An older adult with renal and hepatic impairment has received repeated meperidine doses and develops tremor and confusion. Which actions are appropriate? Select exactly 4 responses.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Repeated exposure in impaired clearance can increase meperidine or normeperidine toxicity and seizure risk, requiring interruption, focused assessment, medication review, and protective management.
Quick answer Select holding, neurologic-respiratory assessment, clearance and exposure review, and seizure-protective alternative management.
Why this is correct Meperidine and its active metabolite can accumulate with renal or hepatic impairment. Prolonged use increases seizure risk from normeperidine, while older adults are more vulnerable to respiratory depression.
Easy analogy or mental picture When a toxic metabolite cannot leave, adding more parent drug fills the reservoir faster.
Memory hook Meperidine plus organ impairment plus tremor: stop and think normeperidine.
NCLEX decision rule Treat a new neurologic change during repeated opioid exposure as possible toxicity, while protecting airway and seizure safety.
Why the other choices are wrong Dose escalation or another scheduled dose worsens the suspected accumulation mechanism.
References
1DailyMed: Meperidine HydrochlorideNormeperidine accumulation, seizure risk, and caution in older or organ-impaired clients
Opioid-metabolite toxicityTrend cumulative exposure, duration, kidney and liver function, mental status, tremor or myoclonus, respirations, and interacting serotonergic or CNS-depressant drugs.