CEN Toxicology and Environmental Emergencies 2

Question 1

A patient presents with confusion, lactic acidosis, and bradycardia after intentional ingestion of his wife's heart medication. Bedside glucose is 220 mg/dL. Which medication overdose is most likely?

Accepted Answer

Calcium channel blocker

Answer

Calcium channel blocker toxicity causes bradycardia, hypotension, and hyperglycemia (by blocking insulin release from pancreatic beta cells).

Question 2

A patient with digoxin toxicity has a potassium level of 6.2 mEq/L and multiple PVCs. Which treatment is indicated?

Accepted Answer

Digoxin-specific antibody fragments (Digibind/DigiFab)

Answer

Digoxin-specific Fab fragments directly bind and inactivate digoxin, reversing toxicity including dysrhythmias and hyperkalemia.

Question 3

A patient presents with fever of 40.5°C, muscle rigidity, clonus, diaphoresis, and agitation after starting a new antidepressant. Which condition is most likely?

Accepted Answer

Serotonin syndrome

Answer

The triad of altered mental status, autonomic instability, and neuromuscular abnormalities (clonus, hyperreflexia) is characteristic of serotonin syndrome.

Question 4

A patient with carbon monoxide poisoning has a carboxyhemoglobin level of 30% and is confused. Which oxygen delivery is the treatment priority?

Accepted Answer

100% oxygen via non-rebreather mask

Answer

100% oxygen via non-rebreather mask is the immediate treatment for CO poisoning; it reduces CO half-life from ~5 hours on room air to ~60–90 minutes.

Question 5

A patient presents with confusion, the smell of bitter almonds on their breath, and lactic acidosis after a house fire. Which antidote should be given?

Accepted Answer

Hydroxocobalamin (Cyanokit)

Answer

Hydroxocobalamin binds cyanide to form cyanocobalamin, which is safely excreted; it is the preferred antidote for cyanide poisoning.

CEN - Certified Emergency Nurse Practice Test

CEN - Certified Emergency Nurse Practice Test

CEN Toxicology and Environmental Emergencies 2