# 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.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=602988&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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 exactly 4 responses.

1

Review cumulative dose, treatment duration, renal function, hepatic function, and interacting medications.

2

Institute seizure precautions and prepare prescribed supportive or alternative analgesic management.

3

Give another dose on schedule before laboratory results are reviewed.

4

Hold further meperidine and notify the authorized clinician.

5

Increase the meperidine dose because tremor indicates undertreated pain.

6

Assess airway, breathing, sedation, tremor, myoclonus, and seizure activity.

## Explanation

Repeated exposure in impaired clearance can increase meperidine or normeperidine toxicity and seizure risk, requiring interruption, focused assessment, medication review, and protective management.

## In-depth explanation

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

## Clinical scenario

Opioid-metabolite toxicity
Trend cumulative exposure, duration, kidney and liver function, mental status, tremor or myoclonus, respirations, and interacting serotonergic or CNS-depressant drugs.

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