduced salivary gland secretion, resulting in xerostomia, or dry mouth, due to inhibition of parasympathetic stimulation.

Choice B rationale

Periorbital edema is not a typical adverse effect of ipratropium. This medication primarily targets muscarinic receptors in the respiratory tract. Edema, particularly around the eyes, is more commonly associated with allergic reactions or fluid retention from other medications.

Choice C rationale

Ipratropium, being an anticholinergic, primarily acts on M3 receptors in the lungs and has minimal systemic absorption, thus rarely causing bradycardia. In fact, anticholinergics can sometimes cause a mild increase in heart rate due to blockade of M2 receptors in the heart, but clinically significant changes are uncommon.

Choice D rationale

While xerostomia can contribute to dental issues over time due to reduced saliva's protective effects, dental caries is not a direct, acute adverse effect of ipratropium itself. It is a potential long-term complication of prolonged dry mouth, rather than a direct drug-induced effect to monitor immediately.

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.