Name that Antidote
Which drug is used in acetaminophen overdose ?
a. Acetylcysteine
b. Physostigmine
c. Acetylsalicylic acid
d. Flumazenil
What is Acetylcysteine!
The nurse is assigned to a patient who has been in the hospital for 24 hours with a diagnosis of acute alcohol intoxication. The patient states, "I am so stressed out in my marriage and with my job. Drinking is the only way that I can relieve that stress." What priority intervention would be beneficial for this patient?
a. Make an appointment for the patient to see a psychiatrist.
b. Commit the patient to a state mental health facility.
c. Inform that there are other methods to relieve stress other than drinking alcohol.
d. Refer the patient to a comprehensive treatment program.
What is.......Refer the patient to a comprehensive treatment program.
Rationale: People who attempt to manage stress through substance abuse require a comprehensive treatment program to address their coping and adaptation problems. There is no rationale for admitting the patient to a mental health facility if he is competent to make decisions for himself and is not a danger to self or others. The patient should make the decision to seek help when he is ready. Informing the patient that there are other methods to relieve stress other than drinking would be appropriate in a less acute situation.
A client is admitted to the hospital 24 hours following an aspirin (acetylsalicylic acid) overdose. The nurse assesses this client for which signs/symptoms indicating the acid-base disturbance that could occur in the client?
a. Disorientation and dyspnea
b. Drowsiness, headache, and tachypnea
c. Tachypnea, dizziness, and paresthesias
d. Decreased respiratory rate and depth, cardiac irregularities
What is B- Drowsiness, headache, and tachypnea
Rationale:
The client who ingests a large amount of acetylsalicylic acid (aspirin) is at risk for developing metabolic acidosis 24 hours later. If metabolic acidosis occurs, the client is likely to exhibit drowsiness, headache, and tachypnea. In the very early hours following aspirin overdose, the client may exhibit respiratory alkalosis as a compensatory mechanism. However, by 24 hours post-overdose, the compensatory mechanism fails and the client reverts to metabolic acidosis. The client with metabolic alkalosis (option 4) is likely to experience cardiac irregularities and a compensatory decreased respiratory rate and depth. Options 1 and 3 indicate respiratory acidosis and alkalosis, respectively.
A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response?
a. "Why do you assume responsibility for his behaviors?"
b. "Codependency is a typical behavior of spouses of alcoholics."
c. "Your husband needs to deal with the consequences of his drinking."
d. "Do you understand what the term 'enabler' means?"
What is "Your husband needs to deal with the consequences of his drinking.
The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Partners of clients with substance abuse must come to realize that the only behavior they can control is their own.
What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?
a. Risk for injury R/T central nervous system stimulation
b. Disturbed thought processes R/T tactile hallucinations
c. Ineffective coping R/T powerlessness over alcohol use
d. Ineffective denial R/T continued alcohol use despite negative consequences
What is.... risk for injury R/T central nervous system stimulation.
Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.
A patient has arrived at the emergency department via ambulance. The EMT states, "She is barely responsive. She took all of the Ativan in this bottle." What medication should the nurse prepare to administer to the patient?
a. Flumazenil (Romazicon)
b. Naloxone (Narcan)
c. Methylene blue
d. Physostigmine (Antilirium)
What is Flumazenil!
Flumazenil (Romazicon) is the antidote for benzodiazepines. Ativan is a benzodiazepine and will be reversed by the flumazenil. Narcan is a narcotic antagonist and is the reversal agent for opioids. Physostigmine is the reversal agent for anticholinergic drugs and methylene blue is the reversal agent for nitrates.
The patient has been taking amitriptyline (Elavil) for neuropathic pain in the lower extremities. He comes into the emergency room stating, I took 15 of them right before I got here. I was tired of it all but should never have done this. Someone help me! What intervention can help prevent absorption of the medication?
A. Syrup of ipecac
B. Benzodiazepines
C. Gastric lavage
D. Hyperbaric oxygen therapy
What is gastric lavage.
