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. Prepare to give oral N-acetylcysteine: N-acetylcysteine is the antidote for acetaminophen toxicity and is most effective when given within 8 hours of ingestion. Since the child ingested a toxic dose 4 hours ago, administering this medication promptly helps prevent severe hepatic injury. B. Send the child home on increased fluid intake: Simply encouraging fluids does not address acetaminophen toxicity. Without antidote therapy, the child is at significant risk for liver damage, so discharge with fluids would place the child in danger. C. Perform gastric lavage with activated charcoal: Activated charcoal may be useful if given within 1 hour of ingestion to reduce absorption. At 4 hours post-ingestion, acetaminophen has already been absorbed, making this intervention ineffective. D. Begin hemodialysis within the next 24 hr: Hemodialysis is rarely indicated in acetaminophen toxicity unless there is massive ingestion, severe liver failure, or extremely high serum levels. The standard and effective treatment at this stage is N-acetylcysteine.