Description
Pharmacology for Nursing Care 7th Edition Lehne Test Bank
ISBN-13: 978-1416062493
ISBN-10: 1416062491
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Lehne: Pharmacology for Nursing Care, 7th Edition
Chapter 108: Management of Poisoning
Test Bank
- A young man is brought to the emergency department (ED) by friends, who say they found him at his home unresponsive. The prescriber suspects that he was poisoned. During the assessment, the man mumbles a word and becomes comatose. The nurse should immediately prepare to administer
| a. | intravenous flumazenil (Romazicon). |
| b. | syrup of ipecac. |
| c. | activated charcoal. |
| d. | intravenous dextrose. |
ANS: D
Intravenous (IV) dextrose should be given immediately for coma of unknown etiology, even if information on the blood glucose level is lacking.
Flumazenil (Romazicon) is indicated for benzodiazepine overdose.
Syrup of ipecac should not be administered to patients with decreased levels of consciousness. Because the drug induces vomiting, the comatose patient would be at risk for aspiration.
If administered within 30 minutes after poison ingestion, charcoal can absorb about 90% of the poison. If administered 60 minutes after poison ingestion, this is decreased to 37% absorption. Although poisoning is suspected, there is no indication of time of ingestion. Therefore, this would not be the best option for treatment.
DIF: Cognitive Level: Application REF: p.1273
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is caring for several patients who have been exposed to various types of poisoning. Which of the following interventions by the nurse would be most inappropriate for the specified toxic (poisoning) situation?
| a. | Activated charcoal; heavy metal poisoning |
| b. | Gastric lavage; overdose of pills 30 minutes ago |
| c. | Whole bowel irrigation; ingestion of lead |
| d. | Surface decontamination; exposure of skin to topical toxicants |
ANS: A
Activated charcoal is contraindicated in heavy metal poisoning, because it is poorly absorbed.
Gastric lavage is indicated for an overdose of pills within 60 minutes. This patient fits that criterion.
Whole bowel irrigation is indicated for lead ingestion. This patient fits the that criterion.
Surface decontamination is appropriate for topical exposure to toxicants. This patient fits that criterion.
DIF: Cognitive Level: Analysis REF: pp. 1274-1275
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care
- The nurse is teaching a class about potential poisons in the home and options for treatment to a group of parents with small children. One of the parents asks the nurse about the use of syrup of ipecac. The nurse discusses syrup of ipecac and attempts to verify that the parents understand the information. Which statement by one of the parents indicates a need for further teaching?
| a. | “Ipecac should not be used routinely.” |
| b. | “Ipecac should not be administered to children with a reduced level of consciousness.” |
| c. | “When used, ipecac should be administered within 1 hour of the poisoning.” |
| d. | “Ipecac is useful when corrosive acids have been ingested.” |
ANS: D
Syrup of ipecac should not be used if it is suspected that the person ingested a corrosive agent. Vomiting could lead to further corrosive effects on the already exposed esophagus. Further teaching is needed.
Ipecac should not be used routinely; no further teaching is needed.
Ipecac should not be administered to those with a history of seizures and/or a reduced level of consciousness; no further teaching is needed.
Ipecac is seldom used anymore, but if it is used, it should be administered within 60 minutes of the poisoning; no further teaching is needed.
DIF: Cognitive Level: Application REF: p. 1274
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
- The nurse is orienting a graduate nurse to a medical-surgical unit. The nurses receive an order to administer a whole bowel irrigation. The graduate nurse would be correct to
| a. | have the patient drink a solution of polyethylene glycol. |
| b. | administer a high-dose rectal laxative. |
| c. | insert an oral-gastric tube so that the patient does not have to drink the solution. |
| d. | administer enemas until clear. |
ANS: A
Whole bowel irrigation is done with a solution of polyethylene glycol, which contains balanced electrolytes. The patient can drink the solution, or it can be delivered through a nasogastric tube so that it passes through the small and large intestines.
Administration of a high-dose rectal laxative will not help evacuate the entire intestinal tract.
