CEN TOX CEN 2 QUESTIONS
An overdose of which drug can cause hyperreflexia, opisthotonus, and increased muscle tone?
Carisoprodol (Soma) Carisoprodol (Soma) is a widely prescribed skeletal muscle relaxant (sedative-hypnotic) and is a drug of abuse when used alone or with methamphetamine. Along with central nervous system depression, a patient with toxicity may present with hyperreflexia, opisthotonus, and increased muscle tone.
Rhabdomyolysis is a complication of which type of toxicity? A. Central nervous system stimulant B. Opiate C. Tricyclic antidepressant D. Calcium channel blocker
Central nervous system stimulants act by simulating or mimicking the sympathetic branch of the autonomic nervous system. Severe intoxication causes rhabdomyolysis, paranoia, shock, hyperthermia, acute tubular necrosis, acidosis, hyperkalemia, seizures, coma, and myocardial infarction. Opiate, tricyclic antidepressant, and calcium channel blocker toxicities do not lead to rhabdomyolysis.
Which intervention is indicated for the initial management of tricyclic antidepressant toxicity? A. Dopamine (Intropin) infusion B. Gastric lavage C. Administration of activated charcoal with sorbitol D. Hemodialysis
Activated charcoal effectively binds with tricyclic antidepressants and reduces their half-life. Because of delayed gastric emptying, the use of sorbitol is recommended to increase gastric emptying. Gastric lavage is not routinely recommended for patients with tricyclic antidepressant toxicity because of the potential for seizures. Instead of dopamine (Intropin), expect to use norepinephrine (Levophed) or phenylephrine (Neo-Synephrine) as vasopressors. Hemodialysis is usually reserved for poisoning with severe acidosis and potentially lethal toxicitiy (such as chronic salicylate poisoning) because it requires vascular access and specialized equipment and personnel.
A patient is admitted after taking an overdose of alprazolam (Xanax). Which antidote should you expect to administer to this patient? A. Flumazenil (Romazicon) B. Naloxone (Narcan) C. Calcium gluconate D. Cyproheptadine (Periactin)
Alprazolam (Xanax) is a benzodiazepine, and flumazenil (Romazicon) is the antidote for a benzodiazepine overdose. Naloxone (Narcan) is the antidote for opiate toxicity. Calcium gluconate is one of several antidotes for calcium channel blocker toxicity. Cyproheptadine (Periactin), a serotonin antagonist, is used to block serotonin syndrome in toxicity due to an overdose of a selective serotonin reuptake inhibitor.
Which antidysrhythmic is most appropriate for treating ventricular dysrhythmias caused by tricyclic antidepressant toxicity? A. Amiodarone (Cordarone) B. Procainamide (Pronestyl) C. Quinidine (Quinidex) D. Digoxin (Lanoxin)
Amiodarone (Cordarone) is the most appropriate antidysrhythmic for treating ventricular dysrhythmias caused by tricyclic antidepressant toxicity. Procainamide (Pronestyl) and quinidine (Quinidex) are contraindicated in tricyclic antidepressant toxicity because of the potential for QRS widening. Digoxin (Lanoxin) is not an antidysrhythmic. It controls the heart rate by blocking the sodium-potassium pump.
Which drug can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality?
Amphetamine (Adderall) Amphetamine is a central nervous system stimulant that can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality. An antihypertensive drug, clonidine (Catapres) is an alpha2 agonist that causes central nervous system depression. Methaqualone (Quaalude) leads to central nervous system depression and may cause hypertonicity, hyperreflexia, or clonus. With a toxic ingestion, the tricyclic antidepressant amitriptyline (Elavil) produces central nervous system depression.
Which drug can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality? A. Clonidine (Catapres) B. Methaqualone (Quaalude) C. Amphetamine (Adderall) D. Amitriptyline (Elavil)
Amphetamine is a central nervous system stimulant that can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality. An antihypertensive drug, clonidine (Catapres) is an alpha2 agonist that causes central nervous system depression. Methaqualone (Quaalude) leads to central nervous system depression and may cause hypertonicity, hyperreflexia, or clonus. With a toxic ingestion, the tricyclic antidepressant amitriptyline (Elavil) produces central nervous system depression.
Which drug can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality? A. Clonidine (Catapres) B. Methaqualone (Quaalude) C. Amphetamine (Adderall) D. Amitriptyline (Elavil)
Amphetamine is a central nervous system stimulant that can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality. An antihypertensive drug, clonidine (Catapres) is an alpha2 agonist that causes central nervous system depression. Methaqualone (Quaalude) leads to central nervous system depression and may cause hypertonicity, hyperreflexia, or clonus. With a toxic ingestion, the tricyclic antidepressant amitriptyline (Elavil) produces central nervous system depression.
