Vol 3 Ch 8 Toxicology and Substance Abuse

Naproxen, ibuprofen, and ketorolac are all examples of: A) MAOIs. B) SSRIs. C) NSAIDs. D) TCAs.

C) NSAIDs. Page Ref: 349-350

Your patient is a two-year-old male who is alert and crying after ingesting bathroom cleaner. Physical examination reveals no obvious burns or irritation to his oropharynx, and his skin is cool and dry. HR = 112, BP = 108/60, RR = 24, SaO2 = 99%. Which of the following is most appropriate? A) Having the patient drink a glass of milk B) Administration of ipecac C) Transport D) Administration of activated charcoal

C) Transport Page Ref: 330, 332, 344-345

The continued use of the drug despite the fact that it may be harmful and serves no medical purpose is: A) substance abuse. B) withdrawal. C) addiction. D) habituation.

C) addiction. Page Ref: 359

You are presented with a 25-year-old male complaining of mouth and stomach pain after accidentally ingesting approximately 8 ounces of benzene. Physical examination reveals irritation to the oral mucosa, skin warm and slightly diaphoretic, and lungs clear and equal bilaterally. HR = 100, BP = 118/66, RR = 14, SaO2 = 99%. Based on the clinical exam findings, treatment would consist of all of the following EXCEPT: A) O2 via nasal cannula 2 lpm. B) rapid transportation to an ED for gastric decontamination. C) administration of activated charcoal. D) IV of NS KVO.

C) administration of activated charcoal. Page Ref: 345

Which of the following is a narcotic? A) Mescaline B) Crack C) Cocaine D) Heroin

D) Heroin Page Ref: 361

The half-life of carboxyhemoglobin is reduced to approximately 22 minutes by using: A) 100% oxygen. B) 44% oxygen. C) hypobaric oxygen therapy. D) hyperbaric oxygen therapy.

D) hyperbaric oxygen therapy. Page Ref: 335

"Rock" and "crack" are street names for: A) cocaine. B) marijuana. C) heroin. D) morphine.

A) cocaine. Page Ref: 361

A 54-year-old female is conscious and alert and in significant pain after a coral snake bite to her hand. You note two small puncture wounds surrounded by a swollen, red area. She states that she is nauseous and has chills. Your management of this patient should include immobilization of the affected arm and: A) placing it at the level of the heart. B) placing it below the level of the heart with a constricting band proximal to the wound. C) elevating it above the level of the heart. D) placing it at the level of the heart with ice packs to the affected area.Answer:

A) placing it at the level of the heart. Page Ref: 358

The order Hymenoptera includes: A) wasps. B) jellyfish. C) spiders. D) scorpions.

A) wasps. Page Ref: 328, 353

Which of the following cause(s) injury by inducing liquefaction necrosis? A) Caustics B) Alkalis C) Emulsifiers D) Acids

B) Alkalis Page Ref: 344

Mushrooms from the class ________ are responsible for over 90 percent of deaths from mushroom toxicity. A) Button B) Amanita C) Shiitake D) Galerina

B) Amanita Page Ref: 352

Which of the following is a highly toxic, odorless, tasteless gas that is a by-product of incomplete combustion? A) Carbon dioxide B) Carbon monoxide C) Cyanide D) Methane

B) Carbon monoxide Page Ref: 333

Which of the following medication combinations is beneficial for a lithium overdose? A) Narcan and sodium bicarbonate B) Mannitol and sodium bicarbonate C) Flumazenil and naloxone D) Haloperidol and furosemide

B) Mannitol and sodium bicarbonate Page Ref: 348

LSD and PCP are examples of: A) amphetamines B) hallucinogens. C) sedatives. D) narcotics.

B) hallucinogens. Page Ref: 362

The pathophysiology of toxic inhalation involves: A) bronchodilation and destruction of cilia. B) irritation, edema, and destruction of alveolar tissue. C) pulmonary hypertension, alveolar atelectasis, and destruction of cilia. D) bronchoconstriction and dispersal of surfactant.

