ENA: Toxicologic Emergencies

In a patient with toxicity due to the beta-blocker sotalol (Betapace), 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

D. Bradycardia and prolonged QT intervals

Increased bowel sounds are a finding in which type of poisoning? A. Barbiturate B. Anticholinergic C. Tricyclic antidepressant D. Organophosphate

D. Organophosphate

An overdose of which nonsteroidal anti-inflammatory drug can cause seizures? A. Ketorolac (Toradol) B. Celecoxib (Celebrex) C. Indomethacin (Indocin) D. Piroxicam (Feldene)

D. Piroxicam (Feldene)

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)

A. Carisoprodol (Soma)

A patient with acute arsenic poisoning may have which odor on the breath? A. Garlic B. Bitter almonds C. Acetone D. Ketones

A. Garlic

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? A. Epinephrine (Adrenalin) B. Atropine C. Methylprednisolone (Solu-Medrol) D. Diphenhydramine (Benadryl)

B. Atropine

Glucagon (GlucaGen) is the antidote for which type of poisoning? A. Opiate B. Beta-blocker C. Acetaminophen (Tylenol) D. Digitalis glycoside

B. Beta-blocker

When used to treat certain toxins, urinary alkalinization can cause which adverse effect? A. Hyponatremia B. Hypokalemia C. Metabolic acidosis D. Dehydration

B. Hypokalemia

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)

A. Amiodarone (Cordarone)

Activated charcoal may be used beyond the 60-minute administration window to treat the ingestion of which substance? A. An anticholinergic medication B. An organic solvent C. A mineral acid D. Iron

A. An anticholinergic medication

A man, age 75, presents with blurred vision, flushing, fever, tachycardia, and urine retention. These manifestations suggest which toxidrome? A. Anticholinergic B. Opioid C. Sympathomimetic D. Cholinergic

A. Anticholinergic

Cyproheptadine (Periactin) may be used to treat an overdose of which drug? A. Bupropion (Wellbutrin) B. Oxycodone (OxyContin) C. Doxepin (Sinequan) D. Amitriptyline (Elavil)

A. Bupropion (Wellbutrin)

For a patient whose skin was exposed to hydrofluoric acid, the nurse should expect to apply which substance? A. Calcium gluconate (Calgonate) gel B. Silver sulfadiazine (Silvadene) cream C. Neomycin and polymyxin (Neosporin) ointment D. Baking soda paste

A. Calcium gluconate (Calgonate) gel

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)

A. Flumazenil (Romazicon)

Nutmeg toxicity is likely to cause which finding? A. Hallucinations B. Salivation C. Rhabdomyolysis D. Seizures

A. Hallucinations

When ingested, morning glory seeds may cause which effect? A. Hallucinations B. Nausea and vomiting C. Digitalis-like effects D. Drowsiness

A. Hallucinations

Constipation is a side effect of which drug? A. Hydrocodone B. Aspirin (Bayer) C. Cocaine D. Paroxetine (Paxil)

A. Hydrocodone

Intestinal obstruction is a complication of which type of poisoning? A. Iron B. Zinc C. Mercury D. Arsenic

A. Iron

Which finding suggests a complication of the toxic ingestion of oil of wintergreen? A. Petechiae B. Metabolic alkalosis C. Jaundice D. Bradycardia

A. Petechiae

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

A. Sodium bicarbonate

For a patient who has swallowed a foreign body, such as a cocaine-filled balloon, which gastric decontamination technique is the most effective? A. Whole bowel irrigation B. Activated charcoal administration C. Gastric lavage D. Syrup of ipecac administration

A. Whole bowel irrigation

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

A. Whole bowel irrigation

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)

B. Acetaminophen (Tylenol)

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

B. Activated charcoal administration

Blurred vision, delirium, flushing, and dry skin are manifestations of which toxidrome? A. Sedative-hypnotic B. Anticholinergic C. Cholinergic D. Sympathomimetic

B. Anticholinergic

Which signs and symptoms are likely to occur in a patient with a sedative-hypnotic toxidrome? A. Blurred vision and urine retention B. Decreased respirations and nystagmus C. Hypothermia and decreased respirations D. Bronchospasm and delirium

B. Decreased respirations and nystagmus

Which drug can cause pinpoint pupils, amnesia, and hypotension? A. Methylphenidate (Ritalin) B. Dextromethorphan (Robitussin) C. Amphetamine (Adderall) D. Cocaine

B. Dextromethorphan (Robitussin)

Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of withdrawal from which drug? A. Cocaine B. Heroin C. Methylphenidate (Ritalin) D. Amphetamine (Adderall)

B. Heroin

Radiography can help detect which substance(s)? A. Organophosphates B. Iron C. Phenazopyridine (Pyridium) D. Hydrocarbons

B. Iron

Which population accounts for almost two-thirds of toxic exposures? A. Older adult men B. Pediatric patients C. Pregnant women D. College students

