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    Hesi rn 315 pharmacology proctored exam

    While assessing a client who takes acetaminophen for chronic pain, the nurse observes that the client's skin looks yellow in color. Which action should the nurse take in response to this finding?

    Explanation & Rationale

    A. Report the finding to the healthcare provider: Yellow discoloration of the skin, or jaundice, suggests possible liver dysfunction, which can occur with acetaminophen toxicity, especially if taken chronically or in high doses. Promptly reporting this finding is crucial so that further evaluation and intervention can be initiated to prevent worsening liver injury. B. Check the client's capillary glucose level: Although liver dysfunction can eventually affect glucose metabolism, checking a capillary glucose level does not directly address the urgent concern of jaundice and potential hepatotoxicity related to acetaminophen use. C. Advise the client to reduce the medication dose: Simply advising dose reduction without proper evaluation could delay diagnosis and treatment of potentially serious liver damage. A healthcare provider needs to assess the situation before any medication changes are made. D. Use a pulse oximeter to assess oxygen saturation: Oxygen saturation monitoring is essential for respiratory or cardiac concerns but does not directly relate to jaundice or liver function. Therefore, it would not be the appropriate first action in this situation.

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