Chapter 109: Management of Poisoning

Chapter 109: Management of Poisoning

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A young patient is brought to the emergency department by friends, who say they found him unresponsive at his home. The prescriber suspects that the patient was poisoned. During the assessment, the man mumbles a word and becomes comatose. The nurse should immediately prepare to administer:

a.	activated charcoal.
b.	intravenous dextrose.
c.	intravenous flumazenil [Romazicon].
d.	syrup of ipecac.

 

 

ANS:  B

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 a patient with a decreased level 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 reduced to 37% absorption. Although poisoning is suspected, there is no indication of the time of ingestion. Therefore, activated charcoal would not be the best option for treatment.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1330

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. A patient is brought to the emergency department after ingestion of an unknown substance. The patient has been vomiting and complains of abdominal pain. The nurse observes that the patient’s oral mucous membranes are dry, the heart rate is 88 beats per minute, and the blood pressure is 90/60 mm Hg. The nurse will prepare to initially:

a.	administer an antiemetic.
b.	give activated charcoal.
c.	infuse normal saline as an IV bolus.
d.	obtain blood for toxicology testing.

 

 

ANS:  C

Initial treatment for poisoning involves supportive care. IV infusions of normal saline or Ringer’s solution should be given to restore volume lost by vomiting. Antiemetics are not indicated. Activated charcoal is given when the ingested substance is known and only if it will help neutralize the substance. Toxicology testing is important, but supportive care is provided initially.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1330

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. A pediatric patient ingested a narcotic analgesic at a grandparent’s house 15 minutes before arriving in the emergency department. The nurse is preparing to administer activated charcoal. Which statement by the nurse is correct?

a.	“The charcoal will cause the child’s stools to be black.”
b.	“The charcoal should absorb about 37% of the drug.”
c.	“The charcoal will make the child vomit the medication.”
d.	“We will need to give the charcoal several times for it to work.”

 

 

ANS:  A

Activated charcoal absorbs the poison, and the charcoal-poison complex then is excreted. The charcoal causes the stools to become black. When administered within 30 minutes of ingestion, 90% of a drug can be absorbed. Activated charcoal does not cause vomiting. It is not necessary to repeat the dose.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1331

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. A parent brings a child to the emergency department, because the child drank a solution containing ferrous sulfate. The nurse will prepare for:

a.	administration of activated charcoal.
b.	gastric lavage.
c.	peritoneal dialysis.
d.	whole-bowel irrigation.

 

 

ANS:  D

Whole-bowel irrigation is done with a solution of polyethylene glycol, which contains balanced electrolytes. It is effective for ingestion of iron, lithium, and lead. Activated charcoal is not effective against heavy metals, because they are poorly absorbed. Gastric lavage and peritoneal dialysis are not recommended.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1331

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies