A 3-year-old boy is brought to the emergency room because of a possible diazepam (Valium) overdose. He is lethargic and confused. Which nursing intervention has the highest priority?

• A. Insert an orogastric tube for gastric lavage.
• B. Prepare a set-up for an endotracheal intubation.
• C. Draw blood for stat chemistries and blood gases.
• D. Insert a Foley catheter to monitor renal functioning.

Answer: (B)

Airway protection is the highest priority when a child with suspected benzodiazepine overdose is lethargic and confused, because CNS depression can rapidly compromise breathing and the airway. If the child’s ability to maintain a patent airway or adequate ventilation is uncertain, preparing for endotracheal intubation ensures oxygen delivery and protects against aspiration while the overdose is treated.

Gastric decontamination, such as gastric lavage, is not the immediate need here; it offers limited benefit in benzodiazepine overdoses and carries risks, especially in a patient who may aspirate or have an unprotected airway. Drawing blood and arterial/venous blood gases are important for monitoring and guiding care, but they do not address the urgent risk to breathing. Inserting a Foley catheter to monitor renal function is not an urgent life-saving step in this acute scenario.