Chapter 108: Management of Poisoning

Chapter 108: Management of Poisoning

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. 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

 

2. 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

 

3. 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

 

4. 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