An overdose of which nonsteroidal anti-inflammatory drug can cause seizures? A. Ketorolac (Toradol) B. Celecoxib (Celebrex) C. Indomethacin (Indocin) D. Piroxicam (Feldene)
An overdose of piroxicam (Feldene) or mefenamic acid (Ponstel) or the ingestion of a large amount of naproxen (Aleve) or ketoprofen (Orudis) can cause seizures. Ketorolac (Toradol) can cause renal failure. Celecoxib (Celebrex) and indomethacin (Indocin) toxicity can cause gastrointestinal effects and drowsiness.
An overdose of which nonsteroidal anti-inflammatory drug can cause seizures? A. Ketorolac (Toradol) B. Celecoxib (Celebrex) C. Indomethacin (Indocin) D. Piroxicam (Feldene)
An overdose of piroxicam (Feldene) or mefenamic acid (Ponstel) or the ingestion of a large amount of naproxen (Aleve) or ketoprofen (Orudis) can cause seizures. Ketorolac (Toradol) can cause renal failure. Celecoxib (Celebrex) and indomethacin (Indocin) toxicity can cause gastrointestinal effects and drowsiness.
A patient admitted with an amphetamine overdose may require which key intervention? A. Systemic alkalinization B. Abdominal radiography C. Administration of a proton pump inhibitor D. Application of a cooling blanket
cooling blanket application Amphetamines are a central nervous system stimulant, so a patient with an amphetamine overdose can experience significant hyperthermia (with a core temperature above 104°F [40°C]) from intense muscle activity and an increased metabolic rate. Aggressive cooling measures, such as a cooling blanket application, are required to treat hyperthermia. Systemic alkalinization with sodium bicarbonate is indicated for patients with QRS widening, ventricular arrhythmias, hypotension, or all three caused by tricyclic antidepressant toxicity. In severe salicylate overdoses, abdominal radiography may be needed to identify concretions or bezoars that may form in the intestines due to the salicylates being slowly released and absorbed over a prolonged time. A proton pump inhibitor may be used to treat the signs and symptoms of gastrointestinal irritation in nonsteroidal anti-inflammatory drug toxicity.
For a patient whose skin was exposed to hydrofluoric acid, the nurse should expect to apply which substance?
A. Calcium gluconate (Calgonate) gel Unlike other caustics, hydrofluoric acid can penetrate the skin, affecting bone and tissue and possibly causing hypocalcemia. Its treatment requires a specific antidote, calcium, in the form of calcium gluconate (Calgonate) or chloride. Silver sulfadiazine (Silvadene) cream, neomycin and polymyxin (Polysporin) ointment, and baking soda paste are ineffective in treating hydrofluoric acid exposure.
The toxic ingestion of which drug can prolong the partial thromboplastin time?
Acetaminophen (Tylenol) The partial thromboplastin time may be prolonged 24 to 48 hours after acetaminophen (Tylenol) ingestion. The toxic ingestion of aspirin (Bayer) may produce a prolonged prothrombin time. Ibuprofen (Advil) and celecoxib (Celebrex) are nonsteroidal anti-inflammatory drugs that could produce a prolonged bleeding time.
You should plan to monitor liver function for a patient with which type of toxicity? A. Ketorolac (Toradol) B. Aspirin (Bayer) C. Indomethacin (Indocin) D. Acetaminophen with hydrocodone (Vicodin)
Acetaminophen (Tylenol) toxicity requires the monitoring of liver function because the patient can develop liver failure. Aspirin (Bayer), indomethacin (Indocin), and ketorolac (Toradol) toxicities require the evaluation of renal function.
You should plan to monitor liver function for a patient with which type of toxicity? A. Ketorolac (Toradol) B. Aspirin (Bayer) C. Indomethacin (Indocin) D. Acetaminophen with hydrocodone (Vicodin)
Acetaminophen (Tylenol) toxicity requires the monitoring of liver function because the patient can develop liver failure. A spirin (Bayer), indomethacin (Indocin), and ketorolac (Toradol) toxicities require the evaluation of renal function.
Acetaminophen (Tylenol) toxicity may occur with lower acetaminophen doses in patients with which disorder? A. Cardiomyopathy B. Asthma C. Alcohol abuse D. Disseminated intravascular coagulation
Acetaminophen toxicity may occur with lower acetaminophen doses in patients with alcohol abuse, malnutrition, or preexisting hepatic dysfunction and in those who take isoniazid (INH), anticonvulsant medications (such as phenytoin [Dilantin] or carbamazepine [Tegretol]), or other cytochrome P450 oxidizers. Cardiomyopathy, asthma, and disseminated intravascular coagulation do not affect acetaminophen levels.