B) irritation, edema, and destruction of alveolar tissue. Page Ref: 328

Two 15-year-old boys have been hiking and camping and using a guide to native plants to determine which plants are edible. They drank a tea made from some plants that they picked. They are now complaining of abdominal cramping, watering eyes, vomiting, diarrhea, and sweating. Which of the following have they most likely ingested? A) Amanita B) Jimson weed C) Holly berries D) Poison sumac

A) Amanita Page Ref: 352

Which of the following classes of drugs is commonly abused to produce hyperactivity and exhilaration? A) Amphetamines B) Barbiturates C) Alcohol D) Benzodiazepines

A) Amphetamines Page Ref: 361

Your patient is a 16-year-old female who has taken an overdose of phenobarbital. She is unresponsive. Her skin is cool and pale, BP = 92/60, HR = 60, RR = 6. You have intubated the patient and started an IV. Which of the following is appropriate? A) Contact poison control—may order bicarbonate. B) Sodium bicarbonate 100 mEq C) Naloxone 2 mg, 25 gm dextrose, transport D) 50 gm activated charcoal through an NG tube en route to the hospital

A) Contact poison control—may order bicarbonate. Page Ref: 361

A 32-year-old is conscious and in mild distress, complaining of nausea and sweating. He states that his symptoms started two days ago when he stopped drinking "cold turkey." Physical examination reveals cool, diaphoretic skin; slightly dilated pupils bilaterally; and a general weakness to all extremities. Which of the following findings would also be likely? A) Delirium tremens, hallucinations, and anxiety B) Insomnia, hyperglycemia, and difficulty breathing C) Hypertension, bradycardia, and hyperglycemia D) Depression, hypotension, and polyuria

A) Delirium tremens, hallucinations, and anxiety Page Ref: 363-364

Your patient is an 18-year-old female college student who is supine in bed and responsive only to painful stimuli. Her roommate states that they went to a party last night. She says the patient only drank soda, but now she thinks a guy who had been following them around might have put something in the patient's drink. Physical examination reveals cool, dry skin and pupils sluggish to light bilaterally. HR = 72, BP = 112/64, RR = 10, SaO2 = 98%. Which of the following drugs was most likely slipped into her drink? A) Flunitrazepam B) LSD C) Amphetamines D) Opium

A) Flunitrazepam Page Ref: 360

Your patient is a 20-year-old female who is conscious and alert, though obviously hallucinating after ingesting LSD. Her friends state that she is having a "bad trip," and you note that she is vigorously scratching her arms to the point of drawing blood. Physical examination reveals warm, slightly diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient? A) Haloperidol B) Thiamine C) Narcan D) Avapro

A) Haloperidol Page Ref: 360

Your patient is a 56-year-old female who is sitting on a park bench. She is conscious, though lethargic, and complaining of faintness. She states she has had a "chest cold" for the past week so had decided to stop taking her "blood pressure pills" until she felt better. She states that this morning she ingested five tablets instead of her normal one tablet dose to "catch up" after the days off. You note cool, slightly diaphoretic skin; lungs clear bilaterally; PEARL; and no motor deficits. HR = 48, BP = 76/30, RR = 12, SaO2 = 97%. Which of the following is least likely to be the medication she overdosed on? A) Metoprolol B) Procardia C) Cardizem D) Verapamil

A) Metoprolol Page Ref: 343, 344

Your patient is a 45-year-old female who became hypertensive after eating some cheese and drinking wine. Which type of medication would most likely account for this reaction? A) Phenothiazines B) Tricyclic antidepressants C) Selective serotonin reuptake inhibitors D) Monoamine oxidase inhibitors

A) Phenothiazines Page Ref: 346-347

A 38-year-old male is conscious and alert after a black widow spider bite to his right hand. You note pain and swelling to the hand, and the patient states that he is dizzy and nauseous. HR = 117, BP = 128/78, RR = 20. During your physical examination, you note that he begins to experience severe, painful muscle spasms in his right arm. Which of the following is NOT appropriate? A) Sodium bicarbonate B) Calcium gluconate C) Diazepam D) Midazolam

A) Sodium bicarbonate Page Ref: 355

A patient is experiencing severe abdominal cramping, vomiting, diarrhea, and facial flushing after eating undercooked chicken. Management of this patient should include all of the following EXCEPT: A) activated charcoal. B) IV of normal saline. C) oxygen. D) transport.

