A nurse in an emergency department is caring for a child who weighs 18 kg (39.7 lb) and ingested six 500 mg acetaminophen tablets 4 hr ago. Which of the following actions should the nurse take?

A. Send the child home on increased fluid intake: Simply encouraging fluids is inappropriate in this case. The child has ingested a potentially toxic dose of acetaminophen, and delayed treatment can result in serious liver damage. Medical intervention is necessary. B. Begin hemodialysis within the next 24 hr: Hemodialysis is not the first-line treatment for acetaminophen overdose. It may be used in rare, severe cases of liver failure or extremely high serum levels, but oral N-acetylcysteine is the standard antidote. C. Perform gastric lavage with activated charcoal: Gastric lavage is typically effective only within 1 hour of ingestion. Since this ingestion occurred 4 hours ago, lavage is unlikely to be beneficial. Activated charcoal may still have some role, but it’s not the primary action at this point. D. Prepare to give oral N-acetylcysteine: This is the antidote for acetaminophen toxicity and is most effective when given within 8 hours of ingestion. The child ingested 3,000 mg which exceeds the toxic dose threshold for a child weighing 18 kg. Prompt administration of N-acetylcysteine is critical.