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 alternative medication?

This question assesses knowledge of the physiological function of essential vitamins. It requires understanding the specific role of fat-soluble vitamin K in the coagulation cascade, as this knowledge is fundamental for understanding clinical coagulation disorders and the action of common anticoagulation medications.

Choice A rationale

Carbohydrate energy production is primarily supported by B-complex vitamins, such as thiamine and niacin. Vitamin K is a lipid-soluble molecule and does not have a functional role in the cellular metabolic pathways that convert carbohydrates into energy.

Choice B rationale

Antioxidant protection against oxidative damage is primarily the role of vitamins C, E, and beta-carotene. Vitamin K is chemically specialized for the modification of specific proteins involved in blood coagulation and does not serve as a cellular antioxidant.

Choice C rationale

Calcium absorption in the intestines is primarily regulated by vitamin D and parathyroid hormone. Vitamin K does not play a direct role in the uptake of dietary calcium across the intestinal mucosa or into the systemic circulation.

Choice D rationale

Vitamin K is a crucial cofactor for the hepatic enzyme gamma-glutamyl carboxylase. This enzyme is required for the post-translational modification of clotting factors II, VII, IX, and X, which is essential for their functional activation in blood coagulation.

This question evaluates the management of side effects resulting from loop diuretic therapy. It requires assessing clinical signs of hypovolemia and electrolyte imbalance (normal potassium 3.5 to 5.0 mEq/L) to implement safety interventions that prevent injury while balancing fluid removal and hemodynamic stability.

Choice A rationale

While potassium supplementation is needed for a level of 3.2 mEq/L, administration requires a provider order to ensure safety and correct dosing. Independent administration of medications is outside of nursing scope and could lead to cardiac toxicity.

Choice B rationale

The patient's blood pressure of 90/60 mm Hg and reported dizziness indicate symptomatic orthostatic hypotension. Implementing fall precautions is the immediate priority to ensure patient safety while the nurse continues to monitor hemodynamic status and notifies the provider for further orders.

Choice C rationale

Encouraging increased fluid intake in a patient receiving diuretics for edema is counterproductive to the therapeutic goal of fluid removal. The focus should be on managing the postural hypotension through safety measures and titration rather than reversing the diuretic effect.

Choice D rationale

While withholding the medication might be appropriate given the hypotension and hypokalemia, the nursing priority is first to ensure the patient's immediate safety through fall prevention, followed promptly by reporting the clinical findings to the provider for a definitive medication plan.