A) activated charcoal. Page Ref: 351-352

Restoril and Ativan are examples of: A) benzodiazepines. B) barbiturates. C) opiates. D) narcotics.

A) benzodiazepines. Page Ref: 362

Lithium is used to treat: A) bipolar disorder. B) schizophrenia. C) depression. D) personality disorders.

A) bipolar disorder. Page Ref: 348

Inhaled toxins: A) cause damage and edema in the lungs. B) are immediately absorbed into the bloodstream. C) are eliminated by first-round metabolism. D) permeate the blood-brain barrier more quickly.

A) cause damage and edema in the lungs. Page Ref: 328

All of the following are roles of a poison control center EXCEPT: A) identifying the toxin or poison. B) determining the potential toxicity of the agent. C) providing information on the most current definitive treatment. D) notifying the receiving hospital and recommending treatment.

A) identifying the toxin or poison. Page Ref: 327

Narcan acts as an antagonist to all of the following medications EXCEPT: A) midazolam. B) methadone. C) codeine. D) heroin.

A) midazolam. Page Ref: 361

An antidote: A) neutralizes a specific toxin. B) enhances the toxin. C) is not indicated in the field. D) is universally oxygen.

A) neutralizes a specific toxin. Page Ref: 330

Some of the most immediate effects from ingesting a poison include: A) oral burns. B) localized skin reaction. C) absorption by the lower intestine. D) clotting disorders.

A) oral burns. Page Ref: 328

Your patient is a 27-year-old male who has possibly overdosed on heroin. He is unresponsive and bradypneic. Which of the following is appropriate? A) 25 mg diphenhydramine B) 2 mg of naloxone C) 1 mg of flumazenil D) 100 mg of thiamine

B) 2 mg of naloxone Page Ref: 361

Which of the following correctly pairs a toxin with its antidote? A) Benzodiazepine: naloxone B) Acetaminophen: N-acetylcysteine C) Carbon monoxide: amyl nitrite D) Aspirin: magnesium citrate

B) Acetaminophen: N-acetylcysteine Page Ref: 330

A 19-year-old male has ingested fifty 325 mg aspirin tablets 20 minutes before your arrival. He is alert and complaining of burning abdominal pain. Which of the following is appropriate in the prehospital management of this patient? A) Syrup of ipecac B) Activated charcoal C) Sodium bicarbonate D) N-acetylcysteine

B) Activated charcoal Page Ref: 330, 349

Your patient is a 24-year-old, 176-pound male who is alert and oriented 12 hours after ingesting thirty 500 mg tablets of Tylenol. Which of the following are the most likely complaints or findings? A) Confusion, lethargy, and hyperthermia B) Nausea, vomiting, weakness, and fatigue C) Abdominal pain and oliguria D) Signs and symptoms of liver failure

B) Nausea, vomiting, weakness, and fatigue Page Ref: 349

Which of the following does NOT typically enter the body through injection? A) Medication overdose B) Organophosphate C) Envenomation D) Illicit drug overdose

B) Organophosphate Page Ref: 328

Your patient is a 56-year-old female who is alert and sitting in a chair. She states that she accidentally took too many of her Cardizem tablets. Which of the following signs or symptoms would you least expect to find? A) Cool, dry skin and mild hypotension B) Warm, dry skin and tachycardia C) Cool, diaphoretic skin and profound hypotension D) Bradycardia and altered mental statusAnswer: BDiff: 3 Page Ref: 343

B) Warm, dry skin and tachycardia Page Ref: 343

Inhalation of a poison causes: A) absorption by the trachea. B) absorption through the alveolar-capillary membrane. C) increase in secretions. D) aspiration.

B) absorption through the alveolar-capillary membrane. Page Ref: 328

All of the following are examples of one of the three "principles of decontamination" that are specific to toxicological emergencies EXCEPT: A) administration of N-acetylcysteine. B) administration of an NS fluid challenge. C) administration of sorbitol. D) removing a patient from a structure that is filled with carbon monoxide.

