# A client on zafirlukast for chronic asthma reports new fatigue, right upper quadrant pain, dark urine, and clay-colored stools. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391781&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client on zafirlukast for chronic asthma reports new fatigue, right upper quadrant pain, dark urine, and clay-colored stools. Which is the priority nursing action?

## Option

1. Add a cholestyramine binder to relieve symptoms
2. Reassure that these symptoms are common in asthma
3. Hold zafirlukast and notify the provider — symptoms suggest hepatotoxicity requiring urgent LFT evaluation **✔ Correct answer**
4. Increase the zafirlukast dose for better control

**Correct answer: 3**

## Explanation

Correct (2): Zafirlukast and zileuton carry hepatotoxicity warnings. Symptoms — fatigue, RUQ pain, jaundice, dark urine, clay-colored stools — strongly suggest cholestatic liver injury. Hold the drug, notify provider, urgent LFT (AST/ALT/bilirubin). (1) Not asthma symptoms. (3) Higher dose worsens liver injury. (4) Cholestyramine without diagnosis is inappropriate.

## In-depth explanation

Memory Tip Zafirlukast/zileuton = "Z = Zafir LFT-watch." Baseline and periodic LFT recommended. Montelukast has lower hepatotoxic risk but neuropsych warning instead.

## Clinical scenario

Scenario 45-year-old female on zafirlukast 20 mg PO BID × 3 months for chronic asthma. Now reports fatigue, RUQ pain, dark urine, clay-colored stools, scleral icterus.

## Key concepts

- **Zafirlukast** — Leukotriene receptor antagonist; second-line for chronic asthma; hepatotoxicity risk.
- **Hepatotoxicity signs** — Fatigue, RUQ pain, jaundice, dark urine, clay-colored stools, elevated AST/ALT.
- **LFT monitoring** — Baseline and periodic AST/ALT/bilirubin recommended with zafirlukast and zileuton.

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