A patient who ingests several alcoholic beverages each day has been taking 1 gm of acetaminophen (Tylenol) six times a day and Percocet for pain relief following knee surgery
The patient is currently complaining of nausea with right upper quadrant pain and has an AST of 60 units/L and ALT of 45 units/L. Which additional laboratory studies would the nurse use when assessing this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prothrombin time and INR to identify coagulation abnormalities
2. Serum potassium to evaluate kidney function
3. Serum acetaminophen level plotted on a Rumack-Matthew nomogram
4. Toxicology screen to identify other substances ingested
5. Urine screen for myoglobin to detect tissue damage
1,3,4
Rationale 1: The PT/PTT and INR are the most important levels to obtain because elevation of these levels is indicative of liver dysfunction and puts the patient at risk for bleeding.
Rationale 2: A more accurate assessment of renal function would be creatinine and blood urea nitrogen in addition to potassium.
Rationale 3: The amount of acetaminophen this patient consumes is 6000 mg/day. This exceeds the safe level of 4000 mg/day. The patient needs to be assessed for acetaminophen toxicity.
Rationale 4: An ethanol level and opiate level would also be appropriate for this patient, given the patient's history.
Rationale 5: Urine myoglobin is only used for those patients with tissue trauma such as those with severe orthopedic injury and burns.
You might also like to view...
Possible causes for a hyperkinetic/bounding pulse would include which of the following? Select all that apply
a. Fever d. Hyperthyroidism b. Exercise e. Cardiogenic shock c. Hypovolemia f. Congestive heart failure
A nurse evaluates a smoking cessation program, the gained or increased financial income, the im-provements in the community attributable to the program, and the costs that would result if the program was not offered
Which of the following best describes the action of the nurse? a. Cost-effectiveness analysis b. Cost-benefit analysis c. Supply and demand d. Microeconomic theory
The local high school offers a course for teens on firearm safety that addresses many issues about the proper use of firearms. This course is:
a. Inappropriate because teens have little use for firearms b. Inappropriate because it encourages the use of guns among gangs c. Appropriate because teens often feel that they are indestructible d. Appropriate because many teens carry guns in their cars
A novice nurse is using the assessment technique of auscultation. What assessment finding can the nurse obtain with this method?
A) size of the liver B) presence of peristalsis C) pupil reaction D) skin temperature