CEN TOX CEN 2 QUESTIONS AND ANSWERS
For a patient with beta-blocker toxicity, you should prepare for which intervention? - ANSWER
Transcutaneous pacer insertion
Patients with beta-blocker toxicity may require transcutaneous pacing to treat bradycardia caused by the
toxicity.
Hemodialysis has limited usefulness in patients with beta-blocker toxicity.
In addition to calcium gluconate, which drugs may be administered to treat calcium channel blocker
toxicity?
A. Sodium bicarbonate and amiodarone (Cordarone)
B. Flumazenil (Romazicon) and naloxone (Narcan)
C. N-acetylcysteine (Mucomyst) and Atropine
D. Insulin (Humalog) and glucagon (GlucaGen) - ANSWER Several antidotes may be used to treat calcium
channel blocker toxicity, including calcium gluconate or chloride, insulin (Humalog), and glucagon
(GlucaGen).
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of
withdrawal from which drug? - ANSWER Heroin
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of
withdrawal from heroin, an illicit opiate that is a central nervous system depressant.
For a patient with benzodiazepine toxicity, which intervention is appropriate for enhancing drug
elimination?
A. Gastric lavage
,B. Activated charcoal administration
C. Hemodialysis
D. Charcoal hemoperfusion - ANSWER Administer activated charcoal promptly and safely to enhance
benzodiazepine elimination.
When a blood sample is drawn at the appropriate time, the serum level of which drug reflects the degree
of acute toxicity?
A. Ibuprofen (Motrin)
B. Acetaminophen (Tylenol)
C. Morphine (MS Contin)
D. Phencyclidine hydrochloride (PCP) - ANSWER When the initial blood sample is drawn at least 4 hours
after acute acetaminophen (Tylenol) ingestion, the serum level can be plotted on the Rumack-Matthew
nomogram to assess the peak acetaminophen level and determine the risk of hepatoxicity.
Quantitative drug levels of ibuprofen (Motrin), morphine (MS Contin), and phencyclidine hydrochloride
(PCP) are not usually available or helpful except for documenting ingestion.
With an overdose, which category of drugs produces coronary artery spasms? - ANSWER Central nervous
system stimulants
One of the cardiac effects of central nervous system stimulant toxicity is coronary artery spasms.
Which antidysrhythmic is most appropriate for treating ventricular dysrhythmias caused by tricyclic
antidepressant toxicity?
A. Amiodarone (Cordarone)
B. Procainamide (Pronestyl)
C. Quinidine (Quinidex)
D. Digoxin (Lanoxin) - ANSWER Amiodarone (Cordarone) is the most appropriate antidysrhythmic for
treating ventricular dysrhythmias caused by tricyclic antidepressant toxicity.
,Procainamide (Pronestyl) and quinidine (Quinidex) are contraindicated in tricyclic antidepressant toxicity
because of the potential for QRS widening.
Digoxin (Lanoxin) is not an antidysrhythmic. It controls the heart rate by blocking the sodium-potassium
pump.
A patient is admitted after taking an overdose of alprazolam (Xanax). Which antidote should you expect
to administer to this patient?
A. Flumazenil (Romazicon)
B. Naloxone (Narcan)
C. Calcium gluconate
D. Cyproheptadine (Periactin) - ANSWER Alprazolam (Xanax) is a benzodiazepine, and flumazenil
(Romazicon) is the antidote for a benzodiazepine overdose.
Naloxone (Narcan) is the antidote for opiate toxicity.
Calcium gluconate is one of several antidotes for calcium channel blocker toxicity.
Cyproheptadine (Periactin), a serotonin antagonist, is used to block serotonin syndrome in toxicity due to
an overdose of a selective serotonin reuptake inhibitor.
Acetaminophen (Tylenol) toxicity may occur with lower acetaminophen doses in patients with which
disorder?
