CPEN CPEN Toxicology and Poisoning Emergencies 2 — Questions and Answers
Question 1: A child presents with opioid overdose. What is the correct initial nursing intervention?
- Administer flumazenil
- Administer naloxone and support airway/breathing (Correct answer)
- Perform activated charcoal lavage
- Administer atropine
Correct answer: Administer naloxone and support airway/breathing
Naloxone reverses opioid-induced respiratory depression, but airway support must be maintained concurrently as naloxone duration may be shorter than the opioid.
Question 2: Which toxic ingestion is best treated with activated charcoal?
- Iron tablet ingestion
- Caustic alkali ingestion
- Aspirin overdose within 1 hour (Correct answer)
- Hydrocarbon ingestion
Correct answer: Aspirin overdose within 1 hour
Activated charcoal is most effective when given within 1 hour of aspirin ingestion, as it adsorbs salicylate and reduces systemic absorption.
Question 3: A pediatric patient ingested a tricyclic antidepressant (TCA). Which ECG finding is most concerning?
- Peaked T waves
- QRS duration greater than 100 ms (Correct answer)
- Prolonged PR interval only
- Tall R wave in V1
Correct answer: QRS duration greater than 100 ms
QRS widening greater than 100 ms in TCA toxicity indicates sodium channel blockade and predicts risk of ventricular arrhythmias and seizures.
Question 4: Which agent is used to treat TCA-induced wide-complex dysrhythmia and hypotension?
- Magnesium sulfate
- Sodium bicarbonate (Correct answer)
- Adenosine
- Calcium gluconate
Correct answer: Sodium bicarbonate
Sodium bicarbonate alkalinizes the blood and provides sodium load to overcome TCA sodium channel blockade, reversing QRS widening and dysrhythmias.
Question 5: A child presents after ingesting a calcium channel blocker. Which hemodynamic pattern is expected?
- Tachycardia and hypertension
- Bradycardia and hypotension (Correct answer)
- Tachycardia and hypotension
- Bradycardia and hypertension
Correct answer: Bradycardia and hypotension
Calcium channel blocker overdose classically causes bradycardia and hypotension due to decreased cardiac conduction and peripheral vasodilation.
Question 6: Which substance ingestion is a contraindication to inducing vomiting in a pediatric patient?
- Aspirin
- Hydrocarbons or caustic agents (Correct answer)
- Antihistamines
- Vitamins
Correct answer: Hydrocarbons or caustic agents
Inducing vomiting after hydrocarbon or caustic ingestion is contraindicated because it increases the risk of aspiration pneumonitis and esophageal re-injury.
CPEN CPEN Toxicology and Poisoning Emergencies 2
A child presents with opioid overdose.
What is the correct initial nursing intervention?