A patient has been admitted to the emergency department after ingesting an unknown substance. The nurse finds agitation, tachycardia, hypertension, and episodes of tonic-clonic muscle movements. Arterial blood gases reveal normal oxygenation and metabolic acidosis. What ingested substance does the nurse most suspect?
a. Antihistamine cold medication
b. Cocaine
c. Ativan
d. Acetaminophen
What is Cocaine
Cocaine results in a sympathetic response. Assessment findings include hypertension, elevated heart rate, hyperthermia, chest pain, nausea, vomiting, tremors, panic attacks, paranoia, hallucinations, delirium and even seizures
A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in teaching parents about how to protect a toddler from accidental poisoning?
a. Label poisonous solutions.
b. Do not leave the toddler alone.
c. Closely monitor the toddler's activity.
d. Keep cleaning solutions locked up.
What is D...Keep cleaning solutions locked up.
The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time.
A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation?
a. The individual is experiencing psychological dependency.
b. The individual is experiencing physical dependency.
c. The individual is experiencing substance dependency.
d. The individual is experiencing social dependency.
What is ...... A-psychological dependency
The nurse should use the term "psychological dependency" to best describe this client's situation. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.
The nurse is working with a patient admitted with diazepam (valium) overdose. What medication will the nurse anticipate the care provider to order to refer the effect of diazepam?
a. naloxone (narcan)
b. flumazenil
c. acetylcysteine
d. hydrocodone
What is flumazenil
After assessing a child's airway, breathing, and circulation (ABCs), which of the following would the nurse do next?
a. Remove the child's clothing.
b. Obtain a full set of vital signs.
c. Assess level of consciousness.
d. Provide pain management.
What is C...Assess level of consciousness.
Once the ABCs are completed, the nurse's next step is to assess the child's level of consciousness or disability. This would be followed by removing the child's clothing and diaper (exposure) to assess for underlying signs of illness or injury. Next, full vital signs are taken while facilitating the family presence, followed by giving comfort by managing pain and providing emotional support. The acronym ABCDEFG is a useful reminder of the order of assessment: airway, breathing, circulation, disability, exposure, full vital signs and facilitating family, and giving comfort.
An adolescent patient has arrived at the emergency department via ambulance after friends reported that she ingested a large quantity of unknown pills after having an argument with her boyfriend. The patient is combative and refuses to divulge the type of pills that she ingested. What lab studies should be performed at this time? (Select all that apply)
a. Electrolyte studies
b. Lipid panel
c. Liver panel
d. T3 and T4
e. Serum osmolality test
f. Acetaminophen level
What is A, C, E, F
Electrolyte studies
Liver panel
Serum osmolality test
Acetaminophen level
An unconscious client is brought to the emergency department after ingesting too much prescribed medication. Which of the following is the highest priority nursing intervention?
a. Establish a patent airway.
b. Establish IV access.
c. Call family members.
d. Administer antacids.
What is a. Establish a patent airway.
Initial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function. This is a priority over communication with the family, establishing IV access or administering other medications.
When a poison has been ingested by a child, the parents should be instructed to do which of the following first?
a. Induce vomiting.
b. Call the local poison control center.
c. Administer an emetic.
d. Get to an emergency facility.
What is B! Call the local poison control center.
Not all poisons should be vomited. Strong acids, for example, could cause as much destruction of tissue being vomited as being swallowed. The poison control center will provide the most accurate information on the next steps for the patient.
What's the Antidote for Tricyclic antidepressants
What is Sodium bicarbonate or phyostigmine
A 4-year-old girl has been admitted to the emergency department after accidently ingesting a cleaning product. Which of the following treatments is most likely appropriate in the immediate treatment of the girl's poisoning?
a. Intravenous rehydration
b. Administration of activated charcoal
c. Gastric lavage
d. Inducing vomiting
What is b. Administration of activated charcoal
Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.
A client takes aspirin (acetylsalicylic acid) daily for pain in the right knee. Which toxic effects may be present with aspirin overdosage? Select all that apply.
a. Tinnitus.
b. Hyperventilation.
c. Gastrointestinal bleeding.
d. Decreased urinary output.
e. Peripheral neuropathy
What is a,b,c,d
Tinnitus.
Hyperventilation.
Gastrointestinal bleeding.
Decreased urinary output.
