A client has ingested a corrosive solution containing lye. Which intervention should the nurse implement first?

A client has ingested a corrosive solution containing lye. Which intervention should the nurse implement first?

• A. Monitor the client's neurological status
• B. Insert a nasogastric (NG) tube in the client's nares.
• C. Assess for the client's ability to breathe.
• D. Administer milk to dilute the corrosive solution.

Answer: (C)

The most important thing here is ensuring the client can breathe. Ingestion of a caustic substance like lye can rapidly irritate and swell the oropharyngeal and laryngeal tissues, leading to airway obstruction. The nurse should quickly assess respiratory status—watch for effort, rate, stridor, use of accessory muscles, and oxygen saturation—and be prepared to secure the airway if there are signs of compromise. Providing oxygen and having equipment ready for intubation if needed takes priority before any other interventions. Giving milk to dilute the caustic solution isn’t recommended because it can provoke vomiting and increase the risk of aspiration, and it does not prevent tissue injury. Inserting an NG tube early is risky due to potential esophageal or gastric perforation and can worsen injury; it’s not performed before airway stabilization. Monitoring neurological status is important, but it does not address the immediate threat to life posed by possible airway compromise.

The most important thing here is ensuring the client can breathe. Ingestion of a caustic substance like lye can rapidly irritate and swell the oropharyngeal and laryngeal tissues, leading to airway obstruction. The nurse should quickly assess respiratory status—watch for effort, rate, stridor, use of accessory muscles, and oxygen saturation—and be prepared to secure the airway if there are signs of compromise. Providing oxygen and having equipment ready for intubation if needed takes priority before any other interventions.

Giving milk to dilute the caustic solution isn’t recommended because it can provoke vomiting and increase the risk of aspiration, and it does not prevent tissue injury. Inserting an NG tube early is risky due to potential esophageal or gastric perforation and can worsen injury; it’s not performed before airway stabilization. Monitoring neurological status is important, but it does not address the immediate threat to life posed by possible airway compromise.