An oral-gastric tube is not appropriate because it will be extremely uncomfortable for an alert patient beyond the initial insertion. If the patient cannot tolerate drinking the solution, a nasogastric tube may be inserted to administer the solution. Discomfort from the tube should be limited to the insertion process.
Administering enemas until they run clear is not useful for evacuating the entire intestinal tract.
DIF: Cognitive Level: Application REF: p. 1274
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse works on a medical-surgical unit and admits a new patient from the ED with many orders, including one to administer an IV solution of sodium bicarbonate. The nurse suspects that the patient has ingested toxic amounts of _________ and understands that the sodium bicarbonate will ____________.
| a. | amphetamines; neutralize the acids to prevent further toxicity |
| b. | acetaminophen (Tylenol); reduce hepatotoxicity |
| c. | aspirin; create an alkaline urine to accelerate excretion |
| d. | opioids; act as an antagonists to receptor sites |
ANS: C
Sodium bicarbonate is indicated for a patient who has toxic levels of aspirin. It acts by creating alkaline urine, which reduces passive reabsorption of acids such as aspirin and accelerates its excretion.
Bicarbonate is not indicated for amphetamine overdose.
Acetylcysteine (Mucomyst), not bicarbonate, is indicated for acetaminophen overdose.
Naloxone (Narcan), not bicarbonate, is indicated for opioid overdose.
DIF: Cognitive Level: Application REF: p. 1275
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- Parents frantically rush their child to the ED, where they report that she got into some lead at the house of a friend who makes lead fishing weights. The prescriber confirms lead poisoning and orders calcium EDTA. What is the correct initial method of administering this medication?
| a. | Slowly, over 1 hour, as an IV infusion |
| b. | Intramuscularly (IM) twice daily for 3 to 5 days |
| c. | Orally for 7 days |
| d. | By suppository for 5 consecutive days |
ANS: B
Edetate calcium disodium (calcium EDTA) is administered to children twice daily intramuscularly for 3 to 5 days; then, after a pause of 4 days or longer, a second course is given.
The drug may be administered intravenously to adults but not children.
Calcium EDTA is not administered orally or by suppository.
DIF: Cognitive Level: Application REF: p. 1276
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- A patient is brought to the emergency department (ED) by ambulance. Friends arrive immediately after the ambulance and tell the prescriber and nurses that they were all working on the man’s car, and he accidentally drank some antifreeze. Alcohol also was involved. The first medication the nurse should prepare to administer is
| a. | fomepizole (Antizole). |
| b. | physostigmine (Antilirium). |
| c. | calcium and sodium bicarbonate. |
| d. | Prussian blue (Radiogardase). |
ANS: A
Fomepizole should be administered immediately to prevent further conversion of glycolic acid in the system, which contributes to profound metabolic acidosis and further life-threatening complications.
Physostigmine is indicated for toxicity associated with anticholinergic agents.
Although calcium and sodium bicarbonate may also be given, they would be administered when hypocalcemia and metabolic acidosis, respectively, occur. The immediate goal is to stop the conversion of glycolic acid.
Prussian blue is indicated for exposure to radioactive material.
DIF: Cognitive Level: Application REF: p. 1277
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care
- The police bring a man to the emergency department (ED) who is visibly ill. The man is vomiting and complains of stomach pain. He tells the ED staff, “My wife is trying to kill me.” The police officer states that the man gave him a small bottle with white power in it. The prescriber runs some tests and confirms arsenic poisoning. The nurse should prepare to administer
| a. | deferoxamine (Desferal). |
| b. | dimercaprol (BAL In Oil). |
| c. | edetate calcium disodium (calcium EDTA). |
| d. | penicillamine (Cuprimine). |
ANS: B
Dimercaprol binds with arsenic, and the resulting chelates are excreted in the urine.
Deferoxamine is indicated for iron toxicity.
Edetate calcium disodium is indicated for lead poisoning.
Penicillamine is indicated for Wilson’s disease, a disorder of copper metabolism.
