The nurse should be concerned about acetaminophen toxicity, as the recommended daily dose of acetaminophen is 4 grams for adults, and this patient has exceeded this amount. (Three 500-milligram tablets every three hours is equal to 12 grams in a 24-hour period.) Acetaminophen toxicity may manifest with nausea and vomiting in the first 24 hours and right upper quadrant abdominal pain afterwards due to liver damage. Tinnitus, high blood pressure, and diarrhea are not symptoms of acetaminophen poisoning. An international normalized ratio (INR) of 1.1 is within normal limits, but may be trending upwards, as the liver is responsible for producing clotting factors. Liver function tests should always be done when acetaminophen poisoning is suspected; aspartate transaminase (AST) and alanine transaminase (ALT) values above  suggest hepatic damage.

The nurse should be aware of potential complications of morphine sulfate, which can cause respiratory depression. Therefore, a respiratory rate of 8 breaths per minute should most concern the nurse (the normal limits are 12-18). The heart rate, blood pressure, and oxygen saturation are within normal limits. A patient on morphine sulfate should complain of pain, and although a pain level of 7 out of 10 requires attention, the respiratory depression takes priority.

The nurse must recognize these signs and symptoms as potential extravasation, where a vesicant medication such as gentamicin, penicillin, dilantin, or chemotherapy has been given. It is essential to first stop the infusion and remove the insult. The nurse must then aspirate the remaining medication in the catheter to reduce the amount of exposure to the vesicant. The nurse can then remove and discontinue the catheter and notify the primary care provider.

The nurse should understand the mechanism of action, indications, and risks of immunizations as they do for all medications administered. Immunizations work by passively providing acquired immunity to specific diseases (such as influenza, hepatitis B, and varicella). They imitate a specific pathogen, influencing the patient’s body to produce antibodies that are capable of defending the body if it is exposed to the disease-causing element. The nurse should know that immunizations are specifically made for some diseases, and do not work for all diseases. Immunizations also come with minimal risks, and although they are widely given, are not universally prescribed. Patients should be educated with potential risks; some patients may experience fevers or rashes. Immunizations do not provide natural immunity to diseases; natural immunity is acquired by the patient when they contract a disease via exposure and the body produces its own antibodies. Immunizations do not provide antibodies to each disease.

Different types of viral hepatitis are transmitted through various routes. Hepatitis A is the only form that is transmitted through the fecal-oral route (contaminated food and water). Hepatitis B and D are transmitted through infected blood/needles as well as sex, and from infected mothers to newborns. Hepatitis C is transmitted through contaminated blood and needles. Recall that hepatitis D is an opportunistic infection, which requires hepatitis B infection.

Papillary carcinoma is the most common thyroid cancer (60-70% of all thyroid cancers). Follicular carcinoma is the second most common thyroid cancer type (10-20% of cases), followed by medullary thyroid cancer (5%), then anaplastic carcinoma (under 5% of cases).

Medullary carcinoma of the thyroid originates from the parafollicular cells (c cells). Elevated levels of calcitonin in these patients cause diarrhea, which is the most common clinical symptom. Papillary carcinoma, follicular carcinoma, and anaplastic carcinoma are not associated with any significant elevation in calcitonin levels.

Hematuria, flank pain, and an abdominal mass are all signs of renal cell carcinoma, an adenocarcinoma originating in the proximal proximal tubule of the kidney. 

Mesothelioma is a form of lung cancer associated with asbestos exposure, Ewing's sarcoma is a type of bone cancer common in children and adolescents, and Hodgkin's lymphoma is a cancer that originates in the lymphocytes of the blood.

Hepatocellular carcinoma accounts for approximately 75% of all primary liver cancers.

Cholangiocarcinoma and hepatoblastoma are rare forms of liver cancer, and a teratoma is a tumor that contains normal-appearing tissues from multiple germ layers, which can appear in multiple locations in the body. 

Breast, lung, kidney, and prostate cancers make up approximately 80% of metastases to bone. Stomach cancer can metastasize to bone, but it does so only rarely.