A nurse receives a call from a parent concerned their toddler ingested half of a bottle of ferrous sulfate vitamins.  What should the nurse instruct the parent to do? 

Choice A rationale

Docusate sodium is a stool softener used to treat constipation and is not indicated for an acute ingestion of ferrous sulfate. Administering this medication would not address the toxic effects of iron overdose, which can cause severe gastrointestinal and metabolic acidosis.

Choice B rationale

Giving a child orange juice is not an appropriate action. While vitamin C in orange juice can enhance iron absorption, this is dangerous in an overdose situation. The priority is to prevent further systemic absorption of the toxic iron.

Choice C rationale

Inducing vomiting is no longer a recommended intervention for most ingestions, including iron, due to the risk of aspiration and the limited effectiveness in removing all the ingested substance. The corrosive nature of iron can also cause esophageal damage upon emesis.

Choice D rationale

Contacting the poison control center is the most appropriate action. Poison control experts can provide the most current, specific, and evidence-based instructions tailored to the child's weight, the amount ingested, and the type of product, ensuring safe management and timely care.

Choice A rationale

Increasing weight loss is an incorrect characteristic. Nephrotic syndrome is marked by massive proteinuria, which leads to a decrease in plasma oncotic pressure. This fluid shift from the intravascular space to the interstitial space results in significant fluid retention, causing weight gain and edema, not weight loss. The body holds onto fluid, masking any potential muscle or fat wasting.

Choice B rationale

Increased urinary output is not a characteristic of nephrotic syndrome. The condition is associated with severe fluid retention and decreased plasma volume, leading to oliguria, or a decreased urinary output. The kidneys are not effectively filtering protein and fluid is being retained in the body, which directly reduces the amount of fluid that can be excreted as urine.

Choice C rationale

Generalized edema is the most common and striking characteristic of nephrotic syndrome. The massive loss of protein, particularly albumin, in the urine leads to a significant decrease in serum albumin levels. Albumin is crucial for maintaining plasma oncotic pressure. The resulting decrease in oncotic pressure causes fluid to shift from the bloodstream into the interstitial spaces, resulting in widespread or anasarca edema.

Choice D rationale

While hypertension can occur, it is not the most common characteristic associated with nephrotic syndrome. The primary physiological change is the massive proteinuria leading to hypoproteinemia and subsequent edema. Hypertension may develop as a result of volume overload, but it is not a hallmark sign. The most prominent and defining symptom is the severe edema.