A. Cardiomyopathy
B. Asthma
C. Alcohol abuse
D. Disseminated intravascular coagulation - ANSWER Acetaminophen toxicity may occur with lower
acetaminophen doses in patients with alcohol abuse, malnutrition, or preexisting hepatic dysfunction
, and in those who take isoniazid (INH), anticonvulsant medications (such as phenytoin [Dilantin] or
carbamazepine [Tegretol]), or other cytochrome P450 oxidizers.
Cardiomyopathy, asthma, and disseminated intravascular coagulation do not affect acetaminophen
levels.
Family members bring a geriatric patient with confusion and delirium to the emergency department.
They report that her symptoms have progressed over the past few days since she started using BENGAY
for her arthritis. Which medication is a likely cause of these symptoms?
A. Acetaminophen (Tylenol) B. Salicylate C. Iron D. Digoxin (Lanoxin) - ANSWER BENGAY contains
salicylate, and chronic salicylate poisoning can cause confusion and delirium in geriatric patients.
Other possible causes include sepsis, pneumonia, and anticholinergic ingestion.
Acetaminophen (Tylenol), iron, and digoxin (Lanoxin) toxicity are not likely to cause confusion and
delirium.
An overdose of which nonsteroidal anti-inflammatory drug can cause seizures?
A. Ketorolac (Toradol) B. Celecoxib (Celebrex) C. Indomethacin (Indocin) D. Piroxicam (Feldene) -
ANSWER An overdose of piroxicam (Feldene) or mefenamic acid (Ponstel) or the ingestion of a large
amount of naproxen (Aleve) or ketoprofen (Orudis) can cause seizures.
Ketorolac (Toradol) can cause renal failure.
Celecoxib (Celebrex) and indomethacin (Indocin) toxicity can cause gastrointestinal effects and
drowsiness.
Which effect occurs in calcium channel blocker toxicity? - ANSWER Hyperglycemia
The signs and symptoms of calcium channel blocker toxicity include hyperglycemia due to inhibited
For a patient with beta-blocker toxicity, you should prepare for which intervention? - ANSWER
Transcutaneous pacer insertion
Patients with beta-blocker toxicity may require transcutaneous pacing to treat bradycardia caused by the
toxicity.
Hemodialysis has limited usefulness in patients with beta-blocker toxicity.
In addition to calcium gluconate, which drugs may be administered to treat calcium channel blocker
toxicity?
A. Sodium bicarbonate and amiodarone (Cordarone)
B. Flumazenil (Romazicon) and naloxone (Narcan)
C. N-acetylcysteine (Mucomyst) and Atropine
D. Insulin (Humalog) and glucagon (GlucaGen) - ANSWER Several antidotes may be used to treat calcium
channel blocker toxicity, including calcium gluconate or chloride, insulin (Humalog), and glucagon
(GlucaGen).
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of
withdrawal from which drug? - ANSWER Heroin
Rhinorrhea, tearing, yawning, dilated pupils, and abdominal pain are the signs and symptoms of
withdrawal from heroin, an illicit opiate that is a central nervous system depressant.
For a patient with benzodiazepine toxicity, which intervention is appropriate for enhancing drug
elimination?
A. Gastric lavage
,B. Activated charcoal administration
C. Hemodialysis
D. Charcoal hemoperfusion - ANSWER Administer activated charcoal promptly and safely to enhance
benzodiazepine elimination.
When a blood sample is drawn at the appropriate time, the serum level of which drug reflects the degree
of acute toxicity?
A. Ibuprofen (Motrin)
B. Acetaminophen (Tylenol)
C. Morphine (MS Contin)
D. Phencyclidine hydrochloride (PCP) - ANSWER When the initial blood sample is drawn at least 4 hours
after acute acetaminophen (Tylenol) ingestion, the serum level can be plotted on the Rumack-Matthew
nomogram to assess the peak acetaminophen level and determine the risk of hepatoxicity.