A client who is experiencing toxic effects from aspirin may experience tinnitus, hyperventilation, GI bleeding, or decreased urine output related to renal impairment. Option (e) is incorrect. A client with salicylate toxicity does not tend to experience peripheral neuropathy
A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication?
a. Giving the medication undiluted for full effect
b. Avoiding use of a straw when giving this medication
c. Disguising the flavor with soda or flavored water
d. Preparing to give this medication via a nebulizer
What is C. Disguising the flavor with soda or flavored water
Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.
A 25 year old presents with an ingestion of acetaminophen 2 hours prior to arrival. Which of the following statements is TRUE?
a. Activated charcoal is indicated to treat this ingestion
b. AST of 32 and ALT of 27 from arrival labs indicate the absence of hepatotoxicity from this ingestion.
c. An acetaminophen level of 84 mg/dl from arrival labs necessitates use of n-acetylcysteine
d. Acetaminophen toxicity is predicted to occur at a dose of 20 mg/kg.
What is A. Activated charcoal is indicated to treat this ingestion
The first stage of acetaminophen toxicity is largely asymptomatic. The toxic acetaminophen dose, when a single ingestion of nonsustained-release preparation is taken, is about 140 mg/kg. Therapy is guided by the Rumack-Matthew nomogram, provided the ingestion is an acute one involving nonsustained-release preparations. The antidote, N-acetylcysteine, prevents toxicity by inhibiting the binding of NAPQI to hepatocytes.
The antidote for lead poisoning ____________
Trick question there is no antidote for lead poisoning. reatment of lead poisoning consists of removal from the source of exposure. Chelation therapy should be considered for treatment of severe symptoms or markedly elevated blood lead levels. There are four available agents used to treat lead toxicity: dimercaprol, CaNa2EDTA, succimer, and D-penicillamine
In order by priority, place the nursing actions that should be taken for a pediatric client in the event of poison ingestion.
1. Administer the antidote prescribed
2. Assess the ABCs – airway, breathing, and circulation.
3. Begin cardiopulmonary resuscitation if necessary.
4. Empty mouth of pills, if present, or flush skin or body part exposed.
5. Identify the poison by asking parents or witnesses to the ingestion.
What is 2, 3, 4, 5, 1
In the event of a poisoning, the nurse treats the child first, not the poison. The ABCs – airway, breathing, and circulation – and vital signs are assessed. Cardiopulmonary resuscitation is initiated immediately if necessary. Exposure to the poison is terminated next, such as emptying the mouth of pills or other materials or flushing the skin or other body area. Then the poison is identified by questioning the parents or witnesses of the event to determine the appropriate treatment. The nurse administers the antidote or takes other measures as prescribed by the primary health care provider, such as administering activated charcoal. The nurse documents the occurrence, assessment findings, poison ingested, treatment measures, and the child's response.
A patient presents after an unknown ingestion. Her initial electrocardiogram (EKG) shows sinus tachy with long intervals. Based on the EKG, an overdose with which of the following medications would be most likely?
a. Amitriptyline
b. Nifedipine
c. Ativan
d. Aspirin
What is Amitriptyline.
Amitriptyline is a tricyclic antidepressant (TCA). As such, it has anticholinergic activity that will cause a sinus tachycardia. Additional EKG findings with TCA toxicity include interval prolongation and terminal 40 ms right axis deviation. Clonidine, nifedipine, and metoprolol typically cause bradycardia. NSAIDs, like ibuprofen, rarely affect the heart rate.
What are 5 symptoms of CARBON MONOXIDE poisoning?
Weakness
Headache
Unconsciousness
Nausea/Vomiting
chest pain
confusion
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to presentation in the ED. Which of the following arterial blood gas results would you expect to come from this patient?
A. pH 7.33 pCO2 48 pO2 58 HCO3 29
B. pH 7.45 pCO2 21 pO2 124 HCO3 14
C. pH 7.47 pCO2 31 pO2 96 HCO3 25
D. pH 7.14 pCO2 68 pO2 102 HCO3 23
What is B. Acute salicylate overdose characteristically causes a metabolic acidosis mixed with a respiratory alkalosis.