B) administration of an NS fluid challenge. C) administration of sorbitol. Page Ref: 329-330

You respond to an ill patient experiencing flu-like symptoms. Upon your arrival, the patient states that she woke up not feeling well. The patient states that she has been heating her home with wood due to the electric bill being too high. You should suspect: A) carbon dioxide poisoning. B) carbon monoxide poisoning. C) hypercarbia. D) hypothermia.

B) carbon monoxide poisoning. Page Ref: 337

You respond to an ill male patient. Upon arrival, you note a farmer who is complaining of not feeling well. The patient presents in a tripod position with copious secretions, lacrimation, vomiting, and evidence of urination and defecation. You suspect: A) anticholinergic exposure. B) cholinergic exposure. C) sympathomimetic exposure. D) extrapyramidal syndrome.

B) cholinergic exposure. Page Ref: 334

Your patient was in the building when a fire started at a factory that manufactures plastics. He is complaining of a headache, palpitations, and a burning sensation in his throat. His airway, breathing, and circulation are intact. Heart rate = 128, respirations = 22, blood pressure = 148/84, SaO2 = 93%. You should immediately: A) administer amyl and sodium nitrate. B) initiate supportive measures. C) apply the cardiac monitor. D) prepare to intubate.

B) initiate supportive measures. Page Ref: 342-343

A 32-year-old female is conscious and alert at a group home for recovering alcoholics and states, "I'm having rum fits." Counselors from the home tell you that she is a chronic alcoholic who entered their program three days ago and has not had a drink since. Physical examination reveals cool, diaphoretic skin; dilated pupils bilaterally that are responsive to light; and obvious anxiety. HR = 122, BP = 156/104, RR = 20, SaO2 = 99%, blood glucose = 62 mg/dL. Based on the clinical exam findings, all of the following should be part of your patient management EXCEPT: A) 25 g of D50W IV. B) metoprolol IV. C) IV of normal saline. D) thiamine 100 mg IM.

B) metoprolol IV. Page Ref: 363-364

Your first priority in the treatment of an inhaled toxin is to: A) decontaminate the patient. B) remove the patient from the source. C) flood with oxygen. D) deluge with water.

B) remove the patient from the source. Page Ref: 332

The need to progressively increase the dose of a drug to reproduce the effect originally achieved at smaller doses is: A) addiction. B) tolerance. C) substance abuse. D) habituation.

B) tolerance. Page Ref: 359

Your patient is a 48-year-old female who is unconscious with snoring respirations after ingesting an unknown substance. You note cold, peripherally cyanotic skin and a weak, rapid pulse. Her pupils are equal and reactive but constricted. She has no unusual odors, and her blood glucose level is 80 mg/dl. HR = 74, BP = 100/68, RR = 4, SaO2 = 91%. Which of the following is appropriate? A) Intubate, ventilate using supplemental oxygen, IV, 1 mEq/kg sodium bicarbonate B) Intubate, ventilate using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 gm dextrose C) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone D) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 gm dextrose

C) Assist ventilations using supplemental oxygen, IV, 2 mg naloxone Page Ref: 332

You have been called to a residence by the parents of a 14-year-old boy, whom they found sniffing paint fumes in an effort to get high. The patient is agitated, coughing, and complaining of dizziness and shortness of breath. His airway is patent, respirations adequate, and radial pulse easily palpable. Closer assessment of the patient reveals paint around his mouth and breath sounds that are clear and equal. Heart rate = 96, respirations = 20, blood pressure = 116/78, and SaO2 = 96%. Oxygen via a nonrebreather has been applied and an IV established. Which of the following is the most important in the assessment and care of this patient? A) Benzodiazepines B) Antipyretics C) Cardiac monitoring D) Albuterol administration

C) Cardiac monitoring Page Ref: 332

Your patient has ingested cyanide in a suicide attempt. Which of the following is the primary threat to life you should anticipate? A) Hypotension B) Pulmonary edema C) Cellular asphyxia D) Liver failure

