NSG 533 Advanced Pharmacology | Exam 3 |
Real Questions and Answers | 2026/2027
Update | 100% Verified
• A patient overdosed on aspirin approximately 30 minutes ago. Her vital signs are:
VS P-100, BP-144/90, RR-24, T-99.9. Which of the following actions is indicated?
Select all that apply. -✓✓Hemodialysis
Orogastric lavage
Multiple doses of activated charcoal
Urinary alkalinization with Sodium bicarbonate
Yes, to manage salicylates extraction.
Yes, to get tablets still in the stomach
Yes, to inactivate medication missed by lavage.
Alkalize the urine.
• The modern approach to a patient with an altered level of consciousness is a
targeted correction of immediate threats to life and often includes the
administration of flumazenil and naloxone. Which of the following is a reason to
be cautious and titrate the dose of these medications? -✓✓Aggressive
administration of flumazenil can cause acute withdrawal, agitation, seizures, and
fatal cardiac arrhythmias.
In the article "Use of flumazenil and naloxone in poisoned patients" the author
states: Antidotes of flumazenil for benzodiazepines, and naloxone for opiates are
commonly given to comatose patients, these should be titrated to the patient
response. Both these antidotes are specific, rapid-acting, short-lived, and titratable.
However, significant adverse effects have been associated with each of them.
Unwise or overly aggressive administration of flumazenil can cause acute
benzodiazepine withdrawal, agitation, seizures, and fatal cardiac arrhythmias.
Since many of the severe adverse effects occur in cases of mixed overdoses, use is
generally discouraged in the comatose poisoned patients where detailed history is
often not available.Although naloxone is often considered safe, it can precipitate
acute opiate withdrawal that, though rarely fatal, can present a risk to medical staff
,and other patients. It is true that both of these antidotes are specific, rapid-acting,
and short-lived and it is exactly for these reasons that the drugs are used.Naloxone
in physically dependent persons may cause acute withdrawal symptoms including;
signs and symptoms may include body aches, fever, sweating, sneezing, yawning,
nausea, vomiting, sweating, lacrimation, rhinorrhea, cramping, insomnia, chills/hot
flashes, piloerection, tachycardia, anxiety, restlessness, irritability, tremulousness,
hypertension, seizures, and cardiac arrest. In the neonate, opioid withdrawal may
also include convulsions, excessive crying, and hyperactive reflexesWhen given in
large doses naloxone can produce dyspnea, respiratory depression, and hypoxia.
However, these effects are not likely a therapeutic levels.
• Hemodialysis can be used as an adjunctive therapy in the elimination of some
medications or toxins. What properties of the toxins are necessary for the most
effective use of hemodialysis? -✓✓Low protein binding, small volume
distribution, small molecular weight, and water soluble
If a medications/toxins is low protein binding, has a small volume distribution,
small molecular weight, and is water soluble it's removal may be enhanced by
hemodialysis.
The other selections are creatively fictional, i.e, entirely made up.
• When dealing with an unconscious patient, where there is no history and attempts
to awaken the patient is unsuccessful. What is the priority and the first steps in
treating this patient? -✓✓Assessment of airway, breathing and circulation
• A patient presents with a chief complaints of GI upset with ringing in her ears
(tinnitus), nausea and vomiting. She is febrile, and analysis of her blood gasses &
electrolytes indicates the presence of a respiratory alkalosis with a compensatory
metabolic acidosis. What drug or class of drugs is likely causing the observed
findings? -✓✓salicylates
• Which of the following methods of gastrointestinal decontamination have low
risk of complications and are recommended for use in the acute care setting? -
✓✓Single dose activated charcoal (SDAC)
Charcoal administration can be used in the acute care setting, particularly single
dose charcoal is effective when the ingested substance is a large complex molecule
, and is known to bind to the charcoal. However, it should be avoided when the
ingested substance is caustic or there is a high risk of aspiration.
Charcoal administration can be used in the acute care setting.
• You are the NP evaluating a 78 year old female whose family brings her into the
ER with complaint of fever , slight agitation and difficulty urinating. They note she
has had a cold for the last week for which she is taking OTC meds with relief and
her symptoms are resolving.
Other medications include Lisinopril 10mg daily for HTN and Elavil 25 mg q HS
prn insomnia. She has been on both of these medications for 10 years.
Physical exam is remarkable for of 101.2F, HR 110 bpm, dilated pupils, dry
mucous membranes and a distended bladder. The toxidrome you are most
concerned about is:) -✓✓anticholinergic
• You are working in the ER and a mother brings her 2 year old in for evaluation
after he was found eating leaves off a plant at his grandmother's house. What is the
most appropriate next action for you as the NP caring for this patient? -✓✓Attempt
to identify the plant
• Which of the following patients would be the BEST candidate for treatment with
activated charcoal? -✓✓19 year old who took a combination of sleeping pills and
benzodiazepines 30 minutes prior
• If a patient takes an acute overdose of acetaminophen how long can N-
acetylcystiene therapy be delayed before losing efficacy? -✓✓8 hours
• The decision whether or not to treat a poisoned patient with single dose activated
charcoal (SDAC) is a clinical one. What factors increase the potential benefit of
administering single dose activated charcoal? -✓✓Anticipation of severe toxicity,
absence of contraindications and a lack of effective antidote
The factors increase the potential benefit of administering single dose activated
charcoal (SDAC)?anticipation of severe toxicity absence of contraindications (such
as decreased mental status, unprotected airway, uncooperative patient, ileum, or
intestinal obstruction)lack of effective antidoteingestion of modified-release
formulation ability to administer a reasonable dose of charcoal (50-100 grams) that
will be at least 10-40 times the dose of poisonAlthough in the absence of
contraindications charcoal is relatively safe, there are definite risks, including
Real Questions and Answers | 2026/2027
Update | 100% Verified
• A patient overdosed on aspirin approximately 30 minutes ago. Her vital signs are:
VS P-100, BP-144/90, RR-24, T-99.9. Which of the following actions is indicated?
