Question 1

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:

Accepted Answer

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.

Question 2

A nurse is teaching a patient who works with heavy metals and who is about to begin taking a chelating agent to treat heavy metal poisoning. Which statement by the patient indicates a need for further teaching?

Accepted Answer

Chelating agents interact with metals to form chelates,which then can be excreted from the body. Chelating agents can strip metals already bound and prevent the binding of metals to endogenous molecules. The chelates are less toxic and can be excreted safely.

Question 3

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

Accepted Answer

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.

Question 4

A child is admitted to the hospital after a routine lead screen reveals an elevated serum lead level. The prescriber has ordered edetate calcium disodium (calcium EDTA)as a chelating agent. During this drug treatment,the nurse will expect to:

Accepted Answer

Edetate calcium disodium (calcium EDTA)is administered to children as a chelating agent for lead poisoning. Its principle toxicity is renal tubular necrosis,as evidenced by hematuria and proteinuria. Daily urinalysis should be performed. The medication is given IV or IM,not orally. The drug does not have significant effects on the heart rate or blood pressure. It does not cause hepatotoxicity.

Question 5

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?

Accepted Answer

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.

Question 6

A prescriber has ordered deferasirox [Exjade] to treat iron overload associated with chronic blood transfusions. The nurse learns that the patient takes cholestyramine to reduce cholesterol. The nurse will contact the provider to request an order to:

Accepted Answer

Cholestyramine can reduce absorption of deferasirox; if the combination cannot be avoided,the dose of deferasirox should be increased. Increasing the dose of cholestyramine will only worsen the problem. It is not necessary to monitor the cholesterol level. Liver function testing should be routine with deferasirox administration,but not because of the combination of this drug with cholestyramine.

Question 7

Which chelating agents can be used to treat iron toxicity? (Select all that apply.)

Accepted Answer

Deferoxamine,fomepizole,and penicillamine can all be used to chelate iron compounds.

Question 8

An alert child is brought to the emergency department after ingesting gasoline. The nurse will prepare to administer which treatment to minimize poison absorption in this child?

Accepted Answer

Treatment with activated charcoal is a preferred method for removing ingested poisons from the GI tract. Chelation therapy is used to bind with substances in the blood. Gastric lavage should not be used with hydrocarbon ingestion due to high aspiration risk. Whole bowel irrigation is used for ingestion of iron,lithium,and lead.

Question 9

A patient overdosed on aspirin several hours ago and is brought to the emergency department. The nurse assists with supportive care and then asks the provider about an order for which drug?

Accepted Answer

Sodium bicarbonate is indicated for a patient who has toxic levels of aspirin. It acts by creating an alkaline urine,which reduces passive reabsorption of acids such as aspirin and accelerates its excretion. Activated charcoal is not effective after hours have passed. Ammonium chloride makes the urine more acidic. Fomepizole is used for ethylene glycol ingestion.

Question 10

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:

Accepted Answer

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.

Question 11

A patient will begin taking dimercaprol [BAL in Oil] for arsenic poisoning. The nurse performs a medical history on this patient. Which aspect of the patient's history would cause the most concern?

Accepted Answer

Dimercaprol is formulated in peanut oil and should not be given to patients with peanut allergy. A history of anemia,previous lead exposure,or peptic ulcer disease are not contraindications to treatment with this drug.

Quiz 109: Management of Poisoning