# A client rescued from an enclosed-space fire has soot around the mouth, altered mental status, severe lactic acidosis, and cardiovascular instability. Which action should the nurse anticipate?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client rescued from an enclosed-space fire has soot around the mouth, altered mental status, severe lactic acidosis, and cardiovascular instability. Which action should the nurse anticipate?

## Option

1. Wait for a measured cyanide concentration before administering antidotal therapy.
2. Give methylene blue first and reassess the lactic acidosis before using another antidote.
3. Give hydroxocobalamin 5 g IV promptly while supporting airway, breathing, circulation, and seizures. **✔ Correct answer**
4. Limit supplemental oxygen because the pulse oximetry reading remains within the expected range.

**Correct answer: 3**

## Explanation

High clinical suspicion of cyanide poisoning after enclosed-space smoke exposure warrants prompt hydroxocobalamin with full supportive resuscitation; laboratory confirmation should not delay treatment.

## In-depth explanation

Quick answer
Treat suspected cyanide poisoning without waiting for confirmation.

Why this is correct
CYANOKIT is indicated for known or suspected cyanide poisoning. The adult starting dose is 5 g IV over 15 minutes, given with airway, oxygen, ventilation, circulatory, and seizure management.

Easy analogy or mental picture
Cells cannot use delivered oxygen, so bind the cyanide while supporting every link in oxygen delivery.

Memory hook
Smoke, soot, shock, lactate: hydroxocobalamin now.

NCLEX decision rule
Use the exposure pattern and physiologic collapse to trigger time-critical antidote and resuscitation.

Why the other choices are wrong
Methylene blue treats methemoglobinemia, normal pulse oximetry cannot exclude cellular hypoxia, and confirmation delay can be fatal.References
1DailyMed: CYANOKITImmediate hydroxocobalamin for known or suspected cyanide poisoning with supportive care

## Clinical scenario

Suspected cyanide poisoning
Administer prescribed hydroxocobalamin through a separate line and continue airway, oxygenation, ventilation, circulation, and seizure support.

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