# A 24-year-old client weighing 60 kg presents 6.5 hours after ingesting 15 g (250 mg/kg) of immediate-release acetaminophen. The 4-hour concentration is 185 mcg/mL, baseline AST and ALT are normal, and the initial acetylcysteine loading order was written as 6,000 mg instead of 9,000 mg. Which actions belong in the immediate overdose plan? Select exactly 4 responses.

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

## Question

A 24-year-old client weighing 60 kg presents 6.5 hours after ingesting 15 g (250 mg/kg) of immediate-release acetaminophen. The 4-hour concentration is 185 mcg/mL, baseline AST and ALT are normal, and the initial acetylcysteine loading order was written as 6,000 mg instead of 9,000 mg. Which actions belong in the immediate overdose plan? Select exactly 4 responses.

Select exactly 4 responses.

1

Begin the corrected acetylcysteine regimen without waiting for transaminases to rise.

2

Trend acetaminophen concentration, AST, ALT, INR, creatinine, glucose, and electrolytes as directed.

3

Verify the exact ingestion time, formulation, and total amount.

4

Delay acetylcysteine until a repeat acetaminophen concentration confirms a downward trend because the baseline AST and ALT are normal.

5

Contact the regional poison center or clinical toxicologist.

6

Use the 6,000-mg loading order now and add the missing 3,000 mg only if vomiting persists or the aminotransferases rise.

## Explanation

Verify the ingestion history, contact poison-center or toxicology support, begin the corrected weight-based acetylcysteine regimen promptly, and trend the acetaminophen concentration and hepatic, coagulation, renal, glucose, and electrolyte measures. Delaying treatment for another level is unsafe because the known 4-hour concentration of 185 mcg/mL is above the treatment line even with normal initial aminotransferases. The 60-kg client requires the full 150-mg/kg loading dose of 9,000 mg; giving 6,000 mg and waiting for symptoms or liver injury before completing it is not an acceptable loading strategy.

## In-depth explanation

Quick answer
Use a verify, treat, consult, and trend bundle.

Why this is correct
Early laboratory values can be normal despite a potentially hepatotoxic ingestion. Treatment and follow-up testing should not wait for overt hepatic injury.

Easy analogy or mental picture
Put out the chemical fire while also checking the building structure for delayed damage.

Memory hook
Verify exposure; start NAC; call toxicology; trend organs.

NCLEX decision rule
Generate solutions that prevent delay and detect evolving hepatic or systemic injury.

Why the other choices are wrong
Stopping surveillance or adding more acetaminophen conflicts with the overdose mechanism and treatment goal.References
1DailyMed: Acetylcysteine InjectionAcute acetaminophen assessment, 300 mg/kg three-dose regimen, monitoring, and continuation criteria
2US and Canada Acetaminophen Poisoning Consensus StatementPeer-reviewed toxicology consensus for assessment, acetylcysteine treatment, monitoring, and stopping decisions

## Clinical scenario

Immediate acetaminophen-overdose plan
Verify exposure, activate toxicology support, correct and begin antidote therapy, and trend the measures needed to decide when treatment can safely stop.

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