C) Cellular asphyxia Page Ref: 341-342

Which of the following is commonly indicated in the management of cocaine overdose? A) Thiamine B) Flumazenil C) Diazepam D) Narcan

C) Diazepam Page Ref: 360

Which of the following is NOT associated with chronic alcohol ingestion? A) Decreased sensation in hands and feet B) Thiamine deficiency C) Hyperactivity D) Esophageal varices

C) Hyperactivity Page Ref: 332, 363

Which of the following best describes the mechanism of action of activated charcoal? A) It absorbs toxins in the stomach. B) It neutralizes both acidic and alkaline substances in the stomach. C) It adsorbs toxins in the stomach. D) It prevents substances from ionizing in the small intestine.

C) It adsorbs toxins in the stomach. Page Ref: 330

The primary goal in the prehospital care of a patient who has been bitten by a pit viper is to: A) induce diuresis. B) slow absorption of the venom. C) alkalinize the urine. D) remove the venom from the surrounding tissue.

C) alkalinize the urine. Page Ref: 357

Alcohol is classified as a(n): A) stimulant. B) anxiolytic. C) depressant. D) hallucinogen.

C) depressant. Page Ref: 362-363

A couple has been experimenting with Ecstasy. They are both complaining of anxiety, nausea, and palpitations. You would also expect: A) dyspnea. B) seizures. C) elevated blood pressure. D) bradycardia.

C) elevated blood pressure. Page Ref: 360

In addition to determining potential toxicity based on the type of agent, poison control centers are able to: A) refer the patient to a specialist. B) determine whether transport is needed. C) guide the paramedic in starting definitive treatment in the field. D) give the paramedic documentation advice.

C) guide the paramedic in starting definitive treatment in the field. Page Ref: 327

Fifty percent of accidental poisonings occur in: A) adults. B) geriatric patients. C) pediatric patients. D) dementia patients.

C) pediatric patients. Page Ref: 327

A patient has accidentally ingested about 4 ounces of drain cleaner. Your primary concern should be: A) metabolic alkalosis. B) internal bleeding. C) potential airway compromise. D) decreased level of consciousness.

C) potential airway compromise. Page Ref: 344-345

Prozac, Paxil, and Zoloft are all examples of: A) phenothiazines. B) monoamine oxidase inhibitors. C) selective serotonin reuptake inhibitors. D) tricyclic antidepressants.

C) selective serotonin reuptake inhibitors. Page Ref: 347

Your patient is a 40-year-old male who ingested 30 tablets of Lexapro and 24 tablets of Tylenol PM. Which of the following is the most important question you should ask? A) "Why did you take these medications?" B) "Have you ever done this before?" C) "Do you have a history of depression?" D) "How long ago did you take these medications?"

D) "How long ago did you take these medications?" Page Ref: 331

Which of the following statements would make you suspicious that your patient has been exposed to cyanide? A) "I think I smoked some bad weed." B) "I inhaled some fumes when I was fueling my truck." C) "I think my car has an exhaust leak." D) "I have been burning carpets and old furniture all day."

D) "I have been burning carpets and old furniture all day." Page Ref: 341-342

Which of the following accounts for more than 90 percent of hospital admissions for toxic substance exposure? A) Pediatric overdoses B) Intentional poisoning by another person C) Pediatric accidental poisonings D) Adult poisonings and overdoses

D) Adult poisonings and overdoses Page Ref: 327

Which of the following is the therapeutic effect of a cathartic? A) Vomiting B) Increased protein binding of drugs C) Alkalinization of the urine D) Diarrhea

D) Diarrhea Page Ref: 330

Your patient is a 29-year-old male who is conscious, alert, and extremely hyperactive after using cocaine. HR = 134, BP = 148/102, RR = 20. Physical examination reveals warm, diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient? A) Metoprolol B) Naloxone C) Propranolol D) Diazepam

D) Diazepam Page Ref: 360

You are presented with a 42-year-old male who is unconscious with snoring respirations after a heroin overdose. HR = 64, BP = 98/50, RR = 6 and shallow, SaO2 = 91%. Which of the following is the most appropriate initial treatment? A) Intubate, ventilate with supplemental oxygen B) IV access, administer a 250 cc fluid bolus C) BLS airway management and ventilation with supplemental oxygen D) IV access, administer naloxone

