Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication?

A patient with a fever of 103.4°F (39.7°C)

A patient admitted with deep vein thrombosis

A patient admitted with severe hepatitis

A patient who had abdominal surgery 1 week earlier

Answer and Explanation

The Correct Answer is C

Acetaminophen is a widely used analgesic and antipyretic. While generally safe, it is primarily metabolized by the liver, and excessive or prolonged use can cause hepatotoxicity. Nurses must assess liver function and consider alternative pain management for patients with significant hepatic impairment.

Rationale for correct answer:

C. A patient admitted with severe hepatitis:
Acetaminophen is contraindicated in patients with active liver disease because it can exacerbate liver injury. Even standard doses may pose a risk in severe hepatic impairment, so an alternate analgesic should be chosen.

Rationale for incorrect answers:

A. A patient with a fever of 103.4°F (39.7°C):
Fever is a standard indication for acetaminophen. It is safe and effective for reducing elevated body temperature.

B. A patient admitted with deep vein thrombosis:
Acetaminophen does not affect coagulation or increase thrombotic risk, making it safe in this context.

D. A patient who had abdominal surgery 1 week earlier:
Postoperative pain is a common indication for acetaminophen. It can be safely used unless there is concurrent liver disease.

Take-home points:

Acetaminophen is hepatotoxic at high doses or in patients with liver disease.
Always review patient history for liver impairment before administration.
Consider alternative analgesics in patients with active hepatitis or severe liver dysfunction.

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Free Nursing Study Resources

Correct Answer is A

Explanation

Morphine and other opioids can cause serious adverse effects when overdosed, including respiratory depression, bradycardia, hypotension, and pinpoint pupils. These are classic signs of opioid toxicity, and prompt reversal is critical to prevent respiratory and cardiac arrest. The antidote is naloxone (Narcan), an opioid receptor antagonist.

Rationale for correct answer:
A. Naloxone (Narcan): Naloxone binds to opioid receptors and displaces morphine, reversing respiratory depression, bradycardia, and CNS depression within minutes. It is the life-saving antidote in cases of opioid overdose.

Rationale for incorrect answers:
B. Meloxicam (Mobic): This is a nonsteroidal anti-inflammatory drug (NSAID) used for arthritis pain. It does not reverse opioid toxicity.
C. Pentazocine (Talwin): A mixed agonist–antagonist opioid. While it has some antagonistic activity, it is not appropriate for treating life-threatening respiratory depression.
D. Propoxyphene (Darvon): A weak opioid analgesic (now largely discontinued due to toxicity). It would worsen opioid overdose rather than treat it.

Take-home points:

Naloxone is the emergency antidote for opioid overdose.
Classic signs of opioid toxicity: respiratory depression, bradycardia, pinpoint pupils, cold/clammy skin.
Prompt reversal prevents respiratory and cardiac arrest in opioid emergencies.

Correct Answer is ["0.75"]

Explanation

Accurate dosage calculation is essential in nursing practice to ensure patient safety and effective pain management. When administering intravenous medications like morphine sulfate, the nurse must carefully convert the ordered dose into the correct volume based on the supplied concentration.

Rationale for correct answers:

Step-by-Step Calculation

To determine the volume of medication to administer, you can use the following formula:

Volume(mL)=ConcentrationSupplied(mg/mL)DoseOrdered(mg)

Identify the ordered dose: The order is for 3 mg of morphine sulfate.
Identify the concentration supplied: The vial is supplied as 4 mg/mL.
Calculate the volume: Volume(mL)=4mg/mL3mg=0.75mL

Therefore, the nurse will draw 0.75 mL into the syringe for this dose.

Take-home points:

Always use the formula: Volume (mL) = (Dose Ordered ÷ Dose on Hand) × Volume on Hand.
Double-check the medication concentration on the vial before calculating to avoid errors.
Correctly calculated, a 3 mg dose from a 4 mg/mL supply equals 0.75 mL to be drawn.

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Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Assessing a patient following IV morphine administration, the nurse notes cold, clammy skin; a pulse of 40 beats/min; respirations of 10 breaths/min; and constricted pupils. Which medication will the patient likely need next?

Correct Answer is A

Explanation

The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose?

Correct Answer is ["0.75"]

Explanation

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