Quantitative drug levels of ibuprofen (Motrin), morphine (MS Contin), and phencyclidine hydrochloride
(PCP) are not usually available or helpful except for documenting ingestion.
With an overdose, which category of drugs produces coronary artery spasms? - ANSWER Central nervous
system stimulants
One of the cardiac effects of central nervous system stimulant toxicity is coronary artery spasms.
Which antidysrhythmic is most appropriate for treating ventricular dysrhythmias caused by tricyclic
antidepressant toxicity?
A. Amiodarone (Cordarone)
B. Procainamide (Pronestyl)
C. Quinidine (Quinidex)
D. Digoxin (Lanoxin) - ANSWER Amiodarone (Cordarone) is the most appropriate antidysrhythmic for
treating ventricular dysrhythmias caused by tricyclic antidepressant toxicity.
,Procainamide (Pronestyl) and quinidine (Quinidex) are contraindicated in tricyclic antidepressant toxicity
because of the potential for QRS widening.
Digoxin (Lanoxin) is not an antidysrhythmic. It controls the heart rate by blocking the sodium-potassium
pump.
A patient is admitted after taking an overdose of alprazolam (Xanax). Which antidote should you expect
to administer to this patient?
A. Flumazenil (Romazicon)
B. Naloxone (Narcan)
C. Calcium gluconate
D. Cyproheptadine (Periactin) - ANSWER Alprazolam (Xanax) is a benzodiazepine, and flumazenil
(Romazicon) is the antidote for a benzodiazepine overdose.
Naloxone (Narcan) is the antidote for opiate toxicity.
Calcium gluconate is one of several antidotes for calcium channel blocker toxicity.
Cyproheptadine (Periactin), a serotonin antagonist, is used to block serotonin syndrome in toxicity due to
an overdose of a selective serotonin reuptake inhibitor.
Acetaminophen (Tylenol) toxicity may occur with lower acetaminophen doses in patients with which
disorder?
A. Cardiomyopathy
B. Asthma
C. Alcohol abuse
D. Disseminated intravascular coagulation - ANSWER Acetaminophen toxicity may occur with lower
acetaminophen doses in patients with alcohol abuse, malnutrition, or preexisting hepatic dysfunction
, and in those who take isoniazid (INH), anticonvulsant medications (such as phenytoin [Dilantin] or
carbamazepine [Tegretol]), or other cytochrome P450 oxidizers.
Cardiomyopathy, asthma, and disseminated intravascular coagulation do not affect acetaminophen
levels.
Family members bring a geriatric patient with confusion and delirium to the emergency department.
They report that her symptoms have progressed over the past few days since she started using BENGAY
for her arthritis. Which medication is a likely cause of these symptoms?
A. Acetaminophen (Tylenol) B. Salicylate C. Iron D. Digoxin (Lanoxin) - ANSWER BENGAY contains
salicylate, and chronic salicylate poisoning can cause confusion and delirium in geriatric patients.
Other possible causes include sepsis, pneumonia, and anticholinergic ingestion.
Acetaminophen (Tylenol), iron, and digoxin (Lanoxin) toxicity are not likely to cause confusion and
delirium.
An overdose of which nonsteroidal anti-inflammatory drug can cause seizures?
A. Ketorolac (Toradol) B. Celecoxib (Celebrex) C. Indomethacin (Indocin) D. Piroxicam (Feldene) -
ANSWER An overdose of piroxicam (Feldene) or mefenamic acid (Ponstel) or the ingestion of a large
amount of naproxen (Aleve) or ketoprofen (Orudis) can cause seizures.
Ketorolac (Toradol) can cause renal failure.
Celecoxib (Celebrex) and indomethacin (Indocin) toxicity can cause gastrointestinal effects and
drowsiness.
Which effect occurs in calcium channel blocker toxicity? - ANSWER Hyperglycemia
The signs and symptoms of calcium channel blocker toxicity include hyperglycemia due to inhibited
