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Body temperature 35° C (95° F): Hypothermia is not expected. Instead, aspirin toxicity more often causes hyperthermia due to increased metabolic activity and heat production.

Lung crackles: Crackles are not a typical finding of aspirin poisoning. While pulmonary edema may occur in very severe toxicity, the more direct and classic presentation is related to acid-base imbalance and respiratory drive changes.

Cool, dry skin: Clients with salicylate toxicity are more likely to present with sweating, dehydration, and flushed skin rather than cool, dry skin.

Digoxin (Lanoxin): Digoxin is a cardiac glycoside used for heart failure and atrial fibrillation. It does not directly interact with aspirin in a way that increases toxicity or bleeding risk.

Metformin (Glucophage): Metformin is an oral hypoglycemic agent. While aspirin at very high doses can potentially alter glucose metabolism, there is no significant contraindication for concurrent use at normal therapeutic levels.

Nitroglycerin (Nitro-Dur): Nitroglycerin is a vasodilator used in angina. It does not interact significantly with aspirin in a way that would contraindicate their use together. In fact, aspirin is often prescribed alongside nitrates in patients with coronary artery disease.

Fever: Both ibuprofen and celecoxib reduce fever due to COX-2 inhibition. This is not unique to ibuprofen.

Constipation: Constipation is not a common NSAID side effect; it is more commonly associated with opioids.

Metallic taste when eating: This is not a typical adverse effect of either ibuprofen or celecoxib.

Pegfilgrastim (Neulasta): This drug stimulates white blood cell production and is used to prevent infection in clients receiving chemotherapy. It has no role in the treatment of acetaminophen overdose.

Misoprostol (Cytotec): Misoprostol is used to prevent gastric ulcers from NSAID therapy or to induce labor. It does not protect the liver or reverse acetaminophen toxicity.

Naltrexone (ReVia): Naltrexone is an opioid antagonist used for opioid or alcohol dependence. It is not effective against acetaminophen overdose because it does not interact with hepatic metabolism.

Administer the drug as ordered: Unsafe, because giving acetaminophen without verifying may exacerbate hepatotoxicity in a client already at risk from hepatitis.

Administer 1 tablet only: Reducing the dose without provider input is outside the nurse’s scope. The underlying concern isn’t just the dose but the appropriateness of acetaminophen at all in this client.

Hold the drug until the health care provider arrives: Holding the drug without communicating directly may delay pain management unnecessarily. The best step is to clarify the order promptly.