In a patient receiving hydrocodone for moderate pain, which of the following should the nurse prioritize to assess for potential adverse effects? (Select all that apply.)

Choice A reason: Hepatotoxicity is not a primary concern with hydromorphone. While liver function should be considered in all drug metabolism, hydromorphone is not known for causing liver damage.

Choice B reason: Renal impairment may affect drug clearance, but it is not the most critical adverse effect. Dose adjustments may be needed, but renal toxicity is not a hallmark of hydromorphone.

Choice C reason: Respiratory depression is the most serious and potentially life-threatening adverse effect of opioid analgesics like hydromorphone. It results from suppression of the brainstem respiratory centers and requires close monitoring, especially in opioid-naïve patients.

Choice D reason: Gastrointestinal bleeding is not associated with hydromorphone. This adverse effect is more common with NSAIDs due to their impact on gastric mucosa and platelet function.

Choice A reason: Hypoactive bowel sounds may be present in the early postoperative period but do not confirm the return of effective peristalsis. They can be misleading and are not a reliable indicator of bowel function recovery.

Choice B reason: Abdominal distention suggests delayed gastric emptying or accumulation of gas and fluids due to impaired peristalsis. It is a sign of ileus or obstruction rather than recovery.

Choice C reason: Passage of flatus is a direct and reliable sign that peristalsis is returning. It indicates that the bowel is moving gas through the intestines, a key milestone in postoperative recovery and readiness for oral intake.

Choice D reason: A request for food or drink may reflect improved alertness or comfort but does not confirm gastrointestinal motility. Without objective signs like flatus or bowel sounds, it cannot be used to assess peristalsis.