Select all that apply. -✓✓Hemodialysis
Orogastric lavage
Multiple doses of activated charcoal
Urinary alkalinization with Sodium bicarbonate
Yes, to manage salicylates extraction.
Yes, to get tablets still in the stomach
Yes, to inactivate medication missed by lavage.
Alkalize the urine.
• The modern approach to a patient with an altered level of consciousness is a
targeted correction of immediate threats to life and often includes the
administration of flumazenil and naloxone. Which of the following is a reason to
be cautious and titrate the dose of these medications? -✓✓Aggressive
administration of flumazenil can cause acute withdrawal, agitation, seizures, and
fatal cardiac arrhythmias.
In the article "Use of flumazenil and naloxone in poisoned patients" the author
states: Antidotes of flumazenil for benzodiazepines, and naloxone for opiates are
commonly given to comatose patients, these should be titrated to the patient
response. Both these antidotes are specific, rapid-acting, short-lived, and titratable.
However, significant adverse effects have been associated with each of them.
Unwise or overly aggressive administration of flumazenil can cause acute
benzodiazepine withdrawal, agitation, seizures, and fatal cardiac arrhythmias.
Since many of the severe adverse effects occur in cases of mixed overdoses, use is
generally discouraged in the comatose poisoned patients where detailed history is
often not available.Although naloxone is often considered safe, it can precipitate
acute opiate withdrawal that, though rarely fatal, can present a risk to medical staff
,and other patients. It is true that both of these antidotes are specific, rapid-acting,
and short-lived and it is exactly for these reasons that the drugs are used.Naloxone
in physically dependent persons may cause acute withdrawal symptoms including;
signs and symptoms may include body aches, fever, sweating, sneezing, yawning,
nausea, vomiting, sweating, lacrimation, rhinorrhea, cramping, insomnia, chills/hot
flashes, piloerection, tachycardia, anxiety, restlessness, irritability, tremulousness,
hypertension, seizures, and cardiac arrest. In the neonate, opioid withdrawal may
also include convulsions, excessive crying, and hyperactive reflexesWhen given in
large doses naloxone can produce dyspnea, respiratory depression, and hypoxia.
However, these effects are not likely a therapeutic levels.
• Hemodialysis can be used as an adjunctive therapy in the elimination of some
medications or toxins. What properties of the toxins are necessary for the most
effective use of hemodialysis? -✓✓Low protein binding, small volume
distribution, small molecular weight, and water soluble
If a medications/toxins is low protein binding, has a small volume distribution,
small molecular weight, and is water soluble it's removal may be enhanced by
hemodialysis.
The other selections are creatively fictional, i.e, entirely made up.
• When dealing with an unconscious patient, where there is no history and attempts
to awaken the patient is unsuccessful. What is the priority and the first steps in
treating this patient? -✓✓Assessment of airway, breathing and circulation
• A patient presents with a chief complaints of GI upset with ringing in her ears
(tinnitus), nausea and vomiting. She is febrile, and analysis of her blood gasses &
electrolytes indicates the presence of a respiratory alkalosis with a compensatory
metabolic acidosis. What drug or class of drugs is likely causing the observed
findings? -✓✓salicylates
• Which of the following methods of gastrointestinal decontamination have low
risk of complications and are recommended for use in the acute care setting? -
✓✓Single dose activated charcoal (SDAC)
Charcoal administration can be used in the acute care setting, particularly single
dose charcoal is effective when the ingested substance is a large complex molecule
, and is known to bind to the charcoal. However, it should be avoided when the
ingested substance is caustic or there is a high risk of aspiration.
Charcoal administration can be used in the acute care setting.
• You are the NP evaluating a 78 year old female whose family brings her into the
ER with complaint of fever , slight agitation and difficulty urinating. They note she
has had a cold for the last week for which she is taking OTC meds with relief and
her symptoms are resolving.
Other medications include Lisinopril 10mg daily for HTN and Elavil 25 mg q HS
prn insomnia. She has been on both of these medications for 10 years.
Physical exam is remarkable for of 101.2F, HR 110 bpm, dilated pupils, dry
mucous membranes and a distended bladder. The toxidrome you are most
concerned about is:) -✓✓anticholinergic
• You are working in the ER and a mother brings her 2 year old in for evaluation
after he was found eating leaves off a plant at his grandmother's house. What is the
most appropriate next action for you as the NP caring for this patient? -✓✓Attempt
to identify the plant
• Which of the following patients would be the BEST candidate for treatment with
activated charcoal? -✓✓19 year old who took a combination of sleeping pills and
benzodiazepines 30 minutes prior
• If a patient takes an acute overdose of acetaminophen how long can N-
acetylcystiene therapy be delayed before losing efficacy? -✓✓8 hours
• The decision whether or not to treat a poisoned patient with single dose activated
charcoal (SDAC) is a clinical one. What factors increase the potential benefit of
administering single dose activated charcoal? -✓✓Anticipation of severe toxicity,
absence of contraindications and a lack of effective antidote
The factors increase the potential benefit of administering single dose activated
charcoal (SDAC)?anticipation of severe toxicity absence of contraindications (such
as decreased mental status, unprotected airway, uncooperative patient, ileum, or
intestinal obstruction)lack of effective antidoteingestion of modified-release
formulation ability to administer a reasonable dose of charcoal (50-100 grams) that
will be at least 10-40 times the dose of poisonAlthough in the absence of
contraindications charcoal is relatively safe, there are definite risks, including