D) IV access, administer naloxone Page Ref: 361

Which of the following is NOT a possible source of cyanide poisoning? A) Fume inhalation from burning plastic, synthetic carpeting, or silk B) Ingestion of apricot, pear, and cherry pits C) Long-term sodium nitroprusside therapy D) Improperly vented heating systems

D) Improperly vented heating systems Page Ref: 341, 342

Your patient is a 24-year-old male complaining of a headache for the past two days. He states he has taken aspirin but cannot get rid of the headache. The patient lives in a basement apartment, which you observe is very chilly. The patient states his furnace hasn't been working and he had to use the oven to help heat the apartment. Which other findings and complaints are most likely? A) Nausea, vomiting, decreased hemoglobin saturation B) Rash, nausea, a metallic taste in the mouth C) Pale skin, sluggish pupils, tachycardia D) Nausea, vomiting, confusion, tachypnea

D) Nausea, vomiting, confusion, tachypnea Page Ref: 337

Which of the following statements concerning Africanized honeybees is accurate? A) Envenomation by Africanized honeybees requires treatment with specific antivenin. B) The venom of Africanized honeybees causes acute renal failure. C) The venom of Africanized honeybees is more toxic than that of other types of bees. D) Patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.

D) Patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees. Page Ref: 353-354

Your patient is an alcoholic who stopped drinking three days ago. Which of the following should concern you the most in the care of this patient? A) Abdominal cramps B) Command hallucinations C) Hypothermia D) Potential for seizures

D) Potential for seizures Page Ref: 363-364

Your patient is a 22-year-old female who has increased her daily dose of lithium without her physician's knowledge. She is complaining of generalized weakness, vomiting, and diarrhea. You notice that her speech is slurred. Heart rate = 68 and irregular, respirations = 16, blood pressure = 104/70, SaO2 = 97% on room air, and the monitor shows a sinus rhythm with PACs and PJCs. Which of the following would be most beneficial to this patient? A) Oxygen B) Magnesium sulfate C) Calcium chloride D) Sodium bicarbonate

D) Sodium bicarbonate Page Ref: 348

Your patient is a 19-year-old male who ingested thirty 500 mg tablets of Tylenol 25 minutes ago. Police officers on the scene are requesting that you "check him out" before they transport him for psychiatric evaluation. The patient denies ingesting other drugs or alcohol and has no complaints. HR = 94, BP = 116/74, RR = 12, SaO2 = 98%. Which of the following would be most appropriate? A) Release the patient to law enforcement custody B) Transport to the emergency department and administer activated charcoal C) Transport to the emergency department and administer sodium bicarbonate D) Transport to the emergency department and start an IV of normal saline

D) Transport to the emergency department and start an IV of normal saline Page Ref: 349

When a substance enters the body through the gastrointestinal tract, it has accessed the body by: A) inhalation. B) surface absorption. C) injection. D) ingestion.

D) ingestion. Page Ref: 328

The three steps of decontamination are: A) reduce absorption, reduce metabolism, increase absorption by the kidney. B) water, elimination in urine, atropine. C) elimination in urine, water, oxygen. D) reduce intake of the toxin, reduce absorption, enhance elimination.

D) reduce intake of the toxin, reduce absorption, enhance elimination. Page Ref: 329-330

Using a pharmaceutical agent for something other than its intended use is called: A) overdose. B) addiction. C) habituation. D) substance abuse.

D) substance abuse. Page Ref: 359

Your patient is a 60-year-old male complaining of chills, fever, joint pain, and vomiting. He states he was bitten by a spider yesterday morning, and now he thinks the bite might be infected. The patient has an ulcerated wound on his left leg. The best treatment for this patient would include: A) diazepam 2.5 mg. B) magnesium sulfate, 2 g. C) calcium gluconate 0.1 mg/kg. D) supportive management.

D) supportive management. Page Ref: 354-355