The nurse is monitoring lab results for a client who is receiving acetaminophen (Tylenol) for chronic pain. Which lab result(s) may be abnormal?
Hematocrit 46 % (reference: males 42% - 52%, females 36% -48%)
Hemoglobin 14.6 g/dL (reference 13 - 18 g/dL)
Elevated liver enzymes
Elevated BUN and creatinine
The Correct Answer is C
A. Hematocrit 46 %: This value falls within the normal physiological range for both adult males and females. Acetaminophen does not typically affect red blood cell volume or hemoglobin concentration. This lab result indicates normal oxygen-carrying capacity and hydration status rather than drug-induced toxicity or pathology.
B. Hemoglobin 14.6 g/dL: This result is well within the standard reference range and indicates no evidence of anemia or polycythemia. Chronic acetaminophen use is not associated with hematological suppression or gastrointestinal bleeding that would lower hemoglobin levels. It reflects a stable hematological profile for the client.
C. Elevated liver enzymes: Acetaminophen is primarily metabolized in the liver, where a small portion is converted into the toxic metabolite NAPQI. Chronic use or high doses can deplete glutathione stores, leading to hepatocyte necrosis. Elevated ALT and AST levels are the primary indicators of this drug-induced hepatic injury.
D. Elevated BUN and creatinine: These markers indicate renal function and are more typically associated with the use of non-steroidal anti-inflammatory drugs like ibuprofen. While massive acetaminophen overdose can cause secondary renal failure, chronic therapeutic use specifically targets the liver. Hepatic enzymes are the specific monitoring priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","F"]
Explanation
A. Edema: Venous insufficiency leads to poor return of blood from the lower extremities, causing fluid accumulation in the interstitial tissues. This manifests as leg swelling (edema), which is a hallmark of venous disease.
B. Pale wound bed: A pale wound bed is more characteristic of arterial ulcers, which result from poor oxygenation and perfusion. Venous ulcers usually have a ruddy, beefy red wound bed due to adequate arterial inflow but impaired venous return.
C. Itchy dry scaly skin: Chronic venous stasis causes skin changes such as stasis dermatitis. Patients often report itching, dryness, and scaling due to impaired circulation and inflammatory changes in the skin.
D. Large amount of drainage: Venous ulcers typically produce copious exudate because of high hydrostatic pressure in the veins, which forces fluid out into the wound bed. This is one of the distinguishing features compared to arterial ulcers, which are usually dry.
E. Wound edges surrounded by calloused tissue: Calloused wound edges are more typical of neuropathic/diabetic ulcers, especially on pressure points of the foot. Venous ulcers usually have irregular, shallow edges without callus formation.
F. Hyperpigmentation of the skin surrounding the ulcerated area: Long-standing venous hypertension causes red blood cells to leak into surrounding tissues. Breakdown of hemoglobin deposits hemosiderin, leading to brownish discoloration (hyperpigmentation) around the ulcer site.
Correct Answer is C
Explanation
A. Sublingual: This route provides rapid mucosal absorption for breakthrough pain but has a relatively short duration of action. It bypasses the gastrointestinal tract for quick systemic entry. However, it does not provide the sustained-release mechanism required for long-term, continuous analgesia.
B. Intravenous: IV administration offers the fastest onset of action but also the shortest duration due to rapid redistribution and clearance. It is ideal for acute, severe pain or titration in controlled settings. It lacks the slow-release properties necessary for extended pain management over several days.
C. Transdermal: Fentanyl patches utilize a rate-controlling membrane to deliver medication continuously through the dermis into the systemic circulation. This route typically provides a steady therapeutic plasma concentration for 48 to 72 hours. It is the preferred method for chronic, stable pain requiring long-acting relief.
D. Intramuscular: The intramuscular route has a slower onset than IV but still offers a limited duration of 2 to 4 hours. Repeated injections are painful and do not provide the consistent basal rate achieved by a patch. It is rarely used for fentanyl due to better alternatives.
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