You should plan to monitor liver function for a patient with which type of toxicity?
Acetaminophen with hydrocodone (Vicodin) Acetaminophen (Tylenol) toxicity requires the monitoring of liver function because the patient can develop liver failure. Aspirin (Bayer), indomethacin (Indocin), and ketorolac (Toradol) toxicities require the evaluation of renal function.
Which intervention is indicated for the initial management of tricyclic antidepressant toxicity? A. Dopamine (Intropin) infusion B. Gastric lavage C. Administration of activated charcoal with sorbitol D. Hemodialysis
Activated charcoal effectively binds with tricyclic antidepressants and reduces their half-life. Because of delayed gastric emptying, the use of sorbitol is recommended to increase gastric emptying. Gastric lavage is not routinely recommended for patients with tricyclic antidepressant toxicity because of the potential for seizures. Instead of dopamine (Intropin), expect to use norepinephrine (Levophed) or phenylephrine (Neo-Synephrine) as vasopressors. Hemodialysis is usually reserved for poisoning with severe acidosis and potentially lethal toxicitiy (such as chronic salicylate poisoning) because it requires vascular access and specialized equipment and personnel.
Which intervention is indicated for the initial management of tricyclic antidepressant toxicity? A. Dopamine (Intropin) infusion B. Gastric lavage C. Administration of activated charcoal with sorbitol D. Hemodialysis
Activated charcoal effectively binds with tricyclic antidepressants and reduces their half-life. Because of delayed gastric emptying, the use of sorbitol is recommended to increase gastric emptying. Gastric lavage is not routinely recommended for patients with tricyclic antidepressant toxicity because of the potential for seizures. Instead of dopamine (Intropin), expect to use norepinephrine (Levophed) or phenylephrine (Neo-Synephrine) as vasopressors. Hemodialysis is usually reserved for poisoning with severe acidosis and potentially lethal toxicitiy (such as chronic salicylate poisoning) because it requires vascular access and specialized equipment and personnel.
For a patient with benzodiazepine toxicity, which intervention is appropriate for enhancing drug elimination? A. Gastric lavage B. Activated charcoal administration C. Hemodialysis D. Charcoal hemoperfusion
Administer activated charcoal promptly and safely to enhance benzodiazepine elimination.
Respiratory alkalosis occurs in which type of toxicity? A. Opiate B. Antidepressant C. Salicylate D. Central nervous system stimulant
At toxic levels, salicylates stimulate the respiratory center in the brainstem, causing hyperventilation and respiratory alkalosis. Opiate, antidepressant, and central nervous system stimulant toxicities do not cause hyperventilation or respiratory alkalosis.
After being sprayed by a crop duster, a patient presents to the emergency department with excessive tearing, salivation, nausea, vomiting, and bradycardia. The nurse should anticipate the administration of which medication?
Atropine This patient is exhibiting signs and symptoms of organophosphate poisoning. Atropine is the antidote for organophosphate poisoning. Epinephrine (Adrenalin), methylprednisolone (Solu-Medrol), and diphenhydramine (Benadryl) are not effective in treating this type of poisoning.
Family members bring a geriatric patient with confusion and delirium to the emergency department. They report that her symptoms have progressed over the past few days since she started using BENGAY for her arthritis. Which medication is a likely cause of these symptoms? A. Acetaminophen (Tylenol) B. Salicylate C. Iron D. Digoxin (Lanoxin)
BENGAY contains salicylate, and chronic salicylate poisoning can cause confusion and delirium in geriatric patients. Other possible causes include sepsis, pneumonia, and anticholinergic ingestion. Acetaminophen (Tylenol), iron, and digoxin (Lanoxin) toxicity are not likely to cause confusion and delirium.
The ingestion of the foxglove plant can cause which cardiac finding?
Bradycardia Digitalis glycosides exist in botanical form in foxglove, rhododendron, oleander, and lily of the valley. The signs and symptoms of toxicity include bradycardia, hypotension, drowsiness, and lethargy (not agitation).
In a patient with toxicity due to the beta-blocker sotalol (Betapace), which electrocardiogram findings should you expect to see?
Bradycardia and prolonged QT intervals Patients with beta-blocker toxicity from sotalol (Betapace) exhibit bradycardia and prolonged QT intervals on electrocardiogram tracings. Patients with calcium channel blocker toxicity exhibit bradycardia and atrioventricular block. Tall, peaked T waves and third-degree atrioventricular block occur in patients with severe digoxin (Lanoxin) toxicity.
