ENPC Toxicological Emergencies 2

Question 1

A child presents with bradycardia, hypotension, and altered mental status after suspected beta-blocker overdose. Which treatment is MOST appropriate?

Accepted Answer

High-dose insulin therapy

Answer

High-dose insulin (1 unit/kg bolus followed by infusion) improves myocardial energy metabolism and cardiac output in beta-blocker toxicity.

Question 2

Which presentation characterizes the second phase (6-24 hours) of iron toxicity in a pediatric patient?

Accepted Answer

Apparent improvement or symptom-free latent period

Answer

Phase II of iron toxicity (6-24 hours) is a deceptive latent period of apparent improvement before systemic toxicity develops.

Question 3

A 3-year-old ingests a button battery confirmed by X-ray to be lodged in the esophagus. What is the PRIORITY intervention?

Accepted Answer

Urgent endoscopic removal within 2 hours

Answer

Esophageal button batteries require emergency endoscopic removal within 2 hours due to rapid liquefactive necrosis and perforation risk.

Question 4

Flumazenil reverses benzodiazepine overdose but should be used cautiously because it can:

Accepted Answer

Precipitate seizures in benzodiazepine-dependent patients

Answer

Flumazenil can precipitate acute benzodiazepine withdrawal seizures in patients with physical dependence on benzodiazepines.

Question 5

A child with carbon monoxide poisoning has a carboxyhemoglobin level of 35%. What is the MOST appropriate oxygen therapy?

Accepted Answer

100% oxygen via non-rebreather mask

Answer

100% oxygen via non-rebreather mask reduces the carboxyhemoglobin half-life from ~5 hours on room air to ~60-90 minutes.

ENPC - Emergency Nurse Practitioner Practice Test