B. Pediatric patients

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

B. Progressive pulmonary dysfunction

Family members bring an older adult 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)

B. Salicylate

Organophosphate toxicity produces which sign or symptom? A. Constipation B. Salivation C. Mydriasis D. Hot, dry skin

B. Salivation

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)

B. Sodium bicarbonate

The toxic ingestion of which drug can prolong the partial thromboplastin time? A. Ibuprofen (Advil) B. Aspirin (Bayer) C. Acetaminophen (Tylenol) D. Celecoxib (Celebrex)

C. Acetaminophen (Tylenol)

For which drugs can you obtain blood levels to determine toxicity? A. Morphine and hydrocodone (Vicodin) B. Marijuana and cocaine C. Acetaminophen (Tylenol) and digoxin (Lanoxin) D. Diazepam (Valium) and midazolam (Versed)

C. Acetaminophen (Tylenol) and digoxin (Lanoxin)

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

C. Administration of activated charcoal with sorbitol

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

C. Alcohol abuse

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)

C. Amphetamine (Adderall)

Hypertension is a finding in which type of poisoning? A. Opioid B. Antidepressant C. Anticholinergic D. Organophosphate

C. Anticholinergic

Which drug is used to treat the effects of organophosphate poisoning? A. Phenytoin (Dilantin) B. Succinylcholine (Anectine) C. Atropine D. Sodium bicarbonate

C. Atropine

With an overdose, which category of drugs produces coronary artery spasms? A. Calcium channel blockers B. Opiates C. Central nervous system stimulants D. Tricyclic antidepressants

C. Central nervous system stimulants

Which substance may be used to treat ethylene glycol or methanol toxicity? A. Succimer (Chemet) B. Calcium disodium ethylene diamine tetraacetic acid (Calcium EDTA) C. Fomepizole (Antizol) D. Atropine

C. Fomepizole (Antizol)

Which effect occurs in calcium channel blocker toxicity? A. Atrial fibrillation B. Tachycardia C. Hyperglycemia D. Seizures

C. Hyperglycemia

Acetone is a toxic metabolite of which alcohol? A. Methanol B. Ethanol C. Isopropanol D. Ethylene glycol

C. Isopropanol

Activated charcoal may be used in acute poisoning because it performs which action? A. It coats the lining of the gastrointestinal tract so poisons cannot be absorbed. B. It accelerates the flow of feces and poisons through the intestines so they are rapidly eliminated. C. It binds to particles and prevents their absorption into the portal circulation. D. It changes the chemical composition of poisons to reduce their toxic effects.

C. It binds to particles and prevents their absorption into the portal circulation.

Urinary alkalinization increases the renal elimination of which substance? A. Atropine B. Digoxin (Lanoxin) C. Phenobarbital (Luminal) D. Cyanide

C. Phenobarbital (Luminal)

After being exposed to an organophosphate insecticide, a landscaping worker presents to the emergency department. Decontamination should begin with which step? A. Brush the insecticide off the patient. B. Remove the patient's clothing. C. Place the patient is a well-ventilated, isolated area. D. Apply a neutralizing agent.

C. Place the patient is a well-ventilated, isolated area.

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)

D. Acetaminophen with hydrocodone (Vicodin)

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)

D. Amiodarone (Cordarone)

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

D. Application of a cooling blanket

An adolescent who siphoned gasoline presents with coughing, vomiting, and a decreased pulse oximetry reading. Which delayed effect is most likely? A. Hepatotoxicity B. Dysrhythmias C. Seizures D. Chemical pneumonitis

D. Chemical pneumonitis

For a patient with iron toxicity, which laboratory test result should you expect to see? A. Elevated blood urea nitrogen level B. Decreased blood glucose level C. Decreased red blood cell count D. Elevated white blood cell count

D. Elevated white blood cell count

Which disorder results from acute lead poisoning? A. Noncardiogenic pulmonary edema B. Agitation C. Renal failure D. Encephalopathy

D. Encephalopathy

In a patient with toxic alcohol poisoning, gastric decontamination should be performed only under which circumstance? A. If the airway is protected B. If the anion gap is positive C. If hemodialysis is unavailable D. If it is performed soon after ingestion

D. If it is performed soon after ingestion

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

D. Increased bleeding time and thrombocytopenia

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)

D. Insulin (Humalog) and glucagon (GlucaGen)

Windshield wiper fluid contains which type of alcohol? A. Ethylene glycol B. Ethanol C. Isopropanol D. Methanol

D. Methanol

For a patient with poisoning, why is activated charcoal used? A. To decrease the gastrointestinal transit time B. To propel the gastric contents past the pylorus C. To induce emesis D. To prevent absorption

D. To prevent absorption

For a patient with beta-blocker toxicity, you should prepare for which intervention? A. Systemic alkalinization B. Cooling blanket application C. Hemodialysis D. Transcutaneous pacer insertion

D. Transcutaneous pacer insertion