An overdose of which drug can cause hyperreflexia, opisthotonus, and increased muscle tone? A. Carisoprodol (Soma) B. Baclofen (Lioresal) C. Hydroxyzine (Vistaril) D. Buspirone (BuSpar)
Carisoprodol (Soma) is a widely prescribed skeletal muscle relaxant (sedative-hypnotic) and is a drug of abuse when used alone or with methamphetamine. Along with central nervous system depression, a patient with toxicity may present with hyperreflexia, opisthotonus, and increased muscle tone. Baclofen (Lioresal) is a skeletal muscle relaxant for which toxicity can cause hypotension and bradycardia. In therapeutic doses, hydroxyzine (Vistaril) causes central nervous system depression; in an overdose, it causes anticholinergic effects, such as hallucinations, agitation, decreased gastric motility, seizures, and dysrhythmias. A patient with a buspirone (BuSpar) overdose may present with central nervous system depression, nausea, vomiting and miosis.
Rhabdomyolysis is a complication of which type of toxicity?
Central nervous system stimulant Central nervous system stimulants act by simulating or mimicking the sympathetic branch of the autonomic nervous system. Severe intoxication causes rhabdomyolysis, paranoia, shock, hyperthermia, acute tubular necrosis, acidosis, hyperkalemia, seizures, coma, and myocardial infarction.
With an overdose, which category of drugs produces coronary artery spasms?
Central nervous system stimulants One of the cardiac effects of central nervous system stimulant toxicity is coronary artery spasms.
Rhabdomyolysis is a complication of which type of toxicity? A. Central nervous system stimulant B. Opiate C. Tricyclic antidepressant D. Calcium channel blocker
Central nervous system stimulants act by simulating or mimicking the sympathetic branch of the autonomic nervous system. Severe intoxication causes rhabdomyolysis, paranoia, shock, hyperthermia, acute tubular necrosis, acidosis, hyperkalemia, seizures, coma, and myocardial infarction. Opiate, tricyclic antidepressant, and calcium channel blocker toxicities do not lead to rhabdomyolysis.
Which drug should you anticipate administering to a patient with clonazepam (Klonopin) toxicity? A. Naloxone (Narcan) B. Flumazenil (Romazicon) C. Sodium bicarbonate D. N-acetylcysteine (Mucomyst)
Clonazepam (Klonopin) is a benzodiazepine, and flumazenil (Romazicon) is the antidote for benzodiazepine toxicity. Flumazenil competes directly with benzodiazepines at their receptor sites. Naloxone (Narcan) is the antidote for opiate toxicity. Sodium bicarbonate is administered to induce urinary alkalinization and increase the renal elimination of: salicylates, phenobarbital (Luminal), tricyclic antidepressants, and chlorpropamide (Diabinese) by changing them to a less-absorbable ionized form. N-acetylcysteine (Mucomyst) is used to treat acetaminophen toxicity.
Which drug should you anticipate administering to a patient with clonazepam (Klonopin) toxicity? A. Naloxone (Narcan) B. Flumazenil (Romazicon) C. Sodium bicarbonate D. N-acetylcysteine (Mucomyst)
Clonazepam (Klonopin) is a benzodiazepine, and flumazenil (Romazicon) is the antidote for benzodiazepine toxicity. Flumazenil competes directly with benzodiazepines at their receptor sites. Naloxone (Narcan) is the antidote for opiate toxicity. Sodium bicarbonate is administered to induce urinary alkalinization and increase the renal elimination of salicylates, phenobarbital (Luminal), tricyclic antidepressants, and chlorpropamide (Diabinese) by changing them to a less-absorbable ionized form. N-acetylcysteine (Mucomyst) is used to treat acetaminophen toxicity.
In a patient who overdosed on cocaine, which finding is expected? A. Nystagmus B. Hypotension C. Hypothermia D. Tachycardia
Cocaine is a central nervous system stimulant, so the signs and symptoms of overdose include tachycardia, hypertension, hyperthermia, insomnia, hallucinations and agitation. Nystagmus occurs in patients with phencyclidine hydrochloride (PCP) toxicity.
Cyproheptadine (Periactin) may be used to treat an overdose of which drug? A. Bupropion (Wellbutrin) B. Oxycodone (OxyContin) C. Doxepin (Sinequan) D. Amitriptyline (Elavil)
Cyproheptadine (Periactin) blocks serotonin syndrome caused by an overdose of a selective serotonin reuptake inhibitor, such as bupropion (Wellbutrin). Cyproheptadine is not used to treat overdoses of opiates, such as oxycodone (OxyContin), or tricyclic antidepressants, such as doxepin (Sinequan) or amitriptyline (Elavil).
