A nurse is caring for a client who ingested a toxic amount of acetaminophen 36 hr ago. Which of the following findings should the nurse monitor? Select all that apply.

Choice A rationale An elevated troponin level indicates myocardial injury or infarction. While severe acetaminophen toxicity can rarely lead to cardiac dysfunction, it is not a primary or common finding. The main organ affected is the liver due to the formation of toxic metabolites. Choice B rationale Hyperglycemia is not a typical finding in acetaminophen toxicity. Liver damage can impair glucose regulation, but the immediate and common metabolic derangements are usually related to liver enzyme elevation and acid-base imbalances, not primary glucose elevation. Choice C rationale Increased alanine aminotransferase (ALT) level is a critical indicator of hepatotoxicity, the primary concern in acetaminophen overdose. N-acetyl-p-benzoquinone imine (NAPQI), a toxic metabolite, depletes glutathione, leading to hepatocellular necrosis and leakage of intracellular enzymes like ALT (normal range 7–55 U/L). Choice D rationale Abdominal discomfort is a common finding in acetaminophen toxicity, particularly as liver damage progresses. This discomfort, often described as right upper quadrant pain, results from hepatocellular injury and inflammation, potentially accompanied by hepatic swelling. Choice E rationale Sweating (diaphoresis) can occur as a nonspecific systemic symptom in toxicity stages, often with nausea or malaise. Monitor vital signs and symptoms for systemic involvement. Diaphoresis is a common clinical manifestation during the initial and middle stages of toxicity. It is part of the systemic metabolic stress response to the circulating toxins and early liver dysfunction.