ENPC Toxicological Emergencies 3

Question 1

Whole bowel irrigation (WBI) is MOST indicated for which pediatric ingestion scenario?

Accepted Answer

Iron tablets, sustained-release medications, or drug body packing

Answer

WBI is reserved for substances not adsorbed by activated charcoal (iron, sustained-release drugs) or illicit drug packets that require mechanical clearance.

Question 2

A 16-year-old with tricyclic antidepressant (TCA) overdose presents with QRS widening on ECG. What is the PRIORITY treatment?

Accepted Answer

Sodium bicarbonate bolus

Answer

Sodium bicarbonate alkalinizes serum and reduces TCA binding to cardiac sodium channels, narrowing the QRS complex and preventing dysrhythmias.

Question 3

Which laboratory test is MOST important to guide treatment in a child with suspected acetaminophen overdose?

Accepted Answer

Serum acetaminophen level at 4 hours post-ingestion plotted on the Rumack-Matthew nomogram

Answer

A 4-hour serum acetaminophen level plotted on the Rumack-Matthew nomogram determines whether N-acetylcysteine therapy is indicated.

Question 4

Which clinical finding in a toddler indicates systemic iron toxicity requiring chelation therapy?

Accepted Answer

Metabolic acidosis with serum iron level >500 mcg/dL

Answer

Serum iron >500 mcg/dL with metabolic acidosis indicates severe systemic iron toxicity requiring deferoxamine chelation therapy.

Question 5

What is the mechanism of action of deferoxamine in iron toxicity?

Accepted Answer

Chelates free iron and promotes its excretion as ferrioxamine in urine

Answer

Deferoxamine binds free iron in a chelate complex (ferrioxamine), which is then renally excreted, producing the classic 'vin rosé' urine color.

ENPC - Emergency Nurse Practitioner Practice Test

ENPC - Emergency Nurse Practitioner Practice Test

ENPC Toxicological Emergencies 3