Which drug can cause pinpoint pupils, amnesia, and hypotension?
Dextromethorphan (Robitussin) Dextromethorphan (Robitussin) is a synthetic opiate, which causes central nervous system depression that may lead to effects such as pinpoint pupils, amnesia, and hypotension. Methylphenidate (Ritalin), amphetamine (Adderall), and cocaine are central nervous system stimulants, which produce pupil dilation.
Which drug can cause pinpoint pupils, amnesia, and hypotension? A. Methylphenidate (Ritalin) B. Dextromethorphan (Robitussin) C. Amphetamine (Adderall) D. Cocaine
Dextromethorphan (Robitussin) is a synthetic opiate, which causes central nervous system depression that may lead to effects such as pinpoint pupils, amnesia, and hypotension. Methylphenidate (Ritalin), amphetamine (Adderall), and cocaine are central nervous system stimulants, which produce pupil dilation.
Which drug can cause pinpoint pupils, amnesia, and hypotension? A. Methylphenidate (Ritalin) B. Dextromethorphan (Robitussin) C. Amphetamine (Adderall) D. Cocaine
Dextromethorphan (Robitussin) is a synthetic opiate, which causes central nervous system depression that may lead to effects such as pinpoint pupils, amnesia, and hypotension. Methylphenidate (Ritalin), amphetamine (Adderall), and cocaine are central nervous system stimulants, which produce pupil dilation.
Which finding is a sign of serotonin syndrome? A. Bradycardia B. Diaphoresis C. Hypothermia D. Lethargy
Diaphoresis The signs and symptoms include diaphoresis, tachycardia, hyperthermia, agitation, confusion, hypertension, tonic-clonic seizures, and rigidity. Rhabdomyolysis and lactic acidosis may also develop. Life-threatening serotonin syndrome may result from the enhancement of normal drug effects or a drug interaction with dextromethorphan (Robitussin), meperidine (Demerol), amphetamines, cocaine, lithium (Eskalith), monamine oxidase inhibitors, or other selective serotonin reuptake inhibitors.
The ingestion of the foxglove plant can cause which finding? A. Hypertension B. Bradycardia C. Agitation D. Lacrimation
Digitalis glycosides exist in botanical form in foxglove, rhododendron, oleander, and lily of the valley. The signs and symptoms of toxicity include bradycardia, hypotension, drowsiness, and lethargy (not agitation). Lacrimation is a finding of organophosphate poisoning.
The ingestion of the foxglove plant can cause which finding? A. Hypertension B. Bradycardia C. Agitation D. Lacrimation
Digitalis glycosides exist in botanical form in foxglove, rhododendron, oleander, and lily of the valley. The signs and symptoms of toxicity include bradycardia, hypotension, drowsiness, and lethargy (not agitation). Lacrimation is a finding of organophosphate poisoning.
For a patient with tricyclic antidepressant toxicity, you should expect to treat ventricular dysrhythmias with which cardiac medication? A. Digoxin (Lanoxin) B. Procainamide (Pronestyl) C. Quinidine (Quinidex) D. Amiodarone (Cordarone)
Expect to use amiodarone (Cordarone) to treat ventricular dysrhythmias caused by tricyclic antidepressant toxicity. Digoxin (Lanoxin) is not used to treat ventricular dysrhythmias. Procainamide (Pronestyl) and other class IA antidysrhythmics, such as quinidine (Quinidex), are contraindicated because of the risk of QRS widening.
Which drug should you anticipate administering to a patient with clonazepam (Klonopin) toxicity?
Flumazenil (Romazicon) Clonazepam (Klonopin) is a benzodiazepine, and flumazenil (Romazicon) is the antidote for benzodiazepine toxicity. Flumazenil competes directly with benzodiazepines at their receptor sites.
Glucagon (GlucaGen) is the antidote for which type of poisoning? A. Opiate B. Beta-blocker C. Acetaminophen (Tylenol) D. Digitalis glycoside
Glucagon (GlucaGen) is the antidote to use in beta-blocker and calcium channel blocker poisonings. Naloxone (Narcan) is the antidote for opiate toxicity; N-acetylcysteine (Mucomyst) for acetaminophen toxicity; and digoxin immune FAB (Digibind) for digitalis glycoside toxicity.
Glucagon (GlucaGen) is the antidote for which type of poisoning? A. Opiate B. Beta-blocker C. Acetaminophen (Tylenol) D. Digitalis glycoside
Glucagon (GlucaGen) is the antidote to use in beta-blocker and calcium channel blocker poisonings. Naloxone (Narcan) is the antidote for opiate toxicity; N-acetylcysteine (Mucomyst) for acetaminophen toxicity; and digoxin immune FAB (Digibind) for digitalis glycoside toxicity.
