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NCLEX · General

A client is admitted after taking 30 acetaminophen tablets 2 hours ago. The client says 'I feel fine now — can I go home?' What is the nurse's best response?

Correct answer

'Feeling fine right now does not mean you're safe — acetaminophen overdose causes delayed liver damage that may not be apparent for 24-72 hours; you need to stay for treatment and monitoring, and this will also include a mental health evaluation'

  1. A 'If you feel okay, you can probably leave soon — the nurse practitioner will check you first'
  2. B 'Feeling fine right now does not mean you're safe — acetaminophen overdose causes delayed liver damage that may not be apparent for 24-72 hours; you need to stay for treatment and monitoring, and this will also include a mental health evaluation'
  3. C 'You're right — if there are no symptoms yet, we'll monitor you for a while and likely discharge you'
  4. D 'The antidote only works if given immediately — if you feel fine, you probably took less than you thought'

Why this is the answer

ACETAMINOPHEN (PARACETAMOL/TYLENOL) OVERDOSE: Classic presentation: ASYMPTOMATIC in the first 24 hours despite significant hepatotoxic dose; PHASES: Phase 1 (0-24h): May be asymptomatic or mild nausea; Phase 2 (24-72h): Liver enzymes begin rising, RUQ pain; Phase 3 (72-96h): Peak hepatotoxicity — jaundice, coagulopathy, liver failure; Phase 4: Recovery or death; CRITICAL TEACHING: 'Feeling fine' is deceptive and dangerous in acetaminophen overdose; ANTIDOTE: N-acetylcysteine (NAC) — most effective within 8 hours but beneficial up to 24 hours; the Rumack-Matthew nomogram guides treatment decisions based on serum acetaminophen level and time since ingestion; MENTAL HEALTH: All intentional overdoses require psychiatric evaluation before discharge — even if medically cleared; this is a sentinel event for suicidal intent.
Source: NCLEX-PN PS — Substance/Overdose, Acetaminophen Delayed Hepatotoxicity

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