# The nurse reviews a client with suspected salicylate poisoning. Which action is the priority?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=515763&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

The nurse reviews a client with suspected salicylate poisoning. Which action is the priority?

History

Vitals

Labs

Orders

Notes

A client reports taking a large amount of aspirin 10 hours ago and now has nausea and ringing in both ears.

Temperature 38.1 C, HR 116/min, RR 32/min with deep respirations, BP 104/62 mm Hg.

Salicylate concentration increased from 52 to 68 mg/dL; pH 7.47; PaCO2 24 mm Hg; bicarbonate 17 mEq/L; potassium 3.2 mEq/L; glucose 88 mg/dL.

Poison-center consultation and sodium bicarbonate protocol are prescribed.

The client is anxious and increasingly confused.

1

Administer prescribed sodium bicarbonate and prepare for toxicology-guided escalation while monitoring potassium and acid-base status.

✕

2

Give an acidifying agent to increase renal salicylate reabsorption.

✕

3

Delay treatment until tinnitus resolves spontaneously.

✕

4

Suppress the respiratory rate with a sedative before obtaining consultation.

✕

## Explanation

Tinnitus, tachypnea, mixed acid-base disturbance, and a rising salicylate concentration require prompt toxicology management, commonly including alkalinization and close potassium and pH monitoring.

## In-depth explanation

Quick answer
Prioritize alkalinization with toxicology consultation.

Why this is correct
Salicylate toxicity can worsen as acidemia increases tissue penetration. Sodium bicarbonate therapy requires potassium and acid-base monitoring, and severe cases may require extracorporeal removal.

Easy analogy or mental picture
Keep the poison ionized and moving out rather than letting acidemia drive it into tissues.

Memory hook
Salicylate: alkalinize, replace potassium, consult early.

NCLEX decision rule
Treat the toxic syndrome and trend response; do not wait for a single symptom to disappear.

Why the other choices are wrong
Acidification and respiratory suppression can worsen toxicity, while delay ignores a rising concentration.References
1AHA Focused Update: Life-Threatening PoisoningPoison-center consultation, sodium bicarbonate, and high-dose insulin recommendations

## Clinical scenario

Salicylate toxicity
Trend mental status, respiratory pattern, pH, bicarbonate, potassium, glucose, salicylate concentration, and urine pH.

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