When ingested, morning glory seeds may cause which effect?
Hallucinations The consumption of morning glory seeds may cause agitation and hallucinations. The remaining signs and symptoms are not associated with morning glory seeds.
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of withdrawal from which drug?
Heroin Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of withdrawal from heroin, an illicit opiate that is a central nervous system depressant.
Constipation is a side effect of which drug? A. Hydrocodone B. Aspirin (Bayer) C. Cocaine D. Paroxetine (Paxil)
Hydrocodone is an opiate that slows the gastrointestinal system, resulting in constipation. Aspirin (Bayer) contains salicylate, which can cause gastrointestinal irritation and produce nausea, vomiting, and hematemesis but not constipation. A central nervous stimulant, cocaine does not cause constipation. Paroxetine (Paxil) is a selective serotonin reuptake inhibitor, and the effects of an overdose are usually limited to sinus tachycardia and central nervous system depression.
Which effect occurs in calcium channel blocker toxicity?
Hyperglycemia The signs and symptoms of calcium channel blocker toxicity include hyperglycemia due to inhibited insulin release, bradycardia, hypotension, atrioventricular block (not atrial fibrillation), confusion, nausea, vomiting, and metabolic acidosis. Seizures are an effect of beta-blocker toxicity.
Which finding is a key manifestation of severe iron toxicity? A. Dark blue or black line along the gum line B. Progressive pulmonary dysfunction C. Motor neuropathy D. Nystagmus
In a patient with severe iron toxicity, the key presentation is progressive pulmonary dysfunction. Chronic mercury poisoning produces a dark blue or black line along the gum line. Motor neuropathy develops with chronic lead poisoning. Nystagmus may occur with ethylene glycol poisoning.
Which finding is a sign of serotonin syndrome? A. Bradycardia B. Diaphoresis C. Hypothermia D. Lethargy
Life-threatening serotonin syndrome may result from the enhancement of normal drug effects or a drug interaction with dextromethorphan (Robitussin), meperidine (Demerol), amphetamines, cocaine, lithium (Eskalith), monamine oxidase inhibitors, or other selective serotonin reuptake inhibitors. The signs and symptoms include diaphoresis, tachycardia, hyperthermia, agitation, confusion, hypertension, tonic-clonic seizures, and rigidity. Rhabdomyolysis and lactic acidosis may also develop.
A patient with chronic toxicity from naproxen (Aleve) is likely to develop which problems? A. Pulmonary edema and hypoglycemia B. Rhabdomyolysis and hypertension C. Respiratory depression and bradycardia D. Increased bleeding time and thrombocytopenia
Naproxen (Aleve) is a nonsteroidal anti-inflammatory drug, and chronic toxicity may cause an increased bleeding time and thrombocytopenia. Chronic salicylate toxicity may lead to pulmonary edema and hypoglycemia. Central nervous system stimulant toxicity or serotonin syndrome is likely to cause rhabdomyolysis and hypertension. Respiratory depression and bradycardia may result from a beta-blocker overdose.
Which finding suggests a complication of the toxic ingestion of oil of wintergreen? A. Petechiae B. Metabolic alkalosis C. Jaundice D. Bradycardia
Oil of wintergreen (methyl salicylate) is a highly toxic, liquid form of salicylate used in products such as BENGAY. Salicylate ingestion causes decreased platelet function that can lead to petechiae. Salicylates stimulate the respiratory center of the brainstem, resulting in hyperventilation and respiratory alkalosis. They also decrease adenosine triphosphate (ATP) production, which leads to metabolic acidosis. Jaundice is a finding in acute acetaminophen (Tylenol) toxicity.
Which finding suggests a complication of the toxic ingestion of oil of wintergreen? A. Petechiae B. Metabolic alkalosis C. Jaundice D. Bradycardia
Oil of wintergreen (methyl salicylate) is a highly toxic, liquid form of salicylate used in products such as BENGAY. Salicylate ingestion causes decreased platelet function that can lead to petechiae. Salicylates stimulate the respiratory center of the brainstem, resulting in hyperventilation and respiratory alkalosis. They also decrease adenosine triphosphate (ATP) production, which leads to metabolic acidosis. Jaundice is a finding in acute acetaminophen (Tylenol) toxicity. Bradycardia is not a complication of salicylate toxicity.
In a patient with toxicity due to the calcium channel blocker, which electrocardiogram findings should you expect to see? A. Bradycardia and atrioventricular block B. Third-degree atrioventricular block and tall, peaked T waves C. Prolonged QT intervals and tall, peaked T waves D. Bradycardia and prolonged QT intervals
Patients with calcium channel blocker toxicity exhibit bradycardia and atrioventricular block. Tall, peaked T waves and third-degree atrioventricular block occur in patients with severe digoxin (Lanoxin) toxicity. Patients with beta-blocker toxicity from sotalol (Betapace) exhibit bradycardia and prolonged QT intervals on electrocardiogram tracings.
Which finding suggests a complication of the toxic ingestion of oil of wintergreen?
Petechiae Oil of wintergreen (methyl salicylate) is a highly toxic, liquid form of salicylate used in products such as BENGAY. Salicylate ingestion causes decreased platelet function that can lead to petechiae. Salicylates stimulate the respiratory center of the brainstem, resulting in hyperventilation and respiratory alkalosis. They also decrease adenosine triphosphate (ATP) production, which leads to metabolic acidosis.
Urinary alkalinization increases the renal elimination of which substance?
Phenobarbital (Luminal) Urinary alkalinization can increase the renal elimination of phenobarbital (Luminal) and salicylates by changing them to a less-absorbable ionized form. Urinary alkalinization does not affect the elimination of nifedipine (Procardia), digoxin (Lanoxin), or paroxetine (Paxil).
An overdose of which nonsteroidal anti-inflammatory drug can cause seizures?
Piroxicam (Feldene) An overdose of piroxicam (Feldene) or mefenamic acid (Ponstel) or the ingestion of a large amount of naproxen (Aleve) or ketoprofen (Orudis) can cause seizures.
For a patient CALcium channel blocker toxicity, which drug is indicated? A. Sodium bicarbonate B. Insulin (Humalog) C. Glucagon (GlucaGen) D. Calcium gluconate
Several antidotes may be used to treat calcium channel blocker toxicity, including calcium gluconate or calcium chloride, insulin (Humalog), and glucagon (GlucaGen).
In addition to calcium gluconate, which drugs may be administered to treat calcium channel blocker toxicity? A.Sodium bicarbonate and amiodarone (Cordarone) B. Flumazenil (Romazicon) and naloxone (Narcan) C. N-acetylcysteine (Mucomyst) and Atropine D. Insulin (Humalog) and glucagon (GlucaGen)
Several antidotes may be used to treat calcium channel blocker toxicity, including calcium gluconate or chloride, insulin (Humalog), and glucagon (GlucaGen).
When treating a patient with severe salicylate toxicity, you should expect to use which drug?
Sodium bicarbonate Sodium bicarbonate is used to treat the metabolic acidosis that occurs in severe salicylate toxicity.
When treating a patient with severe salicylate toxicity, you should expect to use which drug? A. N-acetylcysteine (Mucomyst) B. Sodium bicarbonate C. Naloxone (Narcan) D. Cyproheptadine (Periactin)
Sodium bicarbonate is used to treat the metabolic acidosis that occurs in severe salicylate toxicity. N-acetylcysteine (Mucomyst) is used to treat acetaminophen toxicity. Naloxone (Narcan) is the antidote for opiate toxicity. Cyproheptadine (Periactin), a serotonin antagonist, is used to block serotonin syndrome in patients with selective serotonin reuptake inhibitor toxicity.
When treating a patient with severe salicylate toxicity, you should expect to use which drug? A. N-acetylcysteine (Mucomyst) B. Sodium bicarbonate C. Naloxone (Narcan) D. Cyproheptadine (Periactin)
Sodium bicarbonate is used to treat the metabolic acidosis that occurs in severe salicylate toxicity. N-acetylcysteine (Mucomyst) is used to treat acetaminophen toxicity. Naloxone (Narcan) is the antidote for opiate toxicity. Cyproheptadine (Periactin), a serotonin antagonist, is used to block serotonin syndrome in patients with selective serotonin reuptake inhibitor toxicity.
For a patient with QRS widening, ventricular arrhythmias, and hypotension due to tricyclic antidepressant toxicity, which drug is indicated? A. Sodium bicarbonate B. Insulin (Humalog) C. Glucagon (GlucaGen) D. Calcium gluconate
Systemic alkalinization with sodium bicarbonate is indicated for patients with QRS widening, ventricular dysrhythmias, hypotension, or all three caused by tricyclic antidepressant toxicity. Several antidotes may be used to treat calcium channel blocker toxicity, including calcium gluconate or chloride, insulin (Humalog), and glucagon (GlucaGen).
For a patient with QRS widening, ventricular arrhythmias, and hypotension due to tricyclic antidepressant toxicity, which drug is indicated? A. Sodium bicarbonate B. Insulin (Humalog) C. Glucagon (GlucaGen) D. Calcium gluconate
Systemic alkalinization with sodium bicarbonate is indicated for patients with QRS widening, ventricular dysrhythmias, hypotension, or all three caused by tricyclic antidepressant toxicity. Several antidotes may be used to treat calcium channel blocker toxicity, including calcium gluconate or chloride, insulin (Humalog), and glucagon (GlucaGen).
In a patient who overdosed on cocaine, which cardiac finding is expected?
Tachycardia Cocaine is a central nervous system stimulant, so the signs and symptoms of overdose include tachycardia, hypertension, hyperthermia, insomnia, hallucinations and agitation.
With which toxicity should you expect to find tall, peaked T waves on an electrocardiogram tracing? A. Central nervous system stimulant B. Beta-blocker C. Calcium channel blocker D. Digitalis
Tall, peaked T waves result from digitalis toxicity due to severe hyperkalemia.
With which toxicity should you expect to find tall, peaked T waves on an electrocardiogram tracing? A. Central nervous system stimulant B. Beta-blocker C. Calcium channel blocker D. Digitalis
Tall, peaked T waves result from digitalis toxicity due to severe hyperkalemia. Central nervous system stimulant, beta-blocker, and calcium channel blocker toxicities do not produce tall, peaked T waves on an electrocardiogram tracing.
The toxic ingestion of which drug can prolong the partial thromboplastin time? A. Ibuprofen (Advil) B. Aspirin (Bayer) C. Acetaminophen (Tylenol) D. Celecoxib (Celebrex)
The partial thromboplastin time may be prolonged 24 to 48 hours after acetaminophen (Tylenol) ingestion. The toxic ingestion of aspirin (Bayer) may produce a prolonged prothrombin time. Ibuprofen (Advil) and celecoxib (Celebrex) are nonsteroidal anti-inflammatory drugs that could produce a prolonged bleeding time.
Which effect occurs in calcium channel blocker toxicity? A. Atrial fibrillation B. Tachycardia C. Hyperglycemia D. Seizures
The signs and symptoms of calcium channel blocker toxicity include hyperglycemia due to inhibited insulin release, bradycardia, hypotension, atrioventricular block (not atrial fibrillation), confusion, nausea, vomiting, and metabolic acidosis. Seizures are an effect of beta-blocker toxicity.
For a patient with beta-blocker toxicity, you should prepare for which intervention?
Transcutaneous pacer insertion Patients with beta-blocker toxicity may require transcutaneous pacing to treat bradycardia caused by the toxicity. Hemodialysis has limited usefulness in patients with beta-blocker toxicity.
Urinary alkalinization increases the renal elimination of which substance? A. Nifedipine (Procardia) B. Digoxin (Lanoxin) C. Phenobarbital (Luminal) D. Paroxetine (Paxil)
Urinary alkalinization can increase the renal elimination of phenobarbital (Luminal) and salicylates by changing them to a less-absorbable ionized form. Urinary alkalinization does not affect the elimination of nifedipine (Procardia), digoxin (Lanoxin), or paroxetine (Paxil).
Urinary alkalinization increases the renal elimination of which substance? A. Nifedipine (Procardia) B. Digoxin (Lanoxin) C. Phenobarbital (Luminal) D. Paroxetine (Paxil)
Urinary alkalinization can increase the renal elimination of phenobarbital (Luminal) and salicylates by changing them to a less-absorbable ionized form. Urinary alkalinization does not affect the elimination of nifedipine (Procardia), digoxin (Lanoxin), or paroxetine (Paxil).
When a blood sample is drawn at the appropriate time, the serum level of which drug reflects the degree of acute toxicity? A. Ibuprofen (Motrin) B. Acetaminophen (Tylenol) C. Morphine (MS Contin) D. Phencyclidine hydrochloride (PCP)
When the initial blood sample is drawn at least 4 hours after acute acetaminophen (Tylenol) ingestion, the serum level can be plotted on the Rumack-Matthew nomogram to assess the peak acetaminophen level and determine the risk of hepatoxicity. Quantitative drug levels of ibuprofen (Motrin), morphine (MS Contin), and phencyclidine hydrochloride (PCP) are not usually available or helpful except for documenting ingestion.
Which gastric decontamination technique is most effective for treating a patient who has swallowed cocaine-filled balloons? A. Whole bowel irrigation B. Activated charcoal administration C. Gastric lavage D. Syrup of ipecac administration
Whole bowel irrigation decreases the gastrointestinal transit time and is indicated for swallowed foreign bodies, such as balloons or condoms of cocaine. Gastric lavage and the administration of activated charcoal or syrup of ipecac are ineffective treatments for a patient who has swallowed cocaine-filled balloons.
