The nurse is teaching a client who is prescribed acetaminophen for the control of osteoarthritic joint pain. What statement by the client indicates a need for further teaching?

Choice A rationale The maximum recommended daily dosage of acetaminophen for adults should not exceed 4000 mg (4 grams) to prevent serious liver damage, with some practitioners recommending a lower limit of 3000 mg for chronic use or in those with risk factors like liver disease. Stating a maximum of 5000 mg indicates a need for further teaching about the potentially fatal hepatotoxicity. Choice B rationale Acetaminophen is primarily metabolized by the liver, and excessive doses or chronic use can lead to dose-dependent hepatotoxicity. Monitoring liver function tests (LFTs), specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST), is an important safety measure, especially in clients taking the drug long-term or those with pre-existing liver impairment. Normal ALT is 7 to 56 U/L. Choice C rationale Many over-the-counter and prescription combination products contain acetaminophen (also known as APAP or paracetamol), such as cold remedies or opioid pain relievers (e.g., hydrocodone/acetaminophen). The client must check all medications to avoid exceeding the maximum daily dose and prevent inadvertent acetaminophen overdose and subsequent liver damage. Choice D rationale Topical analgesics, such as patches and creams containing counterirritants or local anesthetics, can be safely used concurrently with oral acetaminophen to provide localized pain relief for osteoarthritic joints. This multimodal approach may allow the client to achieve better pain control with a lower overall oral analgesic dose, reducing systemic risks. —.