DIF: Cognitive Level: Application REF: p. 1276
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- A nurse in the emergency department (ED) cares for a 17-year-old patient brought in by his parents. The parents say they think he overdosed on acetaminophen (Tylenol), because he just had a serious break up with a girlfriend. Which antidote would the nurse anticipate administering?
| a. | Atropine (Sal-Tropine) |
| b. | Naloxone (Narcan) |
| c. | Protamine sulfate |
| d. | Acetylcysteine (Mucomyst) |
ANS: D
The antidote for acetaminophen overdose is acetylcysteine.
Atropine is the appropriate treatment for muscarinic agonists.
Narcan is appropriate for opioid overdose.
Protamine sulfate is appropriate for heparin overdose.
DIF: Cognitive Level: Application REF: p. 1277
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is teaching a class on the management of poisoning to emergency department nurses. The nurse asks the class, “Gastric lavage and aspiration should be reserved for which situation or situations?” Which of the following would be correct? (Select all that apply.)
| a. | Patients who have ingested caustic agents |
| b. | Situations in which the poison was ingested during the preceding hour |
| c. | Comatose patients |
| d. | Patients who have significant cardiac dysrhythmia |
| e. | Life-threatening ingestion of poison |
ANS: B, E
Gastric lavage and aspiration are reserved for patients in life-threatening situations and only if less than 60 minutes has elapsed since the poison was ingested.
Gastric lavage and aspiration are contraindicated in patients who have ingested caustic agents because of the risk of esophageal perforation.
Gastric lavage and aspiration are contraindicated in comatose patients because of the risk of aspiration.
Gastric lavage and aspiration are contraindicated in patients with significant cardiac dysrhythmias.
DIF: Cognitive Level: Application REF: p. 1274
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care
- Calcium EDTA, 35 mg/kg, is prescribed for the treatment of a pediatric patient with lead poisoning. The patient weighs 44 pounds. The nurse will administer _________ milligrams.
ANS:
700
First, convert pounds to kilograms (44 lb ´ 2.2 lb/1 kg = 20 kg). Then, multiply the patient’s weight in kilograms by 35 mg/kg to determine the dose (20 kg ´ 35 mg/kg = 700 mg).
DIF: Cognitive Level: Application REF: p. 1276
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
- The nurse is teaching a community program on potential poisons in the home. The nurse asks the group, “What service or services could a poison control center offer?” Which response by a participant demonstrates the need for further teaching? “The poison control center offers
| a. | poison information and education.” |
| b. | advice and consultation by telephone for toxic exposures.” |
| c. | services provided 5 days a week.” |
| d. | hazard surveillance to achieve hazard elimination.” |
ANS: C
The poison control center is available 24 hours a day, 7 days a week; further teaching is needed.
The poison control center offers poison information and professional and public education; no further teaching is needed.
Poison control centers are accessible by telephone and can provide immediate instruction on management of acute poisoning; no further teaching is needed.
Poison control centers provide hazard surveillance; no further teaching is needed.
DIF: Cognitive Level: Application REF: p. 1278
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
- An individual brought to the emergency department (ED) and is suspected of having taken an overdose of pilocarpine (Pilocar) 3 hours ago. Upon assessment, that nurse notes profuse salivation, lacrimation, bronchospasm, diarrhea, a blood pressure of 82/40, and a heart rate of 51. The nurse should prepare to administer
| a. | epinephrine (Adrenalin). |
| b. | atropine (Sal-Tropine). |
| c. | activated charcoal. |
| d. | syrup of ipecac. |
ANS: B
The patient is showing symptoms of systemic absorption of pilocarpine. Systemic toxicity should be reversed with a muscarinic antagonist, such as atropine.
Epinephrine may be helpful for increasing the heart rate. However, it does not contain anticholinergic properties and would not be the best choice.
Activated charcoal is the preferred method for removing ingested poisons from the gastrointestinal tract.
Syrup of ipecac is not indicated, because it induces vomiting but only removes 30% of the ingested poison even when given early.
DIF: Cognitive Level: Analysis REF: p